Client Is Receiving Intravenous (IV) Vancomycin and the Nurse Plans to Draw Blood for a Peak and Trough to Determine the Serum Level of the Which Collection T

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Sample questions from Client Is Receiving Intravenous (IV) Vancomycin and the Nurse Plans to Draw Blood for a Peak and Trough to Determine the Serum Level of the Which Collection T

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.On a pediatric inpatient unit, a 3-year-old receiving IV vancomycin every 6 hours is due for the next dose at 1200. The provider orders a trough level. The child is afebrile, HR 104/min, RR 24/min, BP 92/58 mm Hg, and urine output is 1.2 mL/kg/hr. When should the nurse arrange to collect the specimen?

   • A.At 1000, midway between doses
   • B.At 1230, after the dose begins
   • C.Immediately before the 1200 dose
   • D.One hour after the 1200 infusion ends

   Rationale: A vancomycin trough is collected immediately before the next dose, so the 1200 specimen should be drawn before administration. A midpoint level is not a trough, and either post-dose option would measure drug after administration rather than the lowest concentration. Coordinate collection and dosing so the level is not mislabeled or collected at the wrong time.

2. 2.In an outpatient infusion center, a 17-year-old with osteomyelitis is prescribed a vancomycin peak and trough. The trough is due immediately before the 1600 dose; the infusion is scheduled to run over 2 hours. Which collection plan is appropriate?

   • A.Draw the trough immediately before the 1600 dose and the peak about 1 to 2 hours after the infusion ends
   • B.Draw the peak at 1600 before the infusion, then draw the trough at 1800
   • C.Draw the peak immediately after the infusion ends and the trough 1 hour later
   • D.Draw both specimens from the IV catheter while the infusion is running

   Rationale: The trough is obtained just before the dose, and a traditional peak sample is generally collected after the infusion has ended and the drug has distributed, commonly about 1 to 2 hours later. A pre-infusion sample cannot be the peak, and sampling during an infusion or from a line carrying vancomycin risks an inaccurate result. The exact timing should follow the laboratory and facility protocol and be documented with the dose and infusion times.

3. 3.Refer to the client's chart. The nurse is coordinating vancomycin monitoring for a 6-year-old with bacteremia. Which actions are appropriate? Select all that apply.

   • A.Document the actual dose and infusion times with the specimen collection times.
   • B.Ask unlicensed assistive personnel to decide whether the timing of the level is correct.
   • C.Collect the trough immediately before the 1000 dose, as ordered.
   • D.Verify the timing requirements with the laboratory or facility protocol before arranging the peak draw.
   • E.Draw the peak from the same lumen while vancomycin is infusing to avoid another puncture.
   • F.Notify the prescriber about the rising creatinine and reduced urine output before the next dose is given.

   Rationale: The trough is due before the 1000 dose, and accurate dose, infusion, and collection times are essential for interpreting the levels. The creatinine has risen from 0.4 to 0.8 mg/dL and urine output has fallen, so the prescriber should be notified promptly because renal function affects vancomycin clearance. Drawing from a lumen carrying the drug can contaminate the specimen, timing decisions require nursing judgment rather than delegation to assistive personnel, and peak timing should follow the laboratory or facility protocol.

4. 4.At change of shift on a medical unit, a 24-year-old receiving IV vancomycin has a trough specimen ordered before the 0800 dose. The previous dose was infused through the client's only central-line lumen, and a peripheral IV is available. What is the best action?

   • A.Hold the 0800 dose until the laboratory reports the trough result
   • B.Use the peripheral IV for the specimen and coordinate collection before the scheduled dose
   • C.Ask the oncoming nurse to draw the trough after the infusion is complete
   • D.Draw the sample from the central lumen before flushing it, then give the dose

   Answer and rationale are in the full material.

5. 5.A 31-year-old in a long-term acute care hospital is receiving vancomycin every 12 hours. A correctly timed trough is reported as 28 mcg/mL, above the facility's target range; the client is alert, BP 124/76 mm Hg, HR 82/min, and urine output has declined from 50 to 25 mL/hr. Which action should the nurse take first?

   • A.Request an immediate peak level before communicating the trough result
   • B.Administer the next dose because the client is hemodynamically stable
   • C.Encourage oral fluids and repeat the trough after the next dose
   • D.Hold the dose and promptly contact the prescriber with the level and urine-output trend

   Answer and rationale are in the full material.