A nurse is caring for a client who has hypertension and asks the nurse about a prescription for propranolol (Inderal). The nurse should inform the client that this medication is contraindicated in clients who have a history of which of the following conditions?

Choice A rationale Propranolol, a nonselective beta-adrenergic blocker, is actually often used in the prophylactic treatment of migraines due to its ability to modulate vascular tone and decrease the frequency and intensity of headache episodes. It works by blocking beta-adrenergic receptors, which can prevent the excessive vasodilation and neuronal excitability associated with migraine pathophysiology. Therefore, migraines are an indication, not a contraindication, for this medication. Choice B rationale While beta-blockers like propranolol can be used to treat glaucoma by decreasing the production of aqueous humor, it is not an absolute contraindication, but rather an indication in many cases. The primary contraindication for propranolol is related to conditions where sympathetic nervous system blockade would be detrimental, such as severe respiratory or cardiac compromise. Glaucoma is not a primary contraindication. Choice C rationale Depression is considered a potential side effect or adverse reaction associated with propranolol use, particularly in susceptible individuals or with high doses, rather than an absolute contraindication. The medication's central nervous system effects are thought to contribute to mood changes. The more significant, absolute contraindications relate to severe respiratory diseases or certain types of heart block. Choice D rationale Propranolol is a nonselective beta-blocker, meaning it blocks both beta-1 receptors (primarily in the heart) and beta-2 receptors (primarily in the lungs and smooth muscle). Blocking beta-2 receptors in the bronchioles causes bronchoconstriction, which can severely worsen asthma symptoms, potentially leading to a life-threatening asthma attack. For this reason, asthma is a major and absolute contraindication for nonselective beta-blockers.