NURS-656-STUDENT QUESTIONS

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NURS-656-STUDENT QUESTIONS

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NURS-656-STUDENT QUESTIONS A female patient, currently at 26 weeks gestation, has experienced a slow rise of her blood pressure over the past 2 weeks. Her urine specimen is negative for protein. She has reduced her sodium intake and has begun a walking program. The patient's blood pressure today is 155/102, which is consistent with her readings at home. Associated symptoms include a dull headache. The nurse practitioner's best response is: a. "Try yoga and meditation to decrease your blood pressure." b. Start the patient on methyldopa 250 mg po twice daily. c. "Monitor your blood pressure at home and call the office if you have swelling or a pounding headache." d. Start the patient on metoprolol 100mg po twice daily. - CORRECT ANSWER -*b. Start the patient on methyldopa 250 mg po twice daily. Rationale: Methyldopa has the longest record of safety at a starting dosage of 250 mg po bid or tid. Therapy with beta blockers or calcium channel blockers is also acceptable. (Papadakis& McPhee, 2015. P. 801.) Metoprolol is a Category C medication and 100 mg po bid is not the lowest possible starting dose. The initiation of anti-hypertensive therapy in pregnant women is indicated if the sustained blood pressure is 150/100 or if there is evidence of end-organ damage (Papadakis &McPhee, 2015, p. 801) Resistant hypertension may be caused by which of the following? a. NSAIDs b. Oral Contraceptives c. Obesity d. All of the above - CORRECT ANSWER -*d. All of the above Rationale: JNC 7 defines resistant hypertension as the inability to control blood pressure in those patients who are compliant with the appropriate three-drug regimen, including a diuretic. Causes of resistant hypertension listed in table 11-11 include nonadherence, NSAIDs, oral contraceptives, adrenal steroids, licorice, obesity, and excessive alcohol intake (Sutters, 2015, p.458-

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