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 B
Explanation
A) Troponins: These are primarily used to assess for cardiac damage, such as in myocardial infarction. They are not directly related to the effects of spironolactone, so monitoring troponins is not necessary in this context.
B) Potassium: Spironolactone is a potassium-sparing diuretic, which can lead to elevated potassium levels (hyperkalemia). This can have serious implications, including cardiac arrhythmias. Therefore, it is crucial to monitor potassium levels regularly in clients taking
spironolactone to prevent potential complications.
C) Albumin: While albumin levels can provide information about the client's nutritional status and liver function, they are not specifically affected by spironolactone. Monitoring albumin is not a priority when considering the use of this medication.
D) Bicarbonate: Bicarbonate levels are important for assessing acid-base balance. Although spironolactone may have some impact on acid-base status, monitoring bicarbonate is not as critical as monitoring potassium levels, which are directly affected by the medication's action.
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.