A nurse is reviewing the medical record of a client who is to undergo open heart surgery. Which of the following findings should the nurse report to the provider as a contraindication to receiving heparin?

A. Born with a high birth weight: Hearing loss is more commonly associated with low birth weight rather than high birth weight. Premature infants or those with complications like neonatal hypoxia are at a greater risk of auditory damage due to underdeveloped structures and increased vulnerability to infections.

B. Frequent exposure to low-volume noise: Prolonged exposure to loud noise, not low-volume noise, is a significant risk factor for hearing loss. High-decibel sounds can cause permanent damage to the cochlear hair cells, leading to sensorineural hearing loss, especially in occupational or recreational settings.

C. Use of a loop diuretic: Loop diuretics like furosemide can be ototoxic, especially when administered in high doses or given too rapidly through IV. They can cause reversible or permanent hearing loss by damaging the stria vascularis of the cochlea, which affects inner ear fluid balance.

D. Chronic infections of the middle ear: Recurrent otitis media can lead to chronic inflammation, scarring, or ossicle damage, resulting in conductive hearing loss. Long-term infections may also cause cholesteatoma formation, which can further impair hearing by destroying middle ear structures.

E. Perforation of the eardrum: Tympanic membrane rupture due to infections, trauma, or barotrauma can lead to conductive hearing loss by impairing sound transmission. While small perforations may heal spontaneously, larger tears might require surgical repair to restore normal hearing function.

• Anticipate client to be prepped for cardiac catheterization: Given the client's diagnosis of myocardial infarction and persistent chest pain, cardiac catheterization may be necessary for evaluating coronary artery patency and determining the need for potential interventions such as angioplasty or stenting. Prepping the client for this procedure is appropriate.
• Assist with a continuous heparin infusion: Heparin is often used in acute coronary syndrome management to prevent thrombus formation and reduce the risk of further myocardial injury. Initiating a continuous heparin infusion may be indicated following an assessment of the client’s condition and provider orders.
• Encourage the client to ambulate: While early ambulation is important for recovery and preventing complications, in the acute phase of a myocardial infarction, clients should be closely monitored and may require bed rest initially. Encouraging ambulation should only occur once the client is stable and after consulting with the healthcare provider.
• Anticipate an increased dosage of metoprolol: Metoprolol is typically administered to manage heart rate and blood pressure, but the dosage should be based on the client’s current vital signs and response to treatment. If the client’s heart rate remains elevated or if there are signs of ongoing ischemia, an increased dosage may be necessary, but this should be based on provider orders rather than an automatic assumption.
• Obtain a prescription for client to be NPO: Clients scheduled for procedures such as cardiac catheterization often require NPO status to prevent aspiration during sedation. Additionally, if the client is experiencing nausea, keeping them NPO can prevent further complications.
• Request a prescription for an antibiotic: There is no indication of an infection or a need for antibiotic therapy. Antibiotics are typically not indicated for the management of myocardial infarction unless there is a concurrent infection. Therefore, requesting an antibiotic prescription is not appropriate.