After change-of-shift report, which patient would the nurse assess first?

Choice A reason: Daily alcohol use may amplify propranolol’s CNS depression, but it’s not a contraindication. It warrants monitoring for sedation, yet hypertension treatment proceeds, as no direct physiologic conflict exists with beta-blockade.

Choice B reason: Asthma contraindicates propranolol, a non-selective beta-blocker, as it blocks β2 receptors, causing bronchoconstriction. This risks severe airway obstruction in asthmatics, prompting consultation for a cardioselective alternative like atenolol.

Choice C reason: Peptic ulcer disease isn’t affected by propranolol directly; beta-blockers don’t alter gastric acid. It’s not a contraindication, though stress-related hypertension management might consider other factors, not this drug.

Choice D reason: Post-MI, propranolol reduces myocardial demand, aiding recovery. It’s beneficial, not contraindicated, lowering reinfarction risk via β1 blockade, so no consultation is needed unless acute decompensation occurs.

Choice A reason: Restricting fluids to 2 liters per day increases blood viscosity in sickle cell disease, promoting sickling and vaso-occlusion. Adequate hydration is critical to dilute hemoglobin S, so this instruction contradicts evidence-based management for crisis prevention.

Choice B reason: Iron supplements are contraindicated in sickle cell disease unless anemia is iron-deficient, which is rare. Most patients have normal or high iron from hemolysis, so a multivitamin with iron risks overload and organ damage.

Choice C reason: Avoiding caffeine lacks evidence in sickle cell crisis prevention; it’s not a trigger. Moderate intake doesn’t dehydrate significantly or affect sickling, making this instruction irrelevant to discharge teaching for this condition.

Choice D reason: Limiting crowd exposure reduces infection risk, a common sickle cell crisis trigger. Infections cause inflammation and hypoxia, promoting sickling, so this instruction aligns with preventing complications and maintaining patient stability post-discharge.