A client with serious MRSA bacteremia is receiving intravenous vancomycin. Which nursing action is appropriate?
1Administer each dose by IV push and check kidney function only if urine output declines.
2Infuse through a secure IV for at least 60 minutes and monitor renal function and serum exposure.✓ Correct answer
3Give the medication intramuscularly and obtain a serum concentration after redness develops.
4Shorten the infusion to 30 minutes if itching occurs so the remaining dose finishes quickly.
Explanation
Vancomycin is administered through a secure intravenous route over at least 60 minutes to reduce infusion reactions. Renal function and serum exposure are monitored because nephrotoxicity is possible; for serious MRSA infection, current consensus guidance favors AUC-guided monitoring according to institutional protocol. IV push, intramuscular administration, and a faster infusion are unsafe.
Clinical reasoning Rapid vancomycin infusion increases the risk of pruritus, erythema, hypotension, and other infusion reactions. Systemic exposure can also cause acute kidney injury.
Decision rule Use a secure IV route and infuse for at least 60 minutes, or longer when required by dose and policy. Monitor renal function and follow the institution's serum-exposure plan; serious MRSA treatment generally uses an AUC target rather than relying only on a 15 to 20 mg/L trough.