The nurse is preparing to administer intravenous gentamicin to an infant through an intermittent needle. The nurse notes that the infant has not had a wet diaper for several hours. The nurse will perform which action?
a. Administer the medication and give the infant extra oral fluids.
b. Contact the provider to request adding intravenous fluids when giving the medication.
c. Give the medication and obtain a serum peak drug level 45 minutes after the dose.
d. Hold the dose and contact the provider to request a serum trough drug level.
ANS: D
Gentamicin can cause nephrotoxicity. When changes in urine output occur, the provider should be notified, and serum trough levels should be obtained to make sure the drug is not at a toxic level. If the drug level is determined to be safe, giving extra fluids either orally or intravenously may be indicated. Serum peak levels give information about therapeutic levels but are not a substitution for avoiding nephrotoxicity in the face of possible oliguria.
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