A client who uses transdermal contraceptive, calls to the clinic because she forgot to apply a new patch three days ago. Which instruction should the nurse provide to the client?

A. Apply the new patch today and use a backup method for 7 days: If a transdermal contraceptive patch is forgotten for more than 48 hours, a new patch should be applied immediately, and a backup method such as condoms should be used for the next 7 days to ensure protection against pregnancy due to the interruption in hormone delivery.

B. Wait until Sunday to apply the new patch and use the same site: Waiting until Sunday would leave the client unprotected for several more days, increasing the risk of pregnancy. Immediate action is needed rather than delaying application based on the day of the week.

C. If a pregnancy test is negative, apply the next patch immediately: While pregnancy testing may be warranted if a patch has been missed for a long period, the priority is to re-establish hormonal contraception immediately. Delaying application for testing first is not appropriate in this acute situation.

D. Wait until the last day of your next menstrual period to apply the patch: Delaying application until after the next menstrual period would leave the client unprotected and vulnerable to unintended pregnancy for an extended time, making this instruction inappropriate.

A. Observe the client for the presence of pain behaviors before the next analgesic dose is due: In a nonverbal client, observing for pain behaviors such as grimacing, restlessness, moaning, or changes in vital signs is crucial. If these behaviors increase before the next scheduled dose, it may suggest that the current analgesic regimen is becoming less effective, indicating tolerance.

B. Review the client's laboratory values for a change in the peak and trough levels of the analgesic: Peak and trough levels are useful for monitoring therapeutic ranges for certain medications but are not reliable indicators of analgesic tolerance. Tolerance is a clinical observation based on pain behavior, not solely on drug concentration measurements.

C. Prolong the interval between analgesic medication doses and monitor the client's vital signs: Extending the interval between doses risks undertreating the client’s pain and causing unnecessary suffering. Tolerance assessment should focus on evaluating pain control, not withholding medication to observe physiological responses.

D. Ask family members to report behaviors suggesting that the client's pain has returned: While family members can provide valuable insight, their observations should supplement, not replace, the nurse's direct clinical assessment. Family members may miss subtle signs of pain or misinterpret behaviors unrelated to pain.