Laboratory Test	Result	reference range
Serum Creatinine	1 mg/dl (88.4 μmol/L)	0.5-1.1 mg/dL (44-97 μmol/L)
BUN	9 mg/dl. (3.2 mmol/L)	10-20 mg/dl. (3.6-7.1 mmol/L)
Sodium	136 mEq/L (136 mmol/L)	136 to 145 mEq/L (136 to 145 mmol/L)
Potassium	6.1 mEq/L (6.1 mmol/L)	3.5 to 5 mEq/L (3.5 to 5 mmol/L)

The nurse reviews the lab values.

What questions can the nurse ask the client based on the lab results? Select all that apply.

A. Thirty minutes into the administration of the IV dose and 30 minutes before the next administration of the medication:

This timing doesn't align with the standard practice of drawing peak levels immediately after the IV dose is completed.

The trough level should be taken just before the next dose, not 30 minutes before.

B. Two hours after completion of the IV dose and 1 hour before the next administration of the medication:

Waiting for two hours after the dose to draw the peak level is too long. Peak levels are typically drawn immediately after completion.

Drawing the trough level one hour before the next dose doesn't provide an accurate assessment of the lowest drug concentration just before the next administration.

C. One hour after completion of the IV dose and one hour before the next administration of the medication:

Similar to choice B, waiting one hour after the dose to draw the peak level is not in line with standard practice.

Drawing the trough level one hour before the next dose is administered is too early to accurately represent the lowest concentration.

The best collection times for determining the peak and trough levels of intravenous (IV) vancomycin are:

D. Immediately after completion of the IV dose and 30 minutes before the next administration of the medication.

Explanation:

Peak Level: Peak levels of vancomycin are drawn immediately after the completion of the IV dose. This is done to assess the highest concentration of the drug in the bloodstream, which is important for ensuring its therapeutic efficacy and monitoring for potential toxicity.

Trough Level: Trough levels are drawn just before the next dose is administered. A trough level represents the lowest concentration of the drug in the bloodstream, ensuring that the drug is still present at a therapeutic level before the next dose is given. Taking the trough level 30 minutes before the next administration is appropriate, as it allows time for the drug to reach its lowest concentration before receiving the next dose.

A. Unpleasant smell when using the medication:

While acetylcysteine has a distinctive odor, this is not the primary therapeutic response to expect. The odor is often described as unpleasant or sulfur-like.

B. Bronchodilation and wheezing:

Acetylcysteine is not primarily used for bronchodilation. It is used to thin mucus and facilitate its removal. Wheezing is not a common response to acetylcysteine.

When administering acetylcysteine via nebulization through an endotracheal tube to a client with pneumonia, the nurse should expect the following therapeutic response:

C. Increased sputum, requiring suctioning.

Explanation: Acetylcysteine is a mucolytic agent used to help thin and loosen mucus in the airways, making it easier to clear secretions. When administered via nebulization, it can stimulate increased mucus production, which may result in the client needing suctioning to remove the loosened secretions. This is a desired therapeutic effect because it helps clear the airways and improve lung function in clients with conditions like pneumonia.

D. Hypotension:

Hypotension is not a common or expected therapeutic response to acetylcysteine. It is important to monitor blood pressure during administration, but hypotension is not the primary effect of this medication.