What should a nurse suspect when an elderly client shows agitation after starting lorazepam?

When an elderly client exhibits agitation after starting lorazepam, it is important for the nurse to consider the possibility of a paradoxical reaction. Lorazepam is a benzodiazepine that is intended to help reduce anxiety and promote calmness. However, in some individuals, particularly in older adults or those with certain neurological conditions, instead of experiencing the expected calming effects, they may have the opposite reaction—becoming agitated, restless, or even aggressive. This unpredictable response is known as a paradoxical reaction.

This is especially pertinent with medications that act on the central nervous system, as older adults are often more sensitive to these effects due to changes in pharmacokinetics and pharmacodynamics that occur with aging. Recognizing that agitation in this context may be a side effect of the medication, rather than an indication of tolerance, misuse, or worsening anxiety, allows the nurse to take appropriate action, such as communicating with the healthcare provider for further evaluation and management.