The nurse uses comfort measures to enhance an older adult's pharmacological pain management. Which of the following would be most helpful for the nurse to use to identify the relationships between the comfort measures, activity, and pharmacotherapy, and the older adult's pain level?

Choice A: Increase in physical activity

Physical activity can strengthen the muscles that help control urination. Exercises such as Kegels can specifically target these muscles, leading to improvements in urinary incontinence.

Choice B: Blood sugar control

While blood sugar control is important for overall health and can prevent complications from diabetes, it is not directly associated with improvements in urinary incontinence.

Choice C: Smoking cessation

Smoking can lead to coughing which puts pressure on the bladder and can exacerbate symptoms of urinary incontinence. Therefore, smoking cessation can lead to improvements.

Choice D: Weight reduction

Excess weight can put pressure on the bladder and surrounding muscles. Losing weight can reduce this pressure and improve symptoms of urinary incontinence.

There is no Choice E in this case. Each of these interventions can contribute to overall health and may indirectly affect urinary incontinence, but Choices A, C, and D are the most directly related to improvements in this condition.

Choice A reason: Organize the reperfusion recombinant tissue plasminogen activator (tPA) infusion is not the appropriate step, as it is a treatment for acute ischemic stroke, which has not been confirmed in this client. tPA is a clot-busting drug that can restore blood flow to the brain, but it has strict criteria and time window for its use. The nurse should not assume that the client has a stroke without further assessment and diagnosis.

Choice B reason: Determine symptom onset or when the fall occurred is not the appropriate step, as it is not the priority for this client. The nurse should first assess the client's vital signs, neurologic status, and potential injuries from the fall. The symptom onset or fall time may be relevant for the diagnosis and treatment of the underlying cause, but it is not the most urgent information to obtain.

Choice C reason: Arrange for a transfer immediately to the radiology department is not the appropriate step, as it is not the most immediate intervention for this client. The nurse should first stabilize the client's condition, perform a thorough assessment, and obtain orders from the medical provider. The radiology department may be needed for diagnostic tests, such as computed tomography (CT) scan or magnetic resonance imaging (MRI), but it is not the first destination for this client.

Choice D reason: Perform a comprehensive neurologic assessment is the appropriate step, as it can help identify the possible cause of the client's balance problem and rule out a stroke or other serious condition. A neurologic assessment includes checking the client's level of consciousness, orientation, speech, cranial nerve function, motor strength, sensory perception, coordination, and reflexes. The nurse should also monitor the client's vital signs, oxygen saturation, and blood glucose levels.