The nurse is caring for a patient receiving vancomycin. The nurse is aware the medication should be adminstered over 2 hours. What is the major adverse effect associated with rapid infusion of vancomycin?

A. Hypernatremia: Hydrochlorothiazide promotes sodium excretion, so high sodium levels are unlikely. The medication tends to lower sodium, making hypernatremia an uncommon concern in this combination therapy.

B. Hypokalemia: Hydrochlorothiazide increases renal potassium excretion, which can lower serum potassium levels. Low potassium enhances the risk of digoxin toxicity, including arrhythmias, making close monitoring essential. This electrolyte imbalance is the most significant concern with this drug combination.

C. Hypocalcemia: Thiazide diuretics like hydrochlorothiazide actually decrease calcium excretion, so low calcium levels are not expected. Monitoring calcium is not a primary concern for this patient.

D. Hypermagnesemia: Hydrochlorothiazide increases magnesium excretion, but high magnesium levels are unlikely. Hypermagnesemia is not a common side effect of this therapy and is not a priority for monitoring in this scenario.

A. Gastrointestinal bleeding: Vancomycin does not typically cause GI bleeding. Its adverse effects are mostly related to infusion reactions and nephrotoxicity rather than direct irritation or ulceration of the gastrointestinal tract. Monitoring for bleeding is not a primary concern.

B. Red man syndrome: Rapid infusion of vancomycin can cause Red Man Syndrome, characterized by flushing, rash, hypotension, and pruritus due to histamine release. Administering the drug over at least 2 hours helps prevent this reaction and ensures patient safety during treatment.

C. Hypertension: Vancomycin infusion is not associated with elevated blood pressure. In fact, Red Man Syndrome can cause hypotension, not hypertension, making this option inconsistent with the known adverse effects of rapid administration.

D. Nausea and vomiting: While gastrointestinal discomfort may occasionally occur, nausea and vomiting are not the major concern related to rapid vancomycin infusion. The primary risk is histamine-mediated infusion reaction rather than direct GI effects.