A nurse is preparing to administer amphotericin B lipid complex via intermittent IV bolus to a client who has infective endocarditis. Which of the following actions should the nurse take?

Amphotericin B is a potent polyene antifungal agent utilized for systemic mycotic infections and endocarditis by binding to fungal ergosterol to create membrane pores. Due to its significant nephrotoxicity and risk of infusion-related reactions, specific administration protocols must be strictly followed to ensure patient safety. Rationale: A. Administering the medication over 2 hr is the standard protocol to minimize the risk of severe infusion-related reactions and cardiovascular instability. Rapid infusion of amphotericin B can lead to hypotension, bronchospasm, and arrhythmias. By extending the infusion time, the nurse allows for better systemic tolerance and reduces the acute inflammatory response associated with this medication. B. Using a gravity flow set is incorrect because amphotericin B must be administered via an electronic infusion pump to ensure a precise and consistent rate. Gravity sets are prone to fluctuations that could inadvertently result in a rapid bolus, increasing the risk of cardiac arrest. Precise flow control is a mandatory nursing safety intervention for this high-alert medication. C. Priming the tubing with 0.9% sodium chloride is contraindicated because amphotericin B is incompatible with saline and will precipitate into solid crystals. The IV line must be primed and flushed exclusively with 5% dextrose in water (D5W) before and after administration. Crystallization in the tubing can lead to emboli or catheter occlusion, posing a significant risk to the patient. D. Discarding the medication if it is yellow is unnecessary because the amphotericin B lipid complex emulsion is naturally yellow or opaque in appearance. The nurse should only discard the medication if there is evidence of foreign particulate matter or distinct precipitation. Understanding the normal physical characteristics of the drug prevents the wasteful disposal of expensive and essential antifungal therapy.