A client has a new prescription for zolpidem, a hypnotic. The client tells the home health nurse that he plans to take a dose of the medication during the day because he is exhausted and needs to take a short afternoon nap prior to an evening activity in his home. Which action should the nurse take?

Choice A reason: Zolpidem is a hypnotic drug that induces sleep by enhancing the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity. Zolpidem is used to treat insomnia, or difficulty falling asleep or staying asleep. Zolpidem should be taken only at bedtime, when the client is ready to go to sleep and can devote at least seven to eight hours for uninterrupted sleep. Taking zolpidem during the day can cause excessive sedation, drowsiness, confusion, memory loss, and impaired coordination. Therefore, the nurse should encourage the client to wait until bedtime to take the medication and avoid daytime naps.

Choice B reason: Reminding the client to drink plenty of fluids when taking the medication is not an action that the nurse should take in this situation, but rather a general recommendation that applies to most medications. Drinking fluids can help to prevent dehydration, flush out toxins, and maintain kidney function. However, drinking fluids is not specific to zolpidem and does not affect its absorption or metabolism.

Choice C reason: Advising the client to take the medication with the noon meal is not an action that the nurse should take in this situation, but rather a harmful suggestion that can reduce the effectiveness of zolpidem and increase its side effects. Taking zolpidem with food can delay its onset of action and make it less potent. Taking zolpidem at noon can also interfere with the client's circadian rhythm, or natural sleep-wake cycle, and cause daytime sleepiness and nighttime insomnia.

Choice D reason: Explaining that the client needs to allow for sleep time of at least two hours is not an action that the nurse should take in this situation, but rather an inaccurate and insufficient information that can mislead the client and endanger their safety. Zolpidem has a half-life of about two hours, which means that half of its dose is eliminated from the body in two hours. However, this does not mean that its effects wear off in two hours. Zolpidem can still cause residual sedation and impairment for several hours after taking it. The client needs to allow for sleep time of at least seven to eight hours when taking zolpidem, not just two hours.

Choice A reason: Stopping the oral contraceptive immediately is not necessary and may increase the risk of unintended pregnancy. Erythromycin can reduce the effectiveness of oral contraceptives by interfering with their metabolism, but it does not make them completely ineffective.

Choice B reason: Taking the medications at least 12 hours apart is not sufficient to prevent the interaction between erythromycin and oral contraceptives. The interaction can occur regardless of the timing of the doses.

Choice C reason: Using an additional form of contraception is the best instruction for the client who is taking an oral contraceptive and erythromycin. This can prevent pregnancy in case the oral contraceptive fails due to the interaction with erythromycin. The additional form of contraception should be non-hormonal, such as a barrier method or a copper intrauterine device.

Choice D reason: Avoiding prolonged exposure to direct sunlight is a good advice for anyone taking erythromycin, as it can cause photosensitivity and increase the risk of sunburn. However, this is not related to the interaction with oral contraceptives and does not affect their efficacy.