Final answer:
In a 71 year old patient with stage III congestive heart failure, thiazolidinediones may cause exacerbation by promoting fluid retention, while NSAIDs can worsen heart failure by causing sodium and water retention and impacting renal function.
Step-by-step explanation:
A 71 year old patient with stage III congestive heart failure (CHF) may experience an exacerbation of their condition with certain medications. Among the options provided, thiazolidinediones (option a) are known to potentially worsen CHF by causing fluid retention and increasing the workload on the heart. In contrast, narcotics (option b) are not typically associated with exacerbation of CHF. However, they must be used cautiously as they can lead to respiratory depression which may indirectly affect heart function. Nonsteroidal anti-inflammatory drugs (NSAIDs) (option c), can also exacerbate CHF by causing sodium and water retention, as well as affecting renal function. Option d, ACE inhibitors, are actually commonly used to treat heart failure and typically do not exacerbate it; they can improve symptoms and survival by reducing afterload and preload.