The nurse receives report that a patient has an elevated trough serum level of a medication.
Which priority provider order should the nurse anticipate?
Repeat the serum peak level test.
Increase the dose of the medication.
Reduce the dose of the medication.
Obtain a creatinine level or eGFR.
The Correct Answer is C
Choice A rationale
The trough level, typically drawn just before the next dose, measures the lowest concentration of the drug in the bloodstream. An elevated trough indicates drug accumulation and risk of toxicity. The peak level, measured at the highest concentration, is generally not needed after an elevated trough, and a repeat peak would not address the immediate concern of potential toxicity.
Choice B rationale
Increasing the dose of the medication would lead to an even higher trough level and peak level, significantly elevating the risk of drug toxicity, as the current dose is already causing accumulation (evidenced by the high trough). Therapeutic drug monitoring (TDM) is used to prevent toxicity and maintain efficacy; therefore, a higher dose is contraindicated.
Choice C rationale
An elevated trough serum level (normal range varies by drug, but often <2 mcg/mL for vancomycin) signifies that the drug is being eliminated too slowly or the interval between doses is too short, leading to accumulation and an increased risk of toxicity. Reducing the dose or lengthening the dosing interval is the priority action to bring the trough level back into the therapeutic range and prevent organ damage.
Choice D rationale
Many medications, especially renally-excreted ones, have levels affected by kidney function. While obtaining a creatinine level (normal range ∼0.6-1.2 mg/dL) or estimated Glomerular Filtration Rate (eGFR) is important for assessing drug clearance and adjusting future dosing, the priority immediate intervention is to modify the existing dose regimen to prevent acute toxicity from the current high level.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Necrosis describes the pathological and uncontrolled process of cell death that occurs due to irreversible external injury, such as ischemia, toxins, or infection, leading to cell swelling, rupture, and subsequent inflammatory response in the surrounding tissue. In contrast, apoptosis is an orderly, genetically-regulated process of cellular self-destruction that does not typically elicit an inflammatory response.
Choice B rationale
Dysplasia refers to an abnormal cellular change characterized by the loss of uniformity of individual cells and their architectural orientation within a tissue. It is often a premalignant condition but is reversible if the irritant is removed. This process is distinct from apoptosis, which is the mechanism of controlled, programmed cell death used to eliminate damaged or unnecessary cells.
Choice C rationale
Apoptosis, or programmed cell death, is a precisely regulated, energy-dependent process used by the body to eliminate damaged, infected, or unnecessary cells without releasing cellular contents into the environment, thus preventing inflammation. It is characterized by cellular shrinkage, nuclear fragmentation (pyknosis), and the formation of apoptotic bodies which are then phagocytosed by neighboring cells.
Choice D rationale
Metaplasia is a reversible process where one mature, differentiated cell type is replaced by another mature cell type in response to chronic irritation or stress, often as an adaptive mechanism. A classic example is the change in the bronchial lining due to smoking, which is a structural change, not a mechanism of cell destruction like apoptosis.
Correct Answer is D
Explanation
Choice A rationale
Opioids act as central nervous system depressants by binding to μ-opioid receptors, primarily in the brainstem's respiratory center. This binding inhibits the release of essential neurotransmitters, significantly decreasing the responsiveness of the chemoreceptors to carbon dioxide changes, which is contrary to increased rate and depth. This effect leads to hypoventilation, hypercapnia, and ultimately severe respiratory acidosis, resulting in respiratory failure.
Choice B rationale
While some opioids can cause minor histamine release, which theoretically could lead to mild bronchoconstriction, the primary and most life-threatening effect is profound central respiratory depression, not peripheral airway narrowing. Bronchoconstriction and wheezing are more characteristic of conditions like asthma or Type I hypersensitivity reactions, not the direct, primary action of opioid agonism on respiratory drive.
Choice C rationale
Opioids cause hypoventilation by reducing the rate and depth of inhalation, rather than primarily causing an inability to exhale. The issue is a depressed respiratory drive from the brainstem. Exhalation is largely a passive process driven by the elastic recoil of the lungs and chest wall after a reduced or shallow inspiration, making an inability to exhale scientifically inaccurate as the primary effect.
Choice D rationale
Opioid agonists depress the central respiratory drive by reducing the sensitivity of the medullary respiratory center to hypercapnia (high CO_2). This direct neuropharmacological effect drastically reduces the frequency (rate) and volume (depth or tidal volume) of breaths, leading to severe hypoventilation, CO_2 retention, and potentially lethal respiratory arrest, which aligns with the observed 6 breaths/min.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.