chapter 3 pharm

A client with cancer has been receiving antineoplastics for several weeks. What assessment finding should the nurse interpret as a possible indication of blood dyscrasia?

Hemoglobin of 6.0 g/dL (60.0 g/L)

A client with an anxiety disorder has been prescribed alprazolam 0.5 mg PO t.i.d. During a follow-up assessment, the client tells the nurse that the medication causes drowsiness that complicates with the client's work performance. What is the nurse's best action?

Educate the client about strategies for managing this primary action

A client develops stomatitis from drug therapy. Which measure would be most appropriate for the nurse to suggest?

frequent rinsing with cool liquids Explanation: For stomatitis, the nurse should recommend frequent mouth care with a nonirritating solution. This may include frequent rinsing with cool liquids. The client should consume frequent small meals rather than three large meals. An astringent mouthwash or a firm toothbrush would be too irritating.

A client comes to the clinic reporting vaginal discharge with itching. Which statement would alert the nurse to the possibility that the client's reports are related to a superinfection?

"I just completed a course of antibiotics prescribed by my dentist to treat a tooth abscess."

A client taking a beta blocker for hypertension tells the nurse he will no longer take the medication because it is causing an inability for him to maintain an erection. What is the best explanation for this issue by the nurse?

"This is an expected adverse effect of the medication, but it is very important that you continue to take it. We can talk about other methods for sexual expression."

The nurse provides health education for a diverse group of clients. For which client should the nurse emphasize the risk of teratogenic drug effects?

20-year-old female client who has been diagnosed with a chlamydial infection

What client is experiencing an adverse effect that is a result of primary action?

A client taking anticoagulants who develops a gastrointestinal bleed

Some clients are excessively responsive to either the primary or secondary effects of a drug. This is known as hypersensitivity, and it may result from a pathological or underlying condition. Which are examples of hypersensitivity? Select all that apply.

A client who has chronic renal failure and is taking diphenhydramine A client on postoperative day 2 from a prostatectomy who takes ipratropium

Drugs can affect the special senses, including the eyes and ears. Alterations in seeing and hearing can pose safety problems for clients. What are examples of sensory effects of drugs? Select all that apply.

Aspirin, one of the most commonly used drugs, is often linked to auditory ringing and eighth cranial nerve effects. A drug used to treat some rheumatoid diseases can cause retinal damage and even blindness

A client who is being treated for cancer developed a serum sickness reaction. The care team has been notified, and the client is being stabilized. What is the nurse's priority action?

Discontinue the drug immediately as ordered.

A client with a diagnosis of bipolar disorder has begun lithium therapy. What is the primary rationale for the nurse's instructions regarding the need for regular monitoring of the client's serum drug levels?

It is necessary to ensure that the client's drug levels are therapeutic but not toxic.

A client is prescribed a combination of medications to treat the disease process. The client is exhibiting signs of toxicity related to the new drug regimen. A possible cause of the change in the absorption of the medications may be enzyme inhibition. What is true of enzyme inhibition? (Select all that apply.)

It may occur with concurrent administration of two or more drugs that compete for the same metabolizing enzymes. It may necessitate the administration of smaller doses of the medication. e. It occurs within seconds or minutes of starting an inhibiting agent.

A client began a new medication four days ago and presents with a temperature of 38.2° C (100.8 °F), dependent edema, and swollen cervical lymph nodes. The nurse has informed the client's provider, who has discontinued the medication. What subsequent intervention should the nurse prioritize?

Provide supportive care to manage fever and inflammation.

A client receiving drug therapy develops numbness and tingling in the extremities and muscle cramps. What assessment should the nurse perform?

Review the client's most recent potassium level.

A client is on antibiotic therapy for an axillary abscess. The client has been outside working in the yard and observes a rash everywhere that is not covered by clothing. What should the client be told about this finding?

The client is having photosensitivity and this can occur even with brief exposure to the sun or UV rays.

A newly admitting client has signs and symptoms of an infection and the nurse anticipates that the client will be prescribed antibiotics. What assessment should the nurse prioritize when determining the client's risk for an excessive drug response due to impaired excretion?

