A nurse is caring for a client who has E. coli infection and a prescription for gentamicin 5mg/kg/day by intermittent IV bolus every 8 hr. Which of the following manifestations indicate the client is experiencing gentamicin toxicity? (Select all that apply.)

A. Restlessness: Restlessness is not a typical manifestation of gentamicin toxicity. It could be related to other factors, such as anxiety or discomfort from the infection, but it is not a direct sign of gentamicin toxicity. B. Dizziness: Dizziness is a common sign of gentamicin toxicity. It is often associated with ototoxicity, which is a potential side effect of aminoglycosides like gentamicin. This can affect the vestibular system and lead to balance issues and dizziness. C. Insomnia: Insomnia is not commonly associated with gentamicin toxicity. It could be a side effect of other factors like infection or stress but is not specific to gentamicin. D. Tinnitus: Tinnitus (ringing in the ears) is a well-known symptom of ototoxicity, a potential adverse effect of gentamicin. The medication can cause hearing loss or other auditory disturbances, and tinnitus is often an early warning sign of ototoxicity. E. Xerostomia: Xerostomia (dry mouth) is not typically associated with gentamicin toxicity. This could occur due to dehydration, medication side effects, or other causes, but it is not a hallmark of gentamicin toxicity.