Upon noticing ringing in the ears of a client receiving intravenous vancomycin, what should the nurse's initial action be?

When a client receiving intravenous vancomycin reports ringing in the ears, also known as tinnitus, the nurse's initial action should be to stop the infusion. Vancomycin is known to potentially cause ototoxicity, especially when administered too quickly or at high doses. The onset of tinnitus is a warning sign that suggests the client may be experiencing an adverse effect that could escalate to more serious issues, such as hearing loss.

Stopping the infusion immediately mitigates the risk of further ototoxic damage and allows the healthcare team to reassess the situation. After stopping the infusion, it is appropriate to notify the healthcare provider to discuss the findings, assess the patient's condition further, and determine the next steps in management. Documenting the findings is also necessary, but this action typically occurs after addressing any immediate concerns regarding the patient's safety, making it secondary to stopping the infusion. Reducing the flow rate may not address the potential risk of ototoxicity effectively and could still leave the client exposed to harm. Thus, the priority should always be the immediate safety of the patient by stopping the infusion.