Final answer:
The nurse is most concerned about postural hypotension and the potential for injury in a 77-year-old patient with stage 2 hypertension who is prescribed a thiazide diuretic and an ACE inhibitor. Such medications can lead to decreased blood volume and reduced blood pressure upon standing, which increases the risk of falls.
Step-by-step explanation:
When a 77-year-old patient is prescribed a thiazide diuretic and an angiotensin-converting enzyme (ACE) inhibitor for newly diagnosed stage 2 hypertension, the nurse’s primary concern would be the risk of postural hypotension and resulting injury. Postural hypotension, also known as orthostatic hypotension, can occur because thiazides affect fluid balance and can lead to decreased blood volume, while ACE inhibitors block the production of angiotensin II, a peptide that increases blood pressure. For the elderly, this combination could result in a sudden drop in blood pressure upon standing, increasing the risk of falls and injuries. In addition to hypotension, another side effect of hypertension medication to watch out for is increased urination due to the diuretic effects of the thiazide, which can lead to dehydration if fluid intake is not adequately adjusted. Ensuring proper fluid balance and monitoring blood pressure levels is critical in elderly patients receiving antihypertensive therapy to prevent complications such as dehydration and hypotension.