# 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.

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> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

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 exactly 4 responses.

1

Hold the next dose and report the acute neurologic change.

2

Initiate seizure precautions and monitor for worsening central nervous system findings.

3

Encourage oral fluids and reevaluate neurologic status at the next medication time.

4

Recalculate renal function and compare the regimen with current dosing guidance.

5

Request immediate prescriber and pharmacist review of dosing and toxicity.

6

Give the next dose as scheduled and attribute confusion to the unfamiliar setting.

## 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.

## In-depth explanation

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

## Clinical scenario

Neurotoxicity check
Trend cognition, myoclonus, seizure activity, renal function, cefepime dose, interval, and last administration time.

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