A nurse is assessing a client receiving treatment for active tuberculosis (TB). Which finding requires immediate intervention?

A. TB often presents with a persistent cough, which may be nonproductive or minimally productive. During treatment, clients may continue to experience this symptom for several weeks. While bothersome, a nonproductive cough alone does not indicate an acute complication and does not require immediate intervention. The nurse should monitor it as part of routine assessment and reinforce adherence to therapy. B. Unintentional weight loss is common in TB due to the chronic infection and metabolic effects of the disease. Some degree of weight loss may also be related to medication side effects such as nausea or decreased appetite. Although the nurse should monitor weight trends and provide nutritional support, this finding is not an emergency. Gradual weight loss is expected and can be addressed through ongoing care and patient education. C. This is a critical finding. Yellowing of the eyes indicates jaundice, which reflects elevated bilirubin levels due to liver dysfunction. TB medications—particularly isoniazid, rifampin, and pyrazinamide—are hepatotoxic and can cause liver injury. Hepatotoxicity can progress quickly and may lead to liver failure if not addressed promptly. Immediate actions include notifying the healthcare provider, holding hepatotoxic medications, assessing liver function tests, and monitoring for additional signs such as dark urine, abdominal pain, nausea, or fatigue. Early recognition and intervention are essential to prevent serious complications. D. TB cultures may remain positive in the early stages of treatment because it takes time for medications to reduce the bacterial load. A positive culture at this stage does not necessarily indicate treatment failure or an immediate risk. It requires ongoing monitoring, adherence checks, and possible evaluation of drug resistance, but it does not require the urgent intervention that hepatotoxicity does.