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. Probiotics: Probiotics are generally considered safe and are not associated with perioperative hypotension. They primarily affect gut flora and digestion and do not have systemic hemodynamic effects that would increase surgical risk. B. Black cohosh: Black cohosh can have estrogen-like effects and may potentiate hypotensive episodes during anesthesia by causing vasodilation. It can interact with anesthetic agents, increasing the risk of intraoperative hypotension, making it important to identify and withhold prior to surgery. C. Flaxseed: Flaxseed is a source of dietary fiber and omega-3 fatty acids. While it may affect coagulation or gastrointestinal motility, it does not typically alter blood pressure or contribute to intraoperative hypotension. D. Soy: Soy contains phytoestrogens and can influence hormone levels but does not significantly affect blood pressure in the perioperative period. Its use does not increase the risk of hypotension during surgery.