A nurse is receiving a client who is immediately postoperative following hip arthroplasty. Which of the following medications should the nurse plan to administer for DVT prophylaxis?

Choice A reason: Bleeding gums is a possible adverse effect of taking gingko biloba, as it may increase the risk of bleeding by inhibiting platelet aggregation and interfering with clotting factors. Gingko biloba may also interact with other medications that affect bleeding, such as anticoagulants, antiplatelets, or NSAIDs. The nurse should advise the client to monitor for signs of bleeding, such as bruising, nosebleeds, or hematuria, and report them to the provider.

Choice B reason: Decreased alertness is not a likely adverse effect of taking gingko biloba, as it may have the opposite effect of enhancing cognitive function and memory. Gingko biloba may improve blood flow to the brain and protect against oxidative stress and neuronal damage. The nurse should inform the client that gingko biloba may take several weeks to show its benefits and that the evidence for its effectiveness is inconclusive.

Choice C reason: Breast enlargement is not a known adverse effect of taking gingko biloba, as it does not affect the hormonal levels or the breast tissue. Gingko biloba may have some estrogenic activity, but it is not significant enough to cause gynecomastia or breast tenderness. The nurse should assess the client for other possible causes of breast enlargement, such as medications, liver disease, or tumors.

Choice D reason: Bad breath is not a common adverse effect of taking gingko biloba, as it does not affect the oral hygiene or the digestive system. Gingko biloba may have a mild odor, but it is not unpleasant or persistent. The nurse should advise the client to maintain good oral care and to check for other possible causes of bad breath, such as infections, dental problems, or dietary factors.

Choice A reason: The client has a history of hypertension is not the correct answer. Hypertension is a condition in which the blood pressure is abnormally high, usually above 140/90 mmHg. Propranolol is a beta-blocker that lowers the blood pressure and reduces the workload of the heart. Propranolol is indicated for the treatment of hypertension and angina pectoris, which is a type of chest pain caused by reduced blood flow to the heart. The nurse does not need to report this finding to the provider, as it is consistent with the prescription.

Choice B reason: The client has a history of hypothyroidism is not the correct answer. Hypothyroidism is a condition in which the thyroid gland does not produce enough thyroid hormones, which regulate the metabolism and energy levels. Propranolol can mask some of the signs of hypothyroidism, such as tachycardia, tremors, and anxiety. Propranolol can also interfere with the absorption and conversion of thyroid hormones. The nurse should monitor the client's thyroid function tests and report any abnormal values to the provider, but this finding is not a contraindication to the use of propranolol.

Choice C reason: The client has a history of bronchial asthma is the correct answer. Bronchial asthma is a chronic inflammatory disorder of the airways that causes wheezing, coughing, and shortness of breath. Propranolol is a non-selective beta-blocker that blocks the beta-1 receptors in the heart and the beta-2 receptors in the lungs. Blocking the beta-2 receptors can cause bronchoconstriction, which can worsen the symptoms of asthma and trigger an asthma attack. Propranolol is contraindicated in clients who have bronchial asthma, and the nurse should report this finding to the provider immediately.

Choice D reason: The client has a history of migraine headaches is not the correct answer. Migraine headaches are recurrent episodes of severe and throbbing pain, usually on one side of the head, that can be accompanied by nausea, vomiting, and sensitivity to light and sound. Propranolol is effective in preventing migraine headaches, as it reduces the frequency and severity of the attacks. Propranolol is indicated for the prophylaxis of migraine headaches, and the nurse does not need to report this finding to the provider, as it is consistent with the prescription.