A nurse is completing the medical reconciliation on an elderly client taking several medications. Which of the following prescribed medications places this client at risk for orthostatic hypotension? (Select all that apply.)
furosemide
Simvastatin
Losartan
Nifedipine
Clopidogrel
Correct Answer : A,C,D
A) Furosemide: This is a loop diuretic that can lead to dehydration and electrolyte imbalances, both of which can contribute to orthostatic hypotension. The medication's diuretic effect can cause a significant drop in blood volume, increasing the risk of low blood pressure upon standing.
B) Simvastatin: This medication is used to lower cholesterol levels and is not associated with orthostatic hypotension. It does not have a direct impact on blood pressure or volume.
C) Losartan: As an angiotensin II receptor blocker (ARB), losartan is used to treat hypertension. It can cause vasodilation and may lead to orthostatic hypotension, particularly in elderly clients or those who are volume-depleted.
D) Nifedipine: This calcium channel blocker is used to treat hypertension and can cause vasodilation. It may lead to orthostatic hypotension as well, especially during dose adjustments or if the client is dehydrated.
E) Clopidogrel: This antiplatelet medication is used to prevent blood clots and does not directly cause orthostatic hypotension. Its primary action is to inhibit platelet aggregation, not to affect blood pressure.
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Correct Answer is A
Explanation
A) Intermittent claudication: This term describes the leg pain and cramping that occurs during physical activity, such as walking, and is relieved by rest. It is a classic symptom of peripheral arterial disease (PAD) and results from insufficient blood flow to the muscles due to narrowed or blocked arteries. The client's description aligns perfectly with this definition.
B) Neuropathy: While neuropathy can cause leg pain, it typically presents differently, often with sensations like tingling, numbness, or burning rather than cramping during activity. Neuropathy does not specifically correlate with the pattern of pain relief upon resting, which is characteristic of intermittent claudication.
C) Deep vein thrombosis (DVT): DVT generally presents with symptoms like swelling, warmth, and tenderness in the affected leg, rather than cramping pain that is related to activity. The pain associated with DVT is not typically relieved by rest, making this option inconsistent with the client’s symptoms.
D) Venous insufficiency: This condition is characterized by symptoms such as swelling, varicosities, and skin changes, primarily in the lower extremities. Pain related to venous insufficiency tends to occur after prolonged standing or sitting and is not typically relieved by rest in the same way as intermittent claudication. Therefore, this option does not accurately describe the client’s experience.
Correct Answer is ["B","E"]
Explanation
A) Provide discharge instructions for a client who has a new skin graft: This task should not be delegated to an assistive personnel (AP) as it requires clinical judgment and knowledge about the specific care needs associated with a new skin graft. Discharge instructions must be provided by a qualified nurse.
B) Weigh a client who is on fluid restriction: This task can be delegated to an AP. Weighing a client is a straightforward procedure that does not require nursing judgment and is within the scope of practice for an AP.
C) Check a blood product with another nurse prior to administration: This task must be performed by a licensed nurse to ensure patient safety and compliance with protocols. Checking blood products requires knowledge of the client's specific needs and potential reactions.
D) Perform an admission assessment on a client: Admission assessments require nursing expertise and critical thinking. This task cannot be delegated to an AP, as it involves evaluating the client's condition and creating a care plan based on the assessment findings.
E) Ambulate an older adult client who has hypertension: This task can be delegated to an AP, provided the client is stable and there are no other complications. Assisting with ambulation is within the scope of practice for an AP, and it can help promote mobility and independence for the client.