A nurse on a medical unit is planning care for an older adult client who takes several medications. Which of the following prescribed medications places the client at risk for orthostatic hypotension? (Select all that apply.)

Duloxetine

Furosemide

Telmisartan

Atorvastatin

Clopidogrel

Answer and Explanation

Correct Answer : A,B,C

A) Duloxetine: Duloxetine, an SNRI (Serotonin-Norepinephrine Reuptake Inhibitor), is commonly used for depression and chronic pain. It can cause orthostatic hypotension, especially in older adults, due to its effects on norepinephrine, which can lead to blood pressure fluctuations upon standing.

B) Furosemide: Furosemide is a loop diuretic that increases urine output, leading to a decrease in blood volume. This reduction in blood volume can result in orthostatic hypotension, particularly when the client changes positions quickly, such as moving from lying down to standing.

C) Telmisartan: Telisartan is an angiotensin II receptor blocker (ARB) used to treat hypertension. It can cause vasodilation and a reduction in blood pressure, which may lead to orthostatic hypotension, especially in older adults who are more sensitive to blood pressure changes.

D) Atorvastatin: Atorvastatin, a statin used to lower cholesterol, does not typically cause orthostatic hypotension. Its primary action is on lipid levels rather than blood pressure, making it less likely to contribute to this condition.

E) Clopidogrel: Clopidogrel is an antiplatelet medication that reduces the risk of blood clots. It does not generally affect blood pressure or cause orthostatic hypotension, as its mechanism of action is related to inhibiting platelet aggregation rather than influencing vascular tone or fluid balance.

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Correct Answer is C

Explanation

C) A client received a crushed bupropion XL tablet mixed with applesauce:
Extended-release (XL) medications like bupropion XL are designed to release their active ingredients gradually over time. Crushing these tablets can alter their release mechanism, potentially leading to an overdose or reduced efficacy. This is a significant error that should be reported through an incident report to ensure patient safety and evaluate the potential impact of the mistake.

A) A nurse injected Demerol IM into the vastus lateralis site of adult:
Injecting Demerol (meperidine) intramuscularly into the vastus lateralis site is not an error. This site is commonly used for intramuscular injections in adults, though other sites like the deltoid or gluteus maximus are also appropriate depending on the situation.

B) A client received gentamicin intermittent IV bolus over 1 hr:
Gentamicin is often administered as an intermittent IV bolus over a period of time, and administering it over 1 hour is a common practice. This does not indicate an error that would require an incident report.

D) A nurse used a 25-gauge 3/8 inch needle to administer a heparin injection:
Heparin injections are typically administered with a smaller gauge needle, but a 25-gauge needle is acceptable for subcutaneous injections. The needle size might be less than ideal but does not necessarily warrant an incident report unless it directly impacts the effectiveness of the medication or causes an issue.

A. Muscle pain B. Ototoxicity C. Hypotension D. Hyperthermia

Correct Answer is C

Explanation

A) Muscle pain:
Verapamil is a calcium channel blocker used to treat cardiac dysrhythmias and hypertension. Muscle pain is not a common adverse effect associated with verapamil. Instead, side effects related to cardiovascular function are more pertinent.

B) Ototoxicity:
Ototoxicity, which refers to hearing damage or tinnitus, is not a known side effect of verapamil. This is more commonly associated with certain antibiotics or chemotherapy agents, not calcium channel blockers like verapamil.

C) Hypotension:
Hypotension is a significant concern with verapamil, as it can lower blood pressure due to its vasodilatory effects. Monitoring blood pressure is crucial when administering verapamil, especially during an IV bolus, to ensure it does not drop too low and lead to symptoms of dizziness or fainting.

D) Hyperthermia:
Hyperthermia, or elevated body temperature, is not typically associated with verapamil use. Verapamil's side effects are more focused on cardiovascular and gastrointestinal systems, rather than temperature regulation.

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A nurse on a medical unit is planning care for an older adult client who takes several medications. Which of the following prescribed medications places the client at risk for orthostatic hypotension? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is C

Explanation

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