Chapter 3: Toxic Effects of Drugs

A patient develops a serum sickness reaction. What would the nurse's first and priority action be? a. Discontinue the drug immediately as ordered. b. Administer topical corticosteroids. c. Encourage the use of a MedicAlert identification. d. Administer prescribed epinephrine subcutaneously.

a. Discontinue the drug immediately as ordered. (Rationale: If serum sickness occurs, the prescribed is notified and the drug is discontinued. Epinephrine is given for an anaphylactic reaction and requires a physician's order. A MedicAlert identification may be indicated, but is not the nurse's first concern. Topical corticosteroids may be used to treat dermatological symptoms such as rash, but would not be the nurse's first concern.)

How does knowledge of a drug's adverse effects impact the care provided by the nurse? (Select all that apply.) a. Drug teaching can address signs and symptoms the patient should be alert for. b. Assessments include monitoring for expected or common adverse effects. c. Baseline can be established to help identify adverse effects that occur. d. Adverse effects can avoided through interventions made before giving the drug. e. Decisions can be made about whether or not to administer drug.

a. Drug teaching can address signs and symptoms the patient should be alert for. b. Assessments include monitoring for expected or common adverse effects. c. Baseline can be established to help identify adverse effects that occur. (Rationale: This information will direct your assessment of the patient, helping you to focus on particular signs and symptoms that would alert you to adverse effects, and helping you to establish a baseline for that patient so that you will be able to identify adverse effects that occur. When teaching the patient about a drug, you should list the adverse effects that should be anticipated, along with the appropriate actions that the patient can take to alleviate any discomfort associated with these effects. Being alert to adverse effects - what to assess and how to intervene appropriately - can increase the effectiveness of a drug regimen, provide for patient safety, and improve patient compliance. Deciding to withhold a drug is outside the nurse's scope of practice. Adverse effects may not be avoided, but they can be minimized or quickly treated with awareness.)

The nurse is assessing a patient for anticholinergic effects of a prescribed drug. What findings would the nurse expect to assess? (Select all that apply.) a. Dry skin b. Blurred vision c. Constipation d. Diaphoresis e. Increased level of alertness

a. Dry skin b. Blurred vision c. Constipation (Rationale: Findings suggesting anticholinergic effects may include dry mouth, dry skin, constipation, blurred vision, urinary hesitancy, and mental confusion.)

The nurse is caring for a patient whose liver was damaged and is awaiting a liver transplant secondary to acetaminophen (Tylenol) overdosage. What symptoms assessed by the nurse are likely to be caused by the malfunctioning liver? (Select all that apply.) a. Elevated AST and ALT b. Jaundice c. Fever d. Increased appetite e. Elevated red blood cell count

a. Elevated AST and ALT b. Jaundice c. Fever (Rationale: Symptoms of liver damage may include fever, malaise, nausea, vomiting, jaundice, change in color of urine or stools, abdominal pain or colic, elevated liver enzymes (e.g., aspartate aminotransferase [AST], alanine aminotransferase [ALT]), alterations in bilirubin levels, and changes in clotting factors (e.g., partial thromboplastin time).)

What would lead the nurse to suspect that a patient has developed a liver injury? a. Elevated aspartate aminotransferase (AST) level b. Elevated creatinine clearance c. Elevated blood urea nitrogen (BUN) d. Elevated blood glucose level

a. Elevated aspartate aminotransferase (AST) level (Rationale: Liver enzymes such as AST and alanine aminotransferase (ALT) would be elevated with liver injury. Elevated BUN levels would be seen with renal injury. Elevated creatinine clearance would be seen with renal injury. Elevated blood glucose levels would suggest hyperglycemia, which is not a result of liver injury.)

