A nurse is caring for a client who is receiving tobramycin. The nurse should monitor the client for which of the following adverse effects?

Choice A rationale Tinnitus, a ringing or buzzing sensation in the ears, is a well-documented ototoxic adverse effect of tobramycin, an aminoglycoside antibiotic. Aminoglycosides can damage hair cells in the cochlea and vestibular apparatus, leading to irreversible hearing loss and balance disturbances due to their accumulation in inner ear fluid. Choice B rationale Decreased salivation, or xerostomia, is not a primary or common adverse effect associated with tobramycin. This symptom is more frequently linked to anticholinergic medications or conditions affecting salivary gland function, rather than the ototoxic or nephrotoxic mechanisms of aminoglycosides. Choice C rationale Blurred vision is not a typical adverse effect of tobramycin. While some medications can cause ocular disturbances, aminoglycosides are primarily known for their effects on the kidneys (nephrotoxicity) and ears (ototoxicity) rather than directly impacting visual acuity through this mechanism. Choice D rationale Rash is a possible, but less common and non-specific, adverse effect of many medications, including antibiotics. While hypersensitivity reactions can manifest as a rash, tinnitus is a more specific and characteristic adverse effect directly related to the pharmacodynamics and known toxicity profile of tobramycin as an aminoglycoside.