A 55-year-old patient with no prior history of hypertension has a ...

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A 55-year-old patient with no prior history of hypertension has a blood pressure greater than 140/90 on three separate occasions. The patient does not smoke, has a body mass index of 24, and exercises regularly.
 
  The patient has no known risk factors for cardiovascular disease. The primary care NP should: a. prescribe a thiazide diuretic and an angiotensin-converting enzyme inhibitor.
  b. perform a careful cardiovascular physical assessment.
  c. counsel the patient about dietary and lifestyle changes.
  d. order a urinalysis and creatinine clearance and begin therapy with a b-blocker.

Question 2

A patient with chronic back pain that is unrelieved by prescription analgesic medications asks a primary care nurse practitioner (NP) about acupuncture treatments. The NP should tell this patient:
 
  a. biofield therapy has been shown to be more effective than acupuncture.
  b. creatine has been shown to be an effective herbal choice to treat back pain.
  c. there is no valid research documenting the efficacy of this treatment for pain.
  d. most studies that show benefits of alternative therapies are based on observation.

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Answer to Question 1

B
If the patient is younger than 20 or older than 50 years old at the onset of elevated blood pressure, the NP should look for causes of secondary hypertension. The physical examination should include a careful cardiovascular assessment. This patient will need pharmacologic treatment, but not until the underlying cause of hypertension is determined.

Answer to Question 2

D
Current literature does not allow definitive conclusions to be drawn regarding the use of complementary and alternative medicine (CAM) because much of what appears in the literature continues to be based on observational reports and small studies. Biofield therapy has not been shown to be more effective than acupuncture. Creatine is used to increase muscle mass.

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Excellent

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Gracias!