The practical nurse (PN) is assisting with the plan of care for a client with costochondritis who is now experiencing increased discomfort in breathing. The client receives a prescription for tramadol. What intervention should the PN include in the client's plan of care?

A. Perform a daily whisper test of the client's hearing to detect symptoms of ototoxicity: Ototoxicity is associated with certain antibiotics and loop diuretics, not tramadol. Hearing assessment is not a priority intervention for this client receiving tramadol. B. Examine the client for stomatitis and erosion of tooth enamel: Stomatitis and tooth enamel erosion are linked to chronic use of acidic medications or poor oral hygiene, not tramadol. These assessments are unrelated to the prescribed opioid therapy for pain. C. Ensure peak and trough serum levels are collected with the third medication dose: Peak and trough monitoring is relevant for medications with narrow therapeutic windows, such as aminoglycosides or anticonvulsants, not tramadol. Routine serum monitoring is unnecessary. D. Implement ongoing assessments for signs of shallow or slow breathing: Tramadol is an opioid analgesic that can cause respiratory depression. Monitoring for shallow, slow, or irregular breathing is essential to ensure client safety, especially in clients experiencing pain that may already alter normal respiratory patterns.