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?

LDL cholesterol is sometimes called “bad” cholesterol because it can build up on the walls of the blood vessels and cause health problems, such as heart disease and stroke.High levels of LDL cholesterol raise your risk for cardiovascular disease. Therefore, decreasing LDL cholesterol levels can lower your risk and improve your health.

Choice A is wrong because increasing LDL cholesterol levels would have the opposite effect of decreasing them.It would increase your risk for cardiovascular disease and plaque buildup in your arteries.

Choice B is wrong because increasing HDL cholesterol levels is not enough to decrease the risk of cardiovascular disease.HDL cholesterol is sometimes called “good” cholesterol because it can move LDL cholesterol from the blood to the liver, where it is broken down and removed from the body.

However, HDL cholesterol levels alone are not a good indicator of your cardiovascular health.You also need to consider your total cholesterol, LDL cholesterol and triglyceride levels.

Choice D is wrong because decreasing HDL cholesterol levels would also increase your risk for cardiovascular disease.HDL cholesterol helps to lower LDL cholesterol levels and protect your blood vessels from plaque buildup.

Therefore, decreasing HDL cholesterol levels would reduce this protective effect and make you more vulnerable to heart disease and stroke.

The ideal ranges for cholesterol levels are as follows:

• Total cholesterol: below 200 mg/dL

• LDL cholesterol: less than 100 mg/dL

• HDL cholesterol: above 40 mg/dL for men and above 50 mg/dL for women

You can lower your LDL cholesterol levels and increase your HDL cholesterol levels by making healthy lifestyle changes, such as eating a balanced diet, exercising regularly, quitting smoking, managing stress and taking medication if prescribed by your doctor.

This is because enoxaparin is administered subcutaneously, which means under the skin, and the needle should be inserted fully into the skin to ensure proper delivery of the drug.

Choice A is wrong because aspirating (pulling back on the plunger) after inserting the needle is not recommended for subcutaneous injections of enoxaparin, as it may increase the risk of bleeding or bruising.

Choice B is wrong because administering the injection in the client’s thigh is not the preferred site for enoxaparin.The preferred site is the abdomen, at least 2 inches away from the navel, as it has more fatty tissue and less blood vessels than other areas.

Choice D is wrong because expelling the air bubble from the prefilled syringe is not necessary for enoxaparin.The air bubble helps to ensure that the entire dose of enoxaparin is injected and prevents blood from entering the syringe.

Normal ranges for enoxaparin dosage depend on the indication and the patient’s weight, but for prophylaxis of deep vein thrombosis after hip arthroplasty, the usual dose is 40 mg once a day for 3 weeks.

The prefilled syringe of enoxaparin 40 mg/0.4 ml contains the correct dose for this indication.