NCLEX Question of the Day – Tuesday, July 07, 2026

Today’s question targets early recognition of medication-related complications in a child with an acute infection. This matters in real nursing because children can worsen fast, and the nurse is often the first person to connect a new symptom with a medication reaction. Safe practice depends on noticing small changes, stopping harm early, and knowing what to report right away.

Clinical Scenario

A 6-year-old child is admitted to a pediatric unit with periorbital cellulitis of the left eye. The child weighs 22 kg and has been receiving IV antibiotics for 24 hours. The parent tells the nurse, “He seems more tired today, and he says his ears are ringing.” The child also reports feeling dizzy when sitting up. The nurse reviews the medication record and notes that the child is receiving gentamicin every 8 hours. On assessment, the child is afebrile, blood pressure is stable, urine output has been adequate, and the facial swelling is slightly improved from admission.

The Question

Which action should the nurse take first?

Answer Choices

1. A. Reassure the parent that mild dizziness is expected with infection and recheck the child in 1 hour.
2. B. Hold the next dose of gentamicin and notify the provider about possible ototoxicity.
3. C. Encourage the child to drink more fluids and document the symptoms as nonurgent.
4. D. Place the child on strict bed rest and request a physical therapy consult for balance training.

Correct Answer

B. Hold the next dose of gentamicin and notify the provider about possible ototoxicity.

Detailed Rationale

This child has two key warning signs: tinnitus and dizziness. In a patient receiving gentamicin, those symptoms raise concern for ototoxicity. Aminoglycosides can damage the inner ear, which affects hearing and balance. That is why the symptoms matter. They are not vague complaints to simply watch. They may be the earliest clue that the drug is causing harm.

The nurse’s first job is to recognize the pattern. Gentamicin is effective against serious bacterial infections, but it has a narrow safety margin. Ototoxicity may begin with ringing in the ears, trouble hearing, vertigo, or unsteady movement. A young child may not say “vertigo.” The child may instead say “the room feels funny,” “my ears are buzzing,” or “I feel wobbly.”

Once the nurse suspects toxicity, the safest first action is to hold the next dose and notify the provider. This prevents more exposure while the team evaluates the child. The provider may order a drug level, renal labs, a hearing evaluation, or a medication change. The nurse should not wait for severe symptoms. Early action can reduce the risk of lasting injury.

The nurse should also assess and monitor several things:

• Ask when the ringing and dizziness started and whether the symptoms are getting worse.
• Check for hearing changes, nausea, balance problems, or unsteady gait.
• Review recent gentamicin doses, timing, and any peak or trough levels if already drawn.
• Review kidney function and urine output, because impaired renal clearance can increase drug accumulation.
• Use fall precautions, since dizziness raises the risk of injury.

It is important to connect hearing and kidney safety with this medication. Gentamicin is cleared by the kidneys. If kidney function worsens, the drug can build up in the body. Higher levels increase the risk of toxicity. Even though this child’s urine output is adequate, that does not cancel out the concern. Ototoxicity can still occur, and symptoms should be taken seriously.

In practice, on shift, the nurse would hold the medication if allowed by facility policy, notify the provider promptly, continue focused assessment, document the symptoms clearly, and protect the child from falls. The nurse should also explain to the parent why the symptoms matter: “Ringing in the ears and dizziness can be side effects of this antibiotic, so I need to report them right away before the next dose is given.”

Why the Other Options Are Wrong

A. Reassure the parent that mild dizziness is expected with infection and recheck the child in 1 hour.

This is unsafe because it delays action on possible drug toxicity. Infection can cause fatigue, but tinnitus is the red flag here. The nurse should not normalize a symptom that may signal inner ear damage.

C. Encourage the child to drink more fluids and document the symptoms as nonurgent.

Hydration can support general health, but it does not address the immediate problem. Documentation alone is not enough. A symptom linked to a high-risk medication requires clinical action, not just a note in the chart.

D. Place the child on strict bed rest and request a physical therapy consult for balance training.

Fall prevention is helpful, but this choice misses the cause. The priority is to stop possible further exposure to the medication and alert the provider. Physical therapy does not treat acute medication toxicity.

Key Takeaways

• Aminoglycosides such as gentamicin can cause ototoxicity and nephrotoxicity.
• Early signs of ototoxicity include tinnitus, dizziness, vertigo, and hearing changes.
• If toxicity is suspected, the nurse should hold the next dose as appropriate and notify the provider promptly.
• Do not dismiss new neurologic or sensory symptoms in a child receiving a high-risk medication.
• Always connect symptoms to the medication list. That is a core NCLEX and real-world nursing skill.

• On-shift mini-checklist:
• Review the medication and timing of the last dose.
• Assess hearing, balance, nausea, gait, and symptom onset.
• Check urine output and recent renal lab trends.
• Use safety precautions for dizziness and falls.
• Hold the dose if indicated by policy and notify the provider.
• Document the symptoms and your actions clearly.

Quick Practice Extension

1. A child receiving IV vancomycin develops flushing and itching during the infusion. What should the nurse assess and do first?

2. A hospitalized child on seizure medication becomes unusually sleepy and difficult to arouse. Which medication safety checks should the nurse perform before giving the next dose?

Category used today: Pediatrics

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