A nurse is caring for a client who is receiving gentamicin, an aminoglycoside antibiotic, for a severe infection.
The nurse should monitor the client for which adverse effects of this drug? (Select all that apply.)

These are signs ofototoxicity, a potentially serious adverse reaction to vancomycin (Vancocin) and other aminoglycosides.Ototoxicity can damage the inner ear and cause permanent hearing loss or balance problems.

Choice A is wrong because redness and itching at the infusion site are not specific to vancomycin (Vancocin) and could indicate a local irritation or an allergic reaction to any drug.

Choice B is wrong because flushing, rash, and pruritus on the face and upper torso are symptoms ofred man syndrome, a common but not serious side effect of vancomycin (Vancocin) that occurs due to rapid infusion and histamine release.Red man syndrome can be prevented by infusing the drug over at least 1 hour.

Choice C is wrong because nausea, vomiting, and abdominal cramps are not specific to vancomycin (Vancocin) and could be caused by many factors, such as infection, food poisoning, or other drugs.

Normal ranges for vancomycin (Vancocin) trough levels are 10 to 20 mcg/mL for most infections and 15 to 20 mcg/mL for serious infections such as osteomyelitis, endocarditis, or meningitis.Levels above 20 mcg/mL increase the risk of ototoxicity and nephrotoxicity.

Therefore, the nurse should monitor the patient’s trough levels regularly and report any abnormal findings to the prescriber.

Gentamicin is an example of a concentration-dependent antimicrobial, which means that it achieves increasing bacterial kill with increasing levels of drug.The peak concentration and the area under the concentration curve (AUC) determine the efficacy of these antibiotics.Other examples of concentration-dependent antimicrobials include fluoroquinolones, daptomycin, aminoglycosides, and amphotericin

Choice A is wrong because ciprofloxacin is a fluoroquinolone, which is also a concentration-dependent antimicrobial.

Choice B is wrong because imipenem is a carbapenem, which is a type of beta-lactam antibiotic.Beta-lactams are time-dependent antimicrobials, which means that their bactericidal activity depends on the duration of the effective concentration.

Choice C is wrong because penicillin V is another type of beta-lactam antibiotic, which is also a time-dependent antimicrobial.

Choice D is wrong because metronidazole is a bactericidal agent that has both time- and concentration-dependent properties.However, it is not classified as a concentration-dependent antimicrobial according to the AMEG categorization of antibiotics in the European Union.