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) Milk:
Milk is not known to interact significantly with verapamil. Therefore, there's no need for the client to avoid consuming milk while taking this medication.

B) Orange juice:
Orange juice does not typically interact with verapamil. However, calcium-containing foods and beverages, including orange juice, may reduce the absorption of verapamil when taken simultaneously. While the interaction is not severe, it's advisable for clients to separate the administration of verapamil from calcium-rich foods and beverages to optimize absorption.

C) Grapefruit juice:
This is the correct answer. Grapefruit juice contains compounds that inhibit the activity of cytochrome P450 enzymes, particularly CYP3A4, which are involved in the metabolism of many medications, including verapamil. Consuming grapefruit juice while taking verapamil can lead to elevated blood levels of the medication, increasing the risk of side effects and toxicity. Therefore, clients should avoid grapefruit juice while on verapamil therapy.

D) Coffee:
Coffee does not typically interact with verapamil. However, caffeine-containing beverages like coffee may exacerbate certain side effects of verapamil, such as dizziness or palpitations, due to their stimulant effects. Clients may be advised to limit caffeine intake or consume coffee in moderation while taking verapamil.

A) Postoperative patients:
Antitussives may be used postoperatively to alleviate coughing, but they are not necessarily best used in this population. Postoperative patients may have different needs based on their surgical procedure and overall health status.

B) Asthma patients:
Antitussives are generally not recommended for asthma patients because they can suppress the cough reflex, which may be important for clearing mucus and irritants from the airways. Asthma patients often have productive coughs associated with bronchial inflammation and excess mucus production.

C) Patients with a dry, irritating cough:
Antitussives are most effective for patients with a dry, irritating cough, as they help suppress the cough reflex and provide relief from coughing without producing sputum.

D) COPD patients who tire easily:
While antitussives may provide symptomatic relief for some COPD patients with a dry, nonproductive cough, they are not necessarily best used in this population. COPD patients may have varied responses to antitussive therapy, and treatment decisions should be individualized based on their overall condition and symptoms."