A new order is received for vancomycin 1 gram IV every 12 hours for a client with a suspected MRSA infection. The client's current creatinine is 180 µmol/L (normal 50-90 µmol/L) and BUN is 12 mmol/L (normal 2.5-7.1 mmol/L). Which action should the nurse take?

Question: A new order is received for vancomycin 1 gram IV every 12 hours for a client with a suspected MRSA infection. The client's current creatinine is 180 µmol/L (normal 50-90 µmol/L) and BUN is 12 mmol/L (normal 2.5-7.1 mmol/L). Which action should the nurse take?

Answer options:

• Administer the vancomycin as ordered.
• Administer a smaller test dose to assess for adverse reactions. ✅ Hold the medication and consult with the primary healthcare provider or pharmacist.
• Infuse the vancomycin slowly over 4 hours instead of the usual 1-2 hours.

Correct answer: Hold the medication and consult with the primary healthcare provider or pharmacist.

Explanation: Vancomycin is renally excreted and nephrotoxic. The client's elevated creatinine and BUN indicate impaired renal function, increasing the risk of vancomycin toxicity (e.g., ototoxicity, nephrotoxicity). The nurse should hold the dose and seek clarification/dose adjustment from the primary healthcare provider or pharmacist.