The use of metoprolol (Lopressor* / Toprol XL*), a cardioselective (also known as β1 selective) beta blocker, is absolutely contraindicated in patients with COPD (or asthma) despite any possible compelling indications (e.g. stable heart failure or IHD).

A 47-year-old woman with hypertension (HTN), hypothyroidism, and osteoarthritis comes to the clinic for a blood pressure follow-up. She was given a diagnosis of HTN 6 months ago and has been unable to get to goal. Today, her blood pressure is 154/88 mm Hg (with similar repeat) and heart rate is 92 beats/minute. She currently takes chlorthalidone (Hygroton*) 25 mg/day, losartan (Cozaar*) 100 mg/day, amlodipine (Norvasc*) 10 mg/day, ibuprofen (Motrin*) 800 mg four times daily, and levothyroxine (Synthroid*) 100 mcg/day. She is adherent to her medications and has asked not to take any more blood pressure medications. Which would best address her elevated blood pressure? 

Which of the following is the recommended daily calcium and vitamin D intake for a 76 yo woman?

A 45-year-old female presents to the clinic with complaints of persistent headaches for the past two weeks. She describes the pain as sudden and severe, unlike any headache she has experienced before. She denies any visual disturbances but reports feeling nauseous during the headaches. She has no significant past medical history. Which of the following red flags suggests a potentially serious underlying cause of her headaches?

A 55-year-old male presents to the emergency department with a productive cough, fever, and chest pain. A chest X-ray confirms the diagnosis of community-acquired pneumonia (CAP). He is started on antibiotic therapy with levofloxacin. After 48 hours of treatment, the patient’s fever resolves, and his vital signs stabilize. He is afebrile with a heart rate of 90 beats/min, respiratory rate of 22 breaths/min, blood pressure of 120/80 mm Hg, and oxygen saturation of 95% on room air. He is tolerating oral intake well and has normal mental status. What is the appropriate course of action regarding antibiotic therapy for this patient?

Which of the following medicatons has been associated with a high risk of developing a clostridium difficile (C. diff) infection?

A 68-year-old female presents to the clinic with complaints of chronic knee pain exacerbated by movement and weight-bearing activities. She reports a history of osteoarthritis (OA) and states that she has been using acetaminophen as needed for pain relief. Recent evidence indicates that acetaminophen monotherapy is ineffective or only modestly better than placebo for long-term OA treatment in most individuals. However, acetaminophen is still considered appropriate for short-term or episodic use in individuals who cannot tolerate or have contraindications to NSAID use. How should the nurse practitioner advise the patient regarding the use of acetaminophen for her OA pain?

Which of the following is a contraindication to the use of spironolactone?

Lynette is a 68 yo female who presents to your clinic for a follow up appointment after her recent heart failure diagnosis.  She complains of weakness, loss of appetite, and she is seeing a blue/green halo.  Her daughter comments that she has appeared confused over the past day or so.  Which medication may be causing these side effects?

Tyson is a 50 yo black male with a past medical history significant for hypertension and a heart attack (resulting in reduced LVEF) one year ago.  He is currently taking lisinopril (Zestril*) and a higher dose of amlodipine (Norvasc*).  He says he is having ankle edema over the past couple months since amlodipine (Norvasc*) was started.  His kidney function is normal, and he has no other signs/symptoms of fluid accumulation (e.g. pulmonary congestion, weight gain).  His BP is 138/70, and HR 72. His laboratory values are normal. Considering not only hypertension, but his past medical history ( prior MI / stable HFrEF) and most recent complaint (ankle edema), which of the following recommendations is most appropriate for Tyson to correct the edema and optimize heart failure therapy?