NCLEX-RNPharmacological and Parenteral TherapiesMedium
A client is prescribed intravenous vancomycin 1 gram every 12 hours. The nurse notes the client's current serum creatinine is 2.1 mg/dL and BUN is 35 mg/dL. The nurse should take which action?
- AAdminister the vancomycin as prescribed and monitor urine output closely.
- BHold the dose and notify the healthcare provider.
- CAdminister at half the prescribed dose and reassess renal function in 24 hours.
- DRequest an order for a vancomycin trough level before administering the dose.
Show answer & explanationAnswer & explanation
Correct answer: B. Hold the dose and notify the healthcare provider.
Elevated creatinine (normal 0.6-1.2 mg/dL) and BUN (normal 10-20 mg/dL) indicate impaired renal function. Vancomycin is renally excreted and is nephrotoxic. Administering the dose without adjustment could worsen kidney injury or lead to toxicity. The nurse must hold the dose and notify the provider for a potential dosage adjustment.
Why the other options are wrong
- A. Administering vancomycin with impaired renal function risks toxicity and further kidney damage.
- C. Nurses cannot independently adjust medication dosages; this requires a provider's order.
- D. While trough levels are important, the immediate concern is the existing renal impairment, which requires a dosage adjustment, not just a trough level.
Vancomycin Renal Impairment
Vancomycin is a nephrotoxic drug primarily excreted by the kidneys. Significant renal impairment (elevated BUN/creatinine) necessitates dosage adjustment or withholding of the drug to prevent toxicity.
- Normal creatinine: 0.6-1.2 mg/dL.
- Normal BUN: 10-20 mg/dL.
- Vancomycin toxicity can cause ototoxicity and nephrotoxicity.
- Dosage adjustments are crucial in renal dysfunction.
Memory trick: Vancomycin + Kidneys = Danger Zone if not careful with dose.