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","C","E","G"]
Explanation
A) Family history: Family history is a significant non-modifiable risk factor for atherosclerosis. While individuals cannot change their genetic predisposition, awareness of family history can inform lifestyle choices and risk assessments. Those with a family history should be particularly vigilant about managing other risk factors.
B) High blood pressure: High blood pressure is a modifiable risk factor that can be controlled through lifestyle changes such as diet, exercise, and medication if necessary. Effective management of hypertension can significantly reduce the risk of atherosclerosis and related cardiovascular diseases.
C) Obesity: Obesity is another modifiable risk factor. Individuals can manage their weight through healthy eating, physical activity, and lifestyle modifications. Reducing obesity can improve overall cardiovascular health and decrease the risk of developing atherosclerosis.
D) Age: Age is a non-modifiable risk factor. As people age, the risk for atherosclerosis naturally increases due to various biological changes. While aging itself cannot be altered, awareness of age-related risks can prompt individuals to adopt healthier lifestyles.
E) Lack of physical activity: This is a modifiable risk factor. Increasing physical activity can improve cardiovascular health and reduce the likelihood of developing atherosclerosis. Regular exercise can help maintain a healthy weight and improve blood pressure and cholesterol levels, contributing to overall heart health.
F) Gender: Gender is also a non-modifiable risk factor. While certain genders may have different risks at various life stages (e.g., men often have a higher risk at a younger age), this characteristic cannot be changed. Understanding gender-related risks can aid in tailoring preventive strategies but does not offer a means of modification.
G) Smoking: Smoking is a critical modifiable risk factor for atherosclerosis. Quitting smoking can significantly lower the risk of cardiovascular diseases and improve overall health. Smoking cessation should be a priority for individuals looking to prevent or manage atherosclerosis effectively.
Correct Answer is A
Explanation
A) Shiny, hairless lower extremities: In advanced peripheral arterial disease (PAD), the skin on the lower extremities often appears shiny and hairless due to reduced blood flow. The lack of hair growth and the shiny appearance are indicative of ischemia and poor circulation, making this a common finding in clients with advanced PAD.
B) Warm lower extremities: This finding is not typical in advanced PAD. Due to compromised blood flow, the lower extremities are more likely to feel cool or cold to the touch rather than warm. Warm skin can indicate good blood flow, which is usually absent in cases of significant arterial disease.
C) Thin toenails: In advanced PAD, toenails may become thin and brittle due to insufficient blood supply, which can lead to impaired nail growth. This change is consistent with the overall effects of reduced circulation and is an expected finding in clients with advanced PAD.
D) Lower extremity bilateral pulse 3+: A 3+ pulse indicates a strong and bounding pulse, which is not typically present in advanced PAD. In fact, patients with PAD often exhibit diminished or absent pulses in the affected extremities due to poor arterial circulation. Therefore, this finding does not align with the expected assessment results for advanced PAD.