A nurse is assisting with the care of a client on a medical surgical unit who was admitted from the emergency department.

Exhibits

For each assessment finding on Day 2 click to specify if the finding is due to lisinopril, carvedilol, or furosemide. Each finding may be related to more than 1 medication.

A. "I can continue my current alcohol intake." The client should avoid alcohol while taking tuberculosis (TB) medications such as isoniazid and rifampin, as alcohol increases the risk of hepatotoxicity.
B. "I can expect my contact lenses to turn red or orange." Rifampin, a common medication used to treat TB, can cause bodily fluids such as urine, sweat, tears, and saliva to turn red or orange. This can stain soft contact lenses permanently, so clients should be informed of this side effect.
C. "I will need to take my medications for a total of 6 weeks." The standard treatment for TB typically lasts at least 6 months, not just 6 weeks. Clients must complete the full course of therapy to prevent drug resistance and recurrence.
D. "I will need to have a repeat Mantoux test in 4 weeks." A Mantoux test (tuberculin skin test) is not needed after a confirmed TB diagnosis with a positive sputum culture. Instead, follow-up evaluations include repeat sputum cultures and chest x-rays.
E. "I am no longer contagious." Clients with active pulmonary TB are considered contagious until they have completed at least two weeks of effective treatment, have improving symptoms, and have three consecutive negative sputum cultures.
F. "I should notify my provider if I start taking new over-the-counter or prescription medications." TB medications, especially rifampin, can interact with many drugs, including oral contraceptives, anticoagulants, and antiretrovirals. Clients must inform their provider of any new medications.
G. "I will need to have someone observe me when I take medication." Directly observed therapy (DOT) is recommended for clients with TB to ensure medication adherence and reduce the risk of treatment failure or drug resistance.

Rationale for Correct Options:

Compartment syndrome is a serious complication that can occur after a fracture, particularly of a long bone like the femur. It results from increased pressure within a muscle compartment, leading to decreased blood flow and potential tissue damage.

Edema of the toes suggests swelling, which may indicate increasing pressure within the affected limb. The adolescent is already reporting significant pain (7/10) and has required repeated doses of IV morphine, which may not be sufficient to relieve compartment syndrome pain (a key warning sign). If left untreated, compartment syndrome can cause nerve and muscle damage, ischemia, and even permanent disability.

Rationale for Incorrect Options:

Deep Vein Thrombosis (DVT): DVT is a risk with immobilization, but it usually presents with unilateral swelling, warmth, and pain in the affected limb, not just toe edema.

Fat Embolism Syndrome: This occurs due to fat globules entering circulation after a long bone fracture. Symptoms include respiratory distress, mental status changes, and petechiae, which are not present here.