A patient who has congestive heart failure and arthritis has been taking chlorthalidone (Zaroxolyn)25 mg daily for 6 months.The primary care NP notes a persistent blood pressure of 145/90 mm Hg.The NP should:

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For diuretic resistance,the NP should evaluate factors such as patient nonadherence,physiologic causes,and drugs that may increase resistance,including nonsteroidal antiinflammatory drugs (NSAIDs).This patient has arthritis,and it is likely that NSAID use may be causing diuretic resistance.A second drug,such as furosemide,should be added after the cause of diuretic resistance is determined.The maximum daily dose of chlorthalidone is 100 mg per day,but increasing the dose is not recommended to treat diuretic resistance.Recommending salt substitutes is not indicated.

A Patient Who Has Congestive Heart Failure and Arthritis Has