A nurse is caring for a client with diabetes mellitus who has fractured her arm. Which action would the nurse take first?

Choice A reason: Celecoxib, a COX-2 inhibitor, can increase bleeding risk by inhibiting platelet aggregation. Reporting signs of bleeding or bruising is critical, as it may indicate gastrointestinal or systemic bleeding, a known adverse effect. This statement shows appropriate understanding of monitoring for serious side effects.
Choice B reason: Taking celecoxib only as prescribed ensures adherence to the recommended dose and schedule, minimizing risks like gastrointestinal irritation or cardiovascular events. This statement reflects correct understanding of the importance of following medical guidance to optimize safety and efficacy.
Choice C reason: Celecoxib is typically taken once or twice daily, and it can be taken with or without food. Taking it three times daily on an empty stomach is incorrect and may increase gastrointestinal irritation, indicating a need for further education on proper dosing and administration.
Choice D reason: Monitoring urine output is relevant, as celecoxib can cause renal toxicity, leading to decreased urine output or acute kidney injury. This statement shows appropriate awareness of the need to monitor for renal side effects, which is critical for safe use.

Choice A reason: Stating that phantom limb pain “does not actually exist” dismisses the client’s experience. Phantom pain is a real neurological phenomenon where the brain perceives pain from the absent limb due to nerve endings at the stump sending signals to the cortex.
Choice B reason: While phantom limb pain is common post-amputation, stating it will “eventually go away” oversimplifies management. Pain may persist due to neuroplastic changes in the sensory cortex, requiring interventions like medications or therapy, and this response does not address immediate needs.
Choice C reason: Offering imagery is a valid pain management strategy, as it can modulate pain perception via cognitive distraction. However, it assumes the pain’s nature without assessing its characteristics, which is critical for tailoring interventions like medications or nerve blocks.
Choice D reason: Asking the client to describe phantom limb pain allows the nurse to assess its quality, intensity, and triggers. This informs targeted interventions, as phantom pain results from nerve sensitization and cortical reorganization, requiring a combination of pharmacological (e.g., gabapentin) and non-pharmacological approaches.