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The nurse checks the patient's laboratory work prior to administering a dose of vancomycin and finds that the trough vancomycin level is 15 mcg/mL. What will the nurse do next?
- A. Administer the vancomycin as ordered.
- B. Hold the drug, and administer 4 hours later.
- C. Hold the drug, and notify the prescriber.
- D. Repeat the test to verify results.
Correct Answer: A
Rationale: Optimal blood levels of vancomycin are a trough level of 10 to 20 mcg/mL. Measurement of peak levels is no longer routinely recommended, and only trough levels are commonly monitored. Because of the increase in resistant organisms, many clinicians use a trough level of 15 to 20 mcg/mL as their goal.
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A patient with a Pseudomonas species urinary infection will be receiving amikacin 5 mg/kg once daily via intravenous infusion. The patient weighs 143 pounds, and the medication is available in an injection solution strength of 250 mg/mL. Identify how many milliliters of medication will be drawn up for this injection. (record answer using one decimal place)
Correct Answer: 1.3 Ml
Rationale: Calculate the patient's weight in kilograms: 143 pounds ?· 2.2 = 65 kg. Calculate mg/kg/dose: 5 mg/kg ?? 65 kg = 325 mg. Calculate volume: 325 mg ?· 250 mg/mL = 1.3 mL.
The nurse is reviewing the medication orders for a patient who will be receiving aminoglycoside therapy. Which other medication or medication class, if ordered, would be a potential interaction concern?
- A. Calcium channel blockers
- B. Phenytoin
- C. Proton pump inhibitors
- D. Loop diuretics
Correct Answer: D
Rationale: Concurrent use of aminoglycosides with loop diuretics increases the risk for ototoxicity. The other drugs and drug classes do not cause interactions.
A patient will be receiving nitrofurantoin treatment for a urinary tract infection. The nurse is reviewing the patient's history and will question the nitrofurantoin order if which disorder is present in the history? (Select all that apply.)
- A. Liver disease
- B. Coronary artery disease
- C. Hyperthyroidism
- D. Type 1 diabetes mellitus
- E. Chronic renal disease
Correct Answer: A,E
Rationale: Nitrofurantoin is contraindicated in cases of known drug allergy and also in cases of significant renal function impairment, because the drug concentrates in the urine. Because adverse effects include hepatotoxicity, which is rare but often fatal, the nurse should also question the order if liver disease is present. The other options are not contraindications.
A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse's best response?
- A. The combined effect of both antibiotics is greater than each of them alone.
- B. One antibiotic is not strong enough to fight the infection.
- C. We have not yet isolated the bacteria, so the two antibiotics are given to cover a wide range of microorganisms.
- D. We can give a reduced amount of each one if we give them together.
Correct Answer: A
Rationale: Aminoglycosides are often used in combination with other antibiotics, such as beta-lactams or vancomycin, in the treatment of various infections because the combined effect of the two antibiotics is greater than that of either drug alone.
The nurse is administering intravenous vancomycin to a patient who has had gastrointestinal surgery. Which nursing measures are appropriate? (Select all that apply.)
- A. Monitoring serum creatinine levels
- B. Restricting fluids while the patient is on this medication
- C. Warning the patient that a flushed feeling or facial itching may occur
- D. Instructing the patient to report dizziness or a feeling of fullness in the ears
- E. Reporting a trough drug level of 11 mcg/mL and holding the drug
- F. Reporting a trough drug level of 24 mcg/mL and holding the drug
Correct Answer: A,C,D,F
Rationale: Constant monitoring for drug-related neurotoxicity, nephrotoxicity, ototoxicity, and superinfection remains critical to patient safety. Monitor for nephrotoxicity by monitoring serum creatinine levels. Ototoxicity may be indicated if the patient experiences dizziness or a feeling of fullness in the ears, and these symptoms must be reported immediately. Vancomycin infusions may cause red man syndrome, which is characterized by flushing of the neck and face and a decrease in blood pressure. Optimal trough blood levels of vancomycin are 10 to 20 mcg/mL; therefore, the drug should not be administered when there is a trough level of 24 mcg/mL.