# An older adult client has a new order for diazepam 5 mg PO at bedtime for insomnia. Which nursing action is the priority?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391724&lang=en  
> language: en  
> subject: Crisis Intervention  
> category: PSI

## Question

An older adult client has a new order for diazepam 5 mg PO at bedtime for insomnia. Which nursing action is the priority?

## Option

1. Withhold the medication and call the prescriber to discuss Beers Criteria concerns and safer alternatives. **✔ Correct answer**
2. Administer the dose and educate the client on fall prevention strategies due to increased sedation risk.
3. Crush the tablet and administer it with a small amount of applesauce to aid swallowing for the client.
4. Administer the medication and monitor the client's respiratory rate every 30 minutes throughout the night.

**Correct answer: 1**

## Explanation

Correct (1): Diazepam is on the Beers Criteria list of potentially inappropriate medications for adults ≥65 because its long half-life active metabolites accumulate, markedly increasing risk of falls, hip fractures, and delirium. The nurse should withhold the dose and advocate with the prescriber for safer alternatives (behavioral interventions, ramelteon, or low-dose trazodone). (2) Patient teaching alone cannot eliminate the pharmacologic fall risk. (3) Blood pressure is not the relevant safety parameter; sedation and gait stability are. (4) Crushing the tablet does not change the underlying pharmacologic risk.

## In-depth explanation

Memory Tip "Old + benzo = Beers bad" — long-acting (diazepam, flurazepam, chlordiazepoxide) is far worse than short-acting in older adults. Clinical Practice Guide Review Beers Criteria at every admission for adults ≥65 and document the alternative chosen when a flagged medication is declined.

## Clinical scenario

Scenario A 78-year-old female with new-onset insomnia and mild anxiety was prescribed diazepam 5 mg PO HS at the outpatient clinic. She lives alone, uses the bathroom multiple times each night, and has no walker. Her most recent fall risk score is moderate-to-high.

## Key concepts

- **Beers Criteria** — American Geriatrics Society list of medications potentially inappropriate for adults ≥65 due to risk of adverse outcomes; long-acting benzodiazepines such as diazepam are listed.
- **Long half-life metabolite** — An active byproduct of drug metabolism that persists longer than the parent drug; diazepam's metabolites accumulate in older adults and amplify fall and cognition risk.
- **Fall risk** — The probability of an unintentional fall, increased by medications causing sedation, orthostasis, or motor impairment; benzodiazepines significantly elevate fall risk in older adults.

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