A nurse is caring for a client who reports an increase in migraine headaches over the past 2 weeks and asks if sumatriptan might be helpful.
Which of the following conditions from the client's medical history should the nurse recognize as a contraindication for this medication?

• conditions. The client has dyspnea, tachycardia, and low oxygen saturation, suggesting acute illness or cardiovascular instability.
• Bumetanide, a loop diuretic, is contraindicated here as it may worsen hypovolemia and electrolyte imbalance. The client’s blood pressure is high but he is already showing signs of dehydration and electrolyte abnormalities (hypokalemia). Diuretics may exacerbate hypokalemia and hypotension later.
• Labetalol is anticipated for managing the acute hypertension (BP 160/98 mm Hg), especially with the client’s tachycardia and hypertensive urgency signs. It acts by blocking alpha and beta receptors to lower blood pressure safely.
• Oxygen is anticipated because the client’s oxygen saturation is 92% on room air with dyspnea and tachypnea; supplemental oxygen will improve tissue oxygenation and reduce hypoxia.
• Midodrine is contraindicated because it raises blood pressure via alpha-1 agonism; given the client’s elevated BP, it would worsen hypertension and increase cardiovascular risk.
• Calcium gluconate is contraindicated because the client’s calcium is within normal limits (10.3 mg/dL) and giving calcium unnecessarily can cause hypercalcemia or arrhythmias.
• Potassium supplementation is anticipated as the client has hypokalemia (2.8 mEq/L) on Day 2, which can cause arrhythmias and muscle weakness, requiring prompt correction.

Choice A rationale

Androgen therapy can lead to fluid retention, which would typically cause weight gain rather than weight loss. Androgens promote anabolism and can increase muscle mass and erythrocyte production, but they also influence fluid balance by affecting renal sodium and water reabsorption.

Choice B rationale

Androgen therapy generally does not cause hypotension. In some cases, it may lead to a slight increase in blood pressure due to fluid retention and effects on the renin-angiotensin-aldosterone system. Hypotension is not a recognized common adverse effect of androgen therapy.

Choice C rationale

Androgen therapy does promote muscle hypertrophy due to its anabolic effects, increasing protein synthesis and muscle mass. However, this is generally a desired therapeutic effect, not an adverse effect requiring monitoring for cessation, especially when used for conditions like muscle wasting.

Choice D rationale

Androgens can cause fluid retention, leading to edema. This occurs due to their influence on mineralocorticoid receptors in the renal tubules, which promotes sodium and water reabsorption. Nurses should monitor for signs of fluid overload, such as peripheral or pulmonary edema, and changes in body weight.