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) "These tests will enable the provider to determine the heart structure and mobility of the heart valves." This statement is incorrect because cardiac enzyme tests, including troponin levels, do not assess heart structure or valve mobility. Imaging studies like echocardiograms are typically used for evaluating heart structure and function.
B) "Cardiac enzymes assist in diagnosing the presence of congestive heart failure." While cardiac enzymes can provide some information about heart function, they are not specifically used to diagnose congestive heart failure. The primary role of cardiac enzymes, particularly troponin, is in diagnosing myocardial injury, such as an acute myocardial infarction.
C) "Cardiac enzymes like troponin shows there has been damage to the heart tissues and muscle." This statement accurately reflects the purpose of measuring troponin levels. Troponin is a protein released into the bloodstream when heart muscle cells are damaged, making it a crucial biomarker for diagnosing an acute myocardial infarction.
D) "Cardiac enzymes will identify the exact location of the MI." This statement is misleading. While troponin levels can indicate that damage has occurred, they do not provide information about the specific location of the myocardial infarction. Other imaging techniques, such as an angiogram, are needed to determine the exact location of blockages or damage.
Correct Answer is B
Explanation
A. Within the expected reference range: While a blood pressure of 130/82 mm Hg is close to normal, it is not considered fully within the expected reference range. The normal range is typically defined as less than 120/80 mm Hg.
B. Elevated: The reading of 130/82 mm Hg falls into the "elevated" category, which is defined as systolic blood pressure between 120-129 mm Hg and diastolic pressure less than 80 mm Hg. This indicates that while the client is not hypertensive, they are at increased risk for developing hypertension in the future.
C. Stage 2 hypertension: This category is defined by a systolic reading of 140 mm Hg or higher, or a diastolic reading of 90 mm Hg or higher. The client’s reading does not meet these criteria, so this option is not applicable.
D. Stage 1 hypertension: Stage 1 hypertension is characterized by systolic readings between 130-139 mm Hg and diastolic readings between 80-89 mm Hg. Although the systolic reading is in the Stage 1 range, the diastolic reading of 82 mm Hg places the overall reading in the "elevated" category, rather than Stage 1 hypertension.