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 C
Explanation
A) Intermittent claudication: This symptom is indicative of arterial insufficiency, not chronic venous insufficiency. Intermittent claudication is characterized by pain in the legs during activity due to insufficient blood flow, which is not typical in venous conditions.
B) Decreased pedal pulses: In chronic venous insufficiency, pedal pulses are usually normal. Decreased pedal pulses suggest arterial disease, where blood flow is compromised. Thus, this finding would not be expected in a client with venous insufficiency.
C) Bronze/brown discoloration of the skin: This is a hallmark finding in chronic venous insufficiency. The discoloration occurs due to the deposition of hemosiderin from the breakdown of red blood cells, which is a result of prolonged venous stasis and chronic edema, particularly around the lower extremities.
D) Cool skin temperature: Skin temperature in chronic venous insufficiency is typically warm due to increased blood flow and stasis in the veins. Cool skin temperature is more characteristic of arterial insufficiency, where blood supply is reduced and can lead to cooler extremities.
E) Full screen mode is in effect during your proctored testing: This statement is irrelevant to the clinical assessment of chronic venous insufficiency and serves no purpose in understanding the client’s condition. It does not contribute to the assessment findings.
Correct Answer is D
Explanation
A. Low fat diet: While a low-fat diet can be beneficial for overall cardiovascular health, it is not the most critical intervention for a client with Buerger's Disease. The primary concern is addressing the underlying causes of the disease rather than just dietary modifications.
B. Blood glucose control: This is important for clients with diabetes but is not specific to Buerger's Disease. Effective management of blood glucose levels does not directly address the primary issues associated with this condition.
C. Blood pressure control: Managing blood pressure is important for overall cardiovascular health; however, it is not the most immediate concern for a client with Buerger's Disease compared to smoking cessation.
D. Smoking cessation: This is the most critical intervention. Buerger's Disease is strongly associated with tobacco use, and smoking cessation is essential to halt the progression of the disease and improve symptoms. Educating the client about the importance of quitting smoking can lead to significant improvements in their condition and overall vascular health.