A woman at 12 weeks' gestation comes to the clinic for her first prenatal visit.

After completing a health history, the nurse should discuss which topic about pregnancy at this initial visit?

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

When the practical nurse (PN) notices that one of the unlicensed assistive personnel (UAP) consistently records subnormal temperatures when using the thermometer, the first action the PN should take is to observe how the UAP obtains temperatures. This allows the PN to directly assess the UAP's technique and determine if any errors or inaccuracies are occurring during temperature measurement. By observing the process, the PN can identify any potential issues, such as incorrect placement of the thermometer or improper technique, and provide appropriate guidance and education.
Let's evaluate the other options:

a) Show the UAP how to chart temperatures.
While accurate charting of temperatures is important, it is not the primary concern in this situation. The PN should first focus on assessing the UAP's temperature measurement technique before addressing charting skills.

b) Return the thermometer for recalibration.
Returning the thermometer for recalibration may be necessary if there is evidence or suspicion of a malfunctioning thermometer. However, before assuming that the thermometer is the issue, it is important to first observe how the UAP obtains temperatures to rule out any human error in the measurement process.

d) Demonstrate how to use the equipment.
Demonstrating how to use the equipment may be beneficial, but it should not be the first action taken in this scenario. The PN should first observe the UAP's technique to identify any potential errors or issues in temperature measurement. Based on the observation, the PN can provide specific guidance and demonstrate the correct technique if necessary.

In summary, when a practical nurse (PN) notices that a UAP consistently records subnormal temperatures when using the thermometer, the first action the PN should take is to observe how the UAP obtains temperatures. This allows for direct assessment of the UAP's technique and identification of any potential errors or issues. Based on the observation, the PN can provide appropriate guidance, education, and intervention as needed to ensure accurate temperature measurement.