A nurse is caring for an adult client who reports having trouble getting to sleep at night. Which of the following recommendations should the nurse make?

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: Documenting infiltration records the event but does not address the immediate issue. Edema and coolness suggest fluid leakage into tissues, which can cause damage if not stopped. Documentation is secondary to halting the infusion, as it only logs data without mitigating the ongoing extravasation harming the client’s tissue integrity.

Choice B reason: Applying a warm compress may increase blood flow and reduce swelling later, but it does not stop the fluid leakage causing the edema. The priority is to cease the infusion to prevent further tissue damage from ongoing infiltration, making this a subsequent action rather than the first step.

Choice C reason: Elevating the arm can help reduce swelling by aiding venous return, but it does not address the source of the problem—fluid leaking from the IV. Stopping the infusion first prevents additional extravasation, as elevation alone cannot halt the ongoing tissue damage caused by the continuous fluid administration.

Choice D reason: Stopping the infusion is the priority because edema and coolness indicate infiltration, where IV fluid leaks into surrounding tissues. Ceasing the flow prevents further damage, such as tissue necrosis or nerve injury, which can occur if fluid continues to accumulate, making this the critical first step in management.