A nurse is caring for a client who is taking multiple medications. Which of the following medications should the nurse identify as a controlled substance?

Rationale for correct choices

• Right lower extremity +2 edema from ankle to below knee: This level of edema in one limb suggests impaired venous return and is a key indicator of possible deep vein thrombosis. Unilateral swelling that develops with reduced mobility places the client at higher risk and warrants immediate assessment. Early detection is important to prevent progression to pulmonary embolism.

• Skin warm and inflamed on right lower extremity: Localized warmth and inflammation are hallmark findings of venous thrombosis or inflammatory processes in the limb. The client’s sedentary pattern and unilateral symptoms strengthen the suspicion of a vascular complication. Prompt evaluation helps guide diagnostic testing such as Doppler ultrasound.

• Slight limp with weight bearing on right extremity: A new limp combined with swelling and inflammation suggests evolving pain or functional impairment. This may indicate deep venous obstruction, localized inflammation, or injury exacerbated by reduced mobility.

Rationale for incorrect choices

• Client is awake, alert, oriented x3: This indicates intact neurological status and does not require follow-up at this time. The client shows no evidence of cognitive changes, syncope, or neurological compromise.

• Client reports no palpitations, heart rhythm regular: A regular heart rhythm without palpitations suggests stable cardiovascular status. There are no immediate arrhythmia-related concerns requiring follow-up.

Rationale:

A. A client who moved to an apartment located on higher ground than her previous home: Relocating to a safer area demonstrates adaptive coping and proactive problem-solving. It does not indicate symptoms of posttraumatic stress disorder (PTSD) and does not require a referral for mental health assessment.

B. A client who has frequent nightmares about the hurricane: Recurrent intrusive thoughts or nightmares about a traumatic event are hallmark symptoms of PTSD. This client should be referred for further evaluation and possible treatment.

C. A client who expresses a realization that life will not return to the way it was before the hurricane: Accepting permanent changes after a disaster reflects normal adjustment and resilience. This insight alone does not suggest PTSD.

D. A client who describes feeling disconnected from those around him following the hurricane: Emotional numbing or detachment from others is a common PTSD symptom. This client should be referred for assessment to address potential social and emotional impairments.

E. A client who describes having persistent feelings of anger about the hurricane: Persistent irritability or anger is another symptom associated with PTSD. Referral is appropriate to evaluate for underlying trauma-related disorder and provide supportive interventions.