The nurse is caring for a client with urolithiasis who reports severe flank and abdominal pain. Which action should the nurse implement?

Choice A reason: Persistent pain after Herpes zoster suggests postherpetic neuralgia (PHN), a neuropathic condition from varicella-zoster virus damaging sensory nerves. Assessing pain intensity, location, and characteristics guides treatment with analgesics or anticonvulsants like gabapentin. This step differentiates PHN from other causes, ensuring targeted therapy to alleviate nerve pain and improve quality of life.

Choice B reason: Checking shingles vaccination status is irrelevant for current pain, as the client already had Herpes zoster. Vaccination prevents initial infection but does not treat PHN, which results from nerve damage during active infection. Pain assessment is critical to address neuropathic symptoms caused by viral-induced sensory nerve dysfunction, making this less urgent.

Choice C reason: A mental status exam evaluates cognition but is not indicated for PHN, a physiological condition from nerve damage, not a cognitive issue. Pain is neuropathic, driven by damaged sensory neurons, not psychological factors. Assessing pain directly addresses the client’s complaint, guiding treatment for nerve-related discomfort, making this action inappropriate.

Choice D reason: Teaching about phantom pain is incorrect, as phantom pain occurs post-amputation, not after shingles. PHN involves persistent nerve pain in the affected dermatome due to viral nerve damage. Misdiagnosing this could delay proper management, as pain assessment is needed to confirm PHN and initiate therapies like gabapentin, not phantom pain education.

Choice A reason: Keeping pressure on the abdomen and coughing is incorrect for diaphragmatic breathing, which enhances lung expansion, not airway clearance. Coughing is for post-drainage. The client’s incorrect technique (abdominal expansion on exhalation) requires correction, as this reverses mechanics, reducing ventilation efficiency in conditions like COPD.

Choice B reason: The client’s technique is incorrect, expanding the abdomen on exhalation, not inhalation, reducing diaphragmatic efficacy. Confirming it as correct is wrong, as it impairs lung expansion. Demonstrating proper technique corrects the error, ensuring effective breathing to improve oxygenation, addressing the physiological need for ventilation.

Choice C reason: Documenting success is inaccurate, as the client’s technique is reversed, expanding the abdomen on exhalation. Diaphragmatic breathing requires inhalation expansion to lower the diaphragm, increasing lung capacity. Correcting the technique via demonstration ensures proper mechanics, not documenting an ineffective method that hinders ventilation.

Choice D reason: Demonstrating proper diaphragmatic breathing corrects the client’s error of exhalation expansion. Inhaling expands the abdomen via diaphragmatic descent, increasing tidal volume; exhaling relaxes it. This optimizes ventilation, addressing the need for effective breathing in conditions requiring enhanced lung function, ensuring the client learns the correct technique.