A nurse is 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?

Choice A reason: Black cohosh is an herbal supplement that is used to treat menopausal symptoms, such as hot flashes and mood swings. It does not have a significant interaction with warfarin and does not affect the coagulation status of the client.

Choice B reason: Echinacea is an herbal supplement that is used to boost the immune system and prevent or treat common colds and infections. It does not have a significant interaction with warfarin and does not affect the coagulation status of the client.

Choice C reason: Feverfew is an herbal supplement that is used to treat migraines, arthritis, and fever. It has a significant interaction with warfarin and can increase the risk of bleeding and bruising. It can also reduce the effectiveness of warfarin and alter the client's international normalized ratio (INR).

Choice D reason: Flaxseed is an herbal supplement that is used to lower cholesterol, blood pressure, and inflammation. It does not have a significant interaction with warfarin and does not affect the coagulation status of the client.

Choice A reason: Vomiting is not a specific sign of a hemolytic reaction, as it can be caused by many other factors, such as anesthesia, infection, or medication. Vomiting may occur in other types of transfusion reactions, such as allergic or febrile reactions, but it is not indicative of hemolysis.

Choice B reason: Flushing is not a specific sign of a hemolytic reaction, as it can be caused by many other factors, such as fever, infection, or medication. Flushing may occur in other types of transfusion reactions, such as allergic or febrile reactions, but it is not indicative of hemolysis.

Choice C reason: Dyspnea is often linked with transfusion-associated circulatory overload (TACO) or transfusion-related acute lung injury (TRALI). Both of these conditions primarily impact the respiratory system, leading to difficulty breathing. Although respiratory symptoms can accompany severe reactions, dyspnea is not a key feature of a hemolytic reaction.

Choice D reason: Hypotension is a significant indicator of an acute hemolytic reaction. When the recipient’s immune system attacks the donor red blood cells, widespread inflammatory and immune responses occur, leading to vascular collapse. This can manifest as sudden low blood pressure, which is life-threatening if not recognized and treated immediately. Alongside other findings such as fever, chills, flank pain, and hemoglobinuria, hypotension is a classic hallmark of hemolysis during transfusion.