For which order would the nurse seek clarification regarding a patient with decreased renal perfusion and lowered glomerular filtration rate?

Question

1. Administer acetylcysteine prior to an intravenous pyelogram procedure.
2. Infuse vancomycin 1,500 mg IV every 12 hours.
3. Check a peak and trough level with every third dose of IV clindamycin.
4. Give furosemide 10 mg by mouth daily.

Answer 1

2
Rationale 1: If contrast dye must be administered, it is given sparingly, or the physician may prescribe acetylcysteine for its renal protective effects.
Rationale 2: This order should be questioned. During the period of decreased renal perfusion and lowered glomerular filtration rate that occurs in prerenal failure, the kidneys are vulnerable to insults from other sources such as medications, contrast dyes, and toxins. The nurse should avoid administering nephrotoxic agents if possible.
Rationale 3: This is an appropriate order. The nurse monitors the peak and trough blood levels of medications that are known to be damaging to the kidney such as clindamycin.
Rationale 4: This is an appropriate order. Drugs that are known to be excreted by the kidneys and that are potentially harmful to the kidneys are given in reduced doses based on the patient's creatinine clearance. Furosemide (Lasix) 10 mg is a reduced dose and is appropriate for this patient.