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. Flaxseed: Flaxseed is primarily used for its fiber content and potential cholesterol-lowering effects; it is not commonly associated with causing hypotension during surgery. B. Soy: Soy contains phytoestrogens and may affect hormone levels, but it does not typically increase the risk of hypotension during surgery. C. Probiotics: Probiotics help maintain gut flora balance and generally have no direct effect on blood pressure or hypotension risk during surgery. D. Black cohosh: Black cohosh has vasodilatory properties and can lower blood pressure, increasing the risk of hypotension during surgery, especially when combined with anesthesia or other medications.