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?

This is because digoxin inhibits the Na-K-ATPase pump on the membrane of cardiac cells, which can cause extracellular potassium levels to rise.Hypokalemia (low potassium) caused by large dosages of diuretics may result in digoxin toxicity even at low serum digoxin levels.Digoxin toxicity can cause gastrointestinal, constitutional, and/or cardiovascular symptoms, as well as ECG changes such as signs of increased automaticity and atrioventricular node blockade.

Choice B is wrong because calcium 9.2 mg/dL is within the normal range of 8.5 to 10.5 mg/dL.Hypercalcemia (high calcium) can increase sensitivity to digoxin effects and lead to toxicity even with a lower concentration of serum digoxin, but this is not the case here.

Choice C is wrong because potassium 4.8 mEq/L is within the normal range of 3.5 to 5.0 mEq/L.

Hyperkalemia (high potassium) can also increase the risk of digoxin toxicity, but this is not the case here.

Choice D is wrong because calcium 10.3 mg/dL is within the normal range of 8.5 to 10.5 mg/dL.Hypercalcemia (high calcium) can increase sensitivity to digoxin effects and lead to toxicity even with a lower concentration of serum digoxin, but this is not the case here.

Lisinopril belongs to the class of drugs calledangiotensin-converting enzyme (ACE) inhibitors.ACE inhibitors work by blocking the enzyme that converts angiotensin I to angiotensin II, a hormone that causes blood vessels to narrow and raise blood pressure.By inhibiting this enzyme, ACE inhibitors relax and widen the blood vessels, lower blood pressure, and improve blood flow to the heart and kidneys.

Choice B.Candesartan is wrong because it belongs to the class of drugs calledangiotensin II receptor blockers (ARBs).ARBs work by blocking the action of angiotensin II on its receptors, preventing it from causing blood vessel constriction and high blood pressure.ARBs are similar to ACE inhibitors in their effects, but they do not affect the enzyme or the level of bradykinin, a peptide that can cause cough and angioedema as side effects of ACE inhibitors.

Choice C.Metoprolol is wrong because it belongs to the class of drugs calledbeta blockers.Beta blockers work by blocking the effects of adrenaline and other hormones that stimulate the heart and blood vessels, causing them to beat slower and with less force.Beta blockers lower blood pressure and reduce the workload on the heart.

Choice D.Amlodipine is wrong because it belongs to the class of drugs calledcalcium channel blockers.Calcium channel blockers work by blocking the entry of calcium into the muscle cells of the heart and blood vessels, causing them to relax and dilate.Calcium channel blockers lower blood pressure and improve blood flow to the heart.

Normal ranges for blood pressure vary depending on age, gender, and other factors, but generally, a systolic blood pressure (the top number) of less than 120 mmHg and a diastolic blood pressure (the bottom number) of less than 80 mmHg are considered normal for adults.A blood pressure of 130/80 mmHg or higher is considered high and may require treatment with medication.