Health Promotion and Maintenance
42. A nurse is working with a nursing student in the care of a young child status post-appendectomy. The student checks the current order of IV gentamicin and discovers the ordered dose is above the safe dose range based on the child's weight. What should be the nurse's first action?
. Check the child's recent lab work.
. Contact the physician.
. Order a hearing test.
. Obtain an order for BUN and creatinine.
Test-Taking Tip
Note that two of the options ( Answers 3 and 4 ) require consultation with the physician, so they are subsumed under the "contact the physician" response. Then, to decide between the first two answers, consider that the nurse should review the assessment data first to determine whether a call to the physician is even necessary.
Content Area: Child Health, Medication Administration; Integrated Process: Nursing Process, Implementation; Cognitive Level: Application; Client Need/Subneed: Physiological Integrity/Pharmacological and Parenteral Therapies/Medication Administration
Health Promotion and Maintenance
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Answer 1 is correct because the nurse should first check the child's recent laboratory work to see if a gentamicin level has been done. The physician may have increased the dose of IV gentamicin above the safe dose range if the child's gentamicin level fell below that which is effective. The safe dose range is the starting point for this medication, but the dose is then increased or decreased to achieve therapeutic blood levels. Answer 2 is incorrect because the nurse should first discover if the dose was changed to achieve a therapeutic blood level. Answer 3 is incorrect because, although gentamicin may be ototoxic, the nurse should first discover if the dose was changed to achieve a therapeutic blood level. Answer 4 is incorrect because, although gentamicin may be nephrotoxic, the nurse should first discover if the dose was changed to achieve a therapeutic blood level.