What type of tissue damage will the nurse assess for when administering antineoplastic medications? (Select all that apply.) a. Stomatitis b. Hyperglycemia c. Neuroleptic malignant syndrome d. Hyperkalemia e. Blood dyscrasia

a. Stomatitis d. Hyperkalemia e. Blood dyscrasia (Rationale: Patients receiving antineoplastic medications are at risk for stomatitis, blood dyscrasias, and hyperkalemia. Hyperglycemia and neuroleptic malignant syndrome are not normally associated with administration of antineoplastic medications, although specific cancers could cause these or virtually any symptom depending on the organ involved.)

The nurse is caring for a patient who exhibits an excessive response to a secondary effect of a drug, which the nurse classifies as a hypersensitivity response. What does hypersensitivity result from? (Select all that apply.) a. Unique receptors and cellular responses b. Creation of antibodies c. Pathological condition d. Overdose of medication e. Age-related changes

a. Unique receptors and cellular responses c. Pathological condition e. Age-related changes (Rationale: Some patients 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. Overdose of medication leads to poisoning while creation of antibodies to a drug results in an allergic reaction.)

A patient comes to the clinic complaining of vaginal discharge with itching. Which statement would alert the nurse to the possibility that the patient's complaints are related to a superinfection? a. "I've been taking aspirin several times a day for the past few months for my back pain." b. "I just completed a course of antibiotics prescribed by my dentist to treat a tooth abscess." c. "For the last 2 months I have been taking a water pill that the doctor prescribed." d. "I've had a cold lately and have been taking some over-the-counter antihistamines."

b. "I just completed a course of antibiotics prescribed by my dentist to treat a tooth abscess." (Rationale: Antibiotics are commonly associated with superinfections because they destroy the normal flora. Diuretics or water pills would be associated with electrolyte imbalances. Aspirin is often linked to tinnitus and eighth cranial nerve function. In addition, its antiplatelet activity increases the risk for bleeding problems. Antihistamines would be associated with anticholinergic effects.)

The nurse is caring for a patient with a drug allergy and understands the allergy is the result of the patient developing what? a. Antigens b. Antibodies c. Secondary effects d. Antihistamine

b. Antibodies (Rationale: Antibodies are formed by the body to react with antigens in an allergic reaction. The antigen, in this case, is the drug that the body recognizes as a foreign substance to be eliminated. Antihistamines are administered to reduce the histamines secreted as a result of the allergic reaction. An allergic reaction is distinct and different from a secondary effect.)

What does the nurse interpret as an example of a primary action? a. Narcotic analgesic leading to hyperactivity in an older person b. Anticoagulant leading to excessive bleeding c. Antibiotic leading to diarrhea d. Antihistamine leading to drowsiness

b. Anticoagulant leading to excessive bleeding (Rationale: Bleeding associated with anticoagulant therapy is an example of a primary action, the extension of the desired effect. A patient taking an antihistamine who experiences drowsiness is an example of a secondary action, an effect in addition to the desired effect of drying up secretions. A patient taking an antibiotic who experiences diarrhea is an example of a secondary action, an effect in addition to the desired effect of eradicating the infection. An older person taking a narcotic analgesic who experiences hyperactivity is an example of hypersensitivity, an excessive response to either the primary or secondary effects of a drug.)

The nurse administers a medication and the patient has an immediate anaphylactic reaction following injection. What symptoms assessed by the nurse would indicate anaphylaxis? (Select all that apply.) a. Constricted pupils b. Diaphoresis c. Difficulty breathing d. Increased blood pressure e. Slow heart rate

b. Diaphoresis c. Difficulty breathing d. Increased blood pressure (Rationale: During an anaphylactic reaction nurses can expect to assess hives, rash, difficulty breathing, increased BP, dilated pupils, diaphoresis, "panic" feeling, increased heart rate, respiratory arrest.)

