Download Enhancing Cardiovascular Health: Screening for Hearing Loss, Mitral Valve Prolapse, and BP and more Exams Nursing in PDF only on Docsity!
- Which patient could be expected to have the highest systolic blood pres- sure? A 21-year-old male A 50-year-old perimenopausal female A 35-year-old patient with Type 2 diabetes A 75-year-old male: D. Nearly 25% of the US population has hypertension. The greatest incidence is in older adults because of changes in the intima of vessels as aging and calcium deposition occur. Males of any age are more likely to be hypertensive than females of the same age. African American adults have the highest incidence in the general population. Among adolescents, African Americans and Hispanics have the highest rates. Hypertension occurs in 5-10% of pregnancies.
- Mrs. Brandy is having contrast dye next week for a heart catheterization. What drug does NOT need to be stopped prior to her catheterization? Naproxen Furosemide Metformin Losartan: D. Naproxen and furosemide should be stopped for 24 hours prior to the catheter- ization. Metformin should be stopped 48 hours prior to the catheterization. Furosemide is stopped because it contributes to volume depletion. NSAIDs like naproxen are withheld because of the impact on renal prostaglandin production. Metformin has been implicated in lactic acidosis when combined with contrast dye in an impaired kidney.
- In older adults, the three most common ailments are: hearing loss, vision loss, hypertension. hearing loss, hypertension, arthritis. depression, vision loss, hypertension. arthritis, hearing loss, depression.: B. Hypertension and arthritis are the two most common ailments in older adults. Hearing loss occurs in half to almost 2/3 of older adults. The most common form is known as presbycusis. There is no consensus for the frequency of screening for hearing loss in older patients, but minimally, it should be grossly evaluated at each visit and screened more thoroughly if deficits are observed. Blood pressure should be screened annually, but it is usually screened at each visit. Arthritis is not routinely screened.
- Mr. Holbrook, a 75-year-old male, is a former smoker with a 30-pack-year history. He has come in today for an annual exam. He walks daily for 25
minutes, has had intentional weight loss, and has a near-normal BMI. On examination, the patient is noted to have an absence of hair growth on his lower legs. Which statement is true regarding this patient? This is a normal consequence of aging. This might indicate disease in the lower extremities. It might be from exercise initiation. This is secondary to long-term smoking.: B. An absence of hair growth likely indicates peripheral artery disease in this patient. It is part of normal changes of aging that hair growth will diminish, but not become absent. His lower extremity pulses should be assessed, his cardiac risk factors should be assessed (he smoked for years), and he should be questioned about leg pain when he walks. An ankle-brachial index could be measured. If < 0.9, further assessment should be done. A normal ankle-brachial index should be greater than 0.9. Less than 0.4 is considered critical.
- The usual clinical course of mitral valve prolapse: is benign. results in sudden cardiac death. results in chronic heart failure. is associated with multiple episodes of emboli.: A. The usual course of mitral valve prolapse (MVP) is benign, and most patients who have MVP are asymptomatic. A murmur may be present and is best auscultated with the diaphragm of the stethoscope over the cardiac apex. In a minority of patients, symptoms of heart failure or sudden death may occur. When heart failure results, it is usually a result of mitral regurgitation. Embolization may occur, but, this is not common or usual in the majority of patients.
- An ACE inhibitor is specifically indicated in patients who have: hypertension, diabetes with proteinuria, and heart failure. diabetes, hypertension, hyperlipidemia. asthma, hypertension, diabetes. renal nephropathy, heart failure, hyperlipidemia.: A. ACE inhibitors have numerous indications. Three are indicated in the first choice. ACE inhibitors are also indicated in patients who have renal insufficiency. However, ACE inhibitors can worsen renal insufficiency, so the patients must be monitored closely with lab tests for BUN, Cr, and potassium. Diabetes without proteinuria is not a specific indication for ACE inhibitors use, though they are used by some healthcare providers in this way. This is an off-label use.
- An older adult who has hypertension and angina takes multiple medica- tions. Which one of the following decreases the likelihood of his having
to be most sodium-sensitive are elderly patients and African American patients. Thus, choice d is the best choice listed.
- A patient who takes HCTZ 25 mg daily has complaints of muscle cramps. He probably has: hypocalcemia. hypomagnesemia. hypokalemia. hypercalcemia.: C. HCTZ is a thiazide diuretic that is potassium-wasting. Patients can become hy- pokalemic and experience side effects of this. A common one is muscle cramps.
