A nurse is collecting data from a client who has pyelonephritis and receiving gentamicin via IV infusion. Which of the following manifestation should the nurse identify as an adverse effect of the treatment?

A) Inject 15 units of air into the regular insulin vial:
When drawing insulin from both NPH (a long-acting insulin) and regular insulin (a short-acting insulin), the nurse should first inject air into the NPH insulin vial (which is the intermediate-acting insulin) and then inject air into the regular insulin vial. This technique helps to prevent contamination of the regular insulin vial with NPH insulin. After injecting air into the regular insulin vial, the nurse would then withdraw the regular insulin first and then the NPH insulin to avoid contamination of the regular insulin with the NPH insulin.

B) Withdraw 10 units of NPH insulin:
This action is premature, as the nurse has not yet injected air into the regular insulin vial. The correct sequence involves injecting air into both vials before withdrawing any insulin. Therefore, withdrawing NPH insulin at this stage is not the correct next step.

C) Verify the dosage with another nurse:
While verifying the insulin dosage with another nurse is a good practice for ensuring medication safety, this action is not the immediate next step after injecting air into the NPH insulin vial. The priority is to follow the correct sequence of air injection into the vials before withdrawing the insulin. Verification can occur after the insulin is drawn.

D) Place the cap over the needle:
Placing the cap over the needle is a safety step that is generally performed after withdrawing the insulin and preparing the injection. However, this is not the next step in the process of mixing or drawing insulin, so it is not the correct action to take at this point.

A) Encourage the client to use overbed trapeze:
Encouraging the client to use an overbed trapeze is an appropriate intervention to promote independence and mobility after an above-the-knee amputation. The trapeze allows the client to move, reposition themselves, and perform activities of daily living more independently, which is important for regaining strength and confidence during the rehabilitation process. It aids in improving upper body strength and assists in early mobility efforts.
B) Maintain abduction of the client's residual limb with a pillow:
Placing a pillow under the residual limb in a position that maintains abduction (separation of the residual limb away from the body) is not recommended after an above-the-knee amputation. This position can lead to contractures of the hip joint, limiting mobility and the ability to use a prosthetic limb in the future. Proper positioning usually involves keeping the residual limb flat or neutral to avoid deformities.

C) Caution the client to avoid a prone position while in bed:
This recommendation is incorrect. In fact, encouraging the client to spend time in the prone position (lying on their stomach) can help prevent hip contractures, especially after an above-the-knee amputation. It is important for the client to position their body in ways that encourage proper limb alignment and prevent long-term complications such as contractures that could impede mobility.

D) Keep a loose, absorbent dressing over the client's surgical site:
A loose, absorbent dressing is not ideal for post-surgical care following an amputation. A dressing should be secure, sterile, and changed regularly to prevent infection and promote optimal wound healing. Keeping a dressing loose could lead to the risk of infection or delayed healing. The nurse should follow the provider’s orders for dressing changes and monitor for signs of infection.