What is the best method of monitoring therapeutic blood levels of vancomycin during therapy?

By assessing the temperature every 4 hours

By repeating a culture and sensitivity test on day 3

By obtaining drug peak and trough levels

By assessing for breathlessness

Answer and Explanation

The Correct Answer is C

A. By assessing the temperature every 4 hours:

Monitoring temperature every 4 hours is a common practice in hospitalized patients to detect fever, which could indicate an infection or an inflammatory response. However, this method does not directly assess the therapeutic blood levels of vancomycin. Fever alone does not provide specific information about the effectiveness or concentration of the antibiotic in the bloodstream.

B. By repeating a culture and sensitivity test on day 3:

Culture and sensitivity tests involve taking a sample from the patient (such as blood, urine, or sputum) and growing the microorganisms in a laboratory to identify the causative organism and determine its susceptibility to antibiotics. While this test is essential for identifying the appropriate antibiotic therapy initially, repeating it on day 3 does not directly monitor therapeutic blood levels of vancomycin. It also doesn't provide real-time information about the concentration of vancomycin in the bloodstream.

C. By obtaining drug peak and trough levels:

This choice involves measuring the highest (peak) and lowest (trough) concentrations of vancomycin in the bloodstream. Peak levels are typically measured about 1 hour after the completion of a vancomycin infusion, while trough levels are measured just before the next dose is administered. These measurements allow healthcare providers to ensure that the drug concentration remains within the therapeutic range to effectively treat the infection while minimizing the risk of toxicity.

D. By assessing for breathlessness:

Assessing for breathlessness is important for monitoring respiratory status, particularly in patients receiving vancomycin, as rare side effects like red-man syndrome or anaphylaxis can cause respiratory distress. However, this method does not directly monitor therapeutic blood levels of vancomycin.

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Correct Answer is ["B","C","D","E"]

Explanation

A. Valerian:

Valerian is an herb commonly used for its sedative and anxiolytic properties. There is limited evidence suggesting potential interactions between valerian and warfarin, but it is not considered a major concern for altering warfarin's anticoagulant effects. However, caution is still warranted, and healthcare providers should monitor patients for any signs of increased bleeding if they are using valerian along with warfarin.

B. Ginkgo biloba:

Ginkgo biloba is an herb often used for its cognitive-enhancing properties and to improve circulation. There is some evidence to suggest that ginkgo biloba may interact with warfarin and increase the risk of bleeding due to its anticoagulant effects. Therefore, patients taking warfarin should use ginkgo biloba cautiously and inform their healthcare providers if they are using it.

C. Echinacea:

Echinacea is an herb commonly used to boost the immune system and treat colds and respiratory infections. Some studies suggest that echinacea may interact with warfarin and potentially increase the risk of bleeding. Therefore, it's essential for patients taking warfarin to avoid or use echinacea cautiously and to inform their healthcare providers if they are using it.

D. Ginger:

Ginger is an herb commonly used for its anti-inflammatory and digestive properties. Some studies suggest that ginger may interact with warfarin and increase the risk of bleeding due to its anticoagulant effects. Patients taking warfarin should use ginger cautiously and inform their healthcare providers if they are using it.

E. Garlic:

Garlic is an herb known for its cardiovascular benefits and potential anticoagulant effects. Some studies suggest that garlic may interact with warfarin and increase the risk of bleeding. Patients taking warfarin should use garlic cautiously and inform their healthcare providers if they are using it.

A. Ototoxicity B. Nausea C. Constipation D. Increased urinary output

Correct Answer is A

Explanation

A. Ototoxicity:

Ototoxicity refers to damage to the auditory and vestibular nerves, leading to hearing loss and balance disturbances. Gentamicin, being an aminoglycoside antibiotic, is known for its potential to cause ototoxicity. Signs and symptoms of ototoxicity include changes in hearing, ringing in the ears (tinnitus), and imbalance. Ototoxicity is irreversible and can occur suddenly or gradually during gentamicin therapy. Therefore, any signs or symptoms of ototoxicity should be reported immediately to the physician for further evaluation and management.

B. Nausea:

Nausea is a common gastrointestinal side effect associated with gentamicin therapy. While it can be bothersome to the patient, nausea alone is not typically considered a severe adverse effect that requires immediate reporting to the physician. However, if nausea is severe or persistent and leads to dehydration or electrolyte imbalances, it should be addressed promptly.

C. Constipation:

Constipation is another potential gastrointestinal side effect of gentamicin therapy. Like nausea, constipation alone is not typically considered a severe adverse effect that requires immediate reporting to the physician. However, if constipation is severe or persistent and leads to discomfort or bowel obstruction, it should be addressed promptly.

D. Increased urinary output:

Increased urinary output may indicate improved renal function, which can be a desired effect during gentamicin therapy. Gentamicin is primarily excreted by the kidneys, and increased urinary output may help in the elimination of the drug from the body. Therefore, increased urinary output alone is not typically considered an adverse effect that requires immediate reporting to the physician. However, if there are signs of dehydration or electrolyte imbalances associated with increased urinary output, they should be addressed promptly.

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What is the best method of monitoring therapeutic blood levels of vancomycin during therapy?

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Naxlex Comprehensive Predictor Exams

The patient is to be started on warfarin (Coumadin) therapy. It is important for the nurse to check for the use of which herbs? (Select All that Apply)

Correct Answer is ["B","C","D","E"]

Explanation

The nurse is caring for a client receiving gentamycin IV. Which of the following adverse effects would the nurse report to the physician immediately?

Correct Answer is A

Explanation

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