A nurse is assessing a clie”t prior to administering atenolol. Which of the following findings should prompt the nurse to withhold the medication?

A) Glaucoma:
While propranolol can exacerbate symptoms of glaucoma, it is not an absolute contraindication. However, caution is warranted in clients with glaucoma due to its potential to increase intraocular pressure.

B) Depression:
Propranolol is not contraindicated in clients with a history of depression. In fact, it is sometimes used to manage anxiety symptoms associated with certain types of depression.

C) Asthma:
Propranolol is contraindicated in clients with a history of asthma or bronchospasm because it can exacerbate bronchoconstriction and potentially precipitate an acute asthma attack.

D) Migraines:
Propranolol is often used prophylactically in clients with migraines to reduce the frequency and severity of attacks. It is not contraindicated in clients with a history of migraines."

A) Lifestyle modification, including exercise, diet, and decreased smoking and alcohol intake:
This statement is accurate. Lifestyle modifications are essential components of hypertension management and are recommended as the first step in treatment. These modifications include regular physical activity, adopting a heart-healthy diet such as the DASH (Dietary Approaches to Stop Hypertension) diet, reducing sodium intake, limiting alcohol consumption, and quitting smoking. These changes can help lower blood pressure and reduce the risk of cardiovascular events.

B) Use of diuretic, beta-blocker, or ACE inhibitor to supplement lifestyle changes:
This statement is also accurate. If lifestyle modifications alone are insufficient to achieve blood pressure control, pharmacotherapy may be initiated. The choice of antihypertensive medications depends on various factors, including the individual's comorbidities, medication tolerance, and response to treatment. Diuretics, beta-blockers, and ACE inhibitors are commonly used as first-line agents in the management of hypertension, either as monotherapy or in combination with other drugs.

C) All of the above:
This statement is correct. The stepped-care approach to hypertension management involves a combination of lifestyle modifications and pharmacotherapy. Lifestyle changes are typically recommended as the initial step, followed by the addition of antihypertensive medications if necessary to achieve target blood pressure goals. Therefore, both lifestyle modifications and pharmacological interventions are integral components of the stepped-care approach.

D) A combination of antihypertensive drug classes to achieve desired control:
While this statement is true, it does not encompass all aspects of the stepped-care approach. The use of combination therapy with multiple antihypertensive drug classes may be necessary in some cases to achieve optimal blood pressure control. However, it is only one component of the broader treatment strategy, which also includes lifestyle modifications as the foundation of therapy. Therefore, while combination therapy is important, it does not fully represent the stepped-care approach on its own.