A nurse caring for a client”who has hypertension and asks the nurse about a prescription for propranolol. The nurse should inform the client that this medication is contraindicated in clients who have a history of which of the following conditions?

A) Lifestyle modification, including exercise, diet, and decreased smoking and alcohol intake:
This statement is accurate. Lifestyle modifications are essential components of hypertension management and are recommended as the first step in treatment. These modifications include regular physical activity, adopting a heart-healthy diet such as the DASH (Dietary Approaches to Stop Hypertension) diet, reducing sodium intake, limiting alcohol consumption, and quitting smoking. These changes can help lower blood pressure and reduce the risk of cardiovascular events.

B) Use of diuretic, beta-blocker, or ACE inhibitor to supplement lifestyle changes:
This statement is also accurate. If lifestyle modifications alone are insufficient to achieve blood pressure control, pharmacotherapy may be initiated. The choice of antihypertensive medications depends on various factors, including the individual's comorbidities, medication tolerance, and response to treatment. Diuretics, beta-blockers, and ACE inhibitors are commonly used as first-line agents in the management of hypertension, either as monotherapy or in combination with other drugs.

C) All of the above:
This statement is correct. The stepped-care approach to hypertension management involves a combination of lifestyle modifications and pharmacotherapy. Lifestyle changes are typically recommended as the initial step, followed by the addition of antihypertensive medications if necessary to achieve target blood pressure goals. Therefore, both lifestyle modifications and pharmacological interventions are integral components of the stepped-care approach.

D) A combination of antihypertensive drug classes to achieve desired control:
While this statement is true, it does not encompass all aspects of the stepped-care approach. The use of combination therapy with multiple antihypertensive drug classes may be necessary in some cases to achieve optimal blood pressure control. However, it is only one component of the broader treatment strategy, which also includes lifestyle modifications as the foundation of therapy. Therefore, while combination therapy is important, it does not fully represent the stepped-care approach on its own.

A) Is it caused by demyelination of the nerve fibers:
Myasthenia gravis is not primarily caused by demyelination of nerve fibers. It is characterized by dysfunction at the neuromuscular junction, specifically involving the acetylcholine receptors.

B) Is it thought to be an autoimmune disease:
This is correct. Myasthenia gravis is considered an autoimmune disorder in which the body's immune system mistakenly targets and attacks its own tissues, particularly the acetylcholine receptors at the neuromuscular junction.

C) It is associated with destruction of acetylcholine receptor sites:
This is correct. In myasthenia gravis, there is a reduction in the number of functional acetylcholine receptors due to autoimmune-mediated destruction or blocking of these receptors.

D) Once symptoms present, it has a 5-year survival rate:
This statement is inaccurate. Myasthenia gravis is a chronic condition, but survival rates are not determined by the onset of symptoms. With appropriate treatment, many individuals with myasthenia gravis can manage their symptoms effectively and have a normal life expectancy.

E) It is a chronic and progressive muscular disease:
This is correct. Myasthenia gravis is a chronic neuromuscular disorder characterized by fluctuating muscle weakness and fatigue. While it is chronic, it is not necessarily progressive in all cases, as symptoms may stabilize or improve with treatment.

F) Is it best treated with antibiotics:
Antibiotics are not the primary treatment for myasthenia gravis. Treatment typically involves medications that enhance neuromuscular transmission, such as acetylcholinesterase inhibitors or immunosuppressive drugs, along with other supportive measures.