A client with a history of angina reports the onset of chest pain. The nurse determines that the heart rate is 104 beats/minute and the blood pressure is 138/86 mm Hg. A transdermal nitroglycerin patch was applied 30 minutes ago to the right upper chest. Which action should the nurse take?

A) Deep-fried shrimp: While deep-fried foods are generally high in fat and calories, there is no specific contraindication for clients taking phenelzine to avoid deep-fried shrimp. However, clients with hypertension may benefit from reducing their intake of high-fat foods.

B) Pan-seared catfish: Pan-seared catfish is a relatively lean protein source and does not contain ingredients known to interact with phenelzine. However, clients with hypertension may benefit from limiting their intake of high-sodium foods, such as pan-seared catfish if it is prepared with added salt.

C) Pepperoni pizza: Pepperoni pizza is a high-sodium food due to its processed meat toppings and cheese, and it may contain ingredients that interact with phenelzine. Phenelzine is a monoamine oxidase inhibitor (MAOI), and consuming foods high in tyramine, such as aged or fermented foods like pepperoni, can lead to hypertensive crisis. Therefore, the nurse should instruct the client to avoid pepperoni pizza to prevent potential interactions and exacerbation of hypertension.

D) Beef tips with gravy: While beef tips with gravy may be high in sodium depending on how it is prepared, there is no specific contraindication for clients taking phenelzine to avoid this food. However, clients with hypertension may benefit from choosing lean cuts of beef and limiting their intake of high-sodium gravies.

A) Instruct the caregiver to withhold the medication until the dosage can be decreased to ensure the client's sa’ety: Withholding the medication without consulting the healthcare provider may not be appropriate, especially if the client is experiencing improvements in cognitive function. The insomnia may be a temporary side effect that could resolve with continued use or adjustment of the dosage.

B) Notify the healthcare provider that the dosage of the medication may need to be increased to manage the client's in’omnia: Increasing the dosage of rivastigmine to manage insomnia may not be the most appropriate action. It's es’ential to assess the client further and explore other interventions before considering a dosage adjustment.

C) Advise the caregiver that the purpose of the medication is to promote sleep, so a change in medication may be needed: Rivastigmine is not typically used to promote sleep. It is a cholinesterase inhibitor used to treat cognitive symptoms associated with Alzheimer's di’ease. Therefore, advising a change in medication solely based on the client's in’omnia is not appropriate.

D) Explain to the caregiver that insomnia is a common and temporary side effect when the medication is first started: Rivastigmine and other cholinesterase inhibitors may cause insomnia, especially when therapy is initiated. Educating the caregiver about this common side effect helps manage expectations and provides reassurance that the insomnia may improve over time as the client's bo’y adjusts to the medication.