Which medication order will provide the most consistent control of the patient's chronic pain?

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.

Choice A reason: This is the correct choice because melatonin is the safest sleep aid for the elderly patient with insomnia. Melatonin is a natural hormone that regulates the sleep-wake cycle. It has few side effects and interactions, and does not cause dependence or withdrawal. Melatonin can improve the quality and duration of sleep, and reduce the time to fall asleep.

Choice B reason: This is an incorrect choice because temazepam is not the safest sleep aid for the elderly patient with insomnia. Temazepam is a benzodiazepine that enhances the activity of GABA, a neurotransmitter that inhibits brain activity. It has many side effects and interactions, and can cause dependence, tolerance, or withdrawal. Temazepam can also impair cognitive and motor functions, and increase the risk of falls, fractures, and delirium.

Choice C reason: This is an incorrect choice because trazodone is not the safest sleep aid for the elderly patient with insomnia. Trazodone is an antidepressant that blocks the reuptake of serotonin, a neurotransmitter that regulates mood and sleep. It has many side effects and interactions, and can cause orthostatic hypotension, cardiac arrhythmias, priapism, or serotonin syndrome. Trazodone can also impair cognitive and motor functions, and increase the risk of falls, fractures, and delirium.

Choice D reason: This is an incorrect choice because triazolam is not the safest sleep aid for the elderly patient with insomnia. Triazolam is a benzodiazepine that enhances the activity of GABA, a neurotransmitter that inhibits brain activity. It has many side effects and interactions, and can cause dependence, tolerance, or withdrawal. Triazolam can also impair cognitive and motor functions, and increase the risk of falls, fractures, and delirium.