The nurse is caring for a client receiving gentamicin (Garamycin) IV. Which adverse effect should the nurse monitor for most closely?

Correct Answer: C

Rationale: Gentamicin, an aminoglycoside, treats severe infections but is ototoxic, risking hearing loss via cochlear damage, a serious, potentially irreversible effect. The nurse must monitor closely (e.g., assess for tinnitus, vertigo) to catch it early, prompting discontinuation. Rash suggests allergy but is less frequent and manageable. Nausea and diarrhea occur but are transient and less critical than auditory damage. Gentamicin's narrow therapeutic index and accumulation in inner ear tissues make ototoxicity the priority, especially with IV dosing where levels peak. Early detection prevents permanent disability, aligning with vigilant nursing care for nephrotoxic and ototoxic drugs, making C the adverse effect to watch most closely.

Correct Answer: D

Rationale: Juvenile pilocytic astrocytoma is a type of brain tumor that can cause neurological symptoms such as changes in cognition and personality. A sudden change in the client no longer recognizing a family member could indicate a worsening of the tumor or potential complications from the treatment with dexamethasone. This change in cognition should raise immediate concern for the nurse as it may signal a decline in the client's neurological status requiring prompt assessment and intervention. The other options are also important to monitor, but the change in cognition is the most concerning as it suggests a more immediate and potentially serious issue.

Correct Answer: C

Rationale: A patient with a history of heart failure (HF) presenting with difficulty breathing, cough, and lower extremity edema is likely experiencing decompensated HF, which is characterized by a decrease in cardiac output and inadequate tissue perfusion. Positive inotropes are medications that increase cardiac contractility, helping to improve the heart's pumping ability. By administering a positive inotrope, such as dobutamine or milrinone, the nurse can help enhance the heart's contractility, increase cardiac output, and improve overall tissue perfusion in the patient with decompensated HF. This can help alleviate symptoms such as difficulty breathing and edema in the lower extremities.

Correct Answer: C

Rationale: When teaching a patient how to use sublingual nitroglycerin, it is essential to include the instruction that if the chest pain is not relieved after one tablet, they should call 911 immediately. This is because persistent chest pain could indicate a serious cardiac event, such as a heart attack, that requires immediate medical attention. It is not advisable to take multiple doses without consulting a healthcare provider, as this can lead to complications. The patient should seek emergency medical help if their symptoms are not relieved after taking one tablet of sublingual nitroglycerin.

Correct Answer: C

Rationale: When a patient is receiving antidysrhythmics, there is a risk of fluid and electrolyte disturbances due to the medication's effects on the heart's electrical activity. Antidysrhythmics can cause arrhythmias, which can impact cardiac output and blood pressure, potentially leading to fluid volume deficits. It is essential for nurses to monitor the patient's fluid balance closely and address any deficits promptly to prevent complications. Therefore, the nursing diagnosis of Deficient fluid volume is most appropriate for a patient receiving antidysrhythmics.