When assessing a patient who has developed an anaphylactic reaction, what would the nurse expect to find? a. Decreased hematocrit b. Difficulty breathing c. Swollen joints d. Swollen lymph nodes

b. Difficulty breathing (Rationale: Difficulty breathing, increased blood pressure, dilated pupils, diaphoresis, and a panicky feeling are associated with an anaphylactic reaction. Decreased hematocrit would be seen with a cytotoxic reaction. Swollen lymph nodes are associated with a serum sickness reaction. Swollen joints are associated with a delayed allergic reaction.)

After teaching a group of students about the toxic effects of a drug, the nursing instructor determines that the teaching was successful when the students state what? a. Several chemical factors need to be impacted in order to create an adverse effect. b. Drugs can cause unexpected reactions even after thorough screening and testing. c. Most drugs are fairly harmless if they are used as prescribed. d. The effects occurring with present-day therapy are much less severe than before.

b. Drugs can cause unexpected reactions even after thorough screening and testing. (Rationale: Even though drugs are carefully screened and tested in animals before being released to use on humans, drug products often cause unexpected or unacceptable reactions when given. Many effects can be seen when just one chemical factor is changed or altered. All drugs have the potential to cause adverse effects whether they are prescribed or over-the-counter. Today's potent and amazing drugs can cause a variety of reactions, many of which are more severe than ever seen before.)

A patient is receiving an antipsychotic drug. What would the nurse be alert for? a. Dry mouth b. Extreme jitteriness c. Hyperthermia d. Hypoglycemia

b. Extreme jitteriness (Rationale: Extreme restlessness or jitters are associated with Parkinson-like syndrome that may occur with antipsychotic agents. Hyperthermia is unrelated to antipsychotic therapy, but is associated with neuroleptic malignant syndrome such as from general anesthetics. Hypoglycemia is unrelated to antipsychotic therapy, but it is associated with the use of antidiabetic agents, which lowers blood glucose levels. Dry mouth is unrelated to antipsychotic use, but is associated with anticholinergic agents such as atropine or cold remedies and antihistamines.)

A patient is receiving antibiotics for treatment of infection. The nurse would be alert for what assessment finding? (Select all that apply.) a. Chills b. Glossitis c. Sore throat d. Swollen tongue e. Hairy tongue

b. Glossitis d. Swollen tongue e. Hairy tongue (Rationale: Use of antibiotics can lead to superinfections manifested by fever, diarrhea, black or hairy tongue, inflamed and swollen tongue, mucous membrane lesions, and vaginal discharge with or without itching. Chills and sore throat suggest a blood dyscrasia.)

When the patient takes more of a medication that directed or prescribed, the nurse assesses the patient for what? a. Hypersensitivity b. Poisoning c. Allergies d. Anaphylactic

b. Poisoning (Rationale: Poisoning occurs when an overdose of a drug damages multiple body systems, leading to the potential for fatal reactions. Hypersensitivity, allergies, and anaphylaxis would not be indicated by an overdosage of the medication.)

A patient is experiencing central nervous system effects related to drug therapy. What is the nurse's priority teaching point to emphasize in the teaching plan? a. Need for follow-up blood tests b. Safety measures c. Proper use of insulin d. Frequent mouth care

b. Safety measures (Rationale: For central nervous system effects such as confusion, delirium, and drowsiness, safety measures would be a priority to prevent injury. Insulin would be used to treat hyperglycemia. Blood tests would be appropriate if the patient was experiencing bone marrow suppression or electrolyte imbalance. Frequent mouth care would be appropriate for the patient with stomatitis.)

A patient develops neuroleptic malignant syndrome. What is the nurse's assessment priority? a. Muscle flaccidity b. Hyperactive reflexes c. Hyperthermia d. Hypotension

c. Hyperthermia (Rationale: Neuroleptic malignant syndrome is manifested by hyperthermia, and extrapyramidal symptoms such as slowed reflexes, involuntary movements, and autonomic disturbances. Hypertension, not hypotension, would be seen with neuroleptic malignant syndrome. Involuntary movement, not muscle flaccidity, would be seen with neuroleptic malignant syndrome. Slowed reflexes would be seen with neuroleptic malignant syndrome.)

