AANP Family Nurse Practitioner (FNP) Certification ExamEvaluationHard
A 40-year-old pregnant patient (G1P0, 28 weeks gestation) presents with new onset gestational hypertension (BP 145/95 mmHg on two occasions, 4 hours apart, no proteinuria). She is otherwise healthy. Which of the following is the most appropriate initial management plan?
- ARecommend strict bed rest at home and daily BP monitoring.
- BAdmit for inpatient observation and bed rest.
- CInitiate low-dose aspirin daily and weekly BP checks.
- DInitiate labetalol 100 mg twice daily.
Show answer & explanationAnswer & explanation
Correct answer: D. Initiate labetalol 100 mg twice daily.
For gestational hypertension with blood pressure consistently at or above 140/90 mmHg, pharmacological treatment is indicated to prevent severe hypertension and its complications. Labetalol is a first-line antihypertensive medication commonly used in pregnancy due to its safety and efficacy profile.
Why the other options are wrong
- A. Strict bed rest is no longer recommended for gestational hypertension as it has not shown to improve outcomes and can increase risks like VTE.
- B. Inpatient admission is typically reserved for severe hypertension, preeclampsia with severe features, or complications, not initial management of uncomplicated gestational hypertension.
- C. Low-dose aspirin is used for preeclampsia prevention in high-risk patients, not for the treatment of established gestational hypertension.
Gestational Hypertension Management
Gestational hypertension (BP ≥140/90 mmHg after 20 weeks gestation without proteinuria) often requires pharmacological management, with labetalol or nifedipine as first-line agents.
- Goal BP is typically 120-150/80-105 mmHg.
- Regular monitoring for proteinuria and other preeclampsia signs is crucial.
- Bed rest is not recommended.
Memory trick: High BP in mom? Labetalol comes, no bed rest hum!