A 54-Year-Old Woman Comes to the Office Due to Lower

question 650

Multiple Choice

A 54-year-old woman comes to the office due to lower extremity swelling and discomfort over the past week.  The patient says that she can no longer fit into her shoes.  Otherwise, she feels fine and has no orthopnea, dyspnea on exertion, or chest pain.  She was recently diagnosed with essential hypertension (systolic blood pressure 165-170 mm Hg and diastolic blood pressure 95-100 mm Hg) and was started on amlodipine.  Complete blood count and chemistry panel were normal at that time.
The patient's current blood pressure is 156/95 mm Hg, pulse is 84/min, and respirations are 14/min.  Pulse oximetry is 98% on room air.  Her BMI is 28 kg/m².  Jugular venous pressure is estimated at 8 cm H₂O.  Lungs are clear to auscultation.  There are no murmurs or additional heart sounds.  The liver span is 10 cm and the spleen is not palpable.  There is 2+ symmetric pitting edema involving her lower extremities.
Laboratory results are as follows:

Which of the following therapies, if it had been initiated with amlodipine, could have most likely prevented this patient's current condition?

• A)ACE inhibitor
• B)Beta blocker
• C)Digoxin
• D)Hydralazine
• E)Thiazide diuretic

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Definitions:

Self-control

The ability to regulate one's emotions, thoughts, and behavior in the face of temptations and impulses.

Sexual Health

A state of physical, mental, and social well-being related to sexuality; it requires a positive and respectful approach to sexuality and sexual relationships.

Encumbrances

Legal claims or liens on property or assets, which can affect the ability to transfer ownership free and clear.

Ostomies

Surgical procedures that create an opening in the body for the discharge of body wastes.