# An 8-year-old (30 kg) with MRSA bacteremia is prescribed IV vancomycin 15 mg/kg every 6 hours. Which set of nursing actions is most appropriate? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=375225&lang=en > language: en > subject: Adverse Effects/Contraindications/Interactions > category: PA ## Question An 8-year-old (30 kg) with MRSA bacteremia is prescribed IV vancomycin 15 mg/kg every 6 hours. Which set of nursing actions is most appropriate? ## Option 1. Round the dose to 1,000 mg every 12 hours for ease of administration, infuse over 60 minutes via a peripheral IV (no central line needed for short therapy), obtain a trough level just before the third dose targeting 15–20 mg/L, watch for red man syndrome, monitor kidney function weekly, and document the weight used for dosing. 2. Calculate the dose as 450 mg every 6 hours, infuse over at least 60 minutes through a patent IV (central access preferred for prolonged therapy), monitor trough before the fourth dose with goal 15 to 20 mg/L (or AUC-guided per institution), assess for red man syndrome by infusion rate, monitor renal function and hearing, and document weight accurately for ongoing dose adjustments. **✔ Correct answer** 3. Determine the dose as 450 mg, prepare for intramuscular administration by selecting a large muscle, inject the medication slowly, rotate injection sites with each dose, monitor for induration and abscess formation, draw a trough level just before the next scheduled dose, check daily BUN and creatinine for early nephrotoxicity, and document the injection site and lot number in the medication record. 4. Calculate the dose as 450 mg, reconstitute the vial to a concentration of 50 mg/mL, administer as a slow IV push over 5 minutes via a peripheral line, observe the patient for red man syndrome immediately, obtain a trough level before the next dose, monitor BUN and creatinine to detect nephrotoxicity, and record the lot number and expiration date. **Correct answer: 2** ## Explanation Pediatric vancomycin dosing for serious MRSA infections is weight-based: 15 to 20 mg/kg per dose every 6 hours IV is typical, with maximum total daily dose adjusted for renal function and not to exceed institutional caps. For a 30 kg child at 15 mg/kg, the calculated dose is 450 mg every 6 hours. Key administration and monitoring: (1) infuse over at least 60 minutes for doses of 1 g or less, longer for higher doses, to reduce red man syndrome; (2) central venous access is preferred for prolonged therapy and high doses because of vesicant potential and the need for repeated draws; peripheral IV is acceptable for short-term with strict site monitoring; (3) trough goal 15 to 20 mg/L for serious MRSA with sampling 30 minutes before the fourth dose at steady state; AUC-guided dosing is the new standard; (4) renal function — daily creatinine and urine output, hold or adjust if rising; (5) ototoxicity monitoring — assess hearing changes, tinnitus, balance; in younger children rely on caregiver report and audiology consult for prolonged therapy; (6) accurate weight documentation because pediatric dosing changes with weight; (7) IV site assessment for infiltration; vancomycin extravasation can cause tissue damage. Adult dose flat conversion, IV push, and IM all wrong. The child should be in a monitored unit with sepsis management and ID consultation. ## In-depth explanation Pediatric vanco is weight-based, infused slowly, monitored for trough/red man/AKI/ototoxicity, given via reliable IV. Round to mg/kg, not to adult-flat dose. ## Related questions - [A nurse is reviewing the morning lab results for an adult client receiving warfarin for at…](https://mymerci.kr/pages/nclex_q.php?qn_id=360515&lang=en) - [A client is admitted to the emergency department after ingesting an unknown amount of acet…](https://mymerci.kr/pages/nclex_q.php?qn_id=362720&lang=en) - [A client with chronic heart failure is prescribed metoprolol 25 mg orally twice daily. Bef…](https://mymerci.kr/pages/nclex_q.php?qn_id=362756&lang=en) - [A 28-year-old client with type 1 diabetes receives regular insulin 6 units and NPH insulin…](https://mymerci.kr/pages/nclex_q.php?qn_id=362792&lang=en) - [A client receives IV vancomycin 1 g every 12 hours for MRSA bacteremia. 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