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.)

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.

Correct Answer: D. Stage 1 hypertension

Rationales

A. Within the expected reference range.
Normal blood pressure is defined as a systolic less than 120 mm Hg and a diastolic less than 80 mm Hg. Since this client’s reading is 130/82 mm Hg, it exceeds the normal range, so it cannot be classified as expected.

B. Elevated.
Elevated blood pressure is defined as systolic 120–129 mm Hg and diastolic less than 80 mm Hg. While the systolic pressure of 130 is only slightly above this range, the diastolic value of 82 exceeds the “less than 80” requirement. Therefore, this reading does not qualify as elevated.

C. Stage 2 hypertension.
Stage 2 hypertension is defined as systolic pressure of 140 mm Hg or higher or diastolic pressure of 90 mm Hg or higher. This client’s values do not meet those thresholds, so stage 2 does not apply.

D. Stage 1 hypertension.
Stage 1 hypertension is defined as systolic 130–139 mm Hg or diastolic 80–89 mm Hg. Since the client’s reading is 130/82 mm Hg, both values fall within this category, making stage 1 hypertension the correct classification.