The nurse checks the patient’s laboratory work prior to administering a dose of vancomycin and finds that the trough vancomycin level is 24 mcg/mL. What will the nurse do next?
Hold the drug, and administer 4 hours later.
Administer the vancomycin as ordered.
Hold the drug, and notify the prescriber.
Repeat the test to verify results.
The Correct Answer is C
Choice A rationale:
Holding the drug and administering it 4 hours later is not the appropriate action. The trough vancomycin level of 24 mcg/mL is higher than the recommended range of 10-20 mcg/mL, indicating potential risk for toxicity. Administering the drug later does not address the immediate concern of a high trough level.
Choice B rationale:
Administering the vancomycin as ordered is not the correct action in this case. The trough level is above the recommended range, which could lead to vancomycin toxicity. The nurse should not administer the medication without addressing the high trough level. Choice C rationale:
This is the correct action. The nurse should hold the drug and notify the prescriber because the trough vancomycin level is higher than the recommended range. The prescriber can then make a decision based on this information, which may include adjusting the dose, extending the dosing interval, or ordering additional tests.
Choice D rationale:
While repeating the test to verify results might be done eventually, it should not be the immediate next step. The nurse has a responsibility to ensure patient safety, and with a trough level above the recommended range, the priority is to prevent potential toxicity. Therefore, the nurse should hold the drug and notify the prescriber.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Phenytoin is an anticonvulsant drug used in the prophylaxis and control of various types of seizures. It has a narrow therapeutic index, which means that the safe and toxic plasma levels of the drug are very close to each other. This characteristic makes the dosing of phenytoin challenging, as even small deviations from the recommended therapeutic range can lead to suboptimal treatment or adverse effects. Therapeutic effect without clinical signs of toxicity occurs more often with serum total concentrations between 10 and 20 mcg/mL34. Therefore, clinicians are advised to initiate therapeutic drug monitoring in patients who require phenytoin.
Choice B rationale:
The statement that phenytoin has a low chance of being effective is incorrect. Phenytoin is a widely used and effective anticonvulsant. It works by slowing down impulses in the brain that cause seizures. It is used to control seizures but does not treat all types of seizures. The effectiveness of phenytoin is not determined by its narrow therapeutic index but by its pharmacological action in the brain.
Choice C rationale:
The assertion that there is no difference between safe and toxic plasma levels of phenytoin is incorrect. There is indeed a difference between the safe (therapeutic) and toxic levels of phenytoin. The therapeutic range for phenytoin is typically between 10 and 20 mcg/mL34. Levels above this range can lead to toxicity, while levels below this range may not provide the desired therapeutic effect.
Choice D rationale:
The statement that a very small dosage of phenytoin can result in the desired therapeutic effect is not entirely accurate. While it’s true that phenytoin is effective in controlling seizures, the dosage required to achieve this effect is not necessarily “very small”. The usual adult dose for seizures is 100 mg orally 3 times a day. The dosage may need to be adjusted based on individual patient factors and response to therapy. Therefore, it’s not accurate to generalize that a “very small” dosage will result in the desired therapeutic effect for all patients.
Correct Answer is ["B","C"]
Explanation
Choice A rationale:
This statement is incorrect. Sulfonamides should be taken for the full time of treatment, even if the patient begins to feel better after a few days. If the medication is stopped too soon, the symptoms may return.
Choice B rationale:
This statement is correct. Sulfonamides can cause increased photosensitivity, which means the skin can be more sensitive to the sun and burn more easily. Therefore, patients should be educated to use sunscreen and protective clothing with sun exposure.
Choice C rationale:
This statement is correct. Sulfonamides are best taken with a full glass (8 ounces) of water. Several additional glasses of water should be taken every day, unless otherwise directed by the doctor. Drinking extra water will help to prevent some unwanted effects of sulfonamides.
Choice D rationale:
This statement is incorrect. Restricting daily fluid intake to 1000ml per day while on sulfonamides could increase the risk of crystalluria that can cause kidney stones or decreased kidney function. Therefore, patients should increase their water intake while taking these medications.
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