The health care provider orders a trough level of an antibiotic administered every twenty four hours.
When should the nurse plan for a trough level to be drawn?

An idiosyncratic drug effect is an unpredictable and uncommon reaction to a drug that is not related to the dose, the pharmacology, or the patient’s allergy or intolerance. It may be caused by genetic factors, metabolic abnormalities, or interactions with other drugs or substances. An example of an idiosyncratic drug effect is paradoxical agitation or excitement after receiving a sedative.

B. A toxic drug effect is a harmful reaction to a drug that is related to the dose or the pharmacology of the drug. It may cause symptoms such as nausea, vomiting, drowsiness, confusion, or respiratory depression. A toxic drug effect is unlikely to cause agitation after receiving a sedative unless there is an overdose or a drug interaction that increases the level of the sedative in the blood.

C. An allergic drug response is an immunological reaction to a drug that is not related to the dose or the pharmacology of the drug. It may cause symptoms such as rash, itching, swelling, fever, or anaphylaxis. An allergic drug response is unlikely to cause agitation after receiving a sedative unless there is a severe anaphylactic reaction that affects the brain or the circulation.

D. An unexpected drug interaction is a modification of the effect of one drug by another drug or substance that is not predictable based on their pharmacology. It may cause an increase or a decrease in the efficacy or toxicity of one or both drugs. An unexpected drug interaction may cause agitation after receiving a sedative if there is a synergistic effect that enhances the central nervous system stimulation of another drug or substance (such as caffeine, cocaine, or amphetamines) or if there is an antagonistic effect that reduces the central nervous system depression of the sedative (such as flumazenil, naloxone, or physostigmine). However, these interactions are usually known and avoidable by checking the patient’s history and medication list.

A private room with negative air pressure is required to care for a client with suspected or confirmed tuberculosis (TB) disease, as this is part of the airborne precautions recommended by the CDC.

A private room with negative air pressure prevents the spread of infectious droplet nuclei that contain the TB bacteria.

Choice A is wrong because gloves, masks, and gowns are not sufficient to protect against TB transmission.

Gloves and gowns are used for contact precautions, which are not indicated for TB.

A regular mask is also not effective in filtering out the small droplet nuclei that carry the TB bacteria.

Choice B is wrong because an N95 mask is not a precaution for the client, but for the healthcare personnel who are in close contact with the client.

An N95 mask is a type of respirator that can filter out at least 95% of airborne particles, including TB bacteria. Health care personnel should wear an N95 mask when entering the client’s room or performing aerosol-generating procedures on the client.

Choice C is wrong because droplet precautions are not indicated for TB.

Droplet precautions are used for infections that are spread by large respiratory droplets that do not remain suspended in the air, such as influenza or pertussis. Droplet precautions require wearing a regular mask and eye protection when within 6 feet of the client.

Choice D is wrong because contact precautions are not indicated for TB.

Contact precautions are used for infections that are spread by direct or indirect contact with the client or the client’s environment, such as Clostridium difficile or MRSA. Contact