The client's blood urea nitrogen level and creatinine clearance rate

The nurse is assessing a diverse group of clients, all of whom are being treated with medications. Which clients are experiencing adverse effects related to the primary actions of their medications? (Select all that apply.)

a client whose diuretic causes episodes of dizziness a client whose benzodiazepine causes sedation

The nurse is caring for a client receiving an aminoglycoside (antibiotic) that can be nephrotoxic. Which will alert the nurse that the client may be experiencing nephrotoxicity?

a decrease in urine output

The nurse should have basic knowledge of drug classifications in order to administer medications safely to clients. What drug information is instrumental in determining nursing actions following drug administration?

adverse effects

A client is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the client develops redness of the skin, itching, and swelling at the site of injection of the drug. The most likely cause of this response is:

an allergic response

The nurse is called to a client's room 15 minutes after the client has received a new medication. The client reports pruritus as well as nausea. The nurse notes that the client appears pale, is sweating, and has begun to cough and wheeze. The nurse determines that the client is experiencing what type of reaction related to the new medication?

anaphylactic shock

The nurse is caring for a client with a drug allergy and understands the allergy is the result of the client developing:

antibodies

Atropine, which is used preoperatively, is considered which drug classification?

anticholinergic

The nurse is assessing a new client who states being allergic to nonsteroidal anti-inflammatories (NSAIDs. What subsequent assessment should the nurse prioritize?

asking the client what the client's response is to taking NSAIDs

A client develops a cytotoxic reaction to a drug. What would the nurse expect to do?

d/c the drug stat as ordered

A client is four months' pregnant. She works in the chemical unit of a research department and is responsible for handling various chemicals. Her gynecologist advised her not to expose herself to chemical or industrial vapors and specific drugs. These restrictions are advised because exposure to industrial vapors could:

damage the immature nervous system of the fetus

What changes due to aging in the geriatric client may affect excretion and promote accumulation of drugs in the body?

decreased glomerular filtration rate

Organ and tissue damage is one adverse reaction caused by drugs. What are examples of such organ and tissue damage? Select all that apply.

dermatological reactions stomatitis blood dyscrasia poisoning

What would the nurse expect to assess in a client experiencing an anaphylactic reaction? (Select all that apply.)

dilated pupils feeling of panic difficulty breathing

A client is diagnosed with hypercholesterolemia and is prescribed a statin. As part of client education, the nurse should teach the client to avoid eating:

grapefruit

When reviewing the medication list of a client being seen in the clinic, the nurse notes that the client is receiving glipizide. Based on the nurse's understanding, this drug is used to treat:

hyperglycemia

The nurse is caring for a client in the intensive care unit. This client took an overdose of acetaminophen 3 days previously and now has jaundice. Laboratory results show elevated liver enzymes. The nurse understands that the client:

is experiencing hepatotoxicity and may have permanent liver damage

A nurse is instructing a client concerning a newly prescribed drug. What should be included to help improve client compliance and safety?

measures to alleviate any discomfort associated with adverse effects

A client develops bone marrow suppression related to a drug's effects. What would be most important for the nurse to do?

monitor lab blood values

A client is receiving an antineoplastic medication for treatment of breast cancer and begins having tonic-clonic seizure activity. What type of toxicity does the nurse recognize that this client is experiencing?

neurotoxicity

The nurse is reviewing the laboratory test results of a client receiving drug therapy. What would the nurse suspect if the results reveal an elevation in the blood urea nitrogen level and creatinine concentration?

renal injury

When instructing a client who is taking an antibiotic about the possibility of nausea and diarrhea, the nurse understands that these effects are examples of:

secondary actions Explanation: Secondary actions are effects that are inevitable and undesired but not related to the desired pharmacologic effects. Nausea and diarrhea are examples of secondary actions due to an antibiotic's effect on the gastrointestinal tract. Primary actions are those associated with the therapeutic effect. Drug allergy involves the formation of antibodies to a particular drug. Hypersensitivity refers to an excessive response to either primary or secondary effects of a drug.

Many drugs that reach the developing fetus or embryo can cause death or congenital defects. What are examples of congenital defects? Select all that apply.

skeletal and limb abnormalities central nervous system alterations heart defects

One of the most common occurrences in drug therapy is the development of adverse effects from simple overdose. In such cases, the client suffers from effects that are merely an extension of the desired effect. Which are examples of this primary action? (Select all that apply.)

spontaneous bleeding after taking an anticoagulant dizziness after starting an antihypertensive

A nurse, planning an educational session of teratogenic drugs, should plan to discuss which drug groups? Select all that apply.

statins antiepileptic antidepressants

An older adult client has an elevated serum creatinine level. This client is at greatest risk for which medication-related effect?

toxicity

A client with a recent history of peripheral edema has been taking hydrochlorothiazide 75 mg PO daily. The client reports increased appetite and restlessness to the nurse and inspection reveals warm, flushed skin. What is the nurse's best action?

