A nurse is contributing to the care plan for a client who has recently been diagnosed with type 2 diabetes mellitus. Which of the following interventions should the nurse include in the plan? (Select all that apply.)

Choice A rationale:

Erythromycin Erythromycin is a macrolide antibiotic that is often used as an alternative to penicillin. It is generally safe for use in patients with a penicillin allergy. It works by inhibiting bacterial protein synthesis and is effective against a wide range of bacteria.

Choice B rationale:

Amphotericin B Amphotericin B is an antifungal medication, not an antibiotic. It is used to treat serious, systemic fungal infections. It has no cross-reactivity with penicillin, so it would not be a concern for a patient with a penicillin allergy.

Choice C rationale:

Amoxicillin-clavulanate Amoxicillin-clavulanate is a type of penicillin antibiotic. Patients with a known penicillin allergy should avoid this medication, as they may have a cross-reactivity to it. This is why the nurse should verify this prescription with the provider.

Choice D rationale:

Gentamicin Gentamicin is an aminoglycoside antibiotic used to treat serious bacterial infections caused by gram-negative bacteria. It is not related to penicillin and would be safe for a patient with a penicillin allergy.

Choice A rationale:

Holding the drug and administering it 4 hours later is not the appropriate action. The trough vancomycin level of 24 mcg/mL is higher than the recommended range of 10-20 mcg/mL, indicating potential risk for toxicity. Administering the drug later does not address the immediate concern of a high trough level.

Choice B rationale:

Administering the vancomycin as ordered is not the correct action in this case. The trough level is above the recommended range, which could lead to vancomycin toxicity. The nurse should not administer the medication without addressing the high trough level. Choice C rationale:

This is the correct action. The nurse should hold the drug and notify the prescriber because the trough vancomycin level is higher than the recommended range. The prescriber can then make a decision based on this information, which may include adjusting the dose, extending the dosing interval, or ordering additional tests.

Choice D rationale:

While repeating the test to verify results might be done eventually, it should not be the immediate next step. The nurse has a responsibility to ensure patient safety, and with a trough level above the recommended range, the priority is to prevent potential toxicity. Therefore, the nurse should hold the drug and notify the prescriber.