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.)

A) Discard the medication:
The safest action is to discard the medication. Medications past their expiration date may not be effective and could potentially be unsafe. Using expired medications can pose risks, and discarding them ensures that the client is not exposed to potentially compromised treatments.

B) Give the medication:
Administering expired medication is not appropriate as it could be ineffective or harmful. The expiration date indicates that the medication may no longer be guaranteed to work as intended or might have degraded, making it unsafe to give.

C) Return the medication to the pharmacy:
Returning expired medication to the pharmacy is not a standard practice. The medication should be disposed of according to facility protocols, and the pharmacy should be notified of the issue so they can take appropriate actions.

D) Notify the provider:
While notifying the provider is important if there are issues with medication availability or alternatives, the immediate action regarding the expired medication itself is to discard it. The provider can be informed as part of addressing the medication issue and determining the next steps.

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.