The primary care NP sees a patient who has a history of hypertension and alcoholism.The patient is not taking any medications.The NP auscultates crackles in both lungs and palpates the liver 2 cm below the costal margin.Laboratory tests show an elevated creatinine level.The NP will refer this patient to a cardiologist and should prescribe:

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In the treatment of heart failure,loop diuretics relieve the congestive symptoms of pulmonary and congestive edema.Loop diuretics are also useful to treat states of volume excess in cirrhosis and renal insufficiency.Because this patient has a history of alcoholism and has an enlarged liver on examination,furosemide is a good first choice to relieve this patient's congestive symptoms.Spironolactone and chlorthalidone are not loop diuretics.Albuterol might be used for symptomatic treatment only.

The Primary Care NP Sees a Patient Who Has a History