A 79-year-old client with a calculated creatinine clearance of 28 mL/min is receiving cefepime 2 g IV every 8 hours. The client develops new confusion and myoclonus. Which actions should the nurse take? Select exactly 4 responses.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Cefepime requires dose adjustment when creatinine clearance is 60 mL/min or lower. New confusion and myoclonus raise concern for neurotoxicity and require prompt evaluation, dose interruption, renal review, and seizure safety.
Quick answer Stop further exposure while promptly reporting the neurologic change, verify renal dosing, involve pharmacy and the prescriber, and protect against seizures.
Why this is correct The cefepime label requires renal adjustment at creatinine clearance 60 mL/min or lower and warns of encephalopathy, myoclonus, seizures, and nonconvulsive status epilepticus. The client has both a renal risk factor and compatible new findings.
Easy analogy or mental picture Imagine a drain that clears medication slowly. If the dosing faucet stays fully open, the level can rise until the nervous system is affected.
Memory hook Renal impairment plus confusion or myoclonus on cefepime: stop, verify, report, protect.
NCLEX decision rule Treat a new neurologic change during renally cleared antimicrobial therapy as a possible adverse response. Do not normalize it or delay escalation.
Why the other choices are wrong Giving the next dose increases exposure before the cause is resolved. Fluids do not substitute for renal-dose review, and waiting another shift delays response to possible neurotoxicity.
References
1DailyMed: Cefepime InjectionRenal dose adjustment and neurotoxicity warning
Neurotoxicity checkTrend cognition, myoclonus, seizure activity, renal function, cefepime dose, interval, and last administration time.