A nurse is caring for a client who is receiving tobramycin. The nurse should monitor the client for which of the following adverse effects?

A. Rash. A rash while taking allopurinol can indicate a serious hypersensitivity reaction, including Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). These life-threatening conditions involve widespread skin blistering, mucosal involvement, and systemic symptoms. Immediate discontinuation of allopurinol and medical intervention are required to prevent severe complications.

B. Diarrhea. Mild gastrointestinal disturbances, including diarrhea, are common with allopurinol use. While bothersome, diarrhea is not life-threatening and can often be managed by adjusting the dose or taking the medication with food. It does not require immediate discontinuation unless severe or persistent.

C. Nausea. Nausea is a common, mild side effect of allopurinol that usually resolves with time or by taking the medication after meals. It is not an emergency and does not require urgent intervention unless accompanied by other concerning symptoms such as vomiting or severe abdominal pain.

D. Metallic taste in mouth. A metallic taste can occur with allopurinol use but is not harmful. It is a minor side effect that does not indicate toxicity or severe adverse reactions. Clients can be reassured that this effect is temporary and not a reason to stop the medication.

• Shortness of breath. The client is experiencing respiratory distress, which could indicate a severe allergic reaction (anaphylaxis). Immediate intervention is needed to prevent airway compromise and respiratory failure.
• Intercostal retractions. Retractions occur when breathing is labored, suggesting airway obstruction or bronchoconstriction. This is a sign of worsening respiratory distress, requiring urgent medical attention.
• Wheezing auscultated throughout lung fields. Wheezing suggests bronchospasm, which is common in anaphylaxis and asthma attacks. The presence of diffuse wheezing indicates that the airways are narrowing, making breathing more difficult.
• Diffuse, raised rash present on trunk. A new-onset rash following antibiotic administration raises suspicion for anaphylaxis or a severe allergic reaction. Immediate treatment with antihistamines and corticosteroids may be required.
• Respiratory rate 30/min. The increased respiratory rate indicates that the client is compensating for airway constriction and hypoxia. This is an early warning sign of impending respiratory failure if not treated promptly.
• Blood pressure 90/55 mmHg. The drop in blood pressure suggests anaphylactic shock, where vasodilation and fluid leakage from capillaries lead to hypotension. Immediate administration of epinephrine is necessary to prevent cardiovascular collapse.
• Oxygen saturation 91% on room air. A decrease in oxygen saturation indicates impaired gas exchange, likely due to airway swelling and bronchospasm. Supplemental oxygen therapy should be provided to prevent further desaturation.