A nurse is reinforcing teaching about ambulating using a cane with a client who has left-sided weakness. Which of the following actions by the client indicates an understanding of the teaching?

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.

Penicillin allergy is an immune-mediated hypersensitivity reaction that can range from mild skin manifestations to severe life-threatening anaphylaxis. True allergic responses involve activation of the immune system and commonly present with urticaria, angioedema, bronchospasm, or hypotension. It is important for nurses to distinguish allergic reactions from common medication side effects such as nausea or diarrhea. Prompt recognition of serious allergic symptoms is essential to prevent airway compromise and severe systemic reactions.

Rationale:
A. Nausea is a common gastrointestinal side effect of many antibiotics, including penicillin, but it does not indicate an allergic reaction. It results from irritation of the gastrointestinal tract rather than an immune response. Although uncomfortable, it does not suggest hypersensitivity or anaphylaxis.

B. Angioedema is a serious allergic manifestation characterized by rapid swelling of deeper layers of the skin, often involving the lips, face, tongue, or airway. It indicates an immune-mediated hypersensitivity reaction and can quickly progress to airway obstruction. This finding requires immediate recognition and intervention.

C. Insomnia is not a typical sign of penicillin allergy and is unrelated to hypersensitivity reactions. It may occur due to stress, illness, or other medications but is not considered an indicator of an allergic response to antibiotics.

D. Diarrhea is a common adverse effect of antibiotics caused by disruption of normal intestinal flora. It reflects gastrointestinal intolerance rather than an immune-mediated allergic reaction. Although severe diarrhea may require evaluation, it does not indicate a penicillin allergy.