A nurse is monitoring a client who just received a first dose of intramuscular Penicillin G. Which of the following findings should the nurse identify as manifestations of an anaphylactic reaction? (Select all that apply.) Multiple options may be correct

A. Urticaria: Urticaria, or hives, is a common manifestation of an IgE-mediated hypersensitivity reaction to medications like Penicillin G. It presents as raised, itchy, erythematous welts on the skin and indicates activation of mast cells and histamine release, which is characteristic of anaphylaxis. B. Circumoral cyanosis: Circumoral cyanosis refers to a bluish discoloration around the lips due to hypoxia. While severe anaphylaxis can lead to hypoxemia, early anaphylactic reactions more commonly present with signs of airway compromise rather than cyanosis initially. It may occur in late or severe cases but is not an early hallmark. C. Angioedema: Angioedema involves sudden swelling of the lips, tongue, face, or airway, resulting from increased vascular permeability caused by histamine and other inflammatory mediators. This is a classic and potentially life-threatening feature of anaphylaxis that requires immediate intervention. D. Hypotension: Hypotension occurs due to widespread vasodilation and increased capillary permeability during anaphylactic reactions. This drop in blood pressure can lead to shock if not promptly treated with epinephrine and supportive measures, making it a critical manifestation of anaphylaxis. E. Scleral icterus: Scleral icterus is a yellowing of the sclera due to hyperbilirubinemia and is unrelated to anaphylaxis. It is typically associated with liver dysfunction or hemolysis, not an acute hypersensitivity reaction. F. Difficulty breathing: Respiratory compromise, including dyspnea, wheezing, and stridor, occurs due to bronchospasm, laryngeal edema, and airway obstruction in anaphylaxis. Difficulty breathing is a key life-threatening sign requiring immediate intervention with epinephrine and airway management. G. Hypertension: Hypertension is not a feature of anaphylaxis; in fact, hypotension is more characteristic due to systemic vasodilation. Elevated blood pressure may occur with anxiety or other conditions but does not indicate an anaphylactic reaction.