The nurse is administering the sixth IV dose of gentamicin to a client with extensive full thickness burns. Which assessment finding warrants further intervention?

Reference Range:

White Blood Cell [5000 to 10,000/mm3 (5 to 10 x 10 %/L)] Blood Urea Nitrogen [10 to 20 mg/dL (3.6 to 7.1 mmol/L)] Creatinine [0.5 to 1.1 mg/dL (44 to 97 µmol/L)]

A. Obtain a platelet count weekly: Regular monitoring of platelet counts is important for clients on methotrexate due to the risk of bone marrow suppression and potential thrombocytopenia. This instruction is appropriate and necessary.
B. Take the medication during pregnancy: Methotrexate is contraindicated during pregnancy due to its teratogenic effects and potential to cause fetal harm. It is crucial for clients to avoid using methotrexate while pregnant or planning to become pregnant.
C. Use folic acid to protect the liver: While folic acid is often used to help reduce the side effects of methotrexate, particularly its gastrointestinal effects and potential for liver toxicity, it is not used to "protect the liver" per se. The correct approach is to use folic acid as directed by a healthcare provider, often to mitigate some of the side effects of methotrexate.
D. Store the medication at room temperature: Methotrexate should be stored according to the manufacturer's instructions, which usually involve keeping it at room temperature. This information is correct and does not require additional instruction.

A. Affirm the decision to use the medication when the symptoms start to worsen: Waiting to start rivastigmine until symptoms worsen may not be the best approach, as early intervention can be more beneficial in managing symptoms and slowing disease progression.
B. Assess the client’s current mental status before deciding to support the decision: While assessing the client's mental status is important, the immediate concern is to educate on the timing of medication use rather than evaluating the current state of the client.
C. Confirm that the daughter is aware of the progressive nature of the disease: It is important for the daughter to understand the progressive nature of Alzheimer's disease, but this does not directly address the timing for starting rivastigmine.
D. Explain that the drug should be used early in the course of the disease process: Rivastigmine, a cholinesterase inhibitor, is most effective when started early in the course of Alzheimer's disease. Early use can help manage symptoms more effectively and potentially delay progression.