The client is a 27-year-old male who had an exploratory laparotomy 8 days ago following a gunshot wound to the abdomen. The surgeons evacuated a large amount of blood in the peritoneum and repaired a liver laceration. The client was in the intensive care unit (ICU) for 4 days and in the surgical floor for 4 days. He started a regular diet 3 days ago but is now refusing to eat and has had several episodes of vomiting in the past 3 hours. Which action should the nurse take?

Choice A reason: Assessing body temperature monitors for infection but is not specific to vancomycin administration. Clostridium difficile causes fever, but oral vancomycin’s safety depends on renal function, as it is minimally absorbed but can accumulate in renal impairment, making temperature less critical before the first dose.

Choice B reason: Checking serum creatinine is essential, as vancomycin, even orally, can be absorbed in small amounts, risking nephrotoxicity in patients with renal impairment. Clostridium difficile treatment requires ensuring renal function is adequate to prevent drug accumulation, which could exacerbate kidney damage, making this the priority action.

Choice C reason: Measuring oxygen saturation assesses respiratory status, irrelevant to oral vancomycin for Clostridium difficile, which primarily affects the gut. While severe infections may cause systemic symptoms, oxygenation is not a direct concern for vancomycin’s safety or efficacy, making this choice inappropriate.

Choice D reason: Auscultating bowel sounds evaluates gastrointestinal motility, relevant to Clostridium difficile’s diarrheal effects but not vancomycin’s administration safety. Oral vancomycin targets gut bacteria, and bowel sounds do not indicate renal or systemic risks, making this less critical than renal function assessment.

Choice A reason: Temporary use until pressure stabilizes is incorrect, as open-angle glaucoma is a chronic condition requiring ongoing intraocular pressure control. Eye drops, like beta-blockers, reduce aqueous humor production, but stopping them risks pressure spikes, leading to optic nerve damage and vision loss.

Choice B reason: Lifelong eye drop use is accurate, as open-angle glaucoma is a progressive disease where optic nerve damage is prevented by maintaining low intraocular pressure. Drops like prostaglandins increase aqueous outflow, requiring continuous use to prevent irreversible vision loss, making this the correct response.

Choice C reason: Using drops only during symptomatic episodes is incorrect, as glaucoma is often asymptomatic until advanced. Consistent eye drop use prevents pressure buildup, protecting the optic nerve. Symptomatic treatment fails to address chronic pressure elevation, risking progressive vision loss.

Choice D reason: Discontinuing drops once vision improves is incorrect, as vision improvement is not expected in glaucoma. Eye drops maintain intraocular pressure to slow disease progression, not reverse damage. Stopping treatment allows pressure to rise, accelerating optic nerve damage and vision loss.