- A 25-year-old patient has aortic stenosis (AS). The etiology of his AS is probably: congenital. rheumatic. acquired calcific. unknown.: A. In someone younger than 65 years, the most likely cause is congenital. The aortic valve usually consists of three cusps, but some people are born with a bicuspid aortic valve. Rheumatic heart disease is the second most common cause of aortic stenosis in this age group, but the incidence has decreased drastically in the last many decades because of the use of antibiotics to treat Streptococcal infections. In more than 90% of patients older than 65 years, acquired calcifications appear on a normal aortic valve and produce aortic stenosis.
- A 75-year-old patient with longstanding hypertension takes an ACE in- hibitor and a thiazide diuretic daily. He has developed dyspnea on exertion and peripheral edema over the past several days. This probably indicates: worsening hypertension. development of heart failure (HF). noncompliance with medication. acute myocardial infarction.: B. The symptoms of dyspnea on exertion and peripheral edema are symptoms of HF. Long standing hypertension is a risk factor for HF. Acute myocardial infarction would result in acute symptoms, not development of symptoms over the past several days. Noncompliance with medication and fluid or sodium excess might result in peripheral edema and development of heart failure.
- A patient with newly diagnosed heart failure has started fosinopril in the last few days. She has developed a cough. What clinical finding can help distinguish the etiology of the cough as heart failure and not related to
fosinopril? It is dry and nonproductive. It is wet and worse with recumbence. It is purulent and tachycardia accompanies it. Shortness of breath always results after coughing.: B. The cough associated with fosinopril, an ACE inhibitor, is a dry, nonproductive cough that may be described as annoying. Its severity does not change with position or time of day. A cough associated with heart failure is wet, worse when lying down, and is usually described by patients as worse at night. Choice c is often associated with fever and probably reflects an infectious process like pneumonia.
- Which choice below would be the best choice for an 80-year-old patient whose blood pressure is 172/72 mm Hg? Chlorthalidone Amlodipine Monopril Acebutolol: B. This patient has isolated systolic hypertension. According to many learned author- ities, this is best treated with a long-acting calcium channel blocker, particularly the ones that end in "pine." These belong to the class of calcium channel blockers termed dihydropyridines. Thiazide diuretics are not potent enough to decrease this patient's blood pressure into normal range, and its effect is not additive when combined with calcium channel blockers.
- Which medication could potentially exacerbate heart failure (HF)? Naproxen Furosemide Atorvastatin Aspirin: A. Naproxen is an NSAID. NSAIDs cause sodium retention and thus, water retention. A single dose of naproxen is unlikely to produce HF symptoms, but repeated sub- sequent doses are very likely to produce water retention sufficient to cause edema and possible shortness of breath in susceptible people. The other medications listed are unlikely to have any direct effect on cardiac output in a patient who has HF.
- Which patient is most likely to have mitral valve prolapse? An adolescent male with no cardiac history A 25-year-old male with exercise intolerance A 30-year-old female with no cardiac history A 65-year-old male with shortness of breath: C.
ACE inhibitor Beta blocker Calcium channel blocker Thiazide diuretic: C. This patient is 77 years old and should have a goal blood pressure of < 150/ mmHg according to JNC8. A thiazide diuretic is not a good first choice in this patient because it will not be potent enough to decrease blood pressure by about 20 points to get him to his goal. A long-acting calcium channel blocker is appropriate for patients who have isolated systolic hypertension and will be more likely to get this patient to goal pressure than HCTZ. Beta-blockers are no longer recommended first-line for uncomplicated hypertension. ACE inhibitors are very effective in patients who are high renin producers. Older patients tend to produce lower amounts of renin.
- The nurse practitioner is caring for an independent 74-year-old female who had acute coronary syndrome (ACS) about 6 weeks ago. What medica- tions should be part of her regimen unless there is a contraindication? ASA and beta blocker ACE and beta blocker ACE, ASA, and beta blocker ACE, ASA, beta blocker, and statin: D. After a myocardial event, an aspirin, ACE inhibitor, beta blocker, and statin should be dosed daily. The aspirin will provide anticoagulation; the ACE inhibitor, statin and beta blocker are associated with reduced morbidity and mortality if given soon after ACS.
