After a change-of-shift report, the nurse needs to prioritize care for four clients. Who should the nurse attend to first?

Choice A rationale

Diltiazem is a calcium channel blocker used to treat high blood pressure and prevent chest pain (angina). It works by relaxing the blood vessels so the heart does not have to pump as hard. It also increases the supply of blood and oxygen to the heart. The sustained-release tablets are designed to release the medication slowly in the body. Therefore, patients are advised to consume the medication in its entirety. Crushing, chewing, or breaking the tablet would cause too much of the drug to be released at one time.

Choice B rationale

While it’s generally a good idea to store medications in a cool, dry place, specific storage instructions for diltiazem sustained-release tablets are not typically emphasized. The focus is more on the method of consumption.

Choice C rationale

Grapefruit and grapefruit juice may interact with diltiazem and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor. Therefore, it’s not advisable to accompany the medication with grapefruit juice.

Choice D rationale

Diltiazem can be taken with or without food. If it upsets the patient’s stomach, it can be taken with food. However, it’s not a mandatory instruction that the medication must be administered during meals.

Choice A rationale

Intermittent abdominal pain is not typically associated with total parenteral nutrition (TPN) or burn injuries.

Choice B rationale

Increased serum glucose levels can occur with TPN due to the high glucose content of the solution. This should be monitored closely, especially in patients with burns, who may have altered glucose metabolism.

Choice C rationale

Absent bowel sounds are not typically associated with TPN or burn injuries.

Choice D rationale

Decreased calcium levels are not typically associated with TPN or burn injuries.