A nurse is caring for a client who has headaches.
In determining a diagnosis, which of the following precipitating factors is common in both tension-type headaches and cluster headaches?

Choice A rationale

Tremor is not a common adverse effect of atenolol, a beta-blocker. Beta-blockers primarily work by blocking beta-adrenergic receptors, leading to decreased heart rate, blood pressure, and myocardial contractility. Tremors are often associated with other medications or neurological conditions, not typically beta-blockers.

Choice B rationale

Constipation is not a primary adverse effect of atenolol. While some cardiovascular medications can affect gastrointestinal motility, beta-blockers are not generally known to cause constipation. Gastrointestinal side effects for beta-blockers are more commonly nausea or diarrhea.

Choice C rationale

Cough is not a typical adverse effect of atenolol. While some antihypertensives, such as ACE inhibitors, are known to cause a dry cough, beta-blockers do not commonly induce this side effect. Coughing associated with beta-blockers is rare and usually indicates a different underlying issue.

Choice D rationale

Bradycardia, a slower than normal heart rate (typically below 60 beats per minute), is a common and expected adverse effect of atenolol. Atenolol is a beta-adrenergic blocker that decreases the heart's chronotropic (rate) and inotropic (contractility) effects by blocking beta-1 receptors in the myocardium, thus lowering heart rate and blood pressure.

Choice A rationale

Teaching about reasons for blood tests is generally part of patient education but is not the primary action for bacteriologic testing for tuberculosis. While blood tests like interferon-gamma release assays (IGRAs) can diagnose latent TB, sputum cultures are essential for confirming active disease and determining drug susceptibility.

Choice B rationale

Scheduling a chest X-ray is a diagnostic step for tuberculosis but does not directly address the order for bacteriologic testing. A chest X-ray can reveal pulmonary infiltrates or cavitations suggestive of TB, but definitive diagnosis of active disease and identification of the causative organism requires microbiological confirmation from sputum.

Choice C rationale

Instructing the patient to collect several separate sputum specimens today is incorrect and would not yield optimal diagnostic results. For accurate bacteriologic diagnosis of active tuberculosis, guidelines recommend collecting early morning sputum specimens on separate, consecutive days to increase the likelihood of detecting mycobacteria.

Choice D rationale

Teaching the patient about providing specimens for 3 consecutive days is the scientifically correct action. Mycobacterial shedding can be intermittent, so collecting three consecutive early morning sputum specimens maximizes the chance of isolating *Mycobacterium tuberculosis* on culture and performing acid-fast bacilli (AFB) smear microscopy, confirming active disease.