- Mr. Smith is a 72-year-old patient who takes warfarin for chronic atrial fibrillation. His INR and CBC results are provided (CBC in the image, INR 4.0). The nurse practitioner should: stop the warfarin for the next 4 days and repeat the INR on day 5. admit to the hospital immediately. administer vitamin K and repeat INR in 2 hours. stop the warfarin today and repeat the INR tomorrow.: D. An INR range of 2.0-3.0 is therapeutic for most people who take warfarin for chronic atrial fibrillation. An INR of 4.0 is elevated, and this patient could suffer a devastating bleed anywhere in the body. A patient with an INR < 5 without bleeding may have warfarin stopped temporarily. The maintenance dose should be decreased when it is safe to resume warfarin, i.e. when the INR is closer to the patient's therapeutic range. If the patient were at high risk for bleeding, was bleeding, or if the INR was greater than 4.0, vitamin K could be administered. A good history should be completed to find out the reason for the increase in
INR. A high-risk client with an elevated INR would be admitted to the hospital and closely monitored, but a client with no comorbidities (no bleeding history or thrombocytopenia) and considered low risk, may be monitored as an outpatient. Five days is too long to stop warfarin without an INR check.
- A patient with poorly controlled hypertension and history of myocardial infarction 6 years ago presents today with mild shortness of breath. He takes quinapril, ASA, metoprolol, and a statin daily. What symptom is NOT indicative of heart failure? Fatigue Headache Orthopnea Cough: B. Fatigue is a common symptom in cardiac patients, and it can represent a wors- ening of many cardiac diseases, such as coronary artery disease, heart failure, or valvular dysfunction. Orthopnea and cough, especially nocturnal, are classic symptoms of worsening heart failure. Headache is a nonspecific symptom and is not typical of heart failure.
- You are managing the warfarin dose for an older adult with a prosthetic heart valve. Which situation listed requires that warfarin be discontinued now? INR of 3, some bleeding INR of 8, no significant bleeding INR of 6, no significant bleeding INR of 2 with minimal bleeding: B. INR is a good measure of the clotting status in an outpatient who takes an oral anticoagulant like warfarin. When warfarin is overdosed and INR climbs, or when warfarin is overdosed because of food or medication that produces deleterious side effects, warfarin doses may be omitted or discontinued until the INR is in a more acceptable range. Generally, one or two doses may be omitted before rechecking INR and resuming warfarin or decreasing the dose.
- A medication that may produce exercise intolerance in a patient who has hypertension is: hydrochlorothiazide. amlodipine. metoprolol. fosinopril.: C. Metoprolol is a cardioselective beta blocker. It can produce bradycardia which is responsible for exercise intolerance. As a patient exercises, a concomitant increase
This patient has isolated systolic hypertension (ISH), common in older adults. Long-acting calcium channel blockers (CCB), specifically those with the suffix "pine," and thiazide diuretics, are recommended for starting treatment in patients with ISH. Amlodipine is probably a better choice in this patient because she needs a substantial decrease in her systolic blood pressure. Thiazide-type diuretics produce an average decrease of 2-8 points in the systolic blood pressure. The CCBs are more potent and a more significant decrease in blood pressure could be expected.
- A patient who has mitral valve prolapse (MVP) reports chest pain and frequent arrhythmias. In the absence of other underlying cardiac anomalies, the drug of choice to treat her symptoms is: lisinopril. metoprolol. amlodipine. chlorthalidone.: B. Beta blockers like metoprolol are indicated to alleviate atrial or ventricular arrhyth- mias associated with mitral valve prolapse. However, long-term effectiveness of beta blockers is uncertain. Most patients with MVP who do not have symptoms of arrhythmias or ectopy at rest usually do not require further evaluation. However, they should be monitored at least annually for a change in their condition.
- A patient with hypertension has been diagnosed with gout. Which home medication may have contributed to this episode of gout? Lisinopril Amlodipine Furosemide Allopurinol: C. Gout is characterized by hyperuricemia. Uric acid levels are increased when a patient consumes any medication that results in less circulating fluid volume, specifically, any diuretic. Diuretics such as furosemide will produce hyperuricemia and thus increase the risk of gout in susceptible patients. Diuretics should be avoided when possible in patients who have a history of gout.