Assess the client's blood glucose level. Explanation: Some medications, such as thiazide diuretics, cause hyperglycemia. Symptoms of hyperglycemia include polyphagia, restlessness and flushed skin. Abdominal girth and weight would help the nurse track the client's edema but would not address the possibility of hyperglycemia. The client's blood pressure is less likely to be affected and increasing fluid intake would be of no clear benefit

The nurse is preparing to administer antineoplastic medication to a client with cancer who has been receiving these medications for several days. When monitoring for potential adverse effects of this medication, the nurse should perform what assessments? (Select all that apply.)

Inspect the client's mucous membranes. Monitor the client's blood cell counts. Monitor the client's potassium levels. Explanation: Clients receiving antineoplastic medications are at risk for stomatitis, blood dyscrasias, and hyperkalemia. Hyperglycemia and decreased urine output are not normally associated with administration of antineoplastic medications, although specific cancers could cause these or virtually any symptom depending on the organ involved

A client with hypertension has been taking spironolactone, a potassium-sparing diuretic, 75 mg PO daily for several weeks. What assessment findings should prompt the nurse to suspect hyperkalemia? (Select all that apply.)

Correct response: The client reports thigh and calf cramps. The client's heart rate is 62 beats per minute. The client's blood pressure is 101/63 mmHg. The client's urine output is 375 mL over the past 24 hours.

What would the nurse include in the teaching plan for a client who is to receive a drug that is associated with anticholinergic effects?

Be sure to drink plenty of fluids to prevent dehydration.

The most serious allergic response is called anaphylaxis. Which clients exhibit possible symptoms of anaphylaxis? (Select all that apply.)

Correct response: A client showing signs of acute respiratory distress. A client with marked hypotension and experiences convulsions. A client with laryngeal edema and pale, cool skin.

A client has been prescribed a tricyclic antidepressant and the nurse recognizes the client's associated risk for anticholinergic effects. What should the nurse teach the client about preventing and managing these adverse effects? (Select all that apply.)

Maintain good oral hygiene to minimize dry mouth. Void before taking the medication so urinary hesitation is less problematic. Use caution in situations where it may be possible to become overheated.

When administering drug therapy for a client, how can the nurse ensure beneficial outcomes? (Select all that apply.)

Maximize therapeutic effects. Minimize adverse effects and drug interactions. Provide appropriate drug education for the client and family.

The nurse on a busy medical floor is caring for several clients whose medication regimens vary widely. What action best addresses a client's risk for adverse effects related to primary actions?

Monitoring the international normalized ratio (INR) of a client taking warfarin

A hospital client began taking a newly prescribed antihypertensive 12 hours ago and has developed a full body rash with edema and pruritis. What is the nurse's best action?

Promptly inform the prescriber of the client's status.

A client with a history of schizophrenia has developed severe drug-induced parkinsonism from treatment with antipsychotic medications. What nursing diagnosis should the nurse identify?

Risk for aspiration related to impaired swallowing Explanation: Parkinson-like symptoms include impaired swallowing, which in turn creates a risk for aspiration. Memory, personality and ventilation are not normally affected by these particular adverse effects.

All drugs have adverse reactions when taken. Organ and tissue damage is one such adverse reaction. Which is an example of organ and tissue damage caused by a drug?

SJS

The nurse has begun the intravenous infusion of the first dose of a client's prescribed antibiotic. A few minutes later, the client is diaphoretic, gasping for breath and has a heart rate of 145 beats per minute. After calling for help, what is the nurse's priority action?

protecting and maintaining the patency of the client's airway

Drugs can affect the special senses, including the eyes and ears. Alterations in seeing and hearing can pose safety problems for clients. What are examples of sensory effects of drugs? (Select all that apply.)

A 4-year-old admitted after taking too many aspirin A 45-year-old taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis

A recent nursing graduate is preparing to enter the workforce. What principle should guide the nurse's administration of medications?

Drugs can cause unexpected reactions even after thorough screening and testing.

An elderly client has been taking a new medication for 2 months. During a follow-up visit, the client's son tells the nurse that he feels his mother's memory is getting worse. What concerns should the nurse have at this time?

This may be coincidental, and the memory loss may be attributed to changes with aging.

The nurse is caring for a client who exhibits an excessive response to a secondary effect of a drug, which the nurse classifies as a hypersensitivity response. What factors can potentially contribute to a hypersensitivity reaction? (Select all that apply.)

pathological condition unique receptors and cellular responses age-related changes Explanation: Some clients are excessively responsive to either the primary or the secondary effects of a drug resulting in a hypersensitivity reaction that may result from a pathological or underlying condition. Sometimes hypersensitivity reactions result with no definite pathological condition because each person has slightly different receptors and cellular responses. Hypersensitivity response can also be related to a change in receptors with age leading to an increased sensitivity to a drug's effects. The creation of antibodies to a drug results in an allergic reaction. Infrequent administration does not lead to hypersensitivity.