Defined as a drop of at least 20 mmHg systolic or 10 mmHg diastolic within 3 minutes of standing.
Before you read
Test yourself first: 5 questions
Question 1 of 5
An older adult has orthostatic hypotension. Which instruction should the nurse provide to reduce dizziness and fall risk?
Answer: B. Rising slowly and sitting on the edge of the bed for a few moments before standing allows blood pressure to stabilize and prevents the drop that causes dizziness. Standing quickly, skipping fluids, and lying flat all worsen or fail to address orthostatic symptoms.
Question 2 of 5
An older adult is at risk for orthostatic hypotension. Which teaching point should the nurse emphasize?
Answer: A. Changing positions slowly and sitting on the edge of the bed before standing reduces orthostatic drops in blood pressure and the risk of falls. Standing up quickly, restricting all fluids, and avoiding any movement worsen the problem or cause deconditioning.
Question 3 of 5
A client in unstable supraventricular tachycardia has a blood pressure of 78/40, chest pain, and altered mental status. What is the priority intervention?
Answer: A. Unstable tachycardia with serious signs and symptoms (hypotension, chest pain, altered mental status) requires immediate synchronized cardioversion. Synchronization times the shock to the R wave to avoid the vulnerable T wave and triggering VF. Vagal maneuvers and oral medications would delay needed treatment.
Question 4 of 5
A client receiving IV procainamide for a ventricular dysrhythmia is on continuous ECG monitoring. The nurse should stop the infusion if which change occurs?
Answer: B. Procainamide is a class IA antidysrhythmic that can prolong the QRS and QT intervals. Infusion should be stopped if the QRS widens by 50 percent or more, the QT prolongs markedly, hypotension develops, or the dysrhythmia is suppressed. A widening QRS complex of 50 percent or greater is a key endpoint to stop the drug. A narrowing QRS, a rising blood pressure, or resolution of nausea are not endpoints for stopping the infusion.
Question 5 of 5
The nurse is assessing a client for the earliest sign of shock. Which change is often the first subtle indicator?
Answer: A. Restlessness, anxiety, or a subtle change in mental status is often the earliest sign of shock because the brain is highly sensitive to decreased perfusion and oxygenation. Marked hypotension, anuria, and mottled skin are later findings.
Keep the streak going with more questions like these, each with a full rationale.
What is orthostatic hypotension?
It causes dizziness, lightheadedness, and increases fall risk. Common causes include dehydration, blood loss, antihypertensive medications, and prolonged bed rest.
Key points to remember
- Defined as a drop of at least 20 mmHg systolic or 10 mmHg diastolic within 3 minutes of standing.
- Causes dizziness, lightheadedness, blurred vision, and syncope, raising fall risk.
- Common causes: volume depletion (dehydration/bleeding), antihypertensives, diuretics, and prolonged bed rest.
- Often accompanied by a compensatory rise in heart rate, especially with volume loss.
- Measure BP and pulse lying, sitting, and standing to assess for orthostatic changes.
- Primary nursing concern is fall prevention through safe, gradual position changes.
Common causes
- Dehydration, blood loss
- Antihypertensives, diuretics
- Prolonged bed rest
Nursing priorities
- Measure orthostatic vital signs (lying, sitting, standing) and document changes.
- Teach the patient to change positions slowly and dangle legs before standing.
- Implement fall precautions and assist with ambulation as needed.
- Address underlying causes: assess hydration, review medications, and replace fluids/volume as ordered.
- Encourage adequate fluid intake and compression stockings when appropriate.
Labs & values
Patient teaching
- Rise slowly: move from lying to sitting, dangle the legs, then stand.
- Stay well hydrated and avoid alcohol and prolonged standing in heat.
- Wear compression stockings if recommended to improve venous return.
- Report frequent dizziness or fainting and review medications with the provider.
Red flags: report now
- Syncope or a fall with injury requires immediate assessment.
- Persistent hypotension with tachycardia and signs of shock may indicate ongoing bleeding or volume loss.
- Severe dizziness with chest pain or neurologic symptoms needs urgent evaluation.
References
Clinical references for this topic
