Sublingual nitroglycerin is prescribed PRN for an older adult female client with a history of chest pain. The client shows the practical nurse (PN) a plastic pill box that she purchased so the medication can always be readily available in her purse. Which action should the PN take?

Choice A reason: Taking medications with food may reduce gastric irritation but does not prevent anaphylactic reactions to penicillin, which are immune-mediated. This advice is irrelevant for avoiding future allergic responses, as it does not address the systemic hypersensitivity triggered by penicillin exposure.

Choice B reason: A medic alert bracelet is critical for a client with a penicillin anaphylaxis history, as it alerts healthcare providers to avoid penicillin, preventing potentially fatal allergic reactions. Anaphylaxis involves IgE-mediated histamine release, and re-exposure risks rapid, life-threatening symptoms, making this the most important instruction.

Choice C reason: Keeping epinephrine is useful for managing anaphylaxis but is secondary to prevention. A medic alert bracelet proactively avoids penicillin exposure, reducing the need for emergency intervention. Epinephrine treats symptoms but does not address the root cause of re-exposure risk.

Choice D reason: Taking all prescribed ampicillin is dangerous, as the client had an anaphylactic reaction, indicating a severe allergy. Continuing the drug risks recurrent, potentially fatal reactions. This choice is incorrect, as it contradicts the need to avoid the allergen entirely.

Choice A reason: Explaining the medication’s purpose is important but does not address the inappropriate bedtime dosing. Diuretics increase urination, causing nocturia and sleep disruption. Administering as scheduled without review risks client discomfort, making this choice less appropriate than verifying timing.

Choice B reason: Reviewing the prescription with the charge nurse is critical, as bedtime diuretic administration causes nocturia, disrupting sleep. Diuretics, like hydrochlorothiazide, increase urine production, and morning dosing aligns with daily activity, minimizing nighttime disturbance, ensuring safe and effective administration timing.

Choice C reason: Withholding the medication until the next day delays treatment, risking conditions like edema or hypertension. Consulting the charge nurse allows timely clarification of dosing time, ensuring therapeutic benefits without sleep disruption, making this choice overly cautious and unnecessary.

Choice D reason: Administering the diuretic early without confirmation violates protocol, as the prescription specifies bedtime. Unilateral changes risk errors, and morning dosing requires provider approval. Reviewing with the charge nurse is safer, ensuring alignment with clinical intent while addressing sleep concerns.