A nurse is reviewing the medication list for a client who has a new diagnosis of a small bowel obstruction.
The nurse should withhold which of the following medications?

This question focuses on contraindications for non-selective beta-blocker therapy. It requires understanding the physiological effect of blocking beta-2 receptors, which leads to bronchoconstriction, posing a significant, life-threatening risk for patients with underlying obstructive airway diseases, necessitating careful assessment prior to administration.

Choice A rationale

Hypertension is a primary therapeutic indication for propranolol. The medication effectively lowers blood pressure by reducing cardiac output and inhibiting renin release from the kidneys, making it a highly indicated and beneficial medication for patients suffering from hypertensive conditions.

Choice B rationale

Propranolol is a non-selective beta-blocker that antagonizes both beta-1 and beta-2 receptors. Beta-2 receptor blockade induces bronchial smooth muscle constriction, which can precipitate a severe, life-threatening bronchospasm in patients with asthma, making it a strict contraindication for this patient population.

Choice C rationale

Tachycardia is a valid indication for propranolol. By blocking beta-1 receptors in the heart, the medication slows the heart rate and decreases myocardial oxygen demand, providing therapeutic relief for patients experiencing tachyarrhythmias or excessive cardiac workload due to heart-related issues.

Choice D rationale

Angina is a standard indication for propranolol. By reducing the heart rate and the force of contraction, the medication decreases the oxygen requirements of the myocardium, which helps to alleviate chest pain and improve the overall exercise tolerance of the cardiac patient.

This question addresses safe medication administration in patients with mechanical bowel obstruction. It requires applying knowledge of gastrointestinal motility to identify agents that are strictly contraindicated, as stimulating peristalsis against a physical blockage can cause severe bowel distension, pain, or potentially life-threatening perforation.

Choice A rationale

Non-steroidal anti-inflammatory drugs like ibuprofen may cause gastric irritation or ulcers, but they do not actively stimulate intestinal peristalsis. While used with caution in some patients, they are not strictly contraindicated in the same way as motility-enhancing agents during obstruction.

Choice B rationale

Zolpidem is a hypnotic agent that works on the central nervous system to induce sleep. It does not have a pharmacological effect on intestinal motility and is not contraindicated in patients diagnosed with a small bowel obstruction during their hospital stay.

Choice C rationale

Omeprazole is a proton pump inhibitor used to decrease gastric acid secretion. It does not influence the motility of the intestinal tract and is not contraindicated in the management of a patient diagnosed with a mechanical small bowel obstruction.

Choice D rationale

Bisacodyl is a stimulant laxative that works by directly increasing peristalsis in the colon and small intestine. Administering a stimulant laxative to a patient with a mechanical bowel obstruction is contraindicated because it can cause perforation, severe pain, and emergency complications.