After administering oral doses of calcitriol and calcium carbonate to a client with hypoparathyroidism, the nurse notes that the client's total calcium level is 14 mg/dL (3.5 mmol/L). Which action should the nurse implement?

Choice A reason: This is not the first action for the nurse to implement. Determining when the last dose was administered is important to prevent overdose and adverse effects of pain medication, but it is not the most immediate intervention. The nurse should first assess the client's pain level and intensity using a pain scale, such as a numeric or a visual analog scale, to determine the appropriate dose and frequency of pain medication.

Choice B reason: This is not the first action for the nurse to implement. Encouraging the client to use diversional thoughts to manage pain is a nonpharmacological strategy that may help reduce the perception of pain and enhance coping, but it is not the most effective intervention. The nurse should first assess the client's pain level and intensity using a pain scale, and then provide pharmacological and nonpharmacological interventions as needed.

Choice C reason: This is not the first action for the nurse to implement. Reviewing the history for a past use of recreational drugs is relevant to identify the risk of addiction, tolerance, or withdrawal from pain medication, but it is not the most urgent intervention. The nurse should first assess the client's pain level and intensity using a pain scale, and then consider the client's history and preferences when selecting the type and dose of pain medication.

Choice D reason: This is the first action for the nurse to implement. Asking the client to rate the current level of pain using a pain scale is the most appropriate and accurate way to assess the client's pain and its impact on the client's recovery and quality of life. The nurse should use a pain scale that is suitable for the client's age, cognitive ability, and language, and ask the client to rate the pain at rest and with movement. The nurse should also ask the client about the location, quality, duration, and aggravating or relieving factors of the pain. The nurse should use the pain assessment as the basis for planning and implementing pharmacological and nonpharmacological interventions for pain management.

Choice A reason: This is not an appropriate action for the nurse to take. Increasing the intake of saturated fats will worsen the side effects of orlistat, which inhibits the absorption of fats in the intestine. The client should be advised to follow a low-fat diet while taking orlistat.

Choice B reason: This is not an appropriate action for the nurse to take. Oily stools and flatus are common and expected side effects of orlistat, and they do not indicate a serious adverse reaction. The client does not need to stop taking the drug or contact her healthcare provider unless the symptoms are severe or persistent.

Choice C reason: This is not an appropriate action for the nurse to take. Obtaining a stool specimen to evaluate for occult blood and fat content is not necessary for a client taking orlistat. The presence of fat in the stool is normal and expected with orlistat, and there is no evidence of bleeding in the client's case.

Choice D reason: This is the appropriate action for the nurse to take. Asking the client to describe her dietary intake history for the last several days will help the nurse assess the client's compliance with the recommended low-fat diet and provide education and counseling as needed. The nurse can also monitor the client's weight loss progress and adjust the dosage of orlistat accordingly.