A nurse is assessing a child who is being treated for bacterial pneumonia. The nurse notes an increase in the child’s blood glucose. The nurse should identify this finding as an adverse effect of which of the following medication?

A. Clonidine: While clonidine can alleviate some nicotine withdrawal symptoms such as anxiety and irritability, it is not a first-line therapy for smoking cessation and is usually reserved for clients who cannot use other approved medications.
B. Naltrexone: Naltrexone is primarily prescribed for alcohol and opioid use disorders and has no significant effect on nicotine addiction or withdrawal.
C. Bupropion: Bupropion is an effective smoking cessation aid that reduces nicotine cravings and withdrawal by affecting neurotransmitters in the brain. It is FDA-approved specifically for helping clients quit smoking.
D. Chlordiazepoxide: This benzodiazepine is used to manage anxiety and alcohol withdrawal but does not target nicotine dependence or support smoking cessation efforts.

Rationale for Correct Choices:

• Compartment syndrome: Occurs when pressure within a closed muscle compartment compromises circulation and tissue function. The client presents with classic signs: pain out of proportion, pallor (cool foot), pulselessness (non-palpable pulses), paresthesia (numbness), and paralysis (inability to move foot/toes) which are hallmark signs of compromised perfusion.

• Osteomyelitis: The presence of drainage from the splint site, increasing temperature, and markedly elevated WBC count (from 14,000 to 28,000/mm³) strongly suggest developing bone infection. The client’s open fracture and internal fixation increase susceptibility, especially with new signs of systemic infection and localized inflammation at the injury site.

Rationale for Incorrect Choices:

• Deep vein thrombosis (DVT): While trauma and immobility increase DVT risk, there is no evidence of unilateral leg swelling, calf tenderness, or redness. The primary concern here is neurovascular compromise, not venous thromboembolism, and the symptoms point more urgently to compartment syndrome and infection.

• Fat embolism syndrome: Fat embolism is a risk with long bone fractures, typically presenting within 24–72 hours with respiratory distress, hypoxia, confusion, and a petechial rash. This client is alert and not in respiratory distress, with normal oxygen saturations and no mental status changes, making fat embolism less likely at this stage.