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: Blurred vision is not a common or serious side effect of simvastatin, as it does not affect the eyes or the vision. Blurred vision may be caused by other factors, such as diabetes, hypertension, or eye disorders.

Choice B reason: Orthostatic hypotension is not a common or serious side effect of simvastatin, as it does not affect the blood pressure or the vascular tone. Orthostatic hypotension may be caused by other factors, such as dehydration, anemia, or medication interactions.

Choice C reason: Urinary retention is not a common or serious side effect of simvastatin, as it does not affect the urinary tract or the bladder function. Urinary retention may be caused by other factors, such as prostate enlargement, infection, or nerve damage.

Choice D reason: Muscle weakness is a common and serious side effect of simvastatin, as it can indicate muscle damage or rhabdomyolysis. Rhabdomyolysis is a life-threatening condition that causes the breakdown of muscle tissue and the release of myoglobin into the bloodstream, which can lead to kidney failure. Muscle weakness may be accompanied by muscle pain, tenderness, or dark urine. The nurse should monitor the client's creatine kinase (CK) levels and report any signs of muscle damage to the provider.

Choice A reason: Distended neck veins is not a manifestation of acute hemolytic reaction, but it may indicate fluid overload, which is another possible complication of blood transfusion. Fluid overload may occur when the blood volume or rate of infusion exceeds the client's circulatory capacity. Fluid overload may manifest as dyspnea, crackles, edema, hypertension, or tachycardia.

Choice B reason: Client report of low back pain is a manifestation of acute hemolytic reaction, which is a life-threatening condition that occurs when the donor blood is incompatible with the recipient's blood. Acute hemolytic reaction may occur within minutes or hours of the transfusion and may cause the destruction of the transfused red blood cells. Acute hemolytic reaction may manifest as fever, chills, low back pain, hemoglobinuria, hypotension, or shock.

Choice C reason: A productive cough is not a manifestation of acute hemolytic reaction, but it may indicate a respiratory infection, which is a potential risk of blood transfusion. Blood transfusion may transmit infectious agents, such as bacteria, viruses, or parasites, from the donor to the recipient. A productive cough may also be a sign of pulmonary edema, which may result from fluid overload or transfusion-related acute lung injury (TRALI).

Choice D reason: Client report of tinnitus is not a manifestation of acute hemolytic reaction, but it may indicate ototoxicity, which is a possible adverse effect of some medications, such as aminoglycosides, loop diuretics, or salicylates. Ototoxicity may damage the inner ear or the auditory nerve and cause hearing loss, tinnitus, or vertigo. The nurse should assess the client's medication history and monitor the client's hearing function.