A patient on a heparin infusion has an aPTT of 90 and is showing signs of excessive bleeding. What prescription will the nurse anticipate administering?

Choice A reason: Gentamicin, an aminoglycoside, causes ototoxicity, manifesting as ringing in the ears (tinnitus). It damages cochlear hair cells, leading to hearing loss or balance issues. Monitoring for tinnitus is critical, as ototoxicity is often irreversible, requiring dose adjustment or discontinuation to prevent further auditory damage.

Choice B reason: Elevated WBC count is not a typical indicator of gentamicin toxicity. Gentamicin’s primary toxicities are nephrotoxicity and ototoxicity. Elevated WBCs suggest infection or inflammation, not a direct effect of gentamicin, which targets bacterial protein synthesis, making this an incorrect monitoring parameter.

Choice C reason: Decreased BUN levels are not associated with gentamicin toxicity. Gentamicin causes nephrotoxicity, increasing BUN and creatinine due to renal tubular damage. Monitoring for elevated, not decreased, BUN is essential to detect kidney injury early, making this an incorrect toxicity indicator.

Choice D reason: Increased body temperature is not a direct indicator of gentamicin toxicity. Fever may indicate infection persistence or a drug reaction, but gentamicin’s primary toxicities are ototoxicity and nephrotoxicity. Monitoring for tinnitus or renal function changes is more relevant than temperature for toxicity assessment.

Choice A reason: Reducing raw vegetables and fruit is not necessary with simvastatin. Dietary vitamin K may affect warfarin, but statins are unaffected by fruits or vegetables, except grapefruit, which inhibits CYP3A4, increasing simvastatin levels. A balanced diet supports cardiovascular health, making this instruction incorrect.

Choice B reason: Drug interactions are not rare with simvastatin, a statin metabolized by CYP3A4. Inhibitors like grapefruit juice or antifungals increase simvastatin levels, risking toxicity, while inducers reduce efficacy. Patients must be educated about potential interactions, making this statement incorrect and misleading for safe statin use.

Choice C reason: Reporting muscle pain immediately is critical with simvastatin, as it may indicate myopathy or rare rhabdomyolysis. Statins disrupt muscle cell membranes, causing pain or weakness. Early reporting allows monitoring of creatine kinase levels and prevents progression to severe muscle damage, ensuring patient safety.

Choice D reason: Reporting bleeding or yellow skin (jaundice) is essential, as simvastatin can cause hepatotoxicity, elevating liver enzymes, or rare bleeding due to drug interactions. Jaundice indicates liver dysfunction, and bleeding may result from interactions with anticoagulants, necessitating prompt reporting to adjust therapy or monitor liver function.

Choice E reason: Limiting fluid intake is not required with simvastatin. Fluid overload is unrelated to statins, which affect cholesterol synthesis, not fluid balance. Adequate hydration supports general health, and no evidence suggests fluid restriction is necessary, making this instruction irrelevant and potentially harmful.