Chapter 3 PrepU
A female client has a 12-year history of ETOH abuse. The client is injured in a motor vehicle accident and requires surgery with general anesthesia. What would the nurse expect for this client?
a larger-than-normal dose of the general anesthetic
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.)
-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.
When assessing a client who has developed an anaphylactic reaction, what would the nurse expect to find?
Difficulty breathing
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 administers penicillin to a client and monitors the client for an adverse reaction despite the fact that the client claimed not to be allergic to penicillin. What is the rationale for checking for adverse reactions? {Select all that apply.}
-A person can be allergic to any medication at any time. -Medications can react with over-the-counter medications to cause toxicity. -Medications can react with herbal supplements to cause adverse reactions. -Medications can react with other medications prescribed for the client.
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.
Which medication classifications cause blood dyscrasias? (Select all that apply.)
-antibiotics -antineoplastics
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.
-central nervous system alterations -heart defects -skeletal and limb abnormalities
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
A drug allergy occurs when the body forms antibodies to a particular drug, resulting in an immune response when the person is re-exposed to the drug. Which symptoms are indicators that the client is having an anaphylactic reaction? (Select all that apply.)
-hives -panicked feeling -difficulty breathing
Organ and tissue damage is one adverse reaction caused by drugs. Which are examples of such organ and tissue damage? Select all that apply.
-rash and hives -inflammation of the mucous membranes -bone marrow suppression -poisoning
What client is experiencing an adverse effect that is a result of primary action?
A client taking anticoagulants who develops a gastrointestinal bleed
A client develops a cytotoxic reaction to a drug. What would the nurse expect to do?
Discontinue the drug immediately as ordered.
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.
An instructor is preparing a class that describes the toxic effects of drugs. Which effect would the instructor expect to include?
Drugs cause unexpected or unacceptable reactions despite screening and testing.
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
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 experiencing central nervous system effects related to drug therapy. Which would be most important for the nurse to emphasize in the teaching plan?
Safety measures
Many drugs that reach the developing fetus or embryo can cause death or congenital defects, which can include skeletal and limb abnormalities, central nervous system alterations, heart defects, and the like. What is the name of the adverse reaction that can cause birth defects?
Teratogenicity
The nurse is caring for a client who is receiving an antidiabetic agent. What assessment finding should the nurse attribute to a possible adverse reaction?
The client reports feeling unusually drowsy and fatigued.
A 70-year-old man who enjoys good health began taking low-dose aspirin several months ago based on recommendations that he read in a magazine article. During the man's most recent visit to his care provider, routine blood work was ordered and the results indicated an unprecedented rise in the man's serum creatinine and blood urea nitrogen (BUN) levels. How should a nurse best interpret these findings?
The man may be experiencing nephrotoxic effects of aspirin
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 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.
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
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
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
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
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
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.
Which prescribed medications should the nurse administer to an adult having an anaphylactic reaction?
epinephrine
A client develops stomatitis from drug therapy. Which measure would be most appropriate for the nurse to suggest?
frequent rinsing with cool liquids
A client is diagnosed with hypercholesterolemia and is prescribed a statin by the physician. 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
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
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
An 85-year-old has a creatinine level of 25. When the client is administered a medication, the client is at risk for which medication-related effect?
toxicity
The nurse is providing for a client who is being treated for a Pseudomonas infection in the intensive care unit. The client's medication regimen includes gentamicin 75 mg IV t.i.d. When monitoring the client for adverse effects, what assessment should the nurse prioritize?
urine output and creatinine clearance
Drugs can produce a wide variety of effects in addition to the desired pharmacological effect. Sometimes the drug dose can be adjusted so that the desired effect is achieved without producing undesired secondary reactions. Which are examples of this secondary action? (Select all that apply.)
-reports of drowsiness after taking an diphenyhydramine (Benadryl) -diarrhea after taking cefuroxime (Ceftin)
Which client is experiencing a secondary action of a medication?
A client who is drowsy after taking antihistamine
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.
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.
A client with recurrent urinary tract infections was prescribed sulfamethoxazole-trimethoprim and experienced an allergic reaction. The client states, "I don't understand. I had a two-day course of the same drug last year with no problems." What is the nurse's best response?
"Allergic reactions happen after your body has been sensitized to a drug in the past."
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.
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
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.
Mrs. Armin is taking several medications. Part of evaluating her response to this therapy is to monitor her blood and urine for adverse reactions. Upon reviewing laboratory test results, the nurse notes that the liver enzyme levels are elevated. The nurse reviews the medications that Mrs. Armin is taking and determines that an adverse effect of one of the medications is hepatotoxicity. What is the most likely explanation for Mrs. Armin's liver damage?
The liver is exposed to relatively large concentrations of ingested drugs or other potentially toxic substances due to the hepatic anatomy.
A parent brings a child to the clinic for an earache. The child receives a prescription for amoxicillin. The parent calls the clinic the next day and says the child has been taking the medicine and now has a rash. The nurse should give the parent instructions about which type of response?
allergic response