AANP Family Nurse Practitioner (FNP) Certification ExamEvaluationEasy
A 75-year-old female with osteoarthritis is taking celecoxib 200 mg daily for chronic knee pain. She has a history of hypertension well-controlled with lisinopril. At her follow-up, her blood pressure is 150/95 mmHg, and she reports mild ankle swelling. What is the most likely cause of these new findings?
- ANew onset heart failure.
- BNSAID-induced hypertension and fluid retention.
- CProgression of essential hypertension.
- DSide effect of lisinopril.
Show answer & explanationAnswer & explanation
Correct answer: B. NSAID-induced hypertension and fluid retention.
NSAIDs like celecoxib can cause sodium and water retention, leading to peripheral edema and elevation of blood pressure, especially in older adults and those with pre-existing hypertension or heart failure.
Why the other options are wrong
- A. While new onset heart failure is a possibility with edema and hypertension, NSAID-induced effects are a more common and direct explanation given the medication history.
- C. While possible, the acute change and association with NSAID use make this less likely to be the primary cause.
- D. Lisinopril is an ACE inhibitor and typically lowers blood pressure and can reduce edema, so it is unlikely to be causing these symptoms.
NSAID Cardiovascular Effects
Non-steroidal anti-inflammatory drugs (NSAIDs) can cause sodium and water retention, leading to elevated blood pressure and peripheral edema, particularly in susceptible individuals.
- Inhibit prostaglandin synthesis, which affects renal blood flow and sodium excretion.
- Can worsen hypertension and heart failure.
- Monitor blood pressure and fluid status in patients taking NSAIDs.
Memory trick: NSAIDs relieve pain, but can make your heart complain, with pressure high and fluid rain.