An 82-year-old client with an eGFR of 22 mL/min takes a standard adult famotidine dose and develops confusion and a prolonged QT interval. Which action should the nurse take?
1Administer an additional dose because confusion indicates uncontrolled gastric acid secretion.
2Continue the same regimen and repeat the electrocardiogram at the annual examination.
3Add a second histamine-2 blocker so famotidine can be cleared more rapidly.
4Hold the next dose and obtain prompt renal-dose and adverse-effect review.✓ Correct answer
Explanation
Famotidine clearance is reduced in moderate or severe renal impairment, increasing the risk of central nervous system reactions and QT prolongation unless the dose is adjusted.
Quick answer Link renal accumulation to new neurologic and electrical toxicity.
Why this is correct The new findings require prompt medication review and assessment rather than further exposure or delayed follow-up.
Easy analogy or mental picture Use a closed medication-safety loop: identify the exposure, connect the new findings, interrupt further harm, support physiology, and verify the response over time.
Memory hook Exposure, interaction, toxicity pattern, immediate action, serial reassessment.
NCLEX decision rule Choose the action that reduces the most immediate medication-related risk while preserving monitoring and escalation.
Why the other choices are wrong Options that continue the exposure, treat only one symptom, or delay reassessment leave the toxic process active.
References
1DailyMed: Famotidine TabletsRenal dose reduction and increased risk of central nervous system reactions and QT prolongation
Medication safety reviewVerify the indication, route, interacting medicines, current respiratory and gastrointestinal findings, authorized action, and measurable follow-up.