Which is the safest sleep aid for the elderly patient with insomnia?

Choice A reason: This is correct. Taking metoprolol to treat hypertension can put the patient at high risk for development of vision problems. Metoprolol is a beta-blocker medication that can lower the blood pressure and heart rate. It can also reduce the blood flow to the eyes and cause dry eyes, blurred vision, or eye irritation.

Choice B reason: This is incorrect. Taking docusate sodium for constipation does not put the patient at high risk for development of vision problems. Docusate sodium is a stool softener medication that can ease the passage of hard stools. It does not have any direct effect on the eyes or vision.

Choice C reason: This is incorrect. Taking acetaminophen for osteoarthritis pain does not put the patient at high risk for development of vision problems. Acetaminophen is a pain reliever medication that can reduce inflammation and fever. It does not have any significant impact on the eyes or vision.

Choice D reason: This is correct. Taking insulin glulisine for type 1 diabetes can put the patient at high risk for development of vision problems. Insulin glulisine is a fast-acting insulin medication that can lower the blood sugar level. It can also cause fluctuations in the fluid balance and pressure in the eyes, leading to blurred vision, cataracts, glaucoma, or diabetic retinopathy.

Choice E reason: This is correct. Taking prednisone for multiple sclerosis can put the patient at high risk for development of vision problems. Prednisone is a corticosteroid medication that can suppress the immune system and reduce inflammation. It can also increase the intraocular pressure and cause cataracts, glaucoma, or optic nerve damage.

Choice A reason: This is incorrect. Reporting the findings to the health care provider immediately is an important step, but not the priority action of the nurse. The nurse should first assess the patient for orthostatic hypotension, which is a common cause of sudden blood pressure drop.

Choice B reason: This is incorrect. Checking the patient’s apical rate to check for a pulse deficit is a relevant step, but not the priority action of the nurse. A pulse deficit is the difference between the apical and radial pulse rates. The nurse should first check the patient for orthostatic hypotension, which is a condition where the blood pressure drops when the patient changes position, causing dizziness and fainting.

Choice C reason: This is correct. Immediately checking the patient for orthostatic hypotension is the priority action of the nurse. Orthostatic hypotension is a condition where the blood pressure drops when the patient changes position, causing dizziness and fainting. It can be caused by dehydration, medications, blood loss, or autonomic nervous system disorders. The nurse should measure the patient’s blood pressure and heart rate while lying down, sitting, and standing, and observe for any signs of hypoperfusion, such as pallor, sweating, or confusion.

Choice D reason: This is incorrect. Elevating the head of the patient’s bed to at least 45 degrees is a helpful step, but not the priority action of the nurse. Elevating the head of the bed can improve the patient’s breathing and reduce the risk of aspiration, but it can also worsen the orthostatic hypotension by lowering the blood pressure further. The nurse should first check the patient for orthostatic hypotension and then adjust the bed position accordingly.