# A 68-year-old woman on zolpidem 10 mg PO HS for 4 weeks is found by family driving to the grocery store at 2 a.m. with no memory of the event the next morning. Which is the priority nursing action?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391736&lang=en  
> language: en  
> subject: Crisis Intervention  
> category: PSI

## Question

A 68-year-old woman on zolpidem 10 mg PO HS for 4 weeks is found by family driving to the grocery store at 2 a.m. with no memory of the event the next morning. Which is the priority nursing action?

## Option

1. Reassure the family this is normal age-related forgetfulness.
2. Hold further doses, notify the provider, and educate about FDA boxed warning for complex sleep behaviors. **✔ Correct answer**
3. Add a benzodiazepine to enhance sedation throughout the night.
4. Increase the dose to 12.5 mg to deepen sleep and prevent night wandering.

**Correct answer: 2**

## Explanation

Correct (2): The 2019 FDA boxed warning applies to complex sleep behaviors (sleep-driving, sleep-eating, sleep-walking) with eszopiclone, zaleplon, and zolpidem — even at recommended doses. After any such event, the drug must be DISCONTINUED. Older adults, women, and concurrent CNS depressant use heighten risk. Beers Criteria also flags non-benzodiazepine sedative-hypnotics for adults ≥65. (1) Sleep-driving is not normal aging. (3) Higher dose magnifies risk. (4) Combining CNS depressants compounds the danger.

## In-depth explanation

Memory Tip Z-drugs (Zolpidem, Zaleplon, esZopiclone) = "Z-drugs, ZERO tolerance for sleep-driving" — one event mandates DISCONTINUATION. Caution Female dose is half male dose (5 mg vs 10 mg) due to slower clearance — a common prescribing error.

## Clinical scenario

Scenario 68-year-old female on zolpidem 10 mg PO HS × 4 weeks. Family reports she was found driving to a grocery store at 2 a.m. and has no memory of doing so. No alcohol use. Vital signs are stable now.

## Key concepts

- **Complex sleep behaviors** — Sleep-driving, sleep-eating, sleep-walking, and other activities performed without conscious awareness; an FDA boxed warning for Z-drugs requiring drug discontinuation.
- **Z-drug (non-benzodiazepine sedative-hypnotic)** — Class including zolpidem, zaleplon, eszopiclone — binds GABA-A receptors selectively; lower abuse potential than benzodiazepines but shares fall and complex-sleep-behavior risks.
- **Sex-specific dosing** — FDA-recommended halved zolpidem dose in females (5 mg vs 10 mg) due to slower drug clearance and higher next-morning impairment risk.

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