What to do first
1. Check renal function and urine output before and during therapy.
2. Ask about hearing changes, tinnitus, dizziness, vertigo, or balance problems.
3. Verify ordered peak/trough or extended-interval monitoring plan.
Gentamicin Nursing Considerations NCLEX Priority Sheet
Gentamicin is an aminoglycoside. NCLEX tests nephrotoxicity, ototoxicity, peak/trough timing, renal monitoring, and high-risk symptoms to report.
Study aid - not medical advice. Not a clinical decision tool. For NCLEX pharmacology review only.
Hold If
Notify the provider and follow protocol for rising creatinine, decreased urine output, high trough, hearing loss, tinnitus, vertigo, severe dizziness, or neuromuscular weakness.
Do not independently change dosing interval. Anticipate ordered drug level and renal evaluation.
Labs to Watch
Classic NCLEX conventional dosing: peak often 5-10 mcg/mL and trough <2 mcg/mL, but targets vary by infection and protocol.
Watch BUN, creatinine, urine output, gentamicin levels, and concurrent nephrotoxic drugs.
Review Details
NCLEX Review Notes
Key Signs
Ototoxicity: tinnitus, hearing loss, dizziness, vertigo, balance problems.
Nephrotoxicity: rising creatinine, reduced urine output, abnormal BUN/Cr, fluid changes.
Neuro/muscular: weakness or respiratory difficulty is high priority.
Nephrotoxicity: rising creatinine, reduced urine output, abnormal BUN/Cr, fluid changes.
Neuro/muscular: weakness or respiratory difficulty is high priority.
NCLEX Trap
Trap: the WBC is improving, so continue despite tinnitus.
Safer answer: tinnitus can signal ototoxicity. Notify the provider and anticipate ordered level and renal/hearing assessment.
Safer answer: tinnitus can signal ototoxicity. Notify the provider and anticipate ordered level and renal/hearing assessment.
Related Pattern
Aminoglycosides: gentamicin, tobramycin, amikacin share nephrotoxicity and ototoxicity risk.
Current clinical note: many hospitals use extended-interval dosing and protocol-specific levels rather than classic peak/trough rules.
Current clinical note: many hospitals use extended-interval dosing and protocol-specific levels rather than classic peak/trough rules.
Mini Quiz
Question: A patient on gentamicin reports ringing in the ears and dizziness. What is the priority?
Answer: notify the provider and assess for ototoxicity; anticipate ordered gentamicin level and renal evaluation.
Answer: notify the provider and assess for ototoxicity; anticipate ordered gentamicin level and renal evaluation.
References
Saunders Comprehensive Review for the NCLEX-RN Examination; Davis's Drug Guide for Nurses; DailyMed gentamicin sulfate labeling; institutional aminoglycoside monitoring protocols.