A female client with multiple sclerosis reports having less fatigue and improved memory since she began using the herbal supplement, ginkgo biloba. Which information is most important for the nurse to include in the teaching plan for this 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: Neutropenic precautions are necessary when the WBC count is critically low, typically below the normal range. Since the client’s WBC count is now within the normal range, these precautions are no longer required.

Choice B reason: Filgrastim is designed to increase white blood cell (WBC) production in individuals with neutropenia. In this case, the client’s WBC count has increased from 2,500/mm³ (2.5 x 10⁹/L) to 5,000/mm³ (5 x 10⁹/L), reaching the lower limit of the normal reference range (5,000 to 10,000/mm³ or 5 to 10 x 10⁹/L). This indicates that the medication has achieved its desired effect, and it is appropriate to inform the client of this positive outcome.

Choice C reason:reason: Reviewing culture and sensitivity reports would be relevant if there was evidence of infection or a need to evaluate ongoing treatment for an infection. This is not indicated by the scenario provided.

Choice D reason: While assessing vital signs is generally important, there is no indication in this scenario that an acute issue requiring immediate vital sign monitoring is present.