In the context of interprofessional care of the client and family, where should a nurse position the stethoscope on the chest to assess a client’s apical heart rate?

The correct answer is Choice D.

Choice A rationale: Allergies to shellfish may indicate iodine allergy, relevant for procedures using iodine-based contrast, like PCI. The client’s shellfish allergy must be reported to the PHCP as a precautionary measure to prevent any allergic reaction.

Choice B rationale: Warm sensations during PCI are a common side effect of the contrast dye used in the procedure. This statement does not indicate an immediate concern requiring PHCP notification as it is a standard patient experience.

Choice C rationale: Anxiety in closed spaces, known as claustrophobia, may affect the client's comfort during PCI but can be managed with sedatives. The PHCP should be aware but it’s not as urgent as taking contraindicated medications.

Choice D rationale: Metformin can lead to lactic acidosis, especially when iodine contrast dye is used during PCI. This condition is serious and may result in adverse interactions. The PHCP must be notified immediately.

Choice A rationale
Propranolol (Inderal) is a beta-adrenergic receptor blocker, also known as a beta-blocker. Beta-blockers can increase airway reactivity and may interfere with the activity of beta-agonists. They should be used with great caution or not at all in patients with chronic asthma.
However, beta blockers are safe for use in most patients with COPD, but less so in patients with asthma. Therefore, Propranolol (Inderal) is not recommended for patients with chronic obstructive pulmonary disease (COPD) and asthma.
Choice B rationale
Captopril (Capoten) is an ACE inhibitor, which is among the most widely used antihypertensive drugs. They are not contraindicated in asthma or COPD, but they can induce a bothersome cough that, although not damaging to the lungs, can be confused with cough due to underlying pulmonary diseases such as asthma and COPD1.
Choice C rationale
Diltiazem (Cardizem) is a calcium antagonist. There is no specific contraindication for using calcium antagonists in patients with COPD or asthma. These medications work by relaxing the muscles of your heart and blood vessels, but they do not have a direct effect on airway reactivity or lung function.
Choice D rationale
Hydrochlorothiazide (HydroDIURIL) is a diuretic. Diuretics help your body get rid of excess salt and water, primarily by stimulating your kidneys. They do not have a direct effect on airway reactivity or lung function, and there is no specific contraindication for using them in patients with COPD or asthma.