# A nurse is initiating the first dose of rituximab for non-Hodgkin lymphoma. Thirty minutes into the infusion the client develops fever, chills, dyspnea, and hypotension. Which is the priority action?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391867&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A nurse is initiating the first dose of rituximab for non-Hodgkin lymphoma. Thirty minutes into the infusion the client develops fever, chills, dyspnea, and hypotension. Which is the priority action?

## Option

1. Wait 30 minutes and reassess
2. Increase the infusion rate to complete the dose faster
3. Stop the infusion, maintain IV access with saline, notify the provider, administer additional antihistamine/steroid/epinephrine per protocol, and monitor for tumor lysis syndrome **✔ Correct answer**
4. Encourage oral fluids

**Correct answer: 3**

## Explanation

Correct (2): Rituximab carries an FDA boxed warning for severe infusion reactions (cytokine release syndrome) — most common within 30-120 min of first dose. STOP infusion, maintain IV with NS, provider notification, additional antihistamine/steroid/epinephrine per severity. After resolution, restart at 50% rate. Monitor for tumor lysis syndrome in high tumor burden. (1,3,4) Dangerous.

## In-depth explanation

Memory Tip Rituximab = "Rit-uxi-DROP" — first infusion drops blood pressure. Slow rate + pre-meds (APAP·diphenhydramine·steroid) reduce reactions. Hep B screening required (reactivation).

## Clinical scenario

Scenario 58-year-old male with NHL receiving first rituximab infusion. Premedicated with acetaminophen + diphenhydramine + steroid. 30 min in: fever 38.5°C, chills, dyspnea, BP 88/52.

## Key concepts

- **Rituximab** — Anti-CD20 monoclonal antibody; B-cell lymphoma, RA, vasculitis; infusion reaction boxed warning.
- **Cytokine release syndrome** — Acute inflammatory response from cytokine surge during biologic infusion.
- **Hep B reactivation** — Rituximab can reactivate latent HBV; screen pre-treatment.

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