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 C

Explanation

A) Determine if the client is taking the medication before meals: While the timing of medication relative to meals can affect absorption, this action assumes a specific problem without first clarifying the client's concerns. It's important to understand the nature of the client's issue before assessing medication administration.
B) Ask if his morning voiding is dark colored: Dark-colored urine may be a side effect of some medications, but this is a less direct approach to understanding why the client feels the medication is not working. It does not directly address the effectiveness of the medication.
C) Explore what the client means by the drug not working: This is the most appropriate initial intervention. Understanding the client's perception and specific concerns about the medication's effectiveness will guide further actions, such as assessing medication adherence, side effects, or the need for a medication adjustment.

D) Evaluate the client for signs of dyskinesia: While assessing for dyskinesia is important, it is more of a specific follow-up step. The priority is to understand the client's concerns about the medication's overall effectiveness before focusing on specific side effects.

A. "I need to notify my healthcare provider if I lose my appetite or get nauseated." B. "I should take my furosemide only if I have shortness of breath or swelling in my feet." C. "I need to check my blood pressure three times a day." D. "If I lose more than one pound in a week, I should hold my next dose of furosemide."

Correct Answer is A

Explanation

A. "I need to notify my healthcare provider if I lose my appetite or get nauseated." This statement shows understanding because loss of appetite and nausea can be symptoms of digoxin toxicity or side effects, and it is important to report these symptoms to a healthcare provider. Monitoring for such side effects is crucial when taking digoxin.
B. "I should take my furosemide only if I have shortness of breath or swelling in my feet." This statement is incorrect because furosemide, a diuretic, should be taken according to the prescribed schedule, not based on symptoms. It is used to manage fluid retention and symptoms of heart failure, and its use should not be dependent solely on the presence of symptoms.
C. "I need to check my blood pressure three times a day." While monitoring blood pressure is important, it is not specifically required for patients on digoxin and furosemide unless instructed by a healthcare provider. The focus should be more on monitoring for symptoms of drug side effects and electrolyte imbalances.
D. "If I lose more than one pound in a week, I should hold my next dose of furosemide." Weight loss can be a normal effect of furosemide due to fluid loss, and the decision to hold a dose should be based on specific medical advice and not solely on weight change.

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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?

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