Question A nurse is preparing to administer intravenous vancomycin to a patient with a severe skin infection caused by methicillin-resistant Staphylococcus aureus (MRSA). Which of the following actions should the nurse take to reduce the risk of red man syndrome?
A. Administer the dose rapidly over 30 minutes.
B. Infuse the medication over at least 60 minutes.
C. Mix the vancomycin with a steroid to reduce reactions.
D. Give the vancomycin as an intramuscular injection.
E. Premedicate the patient with an antihistamine.

Correct Answer: B. Infuse the medication over at least 60 minutes.

Rationale: Vancomycin can cause red man syndrome, a reaction characterized by flushing, rash, and possibly hypotension, which is thought to result from too rapid infusion of the drug. Administering vancomycin over at least 60 minutes helps to minimize this risk by allowing a slower systemic absorption of the medication. Antihistamines can be used to treat symptoms if red man syndrome occurs but are not a preventive measure for the reaction. Vancomycin is not recommended for intramuscular injection due to tissue irritation, and mixing the drug with steroids does not prevent red man syndrome.

Question When monitoring a patient receiving vancomycin therapy, which laboratory value should a nurse prioritize to detect nephrotoxicity?
A. White blood cell count (WBC)
B. Platelet count
C. Serum creatinine
D. Hemoglobin levels
E. Blood urea nitrogen (BUN)

Correct Answer: C. Serum creatinine.

Rationale: Vancomycin can cause nephrotoxicity, especially with high doses or prolonged therapy. Serum creatinine levels are a direct measure of kidney function and can indicate nephrotoxic effects of vancomycin before irreversible kidney damage occurs. Monitoring BUN can also provide insights into kidney function, but serum creatinine is more specific for detecting changes in glomerular filtration rate. WBC, platelet count, and hemoglobin levels are not directly related to kidney function and are not the primary labs to monitor for vancomycin-induced nephrotoxicity.

Question A patient has been prescribed vancomycin for a complicated urinary tract infection. The nurse understands that therapeutic drug monitoring is essential for vancomycin therapy. Which of the following is the primary reason for monitoring vancomycin trough levels?
A. To ensure the drug reaches a therapeutic level
B. To prevent ototoxicity
C. To reduce the risk of drug interactions
D. To monitor for signs of an allergic reaction
E. To assess for renal function impairment

Correct Answer: A. To ensure the drug reaches a therapeutic level.

Rationale: Therapeutic drug monitoring of vancomycin, including trough levels, is essential to ensure that the drug concentration remains within the therapeutic range to effectively treat the infection while minimizing the risk of toxicity. Monitoring trough levels helps to avoid subtherapeutic levels, which could lead to treatment failure, and excessively high levels, which increase the risk of nephrotoxicity and ototoxicity. While preventing ototoxicity and assessing for renal function impairment are important, these are secondary to ensuring that drug levels are therapeutic. Monitoring for drug interactions and allergic reactions is also important but is not the primary reason for therapeutic drug monitoring.

Question A patient receiving vancomycin therapy has developed ototoxicity. Which of the following symptoms would the nurse expect the patient to report?
A. Joint pain
B. Headaches
C. Tinnitus
D. Photophobia
E. Muscle weakness

Correct Answer: C. Tinnitus.

Rationale: Ototoxicity from vancomycin can manifest as hearing loss, ringing in the ears (tinnitus), or dizziness. Tinnitus is a common early symptom of ototoxicity and may be a sign that vancomycin levels are too high or that the patient is particularly sensitive to the drug’s ototoxic effects. Joint pain, headaches, photophobia, and muscle weakness are not typically associated with vancomycin-induced ototoxicity. Monitoring for auditory symptoms is essential when patients are on vancomycin therapy to prevent permanent damage.

Question A healthcare provider orders a loading dose of vancomycin for a patient with a severe MRSA infection. Which of the following patient factors is most important in determining the appropriate loading dose?
A. Age
B. Weight
C. Gender
D. Height
E. Allergy history

Correct Answer: B. Weight.

Rationale: The appropriate loading dose of vancomycin is primarily determined by the patient’s weight to ensure that therapeutic levels are achieved quickly, especially in severe infections. Dosing based on weight helps to individualize treatment and reduce the risk of underdosing or overdosing, which can lead to treatment failure or increased toxicity, respectively. While age, gender, height, and allergy history are important considerations in medication management, they are not as directly influential on the initial loading dose calculation for vancomycin as weight is.

Question For a patient receiving vancomycin therapy, the nurse recognizes the importance of monitoring vancomycin trough levels to avoid toxicity. Which of the following trough levels would typically be targeted for a serious infection to ensure therapeutic efficacy without increasing the risk of toxicity?
A. 5-10 mcg/mL
B. 10-15 mcg/mL
C. 15-20 mcg/mL
D. 20-25 mcg/mL
E. Over 25 mcg/mL

Correct Answer: C. 15-20 mcg/mL.

