A nurse is caring for a client who ingested a toxic amount of acetaminophen 36 hr ago.
Which of the following findings should the nurse monitor? Select all that apply.

Choice A rationale: Persistent coughing with mucopurulent sputum suggests an ongoing respiratory infection or inflammation. Mucopurulent sputum indicates the presence of neutrophils and bacteria, often seen in bacterial pneumonia or tuberculosis. While significant, coughing alone is not an immediate life-threatening finding but rather a symptom requiring monitoring and further diagnostic follow-up to confirm the cause.

Choice B rationale: Joint pain in a patient receiving infliximab for rheumatoid arthritis may reflect an autoimmune flare or side effects of immunosuppression. Although uncomfortable and significant for quality of life, joint pain does not usually require immediate intervention compared to respiratory or infectious signs that may threaten life or transmission risk.

Choice C rationale: Anorexia, or decreased appetite, is a common systemic symptom in chronic infections like tuberculosis. It reflects the body’s inflammatory response and catabolic state but is a nonspecific finding. It requires addressing nutritional support but is not immediately life-threatening or requiring urgent intervention compared to active infectious disease signs.

Choice D rationale: Night sweats are a classic systemic symptom of tuberculosis caused by cytokine-mediated thermoregulatory dysfunction during infection. Although important in clinical suspicion, night sweats themselves do not necessitate immediate intervention but support the need for further diagnostic workup and infection control precautions.

Choice E rationale: An 11 mm induration on the purified protein derivative (PPD) test is considered positive in this patient due to immunosuppression with infliximab, which increases TB risk. The normal cutoff varies by risk factors, but 5 mm or greater is positive in immunosuppressed patients. This finding requires urgent follow-up to initiate treatment and prevent active disease and transmission, making it the most critical.

Choice A rationale

Gingival hyperplasia is an overgrowth of gum tissue, often associated with certain medications like phenytoin or cyclosporine. It is caused by an increase in the number of fibroblasts and collagen deposition in the gingiva. Haloperidol, an antipsychotic, primarily affects dopamine receptors in the brain and does not cause gingival hyperplasia.

Choice B rationale

Haloperidol is a first-generation antipsychotic that blocks D2 dopamine receptors in the brain. This blockade, particularly in the nigrostriatal pathway, can lead to extrapyramidal symptoms (EPS) such as acute dystonia, parkinsonism (including muscle rigidity, bradykinesia, and tremor), and akathisia. Muscle rigidity is a common manifestation of drug-induced parkinsonism.

Choice C rationale

Polyuria is the excessive production of urine, often a symptom of diabetes mellitus or insipidus. It results from impaired water reabsorption in the kidneys. While some medications can affect fluid balance, haloperidol's primary pharmacological action on dopamine receptors does not directly induce polyuria as a typical adverse effect.

Choice D rationale

Bruising, or ecchymosis, results from bleeding under the skin, often due to trauma or coagulation disorders. It is caused by extravasation of blood from capillaries into surrounding tissues. Haloperidol does not affect coagulation factors or platelet function and is not associated with increased bruising as a direct adverse effect.