A client is receiving intravenous (IV) vancomycin and the nurse plans to draw blood for a peak and trough to determine the serum level of the drug. Which collection times provide the best determination of these levels?
Two hours after completion of the IV dose and two hours 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.
Thirty minutes into the administration of the IV dose and 30 minutes before the next administration of the medication.
Immediately after completion of the IV dose and 30 minutes before the next administration of the medication.
None
None
The Correct Answer is D
A. Two hours after completion is too late to accurately capture the peak serum concentration, and drawing a trough two hours before the next dose will result in an artificially elevated trough level, as the drug has not yet cleared to its lowest concentration.
B. One hour after completion may miss the true peak concentration for intravenous vancomycin, and drawing a trough one hour before the next dose does not represent the absolute lowest point of the medication's therapeutic window.
C. Thirty minutes into the infusion is too early to measure a peak because the entire dose has not yet been delivered into the bloodstream, which can lead to inaccurate clinical decision-making.
D. To capture the maximum concentration of the drug in the bloodstream, the peak level should be drawn immediately after completion of the intravenous infusion (or within 30 to 60 minutes depending on facility protocol and infusion duration). To capture the lowest concentration, the trough level must be drawn immediately prior to the next scheduled dose, typically 30 minutes before administration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale: This is not appropriate because the client's elevated calcium level requires immediate attention and further assessment by the healthcare provider before administering any medications that may further raise calcium levels.
Choice B rationale: The client's total calcium level is significantly elevated, which may indicate hypercalcemia. Given the reference range for total calcium in adults is 9 to 10.5 mg/dL (2.25 to 2.62 mmol/L), a calcium level of 14 mg/dL (3.5 mmol/L) is abnormally high. Both calcitriol (active form of vitamin D) and calcium carbonate (calcium supplement) can increase calcium levels in the body. Before administering any medication, the nurse should hold both calcitriol and calcium carbonate and notify the healthcare provider of the elevated calcium level. The healthcare provider will determine the appropriate course of action and may adjust the dosage or temporarily discontinue the medications to prevent further complications related to hypercalcemia.
Choice C rationale: Holding calcium carbonate is a step in the right direction, but given the significant elevation of total calcium, it is best to hold both medications and consult the healthcare provider.
Choice D rationale: Holding calcitriol is a step in the right direction, but both medications should be held to prevent exacerbation of hypercalcemia until further instructions are received from the healthcare provider.
Correct Answer is D
Explanation
Choice A rationale: This instruction is not directly related to spironolactone use or hyperaldosteronism. Excessive bruising may be relevant in some situations but not specifically for this scenario.
Choice B rationale: While heart failure patients are often advised to reduce their sodium intake, the use of a salt substitute (potassium-based) would be contraindicated in this case due to the risk of hyperkalemia.
Choice C rationale: This instruction is not directly related to spironolactone use or
hyperaldosteronism. It may be relevant for sun protection, but it is not a priority in this context.
Choice D rationale: Spironolactone is a potassium-sparing diuretic, which means it helps the body retain potassium while excreting sodium and water. Since the client has heart failure (HF), there is a risk of hyperkalemia (high potassium levels) associated with spironolactone use. To prevent this, the nurse should instruct the client to limit their intake of high-potassium foods, such as bananas, oranges, tomatoes, spinach, and other potassium-rich foods.
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