AANP Family Nurse Practitioner (FNP) Certification ExamEvaluationMedium
A 58-year-old female with a history of hypertension and osteoarthritis is prescribed ibuprofen 600 mg three times daily for acute knee pain. She presents for follow-up reporting worsening edema in her ankles and her blood pressure is now consistently elevated at 150/90 mmHg. Which of the following is the most appropriate initial modification to her treatment plan?
- AAdvise her to elevate her legs and reduce sodium intake.
- BDiscontinue ibuprofen and consider an alternative analgesic.
- CAdd a diuretic to her medication regimen.
- DIncrease the dose of her current antihypertensive medication.
Show answer & explanationAnswer & explanation
Correct answer: B. Discontinue ibuprofen and consider an alternative analgesic.
NSAIDs like ibuprofen can cause fluid retention and elevate blood pressure, especially in patients with pre-existing hypertension. Discontinuing the NSAID is the most appropriate initial step to address these side effects.
Why the other options are wrong
- A. While helpful for edema, these lifestyle modifications do not address the medication-induced hypertension and are insufficient as a sole intervention.
- C. Adding a diuretic might temporarily manage edema but does not address the root cause of the blood pressure elevation and fluid retention related to NSAID use.
- D. Increasing antihypertensive medication without addressing the underlying cause (NSAID) may not resolve the issue and could lead to overtreatment.
NSAID-Induced Hypertension/Edema
Non-steroidal anti-inflammatory drugs (NSAIDs) can cause fluid retention and elevate blood pressure by inhibiting prostaglandin synthesis, which affects renal blood flow and sodium excretion.
- Common in patients with pre-existing hypertension or heart failure.
- Can lead to worsening edema and difficulty controlling blood pressure.
- Discontinuation of NSAID is often the first-line intervention.
Memory trick: NSAID's 'No Salt' effect makes blood pressure soar and ankles swell.