Family Nurse Practitioner Exam

For a patient with hypertension and a history of lifestyle modifications that haven't improved blood pressure, what is the most appropriate action?

1. Continue the lifestyle modifications and recheck in 4 weeks

2. Initiate a prescription of hydrochlorothiazide 12.5 mg PO daily

3. Initiate a prescription of atenolol (Tenormin) 25 mg PO daily

4. Refer the patient to a cardiologist for a stress EKG

The correct answer is: Initiate a prescription of hydrochlorothiazide 12.5 mg PO daily

The most appropriate action for a patient with hypertension who has a history of lifestyle modifications that haven't proven effective is to initiate a prescription of hydrochlorothiazide 12.5 mg orally daily. This choice reflects the established guidelines for the management of hypertension, particularly when lifestyle changes alone do not yield improvements in blood pressure. Hydrochlorothiazide is a thiazide diuretic that is commonly used as a first-line treatment for hypertension. It works by promoting the excretion of sodium and water, leading to a reduction in blood volume and subsequently lowering blood pressure. Starting this medication allows for immediate pharmacological intervention, which is essential in cases where lifestyle modifications have not resulted in adequate control of hypertension. In this scenario, the other options are not as suitable for immediate hypertension management. Continuing lifestyle modifications may be beneficial long term, but since they have already proven ineffective in this case, it does not address the immediate need for blood pressure management. Initiating a prescription of atenolol, a beta-blocker, might be considered in certain patients but is not typically recommended as a first-line agent for uncomplicated hypertension. Referral to a cardiologist for a stress EKG may be warranted under different circumstances, especially if there's concern for underlying heart disease, but