The nurse prepares to administer vancomycin (Vancocin) to an older adult. Which labor-atory test should the nurse review before administering this medication?
a. Stool culture
b. Serum potassium
c. Creatinine clearance
d. Alkaline phosphatase
C
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A Incorrect. The pathogen is already identified; however, some value can be ob-tained from subsequent stool cultures to determine if the infection is eradicated.
B Incorrect. Serum potassium is a reasonable parameter to check in an older adult; however, if used as a measure of renal function, the creatinine clearance is a better choice.
C Correct. Antibiotics as a group of drugs are hard on the kidneys; thus the nurse should check the creatinine clearance of this individual. Although about 30% of absorbed vancomycin is protein bound, it is cleared by the kidneys, and creati-nine clearance is the best index of renal function available. Because approx-imately 70% of vancomycin circulates in the blood stream in the active form, when the older adult has renal dysfunction, the dosage must be reduced or the dosing intervals increased to maintain the desired drug level and prevent toxici-ty.
D Incorrect. Alkaline phosphatase is a measure of hepatic function. It is a reasona-ble parameter to check when administering medications because hepatic clear-ance is important in the metabolism of many medications.
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