- Which class of medication is frequently used to improve long-term out- comes in patients with systolic dysfunction? Loop diuretics Calcium channel blockers ACE inhibitors Thiazide diuretics: C. ACE inhibitors are commonly used in patients with systolic dysfunction because
they reduce morbidity and mortality, i.e. these medications alter prognosis. They also improve symptoms of fatigue, shortness of breath, and exercise intolerance. Loop and thiazide diuretics improve symptoms, but do not alter long-term prog- nosis with heart failure. Beta blockers should be used in conjunction with ACE inhibitors and diuretics, but not as solo agents. Beta blockers can potentially worsen heart failure, so their use in patients with heart failure should be monitored carefully. Despite this fact, beta blockers decrease morbidity and mortality associated with heart failure.
- A patient will be screened for hyperlipidemia via a serum specimen. He should be told: to fast for 12-14 hours. to fast for 6-8 hours. that black coffee is allowed. a non-fasting state will not affect the results.: A. Serum total and HDL cholesterol can be measured in fasting or non-fasting patients. There are very small and clinically insignificant differences in these values whether fasting or not. The primary effect of eating on a patient's lipid values is elevation of the triglyceride levels. The maximum elevation of triglyceride levels occurs at 3-4 hours after eating, but there may be several peaks during a 12-hour period. Therefore, the most accurate triglyceride levels will be obtained following a 12-hour fast.
- Ramipril has been initiated at a low dose in a patient with heart failure. What is most important to monitor in about 1 week? Heart rate Blood pressure EKG Potassium level: D. ACE inhibitors work in the kidney in the renin-angiotensin aldosterone system and can impair renal excretion of potassium in patients who have normal kidney function. In patients who have impaired renal blood flow and/or function, the risk of hyperkalemia is increased. Common practice is to monitor potassium, BUN, and Cr at about 1 week after initiation of an ACE inhibitor and with each increase in dosage in a patient who has heart failure and who receives an ACE inhibitor.
- A nurse practitioner has not increased the dosage of an antihypertensive medication even though the patient's blood pressure has remained >140/ mmHg. This might be described as: clinical inertia. malpractice.
favoring a diagnosis of heart failure. Alternatively, BNP levels less than 80 pg/mL strongly suggest that heart failure is not present (some US institutions use 100 pg/mL). Other conditions may cause elevated BNP levels: thoracic and abdominal surgery, renal failure, and subarachnoid hemorrhage. Consequently, careful as- sessment of the patient is prudent. Echocardiograms mechanically evaluate the heart and establish an ejection fraction. If < 35-40%, then HF can usually be diagnosed. Ejection fractions do not always correlate with patient symptoms. EKG evaluates the electrical activity of the heart. Chest X-ray can indicate heart failure, but a BNP is a more sensitive measure.
- Which mitral disorder results from redundancy of the mitral valve's leaflets? Acute mitral regurgitation Chronic mitral regurgitation Mitral valve prolapse Mitral stenosis: C. Mitral valve prolapse (MVP) is the most common adult murmur. It is best heard with the diaphragm of the stethoscope over the cardiac apex. It is a result of redundancy of the mitral valve leaflets and subsequent degeneration of the mitral tissue. The posterior leaflet is more commonly affected than the anterior leaflet. The valve's annulus becomes enlarged in conjunction with elongation of the chordae tendineae.
- An older adult who has hypertension also has osteoporosis. Which antihypertensive agent would have the secondary effect of improving her osteoporosis? A thiazide diuretic A calcium channel blocker An ACE inhibitor A beta blocker: A. Thiazide diuretics have the secondary effect of increasing serum calcium by decreasing fluid. This makes more calcium available for absorption. This would not be used to treat a patient with osteoporosis, but this mechanism of action could be helpful as an adjunct for patients who are receiving other forms of treatment for osteoporosis. The other agents listed would have no effect on osteoporosis. Calcium channel blockers impede movement of calcium into cells. This has no effect on available serum calcium.
- An independent 82-year-old male patient is very active but retired last year. His total cholesterol and LDLs are moderately elevated. How should the NP approach his lipid elevation?
He has reached an age where treatment holds little benefit Treatment is age dependent; he should receive a statin today Treatment is based on expected length of life He should receive a statin today until he is 85 years: C. Older adults have higher rates of coronary events than younger adults. Treatment of elevated lipids in older adults has been shown to decrease overall mortality, decrease major coronary events, and is associated with relative risk reduction for subsequent coronary events. United States Preventive Services Task Force and American Heart Association recommend lipid-lowering therapy because it clearly benefits older adults. This patient should have a statin started if lifestyle modifications do not allow him to reach goal lipid values.
