A client who is admitted for primary hypothyroidism has early signs of myxedema coma.
In assessing the client, in which sequence should the nurse complete these actions? (Rank the first action at the top with the remainder in descending order.).

The correct answer is Choice C: Assign the remainder of medication administration to another PN who is performing treatments.

Choice A rationale: Denying the medication aide's request to leave before all medications are given does not address the issue at hand and could potentially jeopardize patient care. It is important to acknowledge the medication aide's request and find an appropriate solution that ensures patient safety and well-being.

Choice B rationale: Delegating medication administration to unlicensed assistive personnel (UAP) who may not have the necessary training or authorization could lead to medication errors, adverse drug reactions, or other negative outcomes. It is essential to adhere to the scope of practice guidelines and facility policies when assigning tasks to UAPs.

Choice C rationale: Reassigning the medication administration to another PN with the necessary qualifications and training ensures that patients receive their medications in a safe and timely manner. This action aligns with the practical nurse's responsibility to supervise and delegate tasks appropriately, maintaining patient safety and upholding the standards of care.

Choice D rationale: Documenting why medications were not given to each resident is an important aspect of maintaining accurate and comprehensive patient records. However, it does not address the immediate need to administer medications to residents, and it is not a substitute for ensuring that patients receive their prescribed treatments. Documentation should be completed after the appropriate steps have been taken to administer medications or arrange for an alternative solution.

This is the correct answer because it is the best way to assess for signs of ototoxicity, which is a potential adverse effect of aminoglycosides. Ototoxicity is the damage or injury to the inner ear or auditory nerve caused by certain drugs or chemicals. It can result in hearing loss, tinnitus, vertigo, or balance problems. Aminoglycosides are a class of antibiotics that are effective against gram-negative bacteria, but they can also cause ototoxicity by interfering with the function of the hair cells in the cochlea. The practical nurse (PN) should monitor the client's hearing by asking about any changes in hearing acuity, ringing in the ears, or difficulty understanding speech. The PN should also perform a hearing test using a tuning fork or an audiometer if available. The PN should report any signs of ototoxicity to the health care provider and discontinue the aminoglycoside as ordered.

a) Check for changes in vision.

This is not the correct answer because it is not related to ototoxicity. Vision is the ability to see and perceive objects and colors using the eyes and the brain. Vision may be affected by various factors, such as age, genetics, eye diseases, injuries, infections, or medications. However, aminoglycosides do not cause vision problems or impairments. The PN should check for changes in vision in a client who is receiving other drugs that can cause ocular toxicity, such as ethambutol, chloroquine, or digoxin.

c) Observe the skin for a rash.

This is not the correct answer because it is not related to ototoxicity. A rash is a change in the color, texture, or appearance of the skin that may be caused by various factors, such as allergies, infections, inflammation, or medications. A rash may present as redness, itching, swelling, blisters, bumps, or scales.
Aminoglycosides can cause skin reactions such as rash or urticaria in some clients who are hypersensitive or allergic to them. The PN should observe the skin for a rash in a client who is receiving an aminoglycoside and report any signs of an allergic reaction to the health care provider. However, a rash is not a sign of ototoxicity.

d) Measure the urinary output.

This is not the correct answer because it is not related to ototoxicity. Urinary output is the amount of urine produced and excreted by the kidneys and bladder. It is an indicator of renal function and fluid balance. The normal range for urinary output is 0.5 to 1 mL/kg/hour for adults. Urinary output may be affected by various factors, such as fluid intake, dehydration, diuretics, kidney disease, or medications. Aminoglycosides can cause nephrotoxicity, which is another potential adverse effect of these drugs. Nephrotoxicity is the damage or injury to the kidneys caused by certain drugs or chemicals. It can impair the kidneys' ability to filter waste products from the blood, resulting in reduced urine production and oliguria. The PN should measure the urinary output in a client who is receiving an aminoglycoside and report any signs of nephrotoxicity to the health care provider. However, urinary output is not a sign of ototoxicity