A client who is taking an oral contraceptive receives a new prescription for erythromycin. Which instruction should the nurse provide to the client?

Choice A reason: Determining when the last dose was administered is important to ensure safe and effective pain management, but it is not the first action that the nurse should implement. The nurse should first assess the client's pain level and intensity before deciding on the appropriate dose and frequency of pain medication.

Choice B reason: Encouraging the client to use diversional thoughts to manage pain is a non-pharmacological intervention that can help reduce pain perception and anxiety, but it is not sufficient to address severe or acute pain. The nurse should first assess the client's pain level and intensity before suggesting any complementary or alternative therapies.

Choice C reason: Asking the client to rate the current level of pain using a pain scale is the first action that the nurse should implement, as it can help quantify and communicate the client's pain experience and guide the nurse's decision on pain medication. The nurse should use a valid and reliable pain scale that is appropriate for the client's age, cognitive ability, and language preference.

Choice D reason: Reviewing the history for a past use of recreational drugs is relevant to assess the client's risk of addiction or tolerance to pain medication, but it is not the first action that the nurse should implement. The nurse should first assess the client's pain level and intensity before considering any factors that may influence pain management.

Choice A reason: Holding the calcitriol but administering the calcium carbonate as scheduled is not appropriate, as both drugs can increase the serum calcium level and worsen the condition of hypercalcemia. Calcitriol is a synthetic form of vitamin D that enhances the absorption of calcium from the GI tract and promotes bone mineralization. Calcium carbonate is a supplement that provides additional calcium to the body.

Choice B reason: Holding the calcium carbonate, but administering the calcitriol as scheduled is not appropriate, as calcitriol alone can also raise the serum calcium level and cause hypercalcemia. Calcitriol is a synthetic form of vitamin D that enhances the absorption of calcium from the GI tract and promotes bone mineralization.

Choice C reason: Holding both medications until contacting the healthcare provider is the appropriate action to take, as the client's total calcium level is above the normal range of 9 to 10.5 mg/dL or 2.25 to 2.62 mmol/L and indicates hypercalcemia. Hypercalcemia can cause symptoms such as nausea, vomiting, constipation, confusion, lethargy, muscle weakness, cardiac arrhythmias, and kidney stones. The healthcare provider can adjust the dose or frequency of the medications or prescribe other treatments to lower the serum calcium level.

Choice D reason: Administering both prescribed medications as scheduled is not appropriate, as both drugs can increase the serum calcium level and worsen the condition of hypercalcemia. Calcitriol is a synthetic form of vitamin D that enhances the absorption of calcium from the GI tract and promotes bone mineralization. Calcium carbonate is a supplement that provides additional calcium to the body.