A client receiving IV gentamicin has urine output of 18 mL/hr, a rising serum creatinine, and new tinnitus. Complete the priority response.
Drop-down Cloze
Choose your responses, then check the answer.
Explanation
Oliguria and rising creatinine suggest nephrotoxicity; tinnitus signals ototoxicity. Hold the due dose and notify the provider and pharmacist. Review renal function, urine findings, hearing status, and gentamicin concentrations so the regimen can be adjusted or discontinued before further exposure.
Quick answer Treat oliguria, rising creatinine, and new tinnitus as combined gentamicin nephrotoxicity and ototoxicity cues. Hold the due dose and escalate for immediate renal, auditory, and drug-level review.
Why this is correct Gentamicin can injure the kidneys and the vestibular or auditory branches of cranial nerve VIII. Reduced clearance can further increase exposure, and aminoglycoside-related hearing injury may be irreversible.
Easy analogy or mental picture The kidneys clear gentamicin while the ears reveal a separate toxicity alarm. When both alarms sound, do not add another dose before review.
Memory hook Low urine, rising creatinine, ringing ears: stop and review before more gentamicin.
NCLEX decision rule For new nephrotoxicity or ototoxicity cues, prevent additional exposure and notify the prescribing team. Evaluate BUN, creatinine or creatinine clearance, urine findings, drug concentrations, and hearing or vestibular symptoms; expect dose adjustment or discontinuation based on the results.
Why the other choices are wrong An extra dose increases toxic exposure. NSAIDs may worsen kidney risk, and ignoring oliguria or tinnitus can allow irreversible injury to progress.
Source
1DailyMed: Gentamicin Injection Prescribing Information
22026 NCLEX-RN Test Plan
The nurse compares renal function, urine findings, hearing symptoms, and available gentamicin concentrations with the prescribed regimen. The next dose is due, and the provider and pharmacist are available for immediate toxicity evaluation and dose adjustment or discontinuation.
Aminoglycoside nephrotoxicity — Kidney injury associated with aminoglycoside exposure, often reflected by oliguria or rising nitrogenous waste and creatinine.
Ototoxicity — Toxic injury to hearing or balance pathways that may cause tinnitus, vertigo, or hearing loss.
Trough concentration — The lowest drug concentration before the next dose, used with clinical data to evaluate accumulation and toxicity risk.