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

A. Hold the dose and notify the healthcare provider (HCP) of the changes in the laboratory studies: Fluconazole is hepatotoxic and can cause elevations in liver enzymes, including AST. A rising trend in liver enzymes suggests possible liver injury, and administering another dose without medical clearance could worsen hepatic damage. Immediate communication with the HCP is the safest and most appropriate action. B. Hold the dose and notify the pharmacy to stop dispersing the next premixed doses: Although stopping further dispensing may eventually be needed if the drug is discontinued, the pharmacy cannot make this clinical decision. Notifying the HCP for evaluation and new orders must take priority. C. Begin the infusion and submit a drug reaction report to the nursing supervisor: Initiating the infusion despite abnormal liver function tests can endanger the client. Reporting an adverse reaction to the supervisor is important after ensuring the client’s safety, but the infusion should be held first pending provider instructions. D. Begin the infusion and monitor the client's blood urea nitrogen (BUN), serum creatinine, and liver function tests: While monitoring labs is critical during fluconazole therapy, starting the infusion in the presence of worsening liver enzyme trends without provider approval can increase the risk of serious hepatic complications.