A client is receiving intravenous (1V) vancomycin and the nurse plans to draw blood for a peak a. trough to determine the serum level of the drug. Which collection times provide the best determination of these levels?

Thirty minutes into the administration of the IV dose and 30 minutes before the next administration of the medication.

Two hours after completion of the IV dose 2nd 00 0000 before the next administration of the medication.

One how after completion of the IV dose and one hour before the next administration oldie medication.

Immediately after completion of the IV dose and 30 minutes before the next administration of the medication.

Answer and Explanation

The Correct Answer is D

A. Thirty minutes into the administration of the IV dose and 30 minutes before the next administration of the medication:

This timing doesn't align with the standard practice of drawing peak levels immediately after the IV dose is completed.

The trough level should be taken just before the next dose, not 30 minutes before.

B. Two hours after completion of the IV dose and 1 hour before the next administration of the medication:

Waiting for two hours after the dose to draw the peak level is too long. Peak levels are typically drawn immediately after completion.

Drawing the trough level one hour before the next dose doesn't provide an accurate assessment of the lowest drug concentration just before the next administration.

C. One hour after completion of the IV dose and one hour before the next administration of the medication:

Similar to choice B, waiting one hour after the dose to draw the peak level is not in line with standard practice.

Drawing the trough level one hour before the next dose is administered is too early to accurately represent the lowest concentration.

The best collection times for determining the peak and trough levels of intravenous (IV) vancomycin are:

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

Explanation:

Peak Level: Peak levels of vancomycin are drawn immediately after the completion of the IV dose. This is done to assess the highest concentration of the drug in the bloodstream, which is important for ensuring its therapeutic efficacy and monitoring for potential toxicity.

Trough Level: Trough levels are drawn just before the next dose is administered. A trough level represents the lowest concentration of the drug in the bloodstream, ensuring that the drug is still present at a therapeutic level before the next dose is given. Taking the trough level 30 minutes before the next administration is appropriate, as it allows time for the drug to reach its lowest concentration before receiving the next dose.

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Correct Answer is D

Explanation

A) Unusual irritability: While irritability can be a side effect of metoclopramide, it is not as concerning as tardive dyskinesia. It's important to monitor and report any unusual irritability, but it's not the most critical side effect.

B) Diarrhea: Diarrhea is a common side effect of metoclopramide but is generally less concerning than tardive dyskinesia. It can often be managed with dietary adjustments or other medications.

C) Nausea: Nausea is the very symptom metoclopramide is prescribed to treat. If the client is still experiencing nausea despite taking metoclopramide, this might indicate the need for a different anti-nausea medication, but it's not the most important adverse effect to report.

D.Involutary movements: The most important adverse effect for the nurse to report when a client with chemotherapy-induced nausea is taking metoclopramide is D) Involuntary movements.

Explanation:

Metoclopramide is a medication often used to relieve nausea and vomiting, especially in cases like chemotherapy-induced nausea. However, it can have a side effect known as "tardive dyskinesia," which involves involuntary movements, typically of the face and tongue. Tardive dyskinesia is a serious and potentially irreversible side effect of metoclopramide.

In summary, involuntary movements (tardive dyskinesia) are the most critical side effect to report when a client is taking metoclopramide. This side effect needs prompt attention as it can be irreversible if not addressed.

A. Limit intake of high-potassium foods. B. Cover your skin before going outside. C. Monitor skin for excessive bruising D. Replace salt with a salt substitute

Correct Answer is A

Explanation

When a client with heart failure (HF) develops hyperaldosteronism and is prescribed spironolactone, the nurse should include the following instruction in the client's plan of care:

A. Limit intake of high-potassium foods.

Explanation: Spironolactone is a potassium-sparing diuretic, and one of its actions is to promote the retention of potassium by the body. Therefore, it's important to instruct the client to limit the intake of high-potassium foods to avoid hyperkalemia (high potassium levels), which can be a potential side effect of this medication. High-potassium foods include bananas, oranges, potatoes, tomatoes, and many others.

Why the other choices are not appropriate:

B. Cover your skin before going outside:

This instruction is not directly related to spironolactone or hyperaldosteronism. It may be relevant for clients taking photosensitizing medications but is not specific to this situation.

C. Monitor skin for excessive bruising:

This instruction is also not directly related to spironolactone or hyperaldosteronism. It may be relevant in other clinical contexts, but it does not address the potential side effects or management of spironolactone.

D. Replace salt with a salt substitute:

While reducing sodium intake is often recommended for clients with heart failure, replacing salt with a salt substitute containing potassium is not advisable for clients taking spironolactone. This would increase the risk of hyperkalemia.

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Laboratory Test	Result	reference range
Serum Creatinine	1 mg/dl (88.4 μmol/L)	0.5-1.1 mg/dL (44-97 μmol/L)
BUN	9 mg/dl. (3.2 mmol/L)	10-20 mg/dl. (3.6-7.1 mmol/L)
Sodium	136 mEq/L (136 mmol/L)	136 to 145 mEq/L (136 to 145 mmol/L)
Potassium	6.1 mEq/L (6.1 mmol/L)	3.5 to 5 mEq/L (3.5 to 5 mmol/L)

A client is receiving intravenous (1V) vancomycin and the nurse plans to draw blood for a peak a. trough to determine the serum level of the drug. Which collection times provide the best determination of these levels?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with chemotherapy induced nausea receives a prescription for metoclopramide. Which adverse effect is most important for the nurse to repart?

Correct Answer is D

Explanation

A client with heart failure (HF) develops hyperaldosteronism and spironolactone is prescribed. Which instruction should the nurse include in this client's plan of care?

Correct Answer is A

Explanation

A client with benign prostatic hyperplasia receives a new prescription of tamsulosin. Which intervention should the nurse perform to monitor for an adverse reaction?

A client is receiving intravenous (1V) vancomycin and the nurse plans to draw blood for a peak a. trough to determine the serum level of the drug. Which collection times provide the best determination of these levels?

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