A nurse is assessing a client who is in active labor and just received an epidural. Which of the following findings should the nurse document as an adverse effect?

Rationale:

A. A client who has an open compound fracture of the humerus: This injury requires surgical intervention and has a moderate to high risk of complications. It is typically classified as yellow, indicating delayed care is acceptable but not minor.

B. A client who has multiple facial lacerations: These are superficial injuries that can be treated with simple wound care and suturing. The client is likely stable and ambulatory, fitting the criteria for a green tag, which denotes minor injuries requiring minimal care.

C. A client who has a puncture wound in the right lower lung: This suggests potential internal injury and respiratory compromise. Such a case is urgent and unstable, requiring immediate intervention, and would be tagged red for immediate treatment.

D. A client who has full-thickness burns over the lower extremities: Full-thickness burns covering a large area are life-threatening and resource-intensive to manage. Depending on the extent, this may fall under red or black, depending on survivability and available resources.

Rationale:

A. A client who moved to an apartment located on higher ground than her previous home: Relocating for safety is a rational coping mechanism and does not, on its own, indicate PTSD. This action reflects adaptation rather than signs of trauma-related distress.

B. A client who has frequent nightmares about the hurricane: Recurrent nightmares related to the traumatic event are a hallmark symptom of PTSD and suggest that the client is experiencing persistent re-experiencing of the trauma.

C. A client who expresses a realization that life will not return to the way it was before the hurricane: This statement reflects acceptance and realistic processing of the event, not necessarily indicative of emotional distress or dysfunction associated with PTSD.

D. A client who describes having persistent feelings of anger about the hurricane: Chronic irritability or anger following trauma is a recognized symptom of PTSD and may indicate the client is struggling with emotional regulation due to unresolved trauma.

E. A client who describes feeling disconnected from those around him following the hurricane: Emotional numbing or detachment from others is a common symptom of PTSD, often associated with difficulty in re-establishing interpersonal connections after trauma.