- Tables are used for the determination of maximum blood pressure values for adolescents. How are these blood pressure values established for ado- lescents? Height percentile, body mass index, and gender Gender and age Height percentile, gender, and age Body mass index and gender: C. Body size is an important determinant of blood pressure in adolescents. Blood pressure tables are NOT based on body mass index. The tables include 50th, 90th, 95th, and 99th percentiles based on age (up to 17 years), height, and gender. After age 17 years, all blood pressures are based on adult values. Usually, three separate elevated blood pressure readings are required for diagnosis of hypertension.
- A 75-year-old has isolated systolic hypertension. She started on amlodip- ine 4 weeks ago. She states that since then, she has developed urinary incontinence. What is the nurse practitioner's assessment? This is unrelated to her new medication. It is coincidental. She may have underlying urinary tract pathology. It is probably related to amlodipine.: D. Amlodipine is a long-acting calcium channel blocker (CCB). Calcium is responsible for muscle contraction. Sometimes CCBs worsen or produce urinary incontinence by impairing detrusor contraction. A lower dose of calcium channel blocker could be tried, a different class could be tried, or as a last resort, incontinence products could be used.
- Which study would be most helpful in evaluating the degree of hypertro- phy of the atrium or ventricle?
- The most common indicator of end-organ damage in adolescents with hypertension is: left ventricular hypertrophy. seizure. renal dysfunction. renal artery damage.: A. The most common manifestation of end-organ damage in hypertensive adoles- cents is left ventricular hypertrophy (LVH). According to the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents, as many as 41% of children who have hypertension have LVH identifiable on ECG.
- A patient taking an ACE inhibitor should avoid: strenuous exercise. potassium supplements. protein-rich meals. grapefruit juice.: B. An ACE inhibitor potentially can produce hyperkalemia because its mechanism of action is to spare potassium in the renin-angiotensin aldosterone system. If potassium is taken in the form of potassium supplements, the effect will be additive and the risk of hyperkalemia can be great.
- Which choice below characterizes a patient who has aortic regurgitation? Long asymptomatic period followed by exercise intolerance, then dyspnea at rest An acute onset of shortness of breath in the fifth or sixth decade Dyspnea on exertion for a long period of time before sudden cardiac death A long asymptomatic period with sudden death usually during exercise: A. The natural course of aortic regurgitation (AR) is that the patient has a long asymp- tomatic period with slowing of activities but remains essentially asymptomatic. Shortness of breath develops with activity and finally, shortness of breath at rest. The left ventricle eventually fails unless the aortic valve is replaced.
- An 80-year-old patient with longstanding hypertension takes Monopril and HCTZ for hypertension. His most recent blood pressures are listed. What should be done about his blood pressure? Add an angiotensin receptor blocker (ARB) Add another diuretic Add a calcium channel blocker Stop the HCTZ and add a beta blocker: C. This patient takes medications from two different classes of anti-hypertensives. If
these are at maximum doses, consideration should be given to adding a medica- tion from a different class. Adding an ARB may result in a precipitous decrease in his blood pressure and an increase in potassium levels because he takes an ACE inhibitor, and both of these medications work in the renin-angiotensin-aldosterone system. Adding another diuretic will likely produce hypokalemia with a minimal decrease in blood pressure. The calcium channel blocker is a good choice because it will have a synergistic effect with the ACE inhibitor Monopril (fosinopril). A beta blocker will slow the heart rate, not a desired effect in an older adult unless he has underlying angina or a rapid heart rate.
- A 43-year-old Hispanic male has an audible diastolic murmur best heard in the mitral listening point. There is no audible click. His status has been monitored for the past 2 years. This murmur is probably: mitral valve prolapse. acute mitral regurgitation. chronic mitral regurgitation. mitral stenosis.: D. Mitral valve prolapse (MVP) is an unlikely etiology since MVP is a systolic murmur. Additionally, the question states there is no audible click, and a mid to late systolic click is characteristic of MVP. Acute mitral regurgitation (MR) usually develops after rupture of the chordae tendineae, ruptured papillary muscle after myocardial infarction, or secondary to bacterial endocarditis. Symptoms of failure appear with abrupt clinical deterioration in the patient. A 2-year course for this patient as described would not be appropriate if this were an acute development. Dilation of the left atrium and ventricle is typical in chronic MR since both chambers are affected from regurgitant blood flow across the diseased valve, but MR is a systolic murmur, not diastolic. This is mitral stenosis (MS) because MS produces the only diastolic murmur listed in the question.
