A nurse is caring for a client who is at 34 weeks of gestation. Which of the following statements by the client is the nurse’s priority to report to the provider?

Choice A reason: Hearing loss is a known gentamicin ototoxicity effect, damaging cochlear hair cells irreversibly. Scientifically, this aminoglycoside targets the inner ear, causing tinnitus or deafness, a critical adverse reaction to monitor in pyelonephritis treatment per pharmacology evidence.

Choice B reason: Slurred speech suggests neurological issues (e.g., stroke), not gentamicin effects. Scientifically, this drug affects kidneys and ears, not speech centers, making this unrelated to its toxicity profile, which focuses on auditory and renal damage.

Choice C reason: Constipation isn’t linked to gentamicin; it’s more typical of opioids or immobility. Scientifically, this antibiotic’s side effects center on nephrotoxicity and ototoxicity, not gastrointestinal motility, rendering this an unlikely adverse reaction in this context.

Choice D reason: Hypotension may occur with rapid IV gentamicin, but it’s less common than ototoxicity. Scientifically, hearing loss is a hallmark toxicity, outweighing transient blood pressure drops, which are manageable and less specific to this drug’s adverse profile.

Choice A reason: Counterpressure helps back labor pain, not cesarean incision pain. It targets muscle tension, not surgical site discomfort, which stems from tissue trauma. For a day-old cesarean, this misaligns with pain source, lacking scientific support for reducing abdominal strain during position changes post-surgery.

Choice B reason: Limiting position changes reduces mobility, risking complications like thrombosis or stiffness post-cesarean. Movement aids recovery, and pain management should facilitate, not hinder, it. This advice contradicts evidence-based practice promoting early ambulation, making it an ineffective and potentially harmful nonpharmacological strategy.

Choice C reason: Splinting the incision with a pillow supports the abdominal wall, reducing strain on sutures during movement. This decreases pain from muscle stretching post-cesarean, aligning with scientific principles of mechanical support, making it an effective, evidence-based nonpharmacological method to manage discomfort safely.

Choice D reason: Patterned breathing aids labor or anxiety, not surgical pain. It distracts from discomfort but does not address physical strain on the cesarean incision during position changes. Lacking direct mechanical relief, it’s less effective scientifically compared to splinting for this specific postoperative pain context.