A nurse is providing preoperative teaching to an older adult female client who is scheduled for a laminectomy and uses supplements. Which of the following supplements should the nurse identify as increasing the client's risk for hypotension during surgery?

A. Soy. While soy can have mild estrogen-like effects and may influence thyroid function or interact with certain medications, it is not typically associated with hypotension or increased surgical bleeding risk. B. Black cohosh. Black cohosh is often used to manage menopausal symptoms but is known to cause vasodilation and hypotension in some individuals. Its use can increase the risk of low blood pressure during anesthesia and surgery. C. Flaxseed. Flaxseed is commonly used for digestive health and cardiovascular support. It may have mild blood pressure–lowering effects but is not strongly linked to significant hypotension during surgery. D. Probiotics. Probiotics support gut flora and immunity but do not affect blood pressure significantly. They are not associated with intraoperative complications like hypotension.