A nurse is teaching a client who has a new prescription for transdermal nitroglycerin to treat angina pectoris. Which of the following instructions should the nurse include in the teaching?

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.

Choice A reason: Taking only one dose of nitroglycerin is not a good advice, as it may not be enough to relieve the angina pain and prevent a myocardial infarction. Nitroglycerin is a vasodilator that relaxes the blood vessels and improves the blood flow to the heart. The recommended dose is one tablet or spray under the tongue every 5 minutes for up to three doses, or until the pain is relieved. Taking only one dose may compromise the effectiveness of the medication and the safety of the client.

Choice B reason: Asking the provider to prescribe a different medication is not a necessary action, as nitroglycerin is a first-line treatment for stable angina and has proven benefits for reducing mortality and morbidity. Changing the medication may not be appropriate or feasible, as there may not be a suitable alternative that has the same efficacy and safety profile. The client should continue taking nitroglycerin as prescribed, unless the provider decides otherwise.

Choice C reason: Saying that there's nothing that can be done to relieve the headaches is not a true or helpful statement, as there are some measures that can help reduce or prevent the headaches. Headaches are a common and expected side effect of nitroglycerin, as it dilates the blood vessels in the brain and causes increased intracranial pressure. However, the headaches usually subside over time as the body adapts to the medication. The client can also take a mild analgesic, such as acetaminophen or ibuprofen, to relieve the headache, as long as it does not interact with the nitroglycerin or other medications.

Choice D reason: Trying to take a mild analgesic to relieve the headache is a reasonable and appropriate suggestion, as it can help alleviate the discomfort and improve the quality of life of the client. The client should choose an analgesic that is safe and effective, such as acetaminophen or ibuprofen, and follow the directions on the label. The client should also consult the provider or the pharmacist before taking any over-the-counter medications, as some of them may interact with nitroglycerin or other medications. The client should also avoid aspirin, as it may increase the risk of bleeding.