What factor would contraindicate the use of propranolol (Inderal) in a 38-year-old obese African American patient with diabetes who is being evaluated for hypertension control?

Choice A rationale
Reducing the overall contractility of the heart muscle is not the primary reason for performing Coronary Artery Bypass Surgery (CABG)4. In fact, reducing the contractility of the heart muscle could potentially decrease the heart’s ability to pump blood effectively.
Choice B rationale
Reducing plaque buildup in the carotid artery is not the primary reason for performing CABG4. While plaque buildup in the carotid artery can lead to serious conditions such as stroke, CABG is specifically performed to bypass blocked coronary arteries, not carotid arteries.
Choice C rationale
Increasing the oxygen supply to the heart muscle is the primary reason for performing CABG4. When coronary arteries become blocked or narrowed due to plaque buildup, the heart muscle may not receive enough oxygen-rich blood. CABG is performed to create a new route, or bypass, around the blocked artery, which improves blood flow and oxygen supply to the heart muscle.
Choice D rationale
Increasing the myocardial workload is not the primary reason for performing CABG4. In fact, increasing the workload of the heart could potentially exacerbate heart disease and lead to complications such as heart failure.

Choice A rationale
Education on the necessity of continuous antibiotic prophylaxis is crucial for patients who have just recovered from rheumatic fever. Rheumatic fever is an inflammatory disease that can develop as a complication of untreated or inadequately treated strep throat or scarlet fever.
Patients who have had rheumatic fever are at risk of getting it again if they have another strep infection. Continuous antibiotic prophylaxis can prevent recurrent infections and the development of rheumatic heart disease.
Choice B rationale
While anticoagulation therapy may be necessary for some patients with heart conditions, it is not typically the most important nursing action for a patient who has just recovered from rheumatic fever. Rheumatic fever can cause inflammation and damage to the heart valves, but it does not typically cause blood clots, which are the primary reason for anticoagulation therapy.
Choice C rationale
Adherence to standard infection control procedures is important for all patients, but it is not the most important nursing action for a patient who has just recovered from rheumatic fever. The primary concern for these patients is preventing recurrent strep infections, which can be achieved through continuous antibiotic prophylaxis.
Choice D rationale
While physical activity management may be part of the overall care plan for a patient who has just recovered from rheumatic fever, it is not typically the most important nursing action. The primary concern for these patients is preventing recurrent strep infections, which can be achieved through continuous antibiotic prophylaxis.