Ch.3 Toxic effects of drugs
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 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
Cytotoxic reaction
Antibodies that circulate in the blood and attack antigens on cell sites causing death of that cell. Reaction is not always immediate but may be seen in a few days.
The nurse is conducting an admission assessment of a new client. When asked about any food or drug allergies, the client states that the client is allergic to tetracycline. What action should the nurse next perform?
Ask the client, "What happens when you take a dose of tetracycline?"
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?
Decrease in urine output
intervention for cytotoxic reaction
Discontinue drug. Support pt to prevent infection and conserve energy
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.
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 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 in the ambulatory care clinic is experiencing shortness of breath and facial and throat edema while receiving a pegloticase infusion. What is the nurse's best action?
Notify emergency personnel
Intervention of Serum sickness reaction
Notify the prescriber and/or primary caregiver and discontinue the drug. Provide comfort measures to help the patient cope with the signs and symptoms (cool environment, skin care, positioning, ice to joints, administer antipyretics or anti-inflammatory agents, as appropriate)
The nurse is assessing a client whose debilitating headache did not respond to the recommended dose of an OTC analgesic. In response, the client took another dose 30 minutes later and then a double dose one hour after that. The nurse's assessment should focus on the possibility of:
Poisoning
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.
Assessment of Delayed allergic reaction
Rash, hives, swollen joints (similar to the reaction to poison ivy)
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
Delayed allergic reaction
This reaction occurs several hours after exposure and involves antibodies that are bound to specific white blood cells
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
Which medication classifications cause blood dyscrasias? (Select all that apply.)
antibiotics antineoplastics
Patients receiving antineoplastic drugs that disrupt cell function often have adverse effects involving cells that turn over rapidly in the body. These cells include
bone marrow cells
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 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
What issues is gentamycin, a potent antibiotic, associated with? (Select all that apply.
renal toxicity ototoxicity
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)
What would the nurse expect the physician to order for a client with a delayed allergic reaction?
topical corticosteroid
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."
Anaphylactic reaction
Antibody that reacts with specific sites in the body to cause the release of chemicals including histamine.
Assessment of cytotoxic reaction
Complete blood count showing damage to blood forming cells (decreased hematocrit, WBC count, platelets)
Assessment of anaphylactic reactions
Hives, rash, SOB, dilated pupils, diaphoresis, panic feeling, increased HR, respiratory arrest
Intervention of Delayed allergic reaction
Notify the prescriber and/or primary caregiver and discontinue drug. Provide skin care and comfort measures that may include antihistamines or topical corticosteroids
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
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
The nurse is caring for a client who has been admitted after an acetaminophen overdosage. Which of the nurse's assessment findings suggest liver damage? (Select all that apply.)
The client's skin and eyes are visibly jaundiced. The client's AST and ALT levels are elevated. The client's temperature is 102.5° F (39.2° C).
Serum sickness reaction
This allergy involves antibodies that circulate in the blood and cause damage to various tissues by depositing in blood vessels. This reaction may occur up to 1 wk or more after exposure to the drug
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.
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
What is an example of a secondary action?
an antihistamine causes the client to experience drowsiness
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 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
blood dyscrasia
bone marrow depression caused by drug effects on the rapidly multiplying cells of the bone marrow; lower-than-normal levels of blood components can be seen
An example of a drug allergy is
breathing difficulty after an injection of penicillin.
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
A client began a new medication 4 days ago and has been reporting increasing malaise for the past 72 hours. The nurse is reviewing the client's most recent laboratory findings. What findings should suggest the possibility of a cytotoxic reaction? (Select all that apply.)
decreased hematocrit decreased leukocytes increased liver enzymes
Hypersensitivity
excessive responsiveness to either the primary or the secondary effects of a drug; may be caused by a pathological condition or, in the absence of one, by a particular patient's individual response
A woman has had repeated bouts of bronchitis throughout the fall and has been taking antibiotics. She calls the clinic with complaints of vaginal pain and itching. When she is seen, it is discovered that she has developed a yeast infection. You understand that
she has developed a superinfection, because the antibiotics kill bacteria that normally provide protection.
Knowing that a patient is taking a loop diuretic and is at risk for developing hypokalemia the nurse would assess the patient for
weak pulse, low blood pressure, and muscle cramping.
An older adult client has an elevated serum creatinine level. This client is at greatest risk for which medication-related effect?
Toxicity
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 patient taking glyburide (an antidiabetic drug) has his morning dose and then does not have a chance to eat for several hours. An adverse effect that might be expected from this would be
hypoglycemia
stomatitis
inflammation of the mucous membranes related to drug effects; can lead to alterations in nutrition and dental problems
A patient with a severe infection is given gentamicin, the only antibiotic shown to be effective in culture and sensitivity tests. A few hours after the drug is started intravenously the patient becomes very restless and develops edema. Blood tests reveal abnormal electrolytes and elevated blood urea nitrogen. This reaction was most likely caused by
renal toxicity associated with gentamicin
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
Interventions for anaphylactic shock
Epi pen, Medic Alert ID
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.
drowsiness after taking an antihistamine diarrhea after taking an antibiotic
Which drug classification is used to treat superinfections?
antifungals
What changes due to aging in the geriatric client may affect excretion and promote accumulation of drugs in the body?
decreased glomerular filtration rate.
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 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
A client is being discharged from the emergency department (ED) after being treated for an anaphylactic reaction to shrimp the client ate for dinner. The client asks the nurse to explain food reactions. Which would be correct responses? Select all that apply.
Ananphylactic reactions involve an antibody that causes the release of histamine. Histamines produce immediate reactions. Anaphylactic reactions can lead to respiratory distress and even respiratory arrest.
Assessment of Serum sickness reaction
Itchy rash, high fever, swollen lymph nodes, swollen and painful joints, edema of the face and limbs
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.
Atropine, which is used preoperatively, is considered which drug classification?
anticholinergic
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
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.
heart defects skeletal and limb abnormalities central nervous system alterations
