Before giving vancomycin, what should the nurse do?

• A. Obtain trough levels
• B. Monitor vital signs closely
• C. Check liver enzymes
• D. Administer a test dose

Answer: (A)

Vancomycin has a narrow therapeutic window, so dosing is guided by trough levels—the drug concentration just before the next dose. Drawing a trough before administration ensures the medicine is at a therapeutic level yet not high enough to cause toxicity, helping prevent kidney injury and hearing damage. After starting therapy, troughs are used to adjust the dose based on renal function and infection severity, aiming for target levels appropriate to the infection. While monitoring vital signs is important and vancomycin can cause reactions like red man syndrome if infused too quickly, those signs don’t determine dosing. Liver enzymes aren’t the primary concern with vancomycin, since hepatotoxicity is not the main risk. A test dose isn’t routinely used for vancomycin. Therefore, obtaining trough levels before the next dose is the best practice.