The nurse instructs a client who is receiving their first dose of tramadol. Which statement(s) by the client indicates the need for further education? Select all that apply.

A. "I will focus on drinking more water to prevent constipation.": This demonstrates understanding, as tramadol, like other opioids, can cause constipation. Adequate hydration, fiber intake, and activity help prevent this common side effect. B. "I will move quickly when changing from lying to standing.": This statement indicates the need for further education. Tramadol can cause dizziness and orthostatic hypotension, so clients should change positions slowly to prevent falls and injury. C. "If my pain does not improve, I will let someone know.": This shows appropriate understanding. Reporting insufficient pain control ensures timely evaluation and safe management, including adjustment of pain therapy. D. "After my pain is gone, I can walk to the bathroom by myself.": This requires further education. Until the client’s dizziness and sedation risk are assessed after the first dose, they should have assistance to prevent falls. E. "I will request my next dose once my pain is severe.": This statement reflects misunderstanding. Pain management is most effective when medication is taken before pain becomes severe, following prescribed dosing intervals to maintain comfort and avoid breakthrough pain.