A client receives a prescription for penicillin 1.2 million units IM. The available vial is labeled, “600,000 units/mL.” How many mL should the nurse administer? (Enter numeric value only.)

Choice A Reason:

Inquiring about perceived anxiety is important because anxiety can contribute to sleep difficulties. However, in the context of a client taking dextroamphetamine-amphetamine, the timing of the medication is more directly related to sleep disturbances. While anxiety should be assessed, it is not the most critical factor in this scenario.

Choice B Reason:

Determining what time the dose is taken is crucial because dextroamphetamine-amphetamine is a stimulant that can interfere with sleep if taken too late in the day. Extended-release formulations are designed to provide a steady release of medication throughout the day, but taking the dose too late can lead to insomnia. Adjusting the timing of the dose can help mitigate sleep disturbances.

Choice C Reason:

Determining daily caffeine intake is relevant because caffeine is a stimulant that can also contribute to sleep difficulties. However, the primary concern in this scenario is the timing of the dextroamphetamine-amphetamine dose. While caffeine intake should be assessed, it is secondary to the medication timing.

Choice D Reason:

Asking about the client’s bedtime routine is important for understanding overall sleep hygiene. Good sleep hygiene practices can help improve sleep quality. However, in this context, the timing of the stimulant medication is more directly related to the reported sleep difficulties. Therefore, while bedtime routine is important, it is not the most critical assessment.

Choice A: No known allergies

Reason: The absence of known allergies is crucial when administering any medication, including antibiotics like vancomycin. Allergic reactions to antibiotics can range from mild rashes to severe anaphylaxis, which can be life-threatening. In this case, the patient has reported no known allergies, which significantly reduces the risk of an adverse reaction to vancomycin. This makes it safer to proceed with the administration of the antibiotic. Ensuring that the patient has no known allergies is a standard precaution in medical practice to prevent potential allergic reactions.

Choice B: Dosage in safe range

Reason: The dosage of vancomycin must be within a safe range to avoid toxicity. Vancomycin is typically dosed based on the patient’s weight and renal function. For adults, the usual dose is 15-20 mg/kg, administered every 8-12 hours, depending on the severity of the infection and the patient’s renal function. In this scenario, the prescribed dose is 1 gram in 250 mL of 0.9% sodium chloride, which is within the safe range for an adult patient. Administering the correct dosage is essential to ensure the effectiveness of the antibiotic while minimizing the risk of nephrotoxicity and ototoxicity, which are potential side effects of vancomycin.

Choice C: Potassium 4.4 mEq/L (4.4 mmol/L)

Reason: While the potassium level of 4.4 mEq/L is within the normal range (3.5-5.0 mEq/L), it is not directly related to the safety of administering vancomycin. Potassium levels are more relevant to the overall electrolyte balance and cardiac function but do not specifically impact the administration of vancomycin. Therefore, this choice is not as pertinent to the safety of vancomycin administration as the other options.

Choice D: Peripheral IV in large vein

Reason: Administering vancomycin through a peripheral IV in a large vein is important to reduce the risk of phlebitis and irritation. Vancomycin is known to be irritating to veins, and using a large vein helps to dilute the medication more effectively, reducing the risk of vein inflammation. In this case, the peripheral IV was started in the right antecubital with a 20-gauge catheter, which is appropriate for the administration of vancomycin. Ensuring proper IV placement and using a large vein can help prevent complications associated with IV administration of this antibiotic.

Choice E: Used for prophylaxis

Reason: Vancomycin is being used as a prophylactic measure to prevent endocarditis in this patient. Prophylactic use of antibiotics is common in patients undergoing certain surgical procedures, especially those with a history of heart conditions, to prevent bacterial infections. In this case, the patient is undergoing pacemaker insertion, and the use of vancomycin as prophylaxis is appropriate to prevent potential infections. Prophylactic administration of antibiotics like vancomycin is a standard practice to reduce the risk of postoperative infections, particularly in patients with a higher risk of complications.

Choice F: Blood urea nitrogen 17 mg/dl (6.07 mmol/L)

Reason: The blood urea nitrogen (BUN) level of 17 mg/dL is within the normal range (7-20 mg/dL). While BUN levels are important indicators of renal function, they are not directly related to the safety of administering vancomycin in this context. Vancomycin dosing does need to consider renal function, but the BUN level alone does not provide sufficient information to determine the safety of administration. Therefore, this choice is not as directly relevant as the other options.