A nurse is caring for a 9-year-old child at a clinic.

Vital Signs.

1000:. Temperature 36.8°C (98.2 °F). Heart rate 102/min.

Respiratory rate 22/min.

BP 100/60 mm Hg. Oxygen saturation is 98% on room air.

Nurses' Notes.

1000:.The child has been brought to the clinic by their parent due to a. report of right arm pain.

The parent states that several hours.

ago the child tripped and fell onto the sidewalk while playing.

outside.

The child states, "I was running when we were playing,and I tripped over a curb." The child is supporting their arm across.

their body.

Assessment.

1000:The child is alert and appears developmentally appropriate for their.

age and well nourished.

Respirations are easy and unlabored.

Abdomen nondistended.

The right forearm and fingers are edematous.

Ecchymotic area.

noted on the outer aspect of the forearm.

Radial pulse +2. Fingers.

slightly cool to the touch.

A child can move fingers and reports a mild.

"tingling" sensation.

The child verbalizes a pain level of 4 on a scale.

of 0 to 10. Abrasion noted on the right knee.

No active bleeding.

Multiple areas of bruising were noted on the lower extremities in various.

stages of healing.

The nurse should determine that the assessment findings are consistent with.

which of the following conditions? For each potential condition, click to specify if the assessment findings are.

consistent with a sprain, a fracture, or dislocation.

Each finding may support this.

more than 1 condition.

The correct answer is Choice b: New onset of hearing loss.

Gentamicin, a potent aminoglycoside antibiotic, is renowned for its propensity to cause ototoxicity, particularly manifesting as new-onset hearing loss. Ototoxicity refers to damage to the inner ear structures responsible for hearing and balance, primarily the cochlea and vestibular apparatus. The mechanism of gentamicin-induced ototoxicity involves its accumulation in the endolymphatic fluid of the inner ear, leading to direct toxicity to the sensory hair cells and subsequent hearing impairment.

Manifestations of gentamicin-induced ototoxicity can vary, ranging from subtle high-frequency hearing loss to profound sensorineural deafness. Patients may experience tinnitus (ringing in the ears), difficulty hearing in noisy environments, and imbalance or vertigo. Notably, gentamicin-induced hearing loss is often irreversible and may progress even after discontinuation of the medication.

Now, let's delve into the rationales for the other choices:

Choice a: Hypotension Gentamicin administration is not typically associated with hypotension. However, systemic side effects such as nephrotoxicity and neurotoxicity can occur, particularly with prolonged or high-dose therapy. Nephrotoxicity may manifest as acute kidney injury, characterized by a rise in serum creatinine and blood urea nitrogen levels, oliguria, and fluid-electrolyte imbalances. Neurotoxicity, on the other hand, can lead to symptoms like muscle weakness, paresthesia, and confusion. Monitoring of blood pressure is essential in patients receiving gentamicin, but hypotension is not a direct adverse effect of the medication.

Choice c: Hyperthermia Gentamicin therapy is aimed at treating bacterial infections, such as pyelonephritis, and does not typically induce hyperthermia. Pyelonephritis itself is associated with fever, chills, and flank pain due to the inflammatory response to the urinary tract infection. Administration of gentamicin aims to eradicate the causative bacteria and resolve the underlying infection, which should, in turn, alleviate fever. However, persistent or worsening fever despite antibiotic therapy may indicate treatment failure or the presence of complicating factors, warranting further evaluation and management.

Choice d: Slurred speech Slurred speech is not a recognized adverse effect of gentamicin. Instead, it may suggest central nervous system involvement, such as cerebrovascular accidents (strokes), intoxication, or neurological disorders affecting speech production. Gentamicin primarily exerts its toxic effects on the inner ear structures, leading to auditory dysfunction rather than impairments in speech articulation. Therefore, the presence of slurred speech would prompt an assessment for alternative etiologies unrelated to gentamicin therapy.

In conclusion, while gentamicin is an effective antibiotic for treating infections, it carries the risk of ototoxicity, particularly manifested as new-onset hearing loss. Careful monitoring for this adverse effect is crucial to promptly identify and manage potential complications.

Choice A rationale:

Taking ibuprofen during pregnancy is generally not recommended, especially in high doses or for an extended period, as it can increase the risk of complications, including heart defects in the baby. Therefore, advising the client to take 600 milligrams of ibuprofen every 8 hours is not appropriate and potentially harmful during pregnancy.

Choice B rationale:

Having a cesarean birth (C-section) is recommended if there are visible lesions of genital herpes during labor and delivery. This precautionary measure helps prevent the transmission of the herpes simplex virus (HSV) from the mother to the baby, reducing the risk of neonatal herpes infection, which can be severe or even life-threatening.

Choice C rationale:

Testing the baby's cord blood for HSV is not a standard practice. Instead, if there are visible lesions or symptoms of herpes during labor, a C-section is often performed to minimize the risk of transmission. Testing the baby after birth may be done if there are concerns about potential exposure.

Choice D rationale:

Applying a cortisone cream to the lesions is not recommended without medical supervision during pregnancy. Topical corticosteroids, such as cortisone creams, can be absorbed through the skin and may have adverse effects on both the mother and the baby. It is essential to consult a healthcare provider before using any medications or creams during pregnancy to ensure safety for both the mother and the baby.