A hospitalized patient has a blood pressure of 145/96 mm Hg. The ...

[PhilipSeeMore]

A hospitalized patient has a blood pressure of 145/96 mm Hg. The nurse caring for this patient notes that the blood pressure the day before was 132/98 mm Hg.
 
  The patient reports ambulatory blood pressure readings of 136/98 and 138/92 mm Hg. The patient has a history of a previous myocardial infarction and has adopted a lifestyle that includes use of the DASH diet and regular exercise. What will the nurse do?
  a. Notify the provider and discuss ordering a beta blocker for this patient.
  b. Notify the provider and suggest a thiazide diuretic as initial therapy.
  c. Order a diet low in sodium and high in potassium for this patient.
  d. Recheck the patient's blood pressure in 4 hours to verify the result.

Question 2

A patient with a recent onset of nephrosclerosis has been taking an ACE inhibitor and a thiazide diuretic.
 
  The patient's initial blood pressure was 148/100 mm Hg. After 1 month of drug therapy, the patient's blood pressure is 130/90 mm Hg. The nurse will contact the provider to discuss:
  a. adding a calcium channel blocker to this patient's drug regimen.
  b. lowering doses of the antihypertensive medications.
  c. ordering a high potassium diet.
  d. adding spironolactone to the drug regimen.

[nikmaaacs]

Answer to Question 1

ANS: A
Initial drug selection is determined by the presence or absence of a compelling indication or comorbid condition. This patient has a history of MI; beta blockers are indicated for patients with pre-existing heart disease. Thiazide diuretics are first-line drugs of choice in patients without compelling indications. The patient is already consuming a DASH diet; closer monitoring of sodium or potassium will not help lower blood pressure. The patient has a record of hypertension, so it is unnecessary to recheck the blood pressure to verify the condition.

Answer to Question 2

ANS: A
In patients with renal disease, the goal of antihypertensive therapy is to lower the blood pressure to 130/80 mm Hg or less. Adding a third medication is often indicated. Lowering the dose of the medications is not indicated because the patient's blood pressure is not in the target range. Adding potassium to the diet and using a potassium-sparing diuretic are contraindicated.

[PhilipSeeMore]

TY

[nikmaaacs]

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