The nurse is administering IV fluconazole to a client who has systemic candidiasis. After reviewing the client's di’gnostic studies, the nurse identifies a rising trend in the liver enzyme levels for aspartate aminotransferase (AST). Which action should the nurse implement?

A) Instruct the caregiver to withhold the medication until the dosage can be decreased to ensure the client's sa’ety: Withholding the medication without consulting the healthcare provider may not be appropriate, especially if the client is experiencing improvements in cognitive function. The insomnia may be a temporary side effect that could resolve with continued use or adjustment of the dosage.

B) Notify the healthcare provider that the dosage of the medication may need to be increased to manage the client's in’omnia: Increasing the dosage of rivastigmine to manage insomnia may not be the most appropriate action. It's es’ential to assess the client further and explore other interventions before considering a dosage adjustment.

C) Advise the caregiver that the purpose of the medication is to promote sleep, so a change in medication may be needed: Rivastigmine is not typically used to promote sleep. It is a cholinesterase inhibitor used to treat cognitive symptoms associated with Alzheimer's di’ease. Therefore, advising a change in medication solely based on the client's in’omnia is not appropriate.

D) Explain to the caregiver that insomnia is a common and temporary side effect when the medication is first started: Rivastigmine and other cholinesterase inhibitors may cause insomnia, especially when therapy is initiated. Educating the caregiver about this common side effect helps manage expectations and provides reassurance that the insomnia may improve over time as the client's bo’y adjusts to the medication.

A) While measuring the client’s vital signs is a routine nursing intervention, the reported symptoms of confusion and blurred vision after receiving glipizide suggest the possibility of hypoglycemia. Vital signs may not provide immediate information about the client’s glucose levels or help confirm hypoglycemia. However, if the client’s symptoms persist or worsen, assessing vital signs becomes important to monitor for signs of shock or other complications.

B) Obtaining a fingerstick blood glucose is the priority action in this situation. Glipizide is an oral antidiabetic medication that stimulates insulin release from the pancreas, leading to lower blood glucose levels. Symptoms such as confusion and blurred vision are indicative of hypoglycemia, a potential adverse effect of glipizide. Checking the client’s blood glucose level will confirm hypoglycemia and guide further interventions.

C) While performing a neurological exam may be warranted if the client’s symptoms persist or if there are concerns about other neurological issues, confirming hypoglycemia with a fingerstick blood glucose test should be the immediate priority.

D) Administering glucagon intramuscularly (IM) is indicated for severe hypoglycemia when the client is unconscious or unable to swallow. However, in this scenario, the client is conscious and able to report symptoms. Before administering glucagon, it is essential to confirm hypoglycemia with a blood glucose measurement to avoid unnecessary interventions.

Therefore, the nurse should promptly obtain a fingerstick blood glucose to confirm hypoglycemia and initiate appropriate treatment for the client’s symptoms.