A nurse is reviewing the health record of a client who asks about using propranolol to treat hypertension.
The nurse should recognize which of the following conditions is a contraindication for taking propranolol?

Exposure to cold temperatures should be avoided by the patient with peripheral vascular disease such as Raynaud’s disease.

This is because cold temperatures can trigger vasospasm, which is a sudden narrowing of the small arteries in the fingers or toes, limiting blood flow and causing pain, numbness and color changes.

Choice A is wrong because wearing warm mitten gloves can help prevent or reduce the severity of Raynaud’s attacks by keeping the hands warm.

Choice B is wrong because wearing socks can also help protect the feet from cold exposure and prevent or reduce Raynaud’s attacks.

Choice D is wrong because engaging in regular exercise can improve blood circulation and reduce the frequency and duration of Raynaud’s attacks.However, exercise should be done with caution and proper clothing to avoid injury or frostbite to the affected areas.

Normal ranges for peripheral vascular disease are not applicable, as it is a condition that affects the blood vessels and not a specific blood test or measurement.

However, some tests that can help diagnose peripheral vascular disease or its underlying causes are blood pressure measurement, ankle-brachial index, Doppler ultrasound, angiography, blood tests for cholesterol, glucose, clotting factors and inflammatory markers.

The correct answer is Choice D: Headache.

Choice A rationale: Nausea is not a common adverse effect of sublingual nitroglycerin. Nausea may occur in some patients, but it is usually mild and transient.Nausea may be related to the vasodilatory effects of nitroglycerin, which can cause hypotension and reflex tachycardia1. Nausea may also be caused by other factors, such as anxiety, stress, or food intolerance.Nausea is not a specific indicator of nitroglycerin toxicity or overdose2.

Choice B rationale: Bradycardia is not a common adverse effect of sublingual nitroglycerin. Bradycardia is a slow heart rate, usually defined as less than 60 beats per minute.Bradycardia may occur in some patients who take nitroglycerin, especially in combination with other drugs that affect the heart rate, such as beta-blockers, calcium channel blockers, or digoxin3. Bradycardia may also be caused by other factors, such as vagal stimulation, hypothyroidism, or electrolyte imbalance.Bradycardia is not a specific indicator of nitroglycerin toxicity or overdose2.

Choice C rationale: Hypertension is not a common adverse effect of sublingual nitroglycerin. Hypertension is a high blood pressure, usually defined as more than 140/90 mmHg.Hypertension may occur in some patients who take nitroglycerin, especially in those who have a history of hypertension, renal impairment, or volume overload4. Hypertension may also be caused by other factors, such as stress, pain, or caffeine intake.Hypertension is not a specific indicator of nitroglycerin toxicity or overdose2.

Choice D rationale: Headache is a common adverse effect of sublingual nitroglycerin.Headache may occur in up to 80% of patients who take nitroglycerin, especially during the first few days of therapy or after an increase in dose5. Headache may be related to the vasodilatory effects of nitroglycerin, which can cause cerebral vasodilation and increased intracranial pressure. Headache may also be caused by other factors, such as dehydration, sinusitis, or migraine. Headache is usually mild to moderate in intensity and can be relieved by analgesics, such as acetaminophen or aspirin.Headache is not a specific indicator of nitroglycerin toxicity or overdose