The nurse is caring for a group of patients. Which of the the following patients should the nurse evaluate first?

(A) Swallow the tablet whole with an 8 oz glass of water.
Sublingual nitroglycerin tablets should not be swallowed. They need to be placed under the tongue where they can dissolve and be absorbed quickly to provide rapid relief from angina.

(B) Store the medication in a pill box at the bedside.
Nitroglycerin sublingual tablets should be stored in their original container and kept tightly closed to protect them from light and moisture. Storing them in a pill box at the bedside could lead to degradation of the medication.

(C) Take the medication at the first indication of chest pain.
This is the correct instruction. Nitroglycerin sublingual tablets should be taken at the first sign of chest pain to provide prompt relief. The rapid onset of action helps to alleviate angina symptoms quickly.

(D) Remove the nitroglycerine patch before taking the sublingual tablet.
It is not necessary to remove the nitroglycerin patch before taking a sublingual tablet. The two forms of nitroglycerin can be used together, as the patch provides a continuous dose while the sublingual tablet offers rapid relief of acute symptoms.

(A) Encourage the client to increase participation in community social activities: While social activities can be beneficial for mental health, a client at the end of life may not have the physical strength or energy to participate in community social activities. Moreover, due to the compromised immune system in HIV, exposure to large groups could increase the risk of infections.

(B) Prepare the client to begin highly active antiretroviral therapy (HAART): HAART is typically initiated in the early stages of HIV infection to slow the progression of the disease. In a client who has had HIV for 10 years and is at the end of life, the focus would likely be on palliative care and symptom management rather than starting aggressive therapy.

(c) Promote client weight gain of one to two pounds per week: Weight gain might not be a realistic goal for a client at the end of life. Instead, maintaining a balanced diet to prevent malnutrition and managing symptoms like nausea and loss of appetite would be more appropriate.

(D) Provide routine analgesia to minimize episodes of breakthrough pain: This is the most appropriate intervention. Pain management is a critical aspect of end-of-life care. Providing routine analgesia can help ensure the client’s comfort and improve their quality of life. Breakthrough pain can be very distressing for the client, and managing it effectively can significantly enhance their well-being.