A nurse is collecting data from a client who has pyelonephritis and is receiving gentamicin via IV infusion. Which of the following manifestations should the nurse identify as an adverse effect of the treatment?

Pyelonephritis is a bacterial infection of the kidney parenchyma and renal pelvis, commonly requiring intravenous antibiotics for effective treatment. One frequently used class of antibiotics in severe infections is aminoglycosides, such as gentamicin, which are effective against gram-negative organisms but carry significant toxicity risks. These drugs require close monitoring due to their potential effects on the kidneys and auditory system. Early recognition of adverse effects is essential to prevent permanent damage during therapy. Rationale: A. Hearing loss is a known adverse effect of gentamicin due to its ototoxicity. This occurs when the drug damages the hair cells in the inner ear, leading to tinnitus, balance disturbances, and potentially permanent hearing impairment. The risk increases with high doses, prolonged therapy, or impaired renal function, making careful monitoring essential. B. Chvostek’s sign is a clinical indicator of hypocalcemia, characterized by facial muscle twitching when the facial nerve is tapped. It is not associated with gentamicin use or its toxicity profile. Instead, it is related to electrolyte imbalances, particularly low calcium levels. C. Constipation is not a typical adverse effect of gentamicin. This medication primarily affects the kidneys and auditory system rather than the gastrointestinal tract. Gastrointestinal motility changes are more commonly associated with other medication classes such as opioids. D. Hypertension is not a characteristic adverse effect of gentamicin therapy. Fluid balance and renal function may be affected in toxicity, but the medication does not directly cause elevated blood pressure. More commonly, gentamicin toxicity presents as nephrotoxicity and ototoxicity rather than cardiovascular changes.