A nurse is collecting data from a client who is taking dimenhydrinate to treat motion sickness. Which of the following findings is an adverse effect of this medication?

A. Increased salivation. Tobramycin, an aminoglycoside antibiotic, does not cause increased salivation. It primarily affects the kidneys and auditory system, with no significant impact on saliva production. Increased salivation is more commonly associated with medications affecting the autonomic nervous system, such as cholinergic agents.

B. Bruising. While some antibiotics may impact platelet function, aminoglycosides like tobramycin do not commonly cause thrombocytopenia or increased bruising. Clients experiencing unexplained bruising should be evaluated for other underlying causes, such as coagulation disorders or concurrent medication use.

C. Joint pain. Joint pain is not a typical adverse effect of tobramycin. While some antibiotics, like fluoroquinolones, are associated with tendonitis or joint issues, aminoglycosides primarily affect the kidneys and inner ear, leading to nephrotoxicity and ototoxicity rather than musculoskeletal symptoms.

D. Tinnitus. Tobramycin is ototoxic and can cause tinnitus, hearing loss, or balance disturbances due to its toxic effects on the auditory and vestibular nerves. Clients receiving tobramycin should be monitored for early signs of ototoxicity, and the medication should be discontinued if symptoms develop to prevent permanent hearing damage.

A. Tinnitus. Nitrofurantoin is not commonly associated with ototoxicity or tinnitus. Medications such as aminoglycosides and loop diuretics are more likely to cause this adverse effect. While nitrofurantoin can have some neurological side effects, tinnitus is not a primary concern.

B. Abdominal cramping. Gastrointestinal side effects such as nausea and vomiting can occur with nitrofurantoin, especially if taken on an empty stomach. However, abdominal cramping is usually mild and not a serious adverse effect requiring discontinuation of the medication. Taking the drug with food can help reduce gastrointestinal discomfort.

C. Stevens-Johnson syndrome. Stevens-Johnson syndrome (SJS) is a rare but serious hypersensitivity reaction that can occur with nitrofurantoin use. It presents with flu-like symptoms, followed by a painful rash, blistering, and skin peeling. Immediate discontinuation and medical intervention are required if symptoms develop, as SJS can be life-threatening.

D. Insomnia. Nitrofurantoin does not commonly cause insomnia. Some medications, such as corticosteroids and stimulants, are more likely to interfere with sleep. Nitrofurantoin’s side effects primarily affect the gastrointestinal, pulmonary, and dermatologic systems rather than sleep patterns.