A nurse is reviewing the medication record of a client who has hypertension. Which of the following medications should the nurse administer to lower the client's blood pressure?

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. "If my pain is not relieved in 20 minutes, I will take a second tablet." Sublingual nitroglycerin should be taken at 5-minute intervals, up to a maximum of three doses within 15 minutes. If chest pain persists after three doses, emergency medical assistance is necessary, as this may indicate a myocardial infarction. Delaying a second dose for 20 minutes may lead to worsening of the condition and delay appropriate treatment.

B. "I will keep my tablets on a shelf in the bathroom." Nitroglycerin is highly sensitive to heat, light, and moisture, which can cause it to lose potency. Storing it in the bathroom, where temperature and humidity fluctuate, can degrade the medication. It should be kept in its original dark glass container with the lid tightly closed and stored in a cool, dry place away from moisture and heat sources.

C. "I should be sure to swallow the tablet whole." Sublingual nitroglycerin is designed to dissolve under the tongue for rapid absorption into the bloodstream. Swallowing it whole delays its effect because it would need to pass through the digestive system before being absorbed, reducing its ability to quickly relieve angina. Clients should be instructed to place the tablet under the tongue and allow it to dissolve completely without chewing or swallowing.

D. “If my mouth is dry, I will take a sip of water before I take the tablet.” A dry mouth can slow the dissolution of the sublingual tablet, delaying its absorption and effectiveness. Taking a sip of water before administration ensures the tablet dissolves properly under the tongue, allowing for rapid relief of angina symptoms. However, clients should avoid drinking excessive amounts of water that might wash the tablet down before it dissolves.