After completing an assessment, the nurse reviews the older client's medications. Which finding is most concerning?

Question

1. Client takes diphenhydramine (Benadryl) and zolpidem (Ambien) at night.
2. Client has not filled the new prescription for suvorexant (Belsomra).
3. Client reports taking zolpidem (Ambien) nightly for the past three months.
4. Client takes diazepam (Valium) during the day for anxiety as needed.

Answer 1

1. Client takes diphenhydramine (Benadryl) and zolpidem (Ambien) at night.

Explanation: 1. Antihistamines such as diphenhydramine (Benadryl) should not be used for sleep because of their anticholinergic side effects and the potential to decrease respiratory drive. Taking this with a strong sleep aid such as zolpidem (Ambien) is not recommended or considered safe.
2. This is concerning if the client was supposed to take this medication and has not filled it due to cost, but needs the medication for sleep.
3. Sleep medications should be taken no more than four times per week and for no more than four weeks; however, this is not the most concerning finding.
4. There is a strong risk of dependence with diazepam, it is not recommended for frequent use in the older adult population, a sedative should not be taken during the day as it can disrupt night sleep, and there is a risk that this medication will be taken too close together with other sleep medications. This needs to be addressed, but is not the most concerning finding.