The nurse knows that a fluroquinolone antibiotic like ciprofloxacin can cause which of the following:

A. Ringing in the ears: Tinnitus is more commonly associated with aminoglycosides, high-dose vancomycin, or loop diuretics, which can cause ototoxicity. Fluoroquinolones like ciprofloxacin are not typically linked to auditory toxicity, so ringing in the ears is not a major concern with this class of antibiotics. B. Nephrotoxicity: While some antibiotics such as aminoglycosides and vancomycin are well-known for nephrotoxic potential, fluoroquinolones generally have a low risk of directly causing kidney injury. They are primarily excreted renally, but nephrotoxicity is not a common adverse effect in otherwise healthy patients. C. Cross-reactivity with penicillin: Fluoroquinolones do not share the beta-lactam structure of penicillin, so patients allergic to penicillin are not at increased risk of cross-reactivity with ciprofloxacin. This makes fluoroquinolones a potential alternative in cases of penicillin allergy, though other side effects must still be considered. D. Tendon rupture: Fluoroquinolones carry a well-documented risk of tendonitis and tendon rupture, most notably affecting the Achilles tendon. The risk is higher in older adults, patients on corticosteroids, or those with renal impairment. The mechanism involves fluoroquinolone-induced changes in tendon collagen and extracellular matrix, which can weaken the tendon and increase susceptibility to injury.