Adult-Gerontology Clinical Nurse Specialist (CNS) Practice Exam

For which group of patients are thiazide diuretics typically the initial step in therapy?

1. Patients with diastolic hypertension

2. Older patients with isolated systolic hypertension

3. Young adults with hypertension

4. Patients with reactive airway disease

The correct answer is: Older patients with isolated systolic hypertension

Thiazide diuretics are commonly indicated as the initial step in therapy for older patients with isolated systolic hypertension. This specific group is at a greater risk for cardiovascular complications due to the natural increase in systolic blood pressure that occurs with aging. Isolated systolic hypertension is characterized by an elevated systolic pressure while the diastolic pressure remains normal or low, which is particularly prevalent in the elderly. Thiazide diuretics are effective in managing this condition by reducing overall blood volume, which in turn decreases cardiac output and lowers blood pressure. They are often well-tolerated in older adults and also provide additional benefits, such as improving osteoporosis risk due to their calcium-sparing effects. Other groups, like those with diastolic hypertension or young adults with hypertension, may benefit from different initial therapies, including other classes of antihypertensives that may be more specific to their condition or population characteristics. Furthermore, patients with reactive airway disease often require caution when prescribing diuretics, as the management of their condition typically focuses on bronchodilators and inhaled corticosteroids rather than diuretics, making thiazide diuretics less suitable for them as a first-line treatment.