An older adult client is receiving vancomycin for a hospital acquired infection (HAI). Which intervention is most important for the nurse to implement?

Rationale: A. Obtain a white blood count daily to determine response of infection: Monitoring WBC helps track infection resolution, but it is not the most important intervention specific to vancomycin safety. B. Ensure that vancomycin peak and trough levels are prescribed: Vancomycin has a narrow therapeutic index and carries a high risk of nephrotoxicity and ototoxicity. Monitoring peak and trough levels is essential to ensure efficacy while preventing toxicity. C. Report the acquired infection to the Medicare reimbursement office: Reporting HAIs is an administrative duty, not a direct nursing intervention to ensure client safety with vancomycin therapy. D. Assess the older adult client’s physiological response to the antibiotic: Assessment is important, but without peak/trough monitoring, toxicity or underdosing could go unnoticed. The lab values provide the most precise guide for safe therapy.