NCLEX Question of the Day – Thursday, March 12, 2026

Today’s question focuses on early recognition of a high-risk medication complication in a child. This matters in real nursing because the first clue is often a subtle change in assessment, not a dramatic event. Nurses who connect the medication, the symptoms, and the urgency can prevent respiratory failure, seizures, or worse.

Clinical Scenario

A 6-year-old child is admitted to a pediatric unit with acute lymphoblastic leukemia and fever. The child weighs 20 kg and has a tunneled central venous catheter. Blood cultures are drawn, and the provider prescribes gentamicin IV. Two days later, the nurse enters the room to give the next dose. The child’s mother says, “He seems different today. He keeps asking us to repeat things.”

The nurse reviews the chart and notes that urine output has decreased over the past 12 hours. On assessment, the child is awake, afebrile, and not in distress. Lung sounds are clear. The child says there is “ringing” in both ears. Morning labs show a rising serum creatinine compared with admission.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Administer the scheduled gentamicin dose and document the child’s new symptoms
2. B. Hold the gentamicin and notify the provider about possible toxicity
3. C. Encourage oral fluids and reassess urine output in 4 hours
4. D. Request a prescription for an antiemetic to treat suspected vertigo

Correct Answer

B. Hold the gentamicin and notify the provider about possible toxicity

Detailed Rationale

This child has multiple warning signs of gentamicin toxicity. The key clues are tinnitus, decreased hearing, reduced urine output, and rising creatinine. Gentamicin is an aminoglycoside. This drug class is known for two major serious adverse effects: ototoxicity and nephrotoxicity.

The nurse should recognize that the symptoms are not minor side effects. Ringing in the ears and difficulty hearing suggest early injury to the auditory system. Decreased urine output and higher creatinine suggest impaired kidney function. Since gentamicin is cleared by the kidneys, worsening renal function can raise the drug level further and increase toxicity. That creates a dangerous cycle.

The first priority is to stop further exposure by holding the medication and notifying the provider. In practice, the provider may order a gentamicin trough level, repeat renal labs, hearing evaluation, or a change in antibiotic therapy. The nurse’s role is to prevent the next dose from causing more harm.

The nurse should also continue focused assessment. That includes asking when the ringing started, whether hearing loss is one-sided or both-sided, and whether the child has dizziness or balance problems. Kidney-related assessment should include strict intake and output, urine characteristics, daily weight if ordered, and review of recent labs such as creatinine and blood urea nitrogen.

Monitoring matters because toxicity can progress even after the medication is stopped. The nurse should watch for worsening urine output, edema, fatigue, or continued hearing changes. In children, hearing changes can be easy to miss because they may describe them vaguely or act irritable instead of saying they cannot hear well.

This question tests prioritization. The nurse is not being asked to diagnose formally. The nurse is being asked to identify a medication-related safety problem and act quickly. A child on an aminoglycoside with auditory symptoms and kidney changes should not receive the next dose until the provider is alerted.

Why the Other Options Are Wrong

A. Administer the scheduled gentamicin dose and document the child’s new symptoms

This is unsafe. Documentation is important, but it does not protect the child from further harm. Giving another dose when toxicity is suspected could worsen kidney injury and hearing damage. The nurse must act on the assessment findings, not just record them.

C. Encourage oral fluids and reassess urine output in 4 hours

Fluids may support hydration, but this delays the urgent response. The problem is not simply low intake. The pattern points to drug toxicity. Waiting 4 hours could allow more injury, especially if the dose is due now. Reassessment is needed, but after the medication is held and the provider is notified.

D. Request a prescription for an antiemetic to treat suspected vertigo

This focuses on one symptom while missing the cause. Even if the child has dizziness, treating symptoms without addressing the likely toxic drug effect is poor prioritization. The nurse must first prevent more exposure to the medication causing the problem.

Key Takeaways

• Aminoglycosides such as gentamicin can cause ototoxicity and nephrotoxicity.
• Tinnitus, hearing changes, decreased urine output, and rising creatinine are red flags.
• If toxicity is suspected, do not give the next dose until the provider is notified.
• Kidney injury can increase drug levels, which can make toxicity worse.
• Children may describe hearing changes in simple ways, such as “ringing” or “I can’t hear you.”

What you’d do on shift:

• Pause before administration and review the latest assessment and labs.
• Hold the gentamicin if toxicity signs are present.
• Notify the provider promptly with clear data: symptoms, urine output, creatinine trend, and timing of last dose.
• Start or continue strict intake and output monitoring.
• Reassess hearing, balance, and renal status throughout the shift.
• Teach the family to report ringing in the ears, trouble hearing, dizziness, or decreased urination right away.

Quick Practice Extension

1. A child receiving IV vancomycin develops flushing and itching during the infusion. What assessment findings would help you tell an infusion reaction from anaphylaxis?

2. A pediatric patient on amphotericin B has a sudden drop in potassium level. What complication would you monitor for first, and why?

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