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: Expecting to gain weight while taking this medication is not a correct instruction, as it may discourage the client from adhering to the treatment and may worsen the hypertension. Captopril is an angiotensin-converting enzyme (ACE) inhibitor that lowers the blood pressure by preventing the formation of angiotensin II, a potent vasoconstrictor. Captopril does not cause significant weight gain, but it may cause fluid retention or edema in some cases. The nurse should advise the client to monitor the weight daily and report any sudden or excessive increase to the provider.

Choice B reason: Not using salt substitutes while taking this medication is a correct instruction, as it may prevent the risk of hyperkalemia, a potentially life-threatening condition. Captopril may increase the potassium level in the blood by reducing the secretion of aldosterone, a hormone that regulates the sodium and potassium balance. Salt substitutes may contain potassium chloride, which may further elevate the potassium level. The nurse should advise the client to avoid salt substitutes and high-potassium foods, such as bananas, oranges, or tomatoes, and to have regular blood tests to check the electrolyte levels.

Choice C reason: Counting the pulse rate before taking the medication is not a necessary instruction, as it may not reflect the effect of the medication on the blood pressure. Captopril does not affect the heart rate significantly, but it may lower the blood pressure too much, especially in the first few weeks of treatment or after a dose increase. This may cause hypotension, dizziness, or fainting. The nurse should advise the client to monitor the blood pressure regularly and report any symptoms of hypotension to the provider.

Choice D reason: Taking the medication with food is not a correct instruction, as it may reduce the absorption and effectiveness of the medication. Captopril should be taken on an empty stomach, at least one hour before or two hours after a meal, to ensure optimal bioavailability. The nurse should advise the client to take the medication at the same time every day and to avoid skipping or doubling the doses.

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.