Rationale: For serious infections treated with vancomycin, such as MRSA or complicated skin and soft tissue infections, the therapeutic trough level is typically targeted between 15-20 mcg/mL. This range is considered optimal for ensuring efficacy against the pathogen while minimizing the risk of nephrotoxicity and ototoxicity, which are more likely to occur at higher concentrations. Trough levels lower than 15 mcg/mL may not provide sufficient antimicrobial activity for serious infections, and levels above 20 mcg/mL significantly increase the risk of adverse effects without substantially improving therapeutic outcomes.

Question A nurse is reviewing a patient’s medication list before administering vancomycin. Which of the following medications, if taken concurrently with vancomycin, would most concern the nurse due to the increased risk of nephrotoxicity?
A. Acetaminophen
B. Ibuprofen
C. Furosemide
D. Metformin
E. Lisinopril

Correct Answer: C. Furosemide.

Rationale: Furosemide, a loop diuretic, is associated with an increased risk of nephrotoxicity when used concurrently with vancomycin. Both vancomycin and furosemide can independently cause kidney damage; when used together, the risk of nephrotoxic effects is amplified due to additive nephrotoxic potential. Monitoring kidney function is particularly crucial in patients receiving this combination of medications. While NSAIDs like ibuprofen and ACE inhibitors like lisinopril can also affect kidney function, the combination of vancomycin with a loop diuretic like furosemide poses a more significant risk that requires careful monitoring.

Question A patient has been on vancomycin therapy for 10 days for a severe bloodstream infection. The nurse observes that the patient has developed thrombophlebitis at the site of infusion. Which of the following actions is most appropriate for the nurse to take?
A. Discontinue vancomycin treatment immediately. B. Administer the next dose of vancomycin via intramuscular injection. C. Change the IV site and apply warm compresses to the affected area. D. Increase the rate of infusion to decrease irritation at the site. E. Mix the vancomycin with a vasoconstrictor to reduce vein irritation.

Correct Answer: C. Change the IV site and apply warm compresses to the affected area.

Rationale: Thrombophlebitis at the site of infusion is a common complication of intravenous therapy, particularly with irritant medications like vancomycin. The appropriate action is to change the intravenous (IV) site to prevent further irritation and apply warm compresses to the affected area to reduce discomfort and inflammation. Discontinuing vancomycin therapy abruptly is not indicated unless the drug is deemed the direct cause of a more severe reaction. Vancomycin should not be administered via intramuscular injection due to tissue irritation. Increasing the rate of infusion could exacerbate vein irritation, and mixing vancomycin with a vasoconstrictor is not a standard practice and could potentially cause harm.

Question A healthcare provider is considering the use of vancomycin for a patient with a known penicillin allergy. Which of the following statements best reflects the consideration for using vancomycin in this scenario?
A. Vancomycin is contraindicated in patients with a penicillin allergy. B. Vancomycin should only be used if the allergy to penicillin is not severe. C. Vancomycin is a safe alternative in patients with a penicillin allergy. D. Vancomycin and penicillin allergies are cross-reactive. E. Penicillin allergy increases the risk of vancomycin-induced ototoxicity.

Correct Answer: C. Vancomycin is a safe alternative in patients with a penicillin allergy.

Rationale: Vancomycin is often used as an alternative antibiotic in patients with a penicillin allergy because it has a different mechanism of action and does not cross-react with penicillins. Therefore, it is generally considered safe for patients who cannot receive beta-lactam antibiotics due to allergic reactions. The assertion that vancomycin is contraindicated or should only be used with caution in patients with a penicillin allergy is incorrect; there is no cross-reactivity between vancomycin and penicillins. The risk of vancomycin-induced ototoxicity is not directly related to a history of penicillin allergy.

Question A nurse is educating a patient on the potential side effects of vancomycin. Which of the following side effects should the nurse emphasize due to its potential severity and need for immediate medical attention?
A. Nausea B. Constipation C. Ototoxicity D. Mild rash E. Flushing

Correct Answer: C. Ototoxicity.

Rationale: While vancomycin can cause various side effects, ototoxicity is among the most severe and warrants immediate medical attention. Ototoxicity can result in permanent hearing loss, and patients should be advised to report symptoms such as ringing in the ears, hearing loss, or dizziness as soon as they occur. Nausea, constipation, mild rash, and flushing (part of the red man syndrome) are also possible side effects of vancomycin, but they are generally less severe and can often be managed with supportive care or dose adjustments. Emphasizing the importance of monitoring for ototoxicity helps ensure early detection and intervention to prevent permanent damage.