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) The client should try to take in all of the required dietary fiber with the morning meal:
While it's beneficial for clients to consume dietary fiber with meals to promote regular bowel movements, focusing solely on the morning meal may not provide adequate fiber intake throughout the day. It's essential for clients with chronic constipation to maintain a consistent intake of dietary fiber with each meal and snack.

B) The client should drink two to three 8 oz glasses of water each day:
Hydration is important for overall bowel health, but simply drinking water may not be sufficient to alleviate chronic constipation. While increasing fluid intake can help soften stools and prevent constipation, the amount of water needed varies among individuals. It's important for clients to drink enough fluids throughout the day to maintain hydration and support gastrointestinal function.

C) The client should follow a high-fiber diet to establish bowel regularity:
This is the correct answer. Increasing dietary fiber intake is a cornerstone of managing chronic constipation. A high-fiber diet can help add bulk to stools, improve bowel motility, and establish regularity. The nurse should educate the client about incorporating fiber-rich foods such as fruits, vegetables, whole grains, and legumes into their daily diet to promote optimal bowel function.

D) The client should be taught that the goal of therapy is to have a bowel movement daily:
While having a daily bowel movement may be a reasonable goal for some individuals, it's not universally applicable to all clients with chronic constipation. Bowel habits vary among individuals, and the frequency of bowel movements needed to establish regularity depends on factors such as diet, activity level, and overall health. The focus of therapy should be on achieving comfortable and regular bowel movements rather than a specific frequency.