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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Correct Answer is B

Explanation

A. Reduce caffeine and acidic intake: This is appropriate advice as caffeine and acidic foods can potentially affect uric acid levels and might exacerbate gout symptoms.
B. Double the dose if a dose is missed: This is incorrect and requires additional instruction. Allopurinol should not be doubled if a dose is missed. Instead, the missed dose should be taken as soon as possible unless it is almost time for the next dose. Doubling the dose could lead to increased risk of side effects or adverse reactions.
C. Avoid taking on an empty stomach: This is generally good advice, although allopurinol can be taken with or without food. Taking it with food might help reduce potential gastrointestinal discomfort.
D. Consume 2 liters of water daily: This is recommended to help prevent the formation of uric acid crystals and to ensure adequate hydration, which is beneficial while on allopurinol.

A. Ensure that the client eats breakfast. B. Provide a mid-afternoon snack for the client. C. Assess the client for hypoglycemia around 1500. D. Perform a glucometer reading at 1000.

Correct Answer is A

Explanation

A. Ensure that the client eats breakfast: Regular insulin is a fast-acting insulin that typically begins to work within 30 minutes to an hour after administration, peaks around 2-3 hours, and can last for up to 6 hours. Therefore, it is crucial that the client eats a meal, such as breakfast, shortly after the insulin is administered to prevent hypoglycemia.
B. Provide a mid-afternoon snack for the client: While snacks may be necessary depending on the client's overall meal and insulin schedule, it is more critical to ensure the client eats the meal immediately following insulin administration to manage blood glucose levels.
C. Assess the client for hypoglycemia around 1500: While monitoring for hypoglycemia is important, it is more critical to ensure the client eats their meal soon after insulin administration to prevent hypoglycemia in the first place.
D. Perform a glucometer reading at 1000: A glucometer reading at 1000 might be useful for monitoring blood glucose levels but ensuring that the client eats a meal promptly is a more immediate and critical action following insulin administration.

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