The nurse is reviewing the home medication list with the patient. The nurse recognizes that hydrochlorothiazide is used primarily for which condition?

Choice A reason: Increasing aspirin dosage without medical guidance risks toxicity, including gastrointestinal bleeding and ulceration, as aspirin inhibits COX enzymes, reducing prostaglandin production. Prostaglandins mediate pain and inflammation, but excessive inhibition can damage the stomach lining. This approach is unsafe and not recommended for managing menstrual cramps effectively, as it may exacerbate adverse effects without ensuring better pain relief.

Choice B reason: First-generation NSAIDs, like ibuprofen, are more effective for menstrual cramps due to their stronger inhibition of COX-1 and COX-2 enzymes, which reduce prostaglandin synthesis responsible for uterine contractions and pain. Unlike aspirin, ibuprofen offers better pain relief with a more favorable dosing profile, making it a suitable alternative for dysmenorrhea management in most patients.

Choice C reason: Acetaminophen lacks significant anti-inflammatory effects, as it primarily inhibits COX enzymes in the central nervous system, not peripherally. It reduces pain and fever but does not effectively target prostaglandin-mediated inflammation in menstrual cramps. Therefore, it is less effective than NSAIDs like ibuprofen for dysmenorrhea, making it an inappropriate substitute in this context.

Choice D reason: Avoiding COX inhibitors due to Reye’s syndrome risk is unwarranted here, as Reye’s syndrome is primarily associated with aspirin use in children with viral infections. Menstrual cramps are unrelated to this condition, and COX inhibitors like NSAIDs are standard treatment. This choice is overly restrictive and not clinically justified for managing dysmenorrhea.

Choice A reason: Adrenergic neuron blockers, like guanethidine, reduce blood pressure by inhibiting norepinephrine release. They are not first-line for stage 1 hypertension (140-159/90-99 mm Hg). Their side effects, like orthostatic hypotension, make them less suitable. Lifestyle changes are preferred initially for this patient’s mild elevation and normal diagnostic tests, making this choice inappropriate.

Choice B reason: Beta blockers, like atenolol, reduce heart rate and cardiac output, lowering blood pressure. They are not first-line for stage 1 hypertension without compelling indications (e.g., heart failure). Guidelines recommend lifestyle modifications first for this patient’s blood pressure range, as they effectively reduce risk without medication side effects, making this choice less suitable.

Choice C reason: For stage 1 hypertension (140-159/90-99 mm Hg) with normal diagnostic tests, guidelines recommend lifestyle changes, such as diet, exercise, and weight loss, as first-line treatment. These reduce blood pressure by improving vascular health and reducing cardiac strain, offering a low-risk approach to manage mild hypertension effectively, making this the correct choice.

Choice D reason: ACE inhibitors, like lisinopril, block angiotensin II formation, reducing blood pressure. They are effective but not first-line for stage 1 hypertension without comorbidities. Lifestyle changes are prioritized to avoid medication side effects like cough or hyperkalemia, making this choice less appropriate for initial management in this patient.