A nurse is caring for a client who has a new prescription for a nonbenzodiazepine hypnotic to promote sleep. For which of the following adverse effects should the nurse monitor the client?

A. Alprazolam is a benzodiazepine used primarily for anxiety and panic disorders. Benzodiazepines are generally not recommended as first-line sleep aids in older adults due to increased risk of falls, cognitive impairment, dependence, and respiratory depression.

B. Eszopiclone is a non-benzodiazepine sedative-hypnotic used for insomnia. While it is effective for sleep initiation and maintenance, it carries risks for older adults similar to benzodiazepines, including dizziness, confusion, and increased fall risk. Therefore, it is not considered a first-line option for older adults.

C. Melatonin is a hormone that regulates the sleep-wake cycle and is considered a first-line pharmacological sleep aid for older adults. It has a favorable safety profile, minimal risk of dependency, and is effective in correcting circadian rhythm disturbances often seen in older adults. It is preferred over sedative-hypnotics and antihistamines for this population.

D. Diphenhydramine is an over-the-counter antihistamine with sedative effects. It is not recommended for older adults due to its strong anticholinergic properties, which can cause confusion, urinary retention, constipation, and increased risk of falls.

A. Hyperactivity is not a common adverse effect of OTC sleep aids. These medications, which often contain antihistamines such as diphenhydramine, are generally sedating rather than stimulating, and they are more likely to cause drowsiness, grogginess, or confusion, especially in older adults.

B. Diarrhea is not typically associated with OTC sleep aids. While gastrointestinal upset can occasionally occur with any medication, diarrhea is not a characteristic or common adverse effect of these sedating agents.

C. Excessive salivation is not commonly seen with OTC sleep aids. In fact, antihistamine-containing sleep aids more often cause dry mouth rather than increased salivation due to their anticholinergic effects.

D. Urinary retention is a potential adverse effect of OTC sleep aids that contain antihistamines. Anticholinergic properties of these medications can reduce bladder detrusor muscle activity, making it difficult for clients to empty the bladder. This effect is particularly concerning in older adults or clients with preexisting urinary issues such as benign prostatic hyperplasia.