A patient who has had a previous myocardial infarction has a ...

[SAVANNAHHOOPER23]

A patient who has had a previous myocardial infarction has a blood pressure of 135/82 mm Hg. The patient's body mass index is 28, and the patient has a fasting plasma glucose of 105 mg/dL. The primary care NP should prescribe:
 
  a. an angiotensin-converting enzyme inhibitor.
  b. a thiazide diuretic.
  c. lifestyle modifications.
  d. a calcium-channel blocker.

Question 2

A patient has been using an herbal supplement for 2 years that the primary care NP knows may have toxic side effects. The NP should:
 
  a. tell the patient to stop taking the supplement immediately.
  b. inform the patient of the risks of toxic side effects with this supplement.
  c. refer the patient to a CAM provider who can manage this patient's therapy.
  d. prescribe another herbal drug that has fewer adverse effects than the one the patient is taking.

[jordangronback]

Answer to Question 1

A
This patient has prehypertension but has a compelling reason for treatment. Patients who have had a myocardial infarction should be treated with a B-blocker and angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (ARB).

Answer to Question 2

B
It is important for primary care NPs to inform patients of any known risks associated with herbal supplements. Asking the patient to stop an herbal remedy immediately when the patient has been using it for 2 years would probably be met with resistance. The NP should realize that referral to a CAM provider can incur legal liabilities if the CAM provider does not have proper competencies and licensure. Likewise, unless there is evidence-based documentation about the safety and efficacy of a product, the NP should not prescribe these therapies.

[SAVANNAHHOOPER23]

Excellent

[kswal303]

Great answer, keep it coming