A nurse is reviewing the health history of 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?

Choice A reason : Having the client floss 4 times daily is not typically recommended during chemotherapy because their gums may be more prone to bleeding due to a decrease in platelets, which is a common side effect of chemotherapy¹. Instead, gentle oral care is advised to prevent damage to the oral mucosa.

Choice B reason : Having the client swish with commercial mouthwash before therapy is not generally recommended because many commercial mouthwashes contain alcohol, which can be irritating to the mucous membranes and may exacerbate chemotherapy-induced mucositis¹. Instead, a saline rinse or a prescribed mouthwash without alcohol may be used to help manage oral hygiene during chemotherapy.

Choice C reason : Telling the client to expect dark stools following chemotherapy could be misleading. While some chemotherapy drugs can cause changes in stool color, dark stools can also indicate gastrointestinal bleeding, which requires immediate medical attention¹. Therefore, patients should be instructed to report any significant changes in stool color to their healthcare provider.

Choice D reason : Administering an antiemetic prior to the procedure is a standard practice to prevent nausea and vomiting associated with chemotherapy¹. Antiemetics are medications that can help control these common side effects, improving the patient's comfort and ability to tolerate the treatment.

Choice A reason : Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) which can be detrimental to patients with congestive heart failure (CHF). NSAIDs can lead to sodium and fluid retention, exacerbating CHF symptoms and potentially leading to a worsening of the condition⁶⁷. Therefore, it is not recommended for managing discomfort in CHF patients.

Choice B reason : Slowing down if feeling tired after exercising is a prudent measure for anyone, especially for CHF patients. It indicates the patient is listening to their body and respecting its limits, which is essential in managing CHF. Overexertion can strain an already compromised heart, so moderation and careful monitoring of physical activity are key¹².

Choice C reason : The recommended daily sodium intake for heart failure patients is generally less than 2,000 mg¹⁶¹⁷¹⁸. A limit of 4 grams per day is significantly higher than the recommended amount and could lead to fluid retention and worsening of heart failure symptoms. Therefore, this statement does not reflect effective teaching.

Choice D reason : Diuretics are often prescribed to CHF patients to manage fluid retention. However, taking diuretics before sleep can lead to nocturia, disrupting sleep due to the need to urinate at night. It is generally recommended to take diuretics earlier in the day, with the last dose no later than 4 p.m., to minimize nighttime disruptions¹³¹⁴. Drinking fluids during the day without restriction can also contribute to fluid overload, which is counterproductive in CHF management.