Nokea
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.
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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.
Which problem may occur in a patient who has started aminoglycoside therapy?
- A. Constipation
- B. Renal damage
- C. Gynecomastia
- D. Leukocytosis
Correct Answer: B
Rationale: Patients on aminoglycoside therapy have an increased risk for nephrotoxicity. The other options are incorrect.
A 79-year-old patient is receiving a quinolone as treatment for a complicated incision infection. The nurse will monitor for which adverse effect that is associated with these drugs?
- A. Neuralgia
- B. Double vision
- C. Hypotension
- D. Tendonitis and tendon rupture
Correct Answer: D
Rationale: A black box warning is required by the U.S. Food and Drug Administration for all quinolones because of the increased risk for tendonitis and tendon rupture with use of the drugs. This effect is more common in elderly patients, patients with renal failure, and those receiving concurrent glucocorticoid therapy (e.g., prednisone). The other options are not common adverse effects.
When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity?
- A. Fever
- B. White blood cell count of 8000 cells/mm^3
- C. Tinnitus and dizziness
- D. Decreased blood urea nitrogen (BUN) levels
Correct Answer: C
Rationale: Dizziness, tinnitus, hearing loss, or a sense of fullness in the ears could indicate ototoxicity, a potentially serious toxicity in a patient. Nephrotoxicity is indicated by rising blood urea nitrogen and creatinine levels. Fever may be indicative of the patient's infection; a white blood cell count of 7000 cells/mm^3 is within the normal range of 5000 to 10,000 cells/mm^3.
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.