An older adult receiving intravenous vancomycin and gentamicin has a creatinine increase from 0.9 to 1.8 mg/dL, decreasing urine output, and a vancomycin concentration above the prescribed target. Which action should the nurse take?
1Administer the next vancomycin dose and repeat the renal studies after 48 hours because the change is age related.
2Administer the next dose with furosemide to increase urine output while continuing the current antimicrobial regimen.
3Increase the intravenous fluid rate and give vancomycin early so the elevated concentration is cleared more rapidly.
4Hold the next dose, notify the prescriber, repeat renal and drug-level assessment, and review concurrent nephrotoxins.✓ Correct answer
Explanation
The rising creatinine, oliguria, and above-target vancomycin concentration indicate acute kidney injury and drug accumulation. Vancomycin labeling calls for renal function and serum concentration monitoring and for discontinuation or dose reduction when acute kidney injury occurs. Gentamicin adds nephrotoxic and ototoxic risk. The nurse should hold the pending dose, notify the prescriber, and support prompt reassessment rather than administer more drug or add an unprescribed intervention.
Clinical reasoning Renal injury reduces vancomycin clearance, which can further raise exposure and toxicity. A concurrent aminoglycoside increases nephrotoxic and ototoxic risk.
Decision rule When renal function worsens and vancomycin exposure is above target, pause the pending dose, escalate promptly, reassess renal function and drug exposure, and minimize other nephrotoxins.