The nurse is caring for a patient with glaucoma. The patient is being treated with a beta-blocker, which other health condition if identified would be a contraindication of the medications?

A. Metoclopramide (Reglan): Metoclopramide is an antiemetic and prokinetic agent used to treat nausea and gastroparesis. It has no role in managing bradycardia and would not address the patient’s slow heart rate.

B. Atropine sulfate (Atropine): Atropine is an anticholinergic medication that blocks vagal stimulation of the heart, increasing heart rate. It is the drug of choice for symptomatic sinus bradycardia, especially in acute care settings, to restore adequate cardiac output.

C. Benztropine (Cogentin): Benztropine is used primarily for Parkinson’s disease and extrapyramidal symptoms. It does not have a clinically significant effect on heart rate and is not indicated for bradycardia management.

D. Bethanechol chloride (Urecholine): Bethanechol is a cholinergic agonist that stimulates bladder and gastrointestinal smooth muscle. It can actually lower heart rate rather than increase it, making it inappropriate for treating bradycardia.

A. "I will monitor my pulse rate while I am taking the medication.": Levothyroxine increases metabolic activity and can raise heart rate, so monitoring for tachycardia helps detect early signs of excess dosing. Patients can identify palpitations, irregular beats, or sustained elevations in pulse that may signal the need for dosage adjustment.

B. "I will be able to stop taking the medication when my symptoms improve.": Levothyroxine is a lifelong therapy for most patients because it replaces a hormone the thyroid can no longer produce adequately. Stopping the medication would allow hypothyroid symptoms to return and may lead to complications such as fatigue and bradycardia.

C. "I will probably gain some weight while I am taking this medication.": Levothyroxine tends to increase metabolic rate and often leads to mild weight loss rather than weight gain when dosed appropriately. Weight gain may indicate under-replacement or disease progression rather than a drug effect.

D. "I will take the medication every night at bedtime.": Levothyroxine is best taken in the morning on an empty stomach because food and other medications can interfere with its absorption. Taking it at night may expose it to variable food intake and decrease its effectiveness.