A client is receiving IV vancomycin and the nurse plans to draw blood for a peak and trough to determine the serum level of the medication. Which collection times provide the best determination of these levels?

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

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.

Answer and Explanation

The Correct Answer is A

A. Immediately after completion of the IV dose and 30 minutes before the next administration of the medication: This timing is correct for monitoring vancomycin levels. The peak level is typically measured immediately after the completion of the infusion (though peak levels are less commonly required for vancomycin), and the trough level is measured just before the next dose is due, 30 minutes before administration. This approach helps in evaluating the medication's efficacy and safety.
B. One hour after completion of the IV dose and one hour before the next administration of the medication: This timing is not ideal. The peak level for vancomycin is usually measured immediately after the dose rather than one hour later. Trough levels are measured closer to the next dose, typically 30 minutes before the next dose.
C. Two hours after completion of the IV dose and two hours before the next administration of the medication: Measuring levels two hours after the dose completion is too late for a peak level. The trough level should be measured closer to the next dose, generally 30 minutes before the next administration.
D. Thirty minutes into the administration of the IV dose and 30 minutes before the next administration of the medication: Measuring the level 30 minutes into the infusion is not appropriate for peak levels, which are typically measured.

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Correct Answer is C

Explanation

A) Determine if the client is taking the medication before meals: While the timing of medication relative to meals can affect absorption, this action assumes a specific problem without first clarifying the client's concerns. It's important to understand the nature of the client's issue before assessing medication administration.
B) Ask if his morning voiding is dark colored: Dark-colored urine may be a side effect of some medications, but this is a less direct approach to understanding why the client feels the medication is not working. It does not directly address the effectiveness of the medication.
C) Explore what the client means by the drug not working: This is the most appropriate initial intervention. Understanding the client's perception and specific concerns about the medication's effectiveness will guide further actions, such as assessing medication adherence, side effects, or the need for a medication adjustment.

D) Evaluate the client for signs of dyskinesia: While assessing for dyskinesia is important, it is more of a specific follow-up step. The priority is to understand the client's concerns about the medication's overall effectiveness before focusing on specific side effects.

A. Instruct the client that since the hematocrit remains low, the daily injections are still necessary. B. Notify the healthcare provider of the patient's hematocrit level so the frequency of injections can be reduced. C. Advise the client that the medication is having the desired effect, but daily injections will continue to be needed for life for this chronic condition. D. Offer to instruct the client in self-administration techniques to improve the client's sense of control over the painful daily injections.

Correct Answer is D

Explanation

A. Instruct the client that since the hematocrit remains low, the daily injections are still necessary: A hematocrit of 43% is within the normal range, suggesting the client’s anemia is improving. If the hematocrit were still low, continuing daily injections would be appropriate, but this is not the case here.

B. Notify the healthcare provider of the client’s hematocrit level so the frequency of injections can be reduced: Since the hematocrit is normal, there is no need to notify the healthcare provider specifically for changing the injection frequency based solely on the hematocrit level. Reducing injection frequency should be based on the overall treatment plan and not just the current hematocrit.
C. Advise the client that the medication is having the desired effect, but daily injections will continue to be needed for life for this chronic condition: While the medication may be effective, informing the client about the potential for less frequent injections could improve adherence and reduce discomfort, if the healthcare provider approves.
D. Offer to instruct the client in self-administration techniques to improve the client's sense of control over the painful daily injections: Teaching self-administration can empower the client and potentially reduce discomfort by allowing the client to become more comfortable with the process. It also offers the opportunity for the client to manage their injections more conveniently and with greater control.

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A client is receiving IV vancomycin and the nurse plans to draw blood for a peak and trough to determine the serum level of the medication. Which collection times provide the best determination of these levels?

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