A patient receiving drug therapy develops numbness and tingling in the extremities and muscle cramps. What would the nurse suspect? a. Neurologic dysfunction b. Renal injury c. Hypokalemia d. Hypoglycemia

c. Hypokalemia (Rationale: Hypokalemia is suggested by numbness and tingling in the extremities, muscle cramps, weakness, and irregular pulse. Fatigue, drowsiness, hunger, tremulousness, and cold clammy skin would suggest hypoglycemia. Renal injury would be manifested by elevated BUN and creatinine concentration, decreased hematocrit, and electrolyte imbalances, fatigue, malaise, and irritability. Neurologic dysfunction would most likely be manifested by confusion, delirium, insomnia, drowsiness, and changes in deep tendon reflexes.)

A patient comes to the clinic complaining of ringing in the ears and difficulty hearing. The nurse would investigate the patient's medication history for use of what? a. Loop diuretic b. Antihistamine c. Macrolide antibiotics d. Insulin

c. Macrolide antibiotics (Rationale: Macrolide antibiotics can cause severe auditory nerve damage manifested by ringing in the ears and hearing loss. Insulin is not associated with ringing in the ears but is used to treat hyperglycemia. Loop diuretics are associated with electrolyte imbalances. Antihistamines are associated with anticholinergic effects.)

A patient develops bone marrow suppression related to a drug's effects. What is the nurse's priority action? a. Administer prescribed antifungal therapy. b. Provide frequent mouth care. c. Monitor blood counts. d. Prepare the patient for dialysis.

c. Monitor blood counts. (Rationale: Monitoring blood counts would be most important for the patient with bone marrow suppression. Antifungal therapy may be indicated if the patient develops a superinfection. Frequent mouth care would be appropriate if the patient develops stomatitis. Dialysis would be indicated if the patient develops renal injury due to drug therapy.)

A patient is experiencing drowsiness after taking an antihistamine. The nurse interprets this as what? a. Primary action b. Drug allergy c. Secondary action d. Hypersensitivity

c. Secondary action (Rationale: A secondary action is the development of adverse effects in addition to the desired effects. Drowsiness from an antihistamine is an example. A primary action is the development of adverse effects, an extension of the desired effect, from simple overdosage. With an antihistamine, this would be its antihistamine effects of drying. Drug allergy occurs when the body forms antibodies to a particular drug causing an immune response. Hypersensitivity refers to an excessive response to either a primary or secondary effect of a drug.)

When the nurse administers a medication to a woman of childbearing age, it is important to consider what effect of drugs? a. Primary effects b. Poisoning c. Teratogenicity d. Secondary effects

c. Teratogenicity (Rationale: In a woman of childbearing age, it is important for the nurse to consider the teratogenicity of a medication because teratogens can seriously harm or injure the embryo or fetus. Primary actions, secondary actions, and poisoning would be of no greater concern with a woman of childbearing age than with any patient.)

A patient is receiving an antidiabetic agent. The nurse would be alert for what? a. Kussmaul respirations b. Increased thirst c. Polyuria d. Hunger

d. Hunger (Rationale: Antidiabetic agents can lead to low serum blood glucose levels manifested by fatigue, drowsiness, hunger, cold clammy skin, and lack of coordination. Polyuria, increased thirst, and Kussmaul respirations would indicate hyperglycemia; the reason the patient is receiving the antidiabetic agent.)

The nurse administers chloroquine (Aralen) to a patient to treat rheumatoid disease. What tissue damage would the nurse assess for in this patient, particularly if she had been taking this medication for a significant number of years? a. Auditory damage b. Anticholinergic effects c. Hyperkalemia d. Ocular damage

d. Ocular damage (Rationale: Chloroquine (Aralen), a drug used to treat some rheumatoid diseases, can cause retinal damage and even blindness. The drug is not associated with auditory damage, hyperkalemia, or anticholinergic.)