AANP Family Nurse Practitioner (FNP) Certification ExamEvaluationMedium
A 75-year-old female with osteoarthritis is taking celecoxib 200 mg daily. She has a history of hypertension and well-controlled Type 2 Diabetes. During her annual physical, her FNP notes her blood pressure is 150/92 mmHg, and she has 1+ pedal edema. Her previous BP was 130/80 mmHg. What is the most likely cause of her elevated blood pressure and edema?
- AAdverse effect of celecoxib.
- BWorsening osteoarthritis leading to reduced mobility.
- CNon-adherence to her antihypertensive medication.
- DProgression of Type 2 Diabetes causing nephropathy.
Show answer & explanationAnswer & explanation
Correct answer: A. Adverse effect of celecoxib.
Non-steroidal anti-inflammatory drugs (NSAIDs) like celecoxib are known to cause fluid retention and elevate blood pressure by inhibiting prostaglandin synthesis, which can lead to vasoconstriction and reduced renal blood flow. Given her recent BP increase and edema, celecoxib is the most likely culprit.
Why the other options are wrong
- B. While reduced mobility can impact overall health, it's less likely to cause such an acute and specific elevation in BP and edema.
- C. Non-adherence is always a possibility, but a direct medication side effect is a more immediate and specific explanation for the observed changes in BP and edema with NSAID use.
- D. While diabetes can lead to nephropathy, the acute onset of elevated BP and edema is more consistent with a medication side effect than a rapid progression of diabetic nephropathy.
NSAID-Induced Hypertension/Edema
NSAIDs, including selective COX-2 inhibitors like celecoxib, can cause fluid retention and increase blood pressure by affecting renal prostaglandin synthesis.
- Mechanism involves inhibition of vasodilatory prostaglandins.
- Can worsen existing hypertension or heart failure.
- Patients should be monitored for BP and edema when on NSAIDs.
Memory trick: NSAID's a pain reliever, but BP's a heart receiver!