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 B

Explanation

A) 40-year-old female with frequent vaginal infections: Simvastatin is a medication used primarily to manage cholesterol levels and reduce the risk of cardiovascular diseases. Frequent vaginal infections are not directly related to cholesterol levels or cardiovascular risk. Therefore, this client is unlikely to benefit from education about simvastatin.
B) A 50-year-old male with a history of angina: Simvastatin is a statin medication prescribed to lower cholesterol levels and reduce the risk of cardiovascular events, such as heart attacks and strokes. Since angina is a symptom of coronary artery disease, a condition often related to high cholesterol levels, this client would benefit from education about simvastatin, which can help manage cholesterol and potentially reduce cardiovascular risk.
C) An 18-year-old pregnant female with type 1 diabetes mellitus: Statins, including simvastatin, are generally contraindicated during pregnancy due to potential risks to the developing fetus. Additionally, this client’s primary condition of type 1 diabetes mellitus would not typically be managed with simvastatin alone. Therefore, this client is not the target for simvastatin education.
D) A 75-year-old male with bone cancer: While simvastatin is used for managing cholesterol and preventing cardiovascular events, bone cancer is not directly related to cholesterol levels. The primary focus for this client would be managing cancer-related symptoms and treatments rather than cholesterol levels. Thus, this client would not benefit from education about simvastatin.

A. Withhold the medication until the client's breakfast tray is available on the unit. B. Consult with a pharmacist about scheduling the dose one hour after the client eats. C. Instruct the client that it is necessary to take nothing but water with the medication. D. Assign an unlicensed assistive personnel (UAP) to bring the client a glass of low fat milk.

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.

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