Pharm prepU ch. 3 notes

A client is suspected of having a liver injury as a result of drug therapy. What laboratory finding would best support this diagnosis?

Elevated aspartate aminotransferase (AST) level Liver enzymes such as AST and alanine aminotransferase (ALT) would be elevated with liver injury. Elevated BUN and creatinine levels would be seen with renal injury. Sudden drops in hemoglobin, hematocrit and red cell count are suggestive of bleeding, not liver damage.

A client with a longstanding diagnosis of schizophrenia has taken antipsychotic drugs for several decades. For what adverse effect should the nurse assess?

Parkinsonian symptoms 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 and urinary hesitation are unrelated to antipsychotic use, but is associated with anticholinergic agents such as atropine or cold remedies and antihistamines.

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 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.

Which client is experiencing a secondary action of a medication?

a client who is taking an antihistamine and feeling drowsy A secondary action is the development of adverse effects in addition to the desired effects. Drowsiness from an antihistamine is an example of secondary action. A primary action is the development of adverse effects, an extension of the desired effect, from simple overdosage. Excessive relaxation after taking an antianxiety medication is an example of primary action. Drug allergies and hypersensitivities are not examples of secondary actions.

Upon assessment after giving oral penicillin, the nurse notes that a client has dilated pupils, increased blood pressure, and increased heart rate. The nurse would document these findings as which type of drug allergic reaction?

anaphylactic A client exhibiting hives, rash, increased blood pressure, dilated pupils, diaphoresis, increased heart rate, and respiratory arrest after administration of penicillin is having an anaphylactic reaction.

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

frequent rinsing with cool liquids 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.

The nurse is caring for a client with hypertension who was prescribed a loop diuretic one week ago. The client reports malaise and weakness and the nurse's assessment reveals an irregular heart rate. The nurse should prioritize assessment of the client's:

potassium levels The fact that the client began taking a loop diuretic recently coupled with the client's presentation suggests hypokalemia. Consequently, the client's liver and kidney function would not be the immediate priorities. The client's cognition may be affected but as a result of hypokalemia.

A client with lymphoma is scheduled to begin chemotherapy tomorrow. When providing health education for the client regarding the risk for stomatitis, what should the nurse teach the client?

Techniques for providing safe and effective mouth care Antineoplastic drugs commonly cause stomatitis because they are toxic to rapidly turning-over cells such as those in the mucous membranes of the mouth. Vigilant and appropriate mouth care, whether provided by the nurse or by the client, is an important intervention. Stomatitis is not prevented by sitting upright during eating. Antibiotics and probiotics cannot prevent stomatitis.

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 Ocular damage may occur when some drugs are deposited into the tiny arteries of the eyes, causing inflammation and tissue damage. Auditory damage can occur because the tiny vessels and nerves in the eighth cranial nerve are easily irritated and damaged by certain drugs. Anxiety, insomnia, and nightmares are examples of generalized neurological effects of drugs. Parkinson-like syndrome is when a drug directly or indirectly affects dopamine levels.

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 Renal impairment creates a risk for excessive drug responses due to delayed, or absent, excretion. This variable will likely have a greater bearing than the client's BMI, hydration status and blood glucose, though these may have an effect on pharmcokinetics. The client's hepatic status would primarily affect metabolism, not excretion.

What is an example of a secondary action?

an antihistamine cause the client to experience drowsiness A client taking an antihistamine who experiences drowsiness is an example of a secondary action. The antihistamine is very effective in drying up secretions and helping breathing—the therapeutic effect. Bleeding associated with anticoagulant therapy or a client taking a recommended dose of antihypertensive who becomes dizzy or weak is an example of a primary action. Urinary retention in a client with an enlarged prostate taking an anticholinergic agent is an example of hypersensitivity.

Preoperative atropine belongs to what classification of drugs?

anticholinergic Atropine, a drug used preoperatively to dry up secretions, is the prototype anticholinergic drug. Many cold remedies and antihistamines also cause anticholinergic effects. Atropine is not considered a cholinergic, benzodiazepine, or diuretic.

For several days, a client with hypertension has been inadvertently taking an excessive dose of spironolactone, a potassium-sparing diuretic. The client has presented to the emergency department with signs and symptoms that suggest hyperkalemia. What assessment should the nurse prioritize?

cardiac monitoring Hyperkalemia presents an acute threat to normal cardiac function due to the effect on cardiac action potentials. For this reason, cardiac monitoring is necessary. High potassium levels present a comparatively minor threat to respiratory, renal, and hepatic function. Blood glucose levels may become unstable, but cardiac monitoring is the clear priority.

A client is receiving a drug to lower blood glucose level. What would lead the nurse to suspect that the client's blood glucose level was too low?

cold clammy skin Signs of hypoglycemia, or low blood glucose level, include fatigue; drowsiness; hunger; anxiety; headache; cold, clammy skin; shaking and lack of coordination (tremulousness); increased heart rate; increased blood pressure; numbness and tingling of the mouth, tongue, and/or lips; confusion; and rapid and shallow respirations. In severe cases, seizures and/or coma may occur. Increased urination, fruity breath odor, and increased hunger are signs of hyperglycemia.

Which skin condition would be most likely to cause increased systemic absorption of a topical medication?

severe sunburn Systemic absorption from the skin is minimal but may be increased when the skin is inflamed or damaged. Severe sunburn would be an example of inflamed skin. Multiple nevi (moles) and a port wine stain of the face are not examples of skin disorders that would increase absorption of topical medication. Rosacea is an example of an inflammatory skin condition of the face, but it rarely causes systemic absorption because most of the medications prescribed to treat it are topical.