A nurse is discussing with a client who knows someone taking metoprolol for blood pressure management. The client inquires whether metoprolol would be suitable for her as well. Based on the client's medical record, which of the following should the nurse recognize as a contraindication to metoprolol?

Choice A reason: Walking is a highly beneficial activity for individuals with peripheral vascular disease (PVD). It helps improve circulation, which can be compromised in PVD due to narrowed or blocked blood vessels. Regular walking can lead to the development of collateral circulation, which is the formation of new blood vessels that bypass the blockages and improve blood flow to the affected areas. This can help alleviate symptoms such as pain and cramping during walking, known as claudication. Walking should be done at a pace that is comfortable and should be stopped if pain occurs. Over time, walking can increase the distance a person with PVD can walk without pain.

Choice B reason: Compression stockings are often recommended for individuals with PVD to help improve blood flow. Knee-length stockings exert pressure on the lower legs, helping to reduce edema and discomfort associated with PVD. They can also help prevent deep vein thrombosis, a potential complication of PVD.

Choice C reason: Elevating the legs can help reduce swelling and improve venous return in clients with PVD. It is recommended to elevate the legs above the level of the heart to maximize the effect. This can be done by placing pillows under the legs while lying down.

Choice D reason: Shopping for shoes in the morning is advised because feet can swell throughout the day, especially in clients with PVD. Fitting shoes in the morning can help ensure a more accurate fit, reducing the risk of pressure points that could lead to skin breakdown and ulcers.

Choice A reason : Thickened toenails are often associated with fungal infections and are not a direct symptom of venous insufficiency. However, they can appear in patients with chronic venous insufficiency due to poor circulation that affects the health of the toenails.

Choice B reason : Shiny, thin skin on the lower extremities is more characteristic of arterial insufficiency, where there is a reduction in blood flow and oxygen to the tissues. In venous insufficiency, the skin may instead appear thickened and discolored due to stasis and buildup of hemosiderin from the breakdown of red blood cells.

Choice C reason : A dusky, red color of the feet when dangling can be a sign of dependent rubor, which is associated with arterial insufficiency. This occurs when there is a severe decrease in arterial blood flow to the lower extremities. Venous insufficiency may cause a different color change, typically a brownish discoloration due to hemosiderin deposition.

Choice D reason : Pitting edema is a hallmark sign of venous insufficiency. It occurs due to the accumulation of fluid in the tissues, which is a result of increased pressure in the veins. This pressure causes fluid to leak into the surrounding tissues, leading to swelling that retains an indentation when pressed.