A nurse is collecting data from a client who has hypertension and a prescription for propranolol. A history of which of the following conditions should be reported to the provider?
Depression
Glaucoma
Migraine
Heart failure
The Correct Answer is D
A. Depression: While propranolol can sometimes worsen symptoms of depression, this is not as critical as the impact on conditions like heart failure.
B. Glaucoma: Propranolol does not typically affect glaucoma; however, some beta-blockers are used to treat glaucoma.
C. Migraine: Propranolol is sometimes used to prevent migraines, so a history of migraines would not require discontinuation.
D. Heart failure: Propranolol can exacerbate heart failure by reducing myocardial contractility. Clients with heart failure require careful monitoring or an alternative medication.
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Correct Answer is D
Explanation
A. Schedule deep tissue massage with physical therapy. Massaging the area is contraindicated in cases of suspected deep vein thrombosis (DVT), as it can dislodge the clot, leading to a pulmonary embolism.
B. Monitor Homan's sign. Homan’s sign (pain in the calf upon dorsiflexion) is no longer considered a reliable or safe assessment for DVT due to the risk of dislodging a clot.
C. Obtain platelet aggregation studies. Platelet aggregation studies are not specific to diagnosing a DVT; instead, imaging is preferred.
D. Arrange for a venous duplex ultrasound. A venous duplex ultrasound is a non-invasive test that can confirm the presence of a DVT in the affected extremity.
Correct Answer is B
Explanation
A. Swelling of the lower extremity can create a wound that is difficult to heal. Swelling typically relates to venous ulcers, not arterial ulcers, which are caused by reduced blood flow.
B. Decreased blood flow to the area can cause the wound and decrease the healing. Peripheral artery disease causes decreased blood flow, leading to poor oxygenation and slow healing of arterial ulcers.
C. Lower extremity compression stockings likely caused the wound to occur. Compression stockings are used in venous insufficiency and do not cause arterial ulcers.
D. Increased blood sugar associated with the condition is likely the cause of the wound not healing. While high blood sugar can impair healing, decreased blood flow is the primary cause of arterial ulcers in PAD.