A nurse in an outpatient clinic is caring for a client. Select the 4 findings that indicate the client has been consuming alcohol while taking the newly prescribed medication.

A. Headache: Disulfiram causes an aversive reaction when alcohol is consumed, leading to vasodilation and increased acetaldehyde levels. This often results in a severe, throbbing headache as one of the earliest and most common manifestations. The symptom appears quickly after alcohol intake and signals a disulfiram–alcohol interaction. B. Vomiting: Accumulation of acetaldehyde triggers gastrointestinal distress, including nausea and profuse vomiting. These symptoms occur because the body is unable to metabolize alcohol properly while on disulfiram. Vomiting is a classic indicator that alcohol was consumed after starting therapy. C. Confusion: Neurological effects such as confusion can develop during a disulfiram–alcohol reaction due to hypotension, decreased cerebral perfusion, and heightened toxin buildup. This change in mental status is especially concerning and suggests significant physiological stress after alcohol ingestion. D. Sedation: Sedation is not a typical effect of a disulfiram–alcohol reaction. It is more commonly associated with other CNS depressants or alcohol intoxication alone. Because it does not reflect the vasodilatory or metabolic effects produced by disulfiram, it is not a reliable indicator of concurrent alcohol use. E. Sweating: Sweating results from the sympathetic surge that occurs when acetaldehyde levels rise during a disulfiram–alcohol reaction. Clients may experience flushing, tachycardia, and diaphoresis as part of the acute response. This strongly supports that alcohol was consumed while taking disulfiram.