After 2 months of prescribed treatment with isoniazid, rifampin, pyrazinamide, and ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action would the nurse take next?

Choice A reason: Furosemide, a loop diuretic, increases renal workload, risking kidney injury. Creatinine rises (>1.2 mg/dL) with reduced glomerular filtration, a critical marker to monitor for nephrotoxicity or dehydration in heart failure patients.

Choice B reason: Platelets (150,000-450,000/µL) assess clotting, unaffected by furosemide directly. Diuretics alter volume, not hematopoiesis, so monitoring platelets is irrelevant unless bleeding or unrelated conditions complicate the patient’s status.

Choice C reason: Chloride may drop with furosemide, but it’s less critical than creatinine. Hypochloremia affects acid-base balance, yet renal function takes priority, as kidney damage has broader, immediate implications in therapy.

Choice D reason: RBC count reflects anemia, not furosemide’s primary effects. Diuretics cause hemoconcentration if overused, but creatinine better captures renal impact, making red cell monitoring secondary in this context.

Choice A reason: Pleural effusion with chest discomfort suggests fluid buildup, causing pain but not immediate airway compromise. It’s stable compared to tracheal deviation, prioritizing respiratory distress over this less acute issue.

Choice B reason: Cor pulmonale with 4+ edema indicates chronic right heart failure, a serious but slower process. It’s less urgent than acute airway obstruction, as it’s manageable with diuretics, not an immediate threat.

Choice C reason: Tracheal deviation post-catheter insertion signals tension pneumothorax, a life-threatening emergency. It compresses airways and vessels, requiring immediate assessment and intervention to restore breathing and circulation.

Choice D reason: Fever of 101°F post-lung transplant suggests infection or rejection, critical but not airway-immediate. It’s urgent, yet tracheal deviation’s acute respiratory collapse takes precedence over this systemic concern.