Propranolol (Inderal) is newly prescribed for a patient diagnosed with hypertension. Which information in the patient’s history would prompt the nurse to consult with the health care provider before giving this drug?

Choice A reason: Pneumonia causes cough, chest pain, and dyspnea, not facial pain or nasal drainage primarily. Fever fits, but symptom location (lungs vs. sinuses) rules it out for these presenting complaints.

Choice B reason: Acute sinusitis matches pain over nose/eyes/forehead, purulent drainage, fever, and malaise. Bacterial or viral inflammation of sinuses causes these classic signs, aligning perfectly with the patient’s symptoms.

Choice C reason: Tuberculosis involves chronic cough, weight loss, and night sweats, not acute facial pain or drainage. It’s a lung infection, lacking sinus-specific symptoms, making it an unlikely diagnosis here.

Choice D reason: Pharyngitis causes throat pain, not sinus-area pain or nasal drainage. Fever and malaise fit, but the location and purulence point to sinusitis, not a pharyngeal infection, in this case.

Choice A reason: Ambulation in sickle cell crisis risks worsening pain and ischemia from exertion. Rest preserves oxygen, as sickle hemoglobin clogs vessels; encouraging movement contradicts physiology, delaying recovery in acute vaso-occlusion.

Choice B reason: Opioids relieve severe pain in sickle cell crisis from vaso-occlusion. Evaluating their effect ensures adequate control, as pain signals ongoing tissue hypoxia, guiding dose adjustments for comfort and healing.

Choice C reason: High-protein, high-calorie diets support chronic sickle cell needs, not acute crisis. Teaching this now is secondary, as pain and hydration take priority over nutrition education during active vaso-occlusive events.

Choice D reason: Limiting fluids worsens sickle cell crisis by increasing blood viscosity, promoting sickling. Hydration (IV/oral) dilutes hemoglobin S, improving flow, so restriction contradicts evidence-based crisis management principles.