A client who is experiencing chest pain and an ST elevation in leads II, III, and aVF is receiving an infusion of tissue plasminogen activator (tPA). Which assessment finding warrants immediate intervention by the nurse?

A. Bleeding from needle puncture sites: Minor bleeding is a common and expected side effect of tPA therapy. Although it should be monitored closely, it is not as urgent as signs of potential internal or cerebral bleeding, which require immediate action. B. T wave inversion in leads II, III, aVF: T wave inversion may occur during the evolution of a myocardial infarction and after reperfusion. While it reflects changes in myocardial repolarization, it is not as critical as neurological changes. C. Change in level of consciousness: A sudden change in LOC may indicate intracranial hemorrhage, the most severe and life-threatening complication of thrombolytic therapy. This finding requires immediate cessation of the tPA infusion and emergency evaluation. D. Multifocal premature ventricular contractions (PVCs): Multifocal PVCs suggest ventricular irritability and require monitoring, especially post-MI. However, they are less urgent than neurological symptoms that could signal a catastrophic bleeding.