Which nursing action is contraindicated in a client with myxedema coma?

In the context of a client with myxedema coma, verifying the apical heart rate before administering propranolol is contraindicated due to the potential risks associated with this medication in a severely hypothyroid patient. Myxedema coma represents a life-threatening state of severely decreased metabolism, and administering propranolol— a non-selective beta-blocker— can exacerbate bradycardia and further reduce heart rate and cardiac output in these patients, possibly leading to cardiovascular collapse.

In contrast, other nursing actions, such as observing for signs of infection, administering stool softeners, and applying telemetry leads for monitoring, are not contraindicated and are appropriate. Monitoring for infection is critical because individuals in this state may have impaired immune responses. Administering stool softeners can help manage constipation, which is common in hypothyroid states. Applying telemetry leads is necessary for cardiac monitoring, as patients can experience significant heart rhythm disturbances due to their hormonal imbalance. Thus, these actions support the overall management of a client with myxedema coma, emphasizing the importance of careful assessment and intervention.