A client is recovering from an episode of urinary tract calculi. During discharge teaching, the client asks about dietary restrictions. In discussing food intake, the nurse should include which type of fluid limitation?

Choice A reason: Inserting a nasogastric tube (NGT) and attaching to low intermittent suction is the priority intervention for a client with peptic ulcer disease who is vomiting and experiencing epigastric pain and nausea. This can help decompress the stomach, remove gastric contents, prevent further bleeding, and relieve the symptoms. The NGT should be inserted carefully and checked for proper placement before suctioning.

Choice B reason: Giving a prescribed analgesic for temperature above 101°F (38.3° C) is not the first intervention for a client with peptic ulcer disease who is vomiting and experiencing epigastric pain and nausea. Temperature elevation can indicate infection or inflammation, which can be treated with antibiotics or anti-inflammatory drugs. However, analgesics can have adverse effects on the gastrointestinal tract, such as irritation, ulceration, or bleeding. Analgesics should be given cautiously and after the cause of the fever is identified.

Choice C reason: Placing an indwelling urinary catheter and attaching a bedside drainage unit is not the first intervention for a client with peptic ulcer disease who is vomiting and experiencing epigastric pain and nausea. Urinary catheterization can help monitor the fluid balance, renal function, and blood loss of the client, but it is not a priority in this situation. Urinary catheterization can also pose risks of infection, trauma, or obstruction, and should be avoided unless necessary.

Choice D reason: Sending the client to x-ray for a flat plate of the abdomen is not the first intervention for a client with peptic ulcer disease who is vomiting and experiencing epigastric pain and nausea. X-ray can help diagnose the location and extent of the ulcer, perforation, or obstruction, but it is not a priority in this situation. X-ray can also expose the client to radiation, which can be harmful, and should be done only after the client is stabilized.

Choice A reason: Administering analgesics on a fixed and continuous schedule is the most important intervention that the nurse should include in this client’s plan of care, because it can provide consistent and adequate pain relief for the client with metastatic cancer, who is likely to have chronic and severe pain. The nurse should follow the principles of cancer pain management, such as using the WHO analgesic ladder, titrating the dose according to the pain intensity, and using a multimodal approach that combines opioids, non-opioids, and adjuvants.

Choice B reason: Frequently evaluating the client’s pain is an important intervention that the nurse should include in this client’s plan of care, but it is not the most important one. Evaluating the client’s pain can help the nurse to assess the effectiveness of the analgesics, identify the characteristics and causes of the pain, and adjust the pain management plan accordingly. However, evaluating the pain alone is not enough to provide pain relief, and the nurse should also implement the appropriate interventions based on the evaluation.

Choice C reason: Replacing transdermal analgesic patches every 72 hours is not a relevant intervention that the nurse should include in this client’s plan of care, because it is not applicable to the client’s situation. Transdermal analgesic patches are a form of opioid delivery that can provide long-lasting pain relief, but they are not suitable for acute or breakthrough pain, and they have a delayed onset of action. The client in this scenario is receiving IV analgesics, which have a faster onset and shorter duration of action, and are more appropriate for acute or breakthrough pain.

Choice D reason: Monitoring the client for break-through pain is an important intervention that the nurse should include in this client’s plan of care, but it is not the most important one. Break-through pain is a sudden and transient increase in pain that occurs despite the use of regular analgesics, and it can be caused by various factors, such as movement, infection, or tumor progression. The nurse should monitor the client for break-through pain and administer rescue doses of analgesics as needed. However, monitoring the client for break-through pain is not enough to prevent or treat the pain, and the nurse should also administer analgesics on a fixed and continuous schedule to maintain a steady level of pain relief.