Examine the following patient data for a patient who has been prescribed vancomycin.
The nurse is evaluating a patient after administering several doses of Vancomycin IV. Which of the following changes would indicate a therapeutic response to the medication? (Select all that apply)

Choice A rationale:

A WBC count of 16,000/mm is higher than the normal range of 5,000 to 10,000 cells/mm. This indicates that the body is fighting an infection, which is a common reason for prescribing Vancomycin. Therefore, a high WBC count could indicate a therapeutic response to the medication as it suggests that the body’s immune system is actively fighting the infection.

Choice B rationale:

A BUN level of 42 mg/dl is higher than the normal range of 7 to 20 mg/dL3456. Elevated BUN levels can indicate kidney damage or disease, which is not a desired therapeutic response to Vancomycin. Vancomycin can be nephrotoxic, and its use requires careful monitoring of kidney function. Therefore, a high BUN level does not indicate a therapeutic response to the medication. Choice C rationale:

A blood pressure reading of 95/64 is considered normal. Maintaining normal blood pressure is important for overall health and can indicate that the patient’s body is responding well to the medication. Therefore, a blood pressure reading within the normal range could indicate a therapeutic response to Vancomycin.

Choice D rationale:

A body temperature of 101.8F is considered a fever14. Fever is a common response to infection and can indicate that the body is fighting off an infection, which is a common reason for prescribing Vancomycin. Therefore, a high body temperature could indicate a therapeutic response to the medication as it suggests that the body’s immune system is actively fighting the infection.

Choice A rationale:

Zidovudine, also known as AZT, is a medication used for the treatment of human immunodeficiency virus (HIV) infection. One of the major dose-limiting toxic effects of Zidovudine is hematologic toxicity, which manifests clinically as anemia, neutropenia, and sometimes as platelet deficits with onset after several weeks of treatment. This hematologic toxicity is essentially a form of bone marrow suppression. Therefore, bone marrow suppression is the dose-limiting adverse effect of zidovudine therapy.

Choice B rationale:

Retinitis is not a known dose-limiting adverse effect of zidovudine. While zidovudine has a range of side effects, retinitis is not commonly associated with its use.

Choice C rationale:

Renal toxicity is not a known dose-limiting adverse effect of zidovudine. While zidovudine can have various side effects, renal toxicity is not typically one of them.

Choice D rationale:

Hepatotoxicity is not the dose-limiting adverse effect of zidovudine. While severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of zidovudine, it is not considered the dose-limiting adverse effect. The dose-limiting adverse effect is more specifically related to hematologic toxicity, which includes bone marrow suppression.