A client is receiving intravenous vancomycin, and the nurse plans to draw blood for a peak and trough to determine the serum level of the drug.
Which collection times would provide the best determination of these levels?
One hour after completion of the IV dose and one hour before the next administration of the medication.
Two hours after completion of the IV dose and two hours before the next administration of the medication.
Thirty minutes into the administration of the IV dose and 30 minutes before the next administration of the medication.
Immediately after completion of the IV dose and 30 minutes before the next administration of the medication.
The Correct Answer is D
The correct answer is D. Immediately after completion of the IV dose and 30 minutes before the next administration of the medication.
Explanation:
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Peak levels measure the highest concentration of the drug in the bloodstream and should be drawn immediately after the IV infusion is completed.
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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:
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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.
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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.
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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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Labetalol is a non-selective beta-blocker used to treat hypertension. The goal of labetalol administration is to reduce the blood pressure to 140/90 mmHg, and the diastolic BP must not fall below 90 mmHg. However, in this scenario, the client’s heart rate is 48 beats/minute, which is lower than the normal range (60-100 beats/minute). Administering labetalol, which can further decrease heart rate, could lead to bradycardia, a condition that can cause fainting, fatigue, or chest discomfort. Therefore, the nurse should withhold the scheduled dose and notify the healthcare provider.
Choice B rationale
While it is important to monitor the client’s BP regularly when administering labetalol, given the client’s low heart rate, administering the dose could potentially exacerbate the client’s bradycardia. Therefore, this choice is not the most appropriate action for the nurse to take in this situation.
Choice C rationale
Assessing for orthostatic hypotension before administering the dose is an important consideration when administering medications that can lower blood pressure. However, in this case, the client’s low heart rate is a more immediate concern. Therefore, this choice is not the most appropriate action for the nurse to take in this situation.
Choice D rationale
Applying a telemetry monitor could help in monitoring the client’s heart rate and rhythm. However, given the client’s current heart rate, the priority should be to withhold the medication and inform the healthcare provider.
Correct Answer is B
Explanation
Choice A rationale
Encouraging an increase in oral intake is not the most appropriate action for a client who reports that the urine appears to be darker in color after taking carbidopa/levodopa. While increased fluid intake can sometimes help to lighten the color of urine, it does not address the underlying cause of the color change in this case.
Choice B rationale
Explaining that the color change is normal is the most appropriate action. Carbidopa/levodopa can cause the urine to appear darker in color. This is a harmless side effect of the medication and does not indicate a problem.
Choice C rationale
Obtaining a specimen for a urine culture is not necessary in this case. A urine culture is used to diagnose a urinary tract infection, which is not suggested by the client’s symptoms.
Choice D rationale
Measuring the client’s urinary output is not the most appropriate action in this case. While changes in urinary output can be a sign of a problem, the client’s report of darker urine is a known side effect of carbidopa/levodopa and does not necessarily indicate a problem with urinary output.
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