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. Withhold the medication until the client’s breakfast tray is available on the unit: Withholding the medication until food is available is not necessary, as risedronate should be taken on an empty stomach to ensure proper absorption. Food can interfere with the medication's effectiveness.
B. Consult with a pharmacist about scheduling the dose one hour after the client eats: This option is not suitable as risedronate should be taken on an empty stomach, and delaying the dose until after eating would compromise the medication's effectiveness.
C. Instruct the client that it is necessary to take nothing but water with the medication: Risedronate must be taken on an empty stomach with a full glass of water and the client should remain upright for at least 30 minutes afterward. Milk or other beverages can interfere with the absorption of risedronate.
D. Assign an unlicensed assistive personnel (UAP) to bring the client a glass of low-fat milk: This is not appropriate, as risedronate should be taken with water only to ensure proper absorption. Milk can reduce the effectiveness of the medication.

A. Protect the skin from sunlight while taking the drug. B. Take with orange juice to enhance gastrointestinal (GI) absorption. C. Return to the clinic weekly to obtain serum drug levels. D. Take with milk or antacids to prevent gastrointestinal (GI) irritation.

Correct Answer is A

Explanation

A) Protect the skin from sunlight while taking the drug: Tetracycline is known to increase sensitivity to sunlight, leading to a higher risk of sunburn and skin reactions. Advising clients to protect their skin from sun exposure and to use sunscreen is essential to prevent these adverse effects. This precaution helps mitigate the risk of photosensitivity reactions that are commonly associated with tetracycline use.
B) Take with orange juice to enhance gastrointestinal (GI) absorption: Tetracycline should not be taken with dairy products or antacids, as they can bind with the medication and reduce its absorption. While orange juice can enhance absorption, this is not a standard recommendation for tetracycline. Instead, it is generally advised to take tetracycline with water and avoid substances that could interfere with its absorption.
C) Return to the clinic weekly to obtain serum drug levels: Tetracycline typically does not require regular monitoring of serum drug levels, as it does not have a narrow therapeutic index like some other drugs. Instead, patients are generally advised on how to manage side effects and adherence to the medication regimen, rather than frequent clinic visits for drug level monitoring.
D) Take with milk or antacids to prevent gastrointestinal (GI) irritation: Milk and antacids should be avoided when taking tetracycline because they can bind to the medication and significantly reduce its effectiveness. This instruction could lead to decreased therapeutic efficacy and should be avoided. Tetracycline should be taken on an empty stomach to ensure optimal absorption, avoiding interactions with these substances.

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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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