# Place the actions in order when a client receiving an IV antibiotic develops stridor, wheezing, generalized hives, and a blood pressure of 76/42 mm Hg.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=395465&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

Place the actions in order when a client receiving an IV antibiotic develops stridor, wheezing, generalized hives, and a blood pressure of 76/42 mm Hg.

Continue close monitoring and give repeat epinephrine or advanced support as prescribed if symptoms persist or recur

Administer prescribed intramuscular epinephrine in the mid-anterolateral thigh without waiting for antihistamines or corticosteroids

Apply high-flow oxygen, prepare advanced airway support, and begin prescribed rapid crystalloid resuscitation for hypotension

Position the client supine with legs elevated if tolerated while preparing and giving epinephrine immediately

Stop the antibiotic infusion while preserving IV access, call for emergency help, and assess airway, breathing, circulation, and mental status

## Explanation

Remove the trigger, call for help, and assess the client immediately. Positioning and intramuscular epinephrine should not be delayed. Provide oxygen, airway readiness, and rapid IV crystalloid for shock, then monitor closely and repeat epinephrine or escalate support when prescribed. Antihistamines and corticosteroids are adjuncts and must not delay epinephrine.

## In-depth explanation

Correct sequence
Stop exposure and call → position for perfusion → IM epinephrine → oxygen, airway, and fluids → reassess and repeat or escalate.

Why this is correct
Epinephrine is the first-line drug for anaphylaxis. It treats airway edema, bronchospasm, and vasodilation; antihistamines do not reverse shock or airway obstruction.

NCLEX decision rule
Do not make anaphylaxis wait for a complete history, laboratory result, or second-line medication.References
1World Allergy Organization anaphylaxis guidance
2Emergency management guideline for anaphylaxis

## Clinical scenario

Anaphylaxis with shock
The nurse is at the bedside, emergency medications are available, and the client has a patent IV. Actions that occur nearly simultaneously are combined within a single step.

## Key concepts

- **Anaphylaxis** — A rapidly developing systemic hypersensitivity reaction that can compromise airway, breathing, or circulation.
- **Intramuscular Epinephrine** — First-line anaphylaxis treatment injected into the mid-anterolateral thigh for rapid absorption.
- **Biphasic Reaction** — Recurrence of anaphylaxis symptoms after apparent resolution without a new exposure.

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