A nurse is reviewing the lab work of a client on a medical-surgical unit who has a new prescription for captopril. Which of the following laboratory values should the nurse identify as the priority to monitor?

A. Dyspepsia: While dyspepsia can be uncomfortable, it is not a critical finding that requires immediate reporting to the provider. It may be a common side effect of statins but typically does not warrant urgent intervention.

B. Elevated creatine kinase: An elevated creatine kinase level can indicate muscle damage, which is a serious side effect associated with rosuvastatin and other statins. This finding requires immediate reporting to prevent complications such as rhabdomyolysis.

C. Headache: A headache may occur with many medications and does not usually require immediate reporting unless it is severe or persistent.

D. Mostly cloudy: This option does not pertain to any specific clinical finding or symptom and is therefore not relevant to the question.

E. Decreased HDL cholesterol: While low HDL cholesterol can be a concern, it is not as urgent as elevated creatine kinase levels and typically does not require immediate action.

A. Requesting a serum trough level blood draw for 60 min after completion of infusion is incorrect. Trough levels should be drawn just before the next dose (not after infusion completion) to ensure therapeutic drug levels and avoid toxicity.
B. Changing the infusion site after each dose administration is incorrect. Vancomycin can cause phlebitis, but routine site changes after every dose are unnecessary unless signs of irritation or infiltration are present.
C. Contacting the provider for prescription clarification is correct. Vancomycin should be infused over at least 60 minutes to reduce the risk of Red Man Syndrome, a histamine reaction that can cause flushing, hypotension, and rash. A 30-minute infusion is too rapid and should be adjusted.
D. Requesting a serum peak level to be drawn 30 min prior to infusion is incorrect. Peak levels are drawn 30–60 minutes after infusion completion, not before infusion. Trough levels, not peak levels, are used to monitor vancomycin dosing.