A client develops hives and wheezing during an IV medication infusion. The LVN should first:

Rationale:
A. Phlebitis is incorrect because phlebitis is localized inflammation of the vein and presents with redness, warmth, pain, and a palpable cord along the vein. It does not cause dyspnea or crackles in the lungs.

B. Fluid volume overload is correct because sudden dyspnea, crackles on auscultation, and possibly tachycardia or hypertension are classic signs of pulmonary congestion from excess IV fluid. This is especially likely if fluids are infused too rapidly or in patients with cardiac or renal compromise. Immediate nursing actions include slowing or stopping the infusion, elevating the head of the bed, administering oxygen, and notifying the provider.

C. Air embolism is incorrect because an air embolism typically presents with sudden chest pain, hypotension, tachycardia, dyspnea, and sometimes a “mill wheel” murmur. While dyspnea occurs, crackles are not a characteristic finding of air embolism.

D. Infiltration is incorrect because infiltration involves leakage of IV fluid into surrounding tissue, leading to coolness, pallor, swelling, and discomfort at the insertion site, not pulmonary symptoms like dyspnea or crackles.

Rationale:
A. Rash, itching, or shortness of breath is correct because these are hallmark signs of an allergic or adverse reaction to IV medications. Symptoms may range from mild reactions like localized rash and pruritus to severe reactions such as anaphylaxis, which can include bronchospasm, hypotension, and respiratory distress. Immediate action is required, including stopping the infusion, notifying the provider, and administering emergency interventions if needed.

B. Client reports coolness at IV site is incorrect because coolness indicates infiltration, where IV fluid leaks into the surrounding tissue. Other signs of infiltration include pallor, swelling, and discomfort at the site. This is a local complication of IV therapy, not a systemic adverse medication reaction. It requires removal of the catheter and monitoring of the site, but it does not indicate an allergic reaction.

C. Blood return in the catheter is incorrect because blood return (also called flashback) indicates that the catheter is correctly placed in the vein. This is a normal finding, not a complication or reaction. It demonstrates patency and proper placement for infusion, and therefore does not signify an adverse effect of the medication.

D. Mild discomfort at insertion is incorrect because minor pain or discomfort during IV insertion is expected due to needle penetration of the skin and vein. This is normal procedural discomfort, not an adverse reaction. Nurses should still monitor for signs of phlebitis, infiltration, or infection, but mild insertion pain alone does not indicate a systemic medication reaction.