A nurse is reviewing the health record of a client who asks about using propranolol to treat hypertension.
The nurse should recognize which of the following conditions is a contraindication for taking propranolol?

Nitroglycerin transdermal patches are used to prevent episodes of angina (chest pain) in people who have coronary artery disease (narrowing of the blood vessels that supply blood to the heart).Nitroglycerin is a vasodilator that works by relaxing the blood vessels so that the heart does not need to work as hard and therefore does not need as much oxygen.However, if nitroglycerin is used continuously, the body may develop tolerance to its effects, meaning that it will not work as well to prevent angina attacks.Therefore, it is important to remove the patch at bedtime and apply a new one in the morning, leaving a 10-12 hour nitrate-free interval.This way, the body can restore its sensitivity to nitroglycerin and avoid angina episodes during the day.

Choice A is wrong because allergic response is not a common reason to remove the patch at night.Although some people may experience skin irritation or rash from the patch, this is usually mild and does not require discontinuation of the medication.If the skin reaction is severe or bothersome, the patch can be applied to a different area of the skin or switched to another form of nitroglycerin.

Choice C is wrong because overdose is unlikely to occur from using the patch as prescribed.Nitroglycerin patches come in doses ranging from 0.1 milligrams per hour to 0.8 mg/hr, and should be placed on clean, dry, and hairless skin for 12-14 hours and removed for 10-12 hours.If a patch loosens or falls off, it should be replaced with a fresh one.Overdose symptoms may include severe headache, dizziness, blurred vision, nausea, vomiting, sweating, chest pain, fast or irregular heartbeat, difficulty breathing, fainting, or seizures.If these occur, the patch should be removed immediately and medical attention should be sought.

Choice D is wrong because management of BPH (benign prostatic hyperplasia) is not related to nitroglycerin use.

BPH is a condition

According to the International Society of Hypertension, lifestyle interventions are recommended for three to six months before medication in patients with grade 1 hypertension (BP < 160/100 mm Hg) and no comorbidities.Diet and exercise can lower BP by reducing weight, sodium intake, alcohol consumption, and stress levels.

Choice A is wrong because angiotensin-converting enzyme (ACE) inhibitors are not the first-line medication for hypertension in the general population.They are preferred in patients with diabetes, chronic kidney disease, or heart failure.

Choice B is wrong because combination diuretics are not the initial recommendation for hypertension.They are used when monotherapy is not sufficient to achieve the target BP or when there is fluid retention.

Choice C is wrong because beta-adrenergic blocking agents are not the first-line medication for hypertension in the general population.They are preferred in patients with ischemic heart disease, heart failure, or arrhythmias.