# A 65-year-old client started on amlodipine 5 mg orally daily for hypertension 3 weeks ago calls the clinic reporting bilateral ankle swelling that worsens at the end of the day and improves with leg elevation overnight. The client denies dyspnea, orthopnea, weight gain, jugular venous distention, or chest pain. Which response by the nurse is most appropriate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374905&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 65-year-old client started on amlodipine 5 mg orally daily for hypertension 3 weeks ago calls the clinic reporting bilateral ankle swelling that worsens at the end of the day and improves with leg elevation overnight. The client denies dyspnea, orthopnea, weight gain, jugular venous distention, or chest pain. Which response by the nurse is most appropriate?

## Option

1. "This is a known dose-dependent peripheral edema from dihydropyridine calcium channel blockers; please come in to be evaluated, as the provider may lower the dose, switch to an ARB, or add a low-dose ACE inhibitor." **✔ Correct answer**
2. "It may be best to stop the amlodipine as this swelling could indicate an allergic reaction; please come in for an evaluation this week so we can select a different medication to manage your blood pressure."
3. "Although you do not have trouble breathing, bilateral ankle swelling that increases throughout the day can indicate heart failure; please go to the emergency department now for assessment and possible diuretic therapy."
4. "It is important to follow a very low-sodium diet, around 400 mg daily, and increase your fluid intake to 3 liters per day; this will help eliminate the swelling while you continue the amlodipine."

**Correct answer: 1**

## Explanation

DHP CCB peripheral edema
Dihydropyridine CCBs (amlodipine, nifedipine, felodipine) cause selective arteriolar pre-capillary vasodilation without comparable post-capillary venous dilation, raising hydrostatic pressure in the capillary bed and producing dose-dependent, gravity-dependent peripheral edema (most often bilateral ankles, end-of-day worse, resolves overnight). It occurs in 5-15% of patients and is NOT volume overload — diuretics do not reliably reverse it. Standard management is dose reduction, addition of an ACE inhibitor or ARB (which dilates the venous side and counterbalances the hydrostatic pressure), or a switch to a non-DHP CCB or another antihypertensive class. The absence of dyspnea·orthopnea·weight gain·JVD makes acute heart failure unlikely, so an ED visit is not warranted but an outpatient evaluation is. Self-stopping the drug or substituting aspirin·high-salt diet is incorrect.

## In-depth explanation

Clinical reasoning summary
DHP CCB peripheral edema
Dihydropyridine CCBs (amlodipine, nifedipine, felodipine) cause selective arteriolar pre-capillary vasodilation without comparable post-capillary venous dilation, raising hydrostatic pressure in the capillary bed and producing dose-dependent, gravity-dependent peripheral edema (most often bilateral ankles, end-of-day worse, resolves overnight). It occurs in 5-15% of patients and is NOT volume overload — diuretics do not reliably reverse it. Standard management is dose reduction, addition of an ACE inhibitor or ARB (which dilates the venous side and counterbalances the hydrostatic pressure), or a switch to a non-DHP CCB or another antihypertensive class. The absence of dyspnea·orthopnea·weight gain·JVD makes acute heart failure unlikely, so an ED visit is not warranted but an outpatient evaluation is. Self-stopping the drug or substituting aspirin·high-salt diet is incorrect.

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