- A patient taking candesartan for treatment of hypertension should avoid: strenuous exercise potassium supplements. protein-rich meals. grapefruit juice.: B. An ARB like candesartan potentially can produce hyperkalemia because its mech- anism of action is to spare potassium in the renin-angiotensin aldosterone system. If potassium is taken in the form of potassium supplements, the effect will be additive and the risk of hyperkalemia will be great.
- Older adults have a unique blood pressure pattern. Which blood pressure reading below reflects this pattern?
in and around the ankle joint. in the calf muscle. radiating down his leg from the thigh. pain in his lower leg which waxes and wanes.: B. This patient's symptoms are typical of arteriosclerosis. The term used to describe this patient's symptom is intermittent claudication. When there is compromised arterial blood flow in the lower legs, a common complaint is reproducible pain in a specific group of muscles. The pain occurs because there is an incongruence between blood supply and demand. This produces pain that causes a patient to stop exercising in order to obtain pain relief.
- The major difference between varicose veins and arteriosclerosis is the: limbs affected. gender affected. vessels affected. degree of pain.: C. Varicose veins and arteriosclerosis are very different disease processes. While differences can be found in the gender affected, the major difference between the two diseases is the vessel affected. Arteriosclerosis affects the arteries, varicose veins affect the veins. While there is a predilection for the lower extremities in varicose veins, peripheral artery disease (PAD) is most common in the lower extremities too. Varicose veins are especially common in women 2:1; PAD is more common in men 2:1 after age 70 years. Pain is a subjective measure.
- Classic symptoms of deep vein thrombosis (DVT) include: swelling, pain, redness. calf complaints, pain with walking, history of exercise. swelling, pain, and discoloration in lower extremity. warmth, edema, and relief of pain with walking.: C. Swelling, pain, and discoloration from impaired blood flow are the classic symp- toms. Choice A could describe infection, like cellulitis, and is not classic for DVT. Redness is an inconsistent sign of DVT as is a positive Homan's sign. A history of exercise actually decreases the risk of DVT. Pain secondary to DVT is not relieved by walking. The lower extremities are the most likely location of DVT, but symptoms don't always correlate with location of the thrombosis. Patients must be asked about history, family history of DVT, and precipitating conditions.
- Which test listed below may be used to exclude a secondary cause of hyperlipidemia in a patient who has elevated lipids? CBC TSH
Urine culture and sensitivity Sedimentation rate: B. Patients who have dyslipidemia should be screened for diabetes, renal disease, and hypothyroidism. Nephrotic syndrome can produce remarkably elevated cho- lesterol levels. Therefore, measurements of glucose, creatinine or eGFR, and thyroid-stimulating hormone should be performed when evaluating a patient who presents with dyslipidemia. Sedimentation rate is a measure of nonspecific in- flammation and so is not helpful in this situation. Specifically, hypothyroidism can produce marked lipid abnormalities.
- Besides hypertension, which risk factor most contributes to development of an abdominal aortic aneurysm? Valvular dysfunction Elevated LDL values Cigarette smoking Alcohol consumption: C. Smoking clearly increases the risk for abdominal aortic aneurysm (AAA). The prevalence in women is far lower than in men, and the benefits associated with screening women for AAA do not justify the costs. However, the United States Preventive Services Task Force and American Heart Association recommend one-time screening for males aged 65 to 75 who have ever smoked. Other learned authorities recommend screening between ages 65 and 75 if they have a first-de- gree relative who required repair of an AAA.
- Which of the following medications may have an unfavorable effect on a hypertensive patient's blood pressure? Lovastatin Naproxen Inhaled fluticasone Amoxicillin: B. Naproxen is an NSAID. NSAIDs produce sodium retention and hence, water retention. This produces many systemic effects, such as an increase in blood pressure, lower extremity edema, increased workload on the heart, and inhibition of prostaglandin synthesis. Patients with hypertension and heart failure should use NSAIDs cautiously. Lovastatin, fluticasone, and amoxicillin would not be expected to increase or decrease blood pressure.
- A characteristic of an ACE inhibitor-induced cough is that it: is mildly productive. is worse at nighttime. usually begins within 2 weeks of starting therapy.
