The nurse is administering the sixth IV dose of gentamicin to a client with extensive full thickness burns. Which assessment finding warrants further intervention?

Reference Range:

White Blood Cell [5000 to 10,000/mm3 (5 to 10 x 10 %/L)] Blood Urea Nitrogen [10 to 20 mg/dL (3.6 to 7.1 mmol/L)] Creatinine [0.5 to 1.1 mg/dL (44 to 97 µmol/L)]

Serum creatinine level of 1.6 mg/l. (141 µmol), a blood urea nitrogen (BUN) of 20 mg/dL.(7.1 mmol/L)

Reports a sore mouth and three episodes of diarrhea that began this morning.

White blood count of 9,000/mm3 (9 x 109/L) and an oral temperature of 98.2° F (36.7° C) two hours ago.

Urinary output of 400 ml of clear, amber colored urine in the past eight hours.

Answer and Explanation

The Correct Answer is A

A. Serum creatinine level of 1.6 mg/dL (141 µmol/L), a blood urea nitrogen (BUN) of 20 mg/dL (7.1 mmol/L): Gentamicin is an aminoglycoside that is known for its nephrotoxic potential. Elevated serum creatinine and BUN levels are indicative of impaired kidney function, which warrants further investigation and possible intervention. This finding is significant because it may reflect kidney damage or reduced renal clearance of the drug.
B. Reports a sore mouth and three episodes of diarrhea that began this morning: While these symptoms are important and could suggest a possible adverse effect or secondary infection, they are not as immediately concerning in the context of gentamicin therapy as the potential for kidney damage indicated by elevated creatinine and BUN levels.
C. White blood count of 9,000/mm³ (9 x 10^9/L) and an oral temperature of 98.2°F (36.7°C) two hours ago: These values are within normal ranges and do not suggest an immediate concern related to gentamicin toxicity.
D. Urinary output of 400 mL of clear, amber-colored urine in the past eight hours: While monitoring urinary output is important, this level of output does not necessarily indicate a problem in the context of gentamicin therapy compared to elevated creatinine and BUN levels.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. Restlessness: Restlessness is a sign of excessive levothyroxine sodium, which can lead to symptoms of hyperthyroidism. Other signs include palpitations, nervousness, and insomnia. Overmedication can accelerate metabolism and cause these symptoms.
B. Decreased appetite: Decreased appetite is not typically associated with overmedication of levothyroxine. Instead, a decreased appetite might be related to other conditions or medications but is not a primary indicator of excessive thyroid hormone.
C. Intolerance to cold: Intolerance to cold is more indicative of hypothyroidism or insufficient dosing of levothyroxine rather than overmedication. Excessive levothyroxine usually causes symptoms of hyperthyroidism, such as heat intolerance.
D. Constipation: Constipation is more commonly associated with hypothyroidism or insufficient levothyroxine dosing. Overmedication generally leads to symptoms like diarrhea rather than constipation.

A. Withhold the medication until the client's breakfast tray is available on the unit. B. Consult with a pharmacist about scheduling the dose one hour after the client eats. C. Instruct the client that it is necessary to take nothing but water with the medication. D. Assign an unlicensed assistive personnel (UAP) to bring the client a glass of low fat milk.

Correct Answer is C

Explanation

A. Withhold the medication until the client’s breakfast tray is available on the unit: Withholding the medication until food is available is not necessary, as risedronate should be taken on an empty stomach to ensure proper absorption. Food can interfere with the medication's effectiveness.
B. Consult with a pharmacist about scheduling the dose one hour after the client eats: This option is not suitable as risedronate should be taken on an empty stomach, and delaying the dose until after eating would compromise the medication's effectiveness.
C. Instruct the client that it is necessary to take nothing but water with the medication: Risedronate must be taken on an empty stomach with a full glass of water and the client should remain upright for at least 30 minutes afterward. Milk or other beverages can interfere with the absorption of risedronate.
D. Assign an unlicensed assistive personnel (UAP) to bring the client a glass of low-fat milk: This is not appropriate, as risedronate should be taken with water only to ensure proper absorption. Milk can reduce the effectiveness of the medication.

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Naxlex Comprehensive Predictor Exams

Levothyroxine sodium is prescribed for a client with hypothyroidism. The nurse should instruct the client to report which symptom because it indicates that the client is taking too much levothyroxine sodium.

Correct Answer is A

Explanation

The nurse administers risedronate to a client with osteoporosis at 0700. The client asks for a glass of milk to drink with the medication. Which action should the nurse take?

Correct Answer is C

Explanation

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