A client has been prescribed ciprofloxacin 400 mg intravenously (IV) every 12 hours to be infused over an hour.

The IV bag contains ciprofloxacin 400 mg in dextrose 5% in water (D5W) 200 mL. How many mL/hour should the nurse program the infusion pump to deliver? (Enter numerical value only.)

Choice A rationale

While salt substitutes can be a good option for some patients with heart failure, they are often high in potassium. Because spironolactone is a potassium-sparing diuretic, using a salt substitute could lead to dangerously high levels of potassium.

Choice B rationale

Protecting your skin before going outside is generally good advice, but it’s not specifically related to the use of spironolactone.

Choice C rationale

Spironolactone is a potassium-sparing diuretic, which means it can cause the body to retain potassium. Therefore, patients taking spironolactone should limit their intake of high- potassium foods to prevent hyperkalemia.

Choice D rationale

While it’s always important to monitor for side effects when taking a new medication, excessive bruising is not a common side effect of spironolactone.

The correct answer is D. Immediately after completion of the IV dose and 30 minutes before the next administration of the medication.

Explanation:

• Peak levels measure the highest concentration of the drug in the bloodstream and should be drawn immediately after the IV infusion is completed.

• Trough levels measure the lowest concentration of the drug and should be drawn 30 minutes before the next scheduled dose. This helps ensure the drug remains within therapeutic levels and prevents toxicity.

Why the other options are incorrect:

• A. One hour after completion of the IV dose and one hour before the next administration – Waiting one hour for the peak level is too long and may lead to an inaccurate measurement.

• B. Two hours after completion of the IV dose and two hours before the next administration – Waiting two hours for both peak and trough levels is too late for effective monitoring.

• C. Thirty minutes into the administration of the IV dose and 30 minutes before the next administration – The sample drawn mid-infusion does not represent peak levels, making this method ineffective.

Key takeaway:

Proper timing of vancomycin peak and trough monitoring ensures therapeutic drug levels while minimizing nephrotoxicity and ototoxicity.