A nurse is reviewing the health history for a client who has angina pectoris and a prescription for propranolol hydrochloride PO 40 mg twice daily. Which of the following findings in the history should the nurse report to the provider?
The client has a history of hypertension.
The client has a history of hypothyroidism.
The client has a history of bronchial asthma.
The client has a history of migraine headaches.
The Correct Answer is C
Choice A reason: The client has a history of hypertension is not the correct answer. Hypertension is a condition in which the blood pressure is abnormally high, usually above 140/90 mmHg. Propranolol is a beta-blocker that lowers the blood pressure and reduces the workload of the heart. Propranolol is indicated for the treatment of hypertension and angina pectoris, which is a type of chest pain caused by reduced blood flow to the heart. The nurse does not need to report this finding to the provider, as it is consistent with the prescription.
Choice B reason: The client has a history of hypothyroidism is not the correct answer. Hypothyroidism is a condition in which the thyroid gland does not produce enough thyroid hormones, which regulate the metabolism and energy levels. Propranolol can mask some of the signs of hypothyroidism, such as tachycardia, tremors, and anxiety. Propranolol can also interfere with the absorption and conversion of thyroid hormones. The nurse should monitor the client's thyroid function tests and report any abnormal values to the provider, but this finding is not a contraindication to the use of propranolol.
Choice C reason: The client has a history of bronchial asthma is the correct answer. Bronchial asthma is a chronic inflammatory disorder of the airways that causes wheezing, coughing, and shortness of breath. Propranolol is a non-selective beta-blocker that blocks the beta-1 receptors in the heart and the beta-2 receptors in the lungs. Blocking the beta-2 receptors can cause bronchoconstriction, which can worsen the symptoms of asthma and trigger an asthma attack. Propranolol is contraindicated in clients who have bronchial asthma, and the nurse should report this finding to the provider immediately.
Choice D reason: The client has a history of migraine headaches is not the correct answer. Migraine headaches are recurrent episodes of severe and throbbing pain, usually on one side of the head, that can be accompanied by nausea, vomiting, and sensitivity to light and sound. Propranolol is effective in preventing migraine headaches, as it reduces the frequency and severity of the attacks. Propranolol is indicated for the prophylaxis of migraine headaches, and the nurse does not need to report this finding to the provider, as it is consistent with the prescription.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Taking the medication in the morning is not the correct instruction. Simvastatin is a statin drug that lowers cholesterol levels by inhibiting the enzyme that produces cholesterol in the liver. The liver produces more cholesterol at night, so simvastatin is more effective when taken in the evening or at bedtime.
Choice B reason: Avoiding grapefruit juice is the correct instruction. Grapefruit juice can increase the blood levels of simvastatin and cause serious side effects such as muscle damage, liver damage, and kidney failure. Grapefruit juice inhibits the enzyme that metabolizes simvastatin in the intestine, leading to higher concentrations of the drug in the bloodstream.
Choice C reason: Monitoring for ringing in the ears is not the correct instruction. Ringing in the ears, or tinnitus, is not a common or serious side effect of simvastatin. However, some other medications that lower cholesterol, such as niacin and gemfibrozil, can cause tinnitus. The client should report any unusual or persistent symptoms to the prescriber.
Choice D reason: Expecting brown-colored urine is not the correct instruction. Brown-colored urine, or hematuria, is not a normal or expected side effect of simvastatin. However, it may indicate a serious condition such as rhabdomyolysis, which is a rare but life-threatening complication of statin therapy. Rhabdomyolysis is the breakdown of muscle tissue that releases a protein called myoglobin into the bloodstream. Myoglobin can damage the kidneys and cause brown-colored urine. The client should seek immediate medical attention if they notice any signs of rhabdomyolysis, such as muscle pain, weakness, fever, or dark urine.
Correct Answer is C
Explanation
Choice A reason: This is incorrect because extravasation is not related to the lifetime cumulative dose limit of doxorubicin, but to the leakage of the medication from the vein into the surrounding tissue. Extravasation can cause severe tissue damage and necrosis, and should be prevented by using a central venous catheter and monitoring the infusion site.
Choice B reason: This is incorrect because red tinged urine and sweat are not related to the lifetime cumulative dose limit of doxorubicin, but to the normal excretion of the medication from the body. Red tinged urine and sweat are expected side effects of doxorubicin and do not indicate toxicity or harm.
Choice C reason: This is correct because an excess amount of doxorubicin can lead to cardiomyopathy, which is a serious and potentially fatal complication of the medication. Cardiomyopathy is a condition in which the heart muscle becomes weak and unable to pump blood effectively. The risk of cardiomyopathy increases with the cumulative lifetime dose of doxorubicin, which should not exceed 450 to 550 mg/m2.
Choice D reason: This is incorrect because myelosuppression is not related to the lifetime cumulative dose limit of doxorubicin, but to the dose-dependent effect of the medication on the bone marrow. Myelosuppression is a condition in which the production of blood cells is reduced, leading to anemia, leukopenia, and thrombocytopenia. Myelosuppression can be managed by adjusting the dose and frequency of doxorubicin and monitoring the blood counts.
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