# A 70-year-old client on day 6 of gentamicin develops creatinine rising from 1.0 to 1.6 mg/dL, urine output 0.4 mL/kg/h, new tinnitus, and reports the room "feels like it is spinning" with unsteady gait. Which is the priority nursing action?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375227&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PA

## Question

A 70-year-old client on day 6 of gentamicin develops creatinine rising from 1.0 to 1.6 mg/dL, urine output 0.4 mL/kg/h, new tinnitus, and reports the room "feels like it is spinning" with unsteady gait. Which is the priority nursing action?

## Option

1. Document and continue the gentamicin because the symptoms will resolve on their own.
2. Add a second aminoglycoside for synergy.
3. Increase the dose to overcome resistance.
4. Hold the next gentamicin dose and notify the prescriber immediately because nephrotoxicity (rising Cr, oliguria) and ototoxicity (tinnitus, vertigo, gait disturbance reflecting vestibular and cochlear involvement) suggest aminoglycoside-related toxicity; anticipate dose hold or discontinuation, repeat creatinine and aminoglycoside levels, audiology and balance evaluation, fall precautions, and review of all concurrent nephrotoxins. **✔ Correct answer**

**Correct answer: 4**

## Explanation

Aminoglycosides cause both nephrotoxicity and ototoxicity. Nephrotoxicity is reversible if recognized early — risk increases with prolonged therapy more than 5 to 7 days, supratherapeutic trough levels, advanced age, hypovolemia, pre-existing renal disease, and concurrent nephrotoxins (vancomycin, IV contrast, NSAIDs, ACE inhibitors, ARBs, loop diuretics). Ototoxicity affects both vestibular (vertigo, ataxia, oscillopsia, fall risk) and cochlear (high-frequency hearing loss progressing to lower frequencies, tinnitus); cochlear damage can be permanent. The combination in this scenario — rising creatinine, oliguria, new tinnitus, vertigo — strongly suggests aminoglycoside toxicity. Standard nursing response: (1) hold the next dose and notify the prescriber immediately; (2) anticipate dose hold or discontinuation and substitution with a non-aminoglycoside agent guided by culture; (3) repeat creatinine and aminoglycoside trough; (4) audiology consult for formal hearing evaluation, vestibular assessment for balance and gait safety; (5) fall precautions — bed rails, call light within reach, assistance with ambulation, footwear, and reorientation; (6) review and minimize concurrent nephrotoxins; (7) ensure adequate hydration unless contraindicated. Documenting and continuing, increasing the dose, and adding a second aminoglycoside are unsafe.

## In-depth explanation

AKI plus tinnitus plus vertigo on day 6 = aminoglycoside toxicity. Hold and notify, fall precautions, audiology and renal evaluation. Cochlear damage may be permanent.

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