A client's most recent vital signs include heart rate 80 beats/minute and blood pressure 119/70 mm Hg. When the client reports dizziness after rising quickly, which finding should the nurse expect on reassessment?

A. Recommend substituting opioids with other pain medication: Simply switching to another pain medication without addressing underlying misuse behaviors may reinforce dependency. This overlooks the denial and psychological aspects of addiction.

B. Explore other coping strategies aside from using medications: This client-centered approach gently addresses the issue without direct confrontation. It encourages self-reflection, promotes healthy alternatives, and meets the client where they are in terms of readiness for change, which is essential in early recovery.

C. Provide a list of local Narcotics Anonymous meetings: Although this is useful, offering it during the first interaction with a client in denial may lead to resistance. Engagement and trust-building through conversation about alternatives are more effective initially.

D. Explain that opioid abuse poses a great risk to life: Providing factual information about risk can be helpful, but directly labeling it as abuse when the client is in denial may trigger defensiveness. It is more therapeutic to explore behaviors and build insight before confrontation.

Rationale for Correct Findings:

• Balancing periods of activity with rest: This indicates effective self-management and understanding of a key principle in managing rheumatoid arthritis. Maintaining this balance helps prevent overexertion and joint flares while preserving mobility and function.
• Client reports pain as 1 to 2 on a 0 to 10 pain scale in bilateral hands: The reduction in pain from a previous score of 3 to 1-2 indicates a positive response to treatment. Pain reduction is a key marker of progress in managing rheumatoid arthritis, especially with the initiation of methotrexate.
• She is tolerating weekly medication without side effects: Tolerating methotrexate without side effects is a positive outcome. Methotrexate is a cornerstone treatment for rheumatoid arthritis, and its ability to be well-tolerated suggests good disease control.
• The client is pleased with the improvements: The client’s satisfaction with her treatment and the improvements in her condition demonstrate effective management of her rheumatoid arthritis and a positive response to the prescribed interventions.

Rationale for Incorrect Findings:

• She has continued to garden, but crocheting is too painful: The client’s inability to crochet due to pain suggests that joint function is still limited in certain fine motor activities. This shows that while some improvement has been made, the disease still affects specific functions.
• She recently attended a large family wedding and became fatigued quickly: Fatigue is common in RA and suggests that the client’s energy levels still need better management. Overexertion could indicate a need for better pacing between rest and activity to avoid exacerbating symptoms.
• She has noticed "heartburn" about an hour after using ibuprofen for pain relief: Heartburn is a common side effect of NSAIDs like ibuprofen, which could lead to gastrointestinal irritation. This issue requires attention, as it could progress to more serious gastrointestinal complications.