# A 78-year-old client newly prescribed cimetidine 400 mg PO BID for dyspepsia develops new confusion and forgetfulness. Which is the nurse's most appropriate action?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391803&lang=en  
> language: en  
> subject: Crisis Intervention  
> category: PSI

## Question

A 78-year-old client newly prescribed cimetidine 400 mg PO BID for dyspepsia develops new confusion and forgetfulness. Which is the nurse's most appropriate action?

## Option

1. Notify the provider — cimetidine has anticholinergic and CNS effects in older adults; alternative H2 blocker (famotidine) or PPI may be safer **✔ Correct answer**
2. Add diphenhydramine to help with sleep
3. Double the cimetidine dose for better symptom control
4. Reassure the family that this is normal aging

**Correct answer: 1**

## Explanation

Correct (2): Cimetidine has more CNS penetration and anticholinergic activity than other H2 blockers, causing confusion and delirium in older adults. Cimetidine is on the Beers Criteria. Switch to famotidine or PPI. Cimetidine also inhibits CYP450 widely. (1) Not normal aging. (3) Higher dose worsens. (4) Anticholinergic burden increases.

## In-depth explanation

Memory Tip Cimetidine = "CIMe-tidine = Cognitive Impairment + CYP Mess." Famotidine and nizatidine are safer in elderly; ranitidine is no longer marketed.

## Clinical scenario

Scenario 78-year-old male on cimetidine 400 mg PO BID × 1 week for dyspepsia. Family reports new confusion, forgetfulness. Baseline cognition was intact.

## Key concepts

- **H2 receptor antagonist** — Famotidine, cimetidine, nizatidine; reduce gastric acid; less effective than PPI.
- **Cimetidine adverse effects** — CNS effects in elderly, gynecomastia, CYP450 inhibition with many drug interactions.
- **Beers Criteria H2** — Cimetidine flagged for cognitive risk in older adults; famotidine preferred.

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