Chapter 3: Toxic Effects of Drugs PrepU

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. -Ex:All drugs are potentially dangerous. Even though chemicals are carefully screened and tested in animals and in people before they are released as drugs, drug products often cause unexpected or unacceptable reactions when they are administered. Drugs are chemicals, and the human body operates by a vast series of chemical reactions. Consequently, many effects can be seen when just one chemical factor is altered. Today's potent drugs can cause a great variety of reactions, many of which are more severe than ever seen before.

What does the nurse need to do when there is any indication of an allergic reaction in clients?

Maintain the client's safety during drug therapy.

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 -ex:Neurotoxicity, sometimes referred to as central nervous system toxicity, is a drug's ability to harm or poison a nerve cell or nerve tissue. Signs and symptoms of neurotoxicity include drowsiness, auditory and visual disturbances, restlessness, nystagmus, and tonic-clonic seizures. Neurotoxicity can occur after exposure to drugs and other chemicals and gases.

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. -Ex:This client's presentation and history are suggestive of a serum sickness reaction. Interventions include discontinuing the drug and providing supportive care. Resuscitation is not justified by this client's presentation. Epinephrine is prescribed to clients experiencing anaphylaxis. Naloxone is used to treat narcotic overdoses, not serum sickness reactions.

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. -Explanation: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, decreased urine output and irritability. Neurologic dysfunction would most likely be manifested by confusion, delirium, insomnia, drowsiness, and changes in deep tendon reflexes.

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 -Ex:For central nervous system effects such as confusion, delirium, and drowsiness, safety measures would be a priority to prevent injury. CNS effects do not normally affect the client's stroke risk. Blood tests would be appropriate if the client was experiencing bone marrow suppression or electrolyte imbalance. Safety is a priority over maintaining a low-stimulation environment.

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 -Ex: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 pharmacokinetics. The client's hepatic status would primarily affect metabolism, not excretion.

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 -ex:Damage to the kidneys is called nephrotoxicity. Decreased urinary output, elevated blood urea nitrogen, increased serum creatinine, altered acid-base balance, and electrolyte imbalances can all occur with kidney damage.

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. -ex:It is important for nurses and other health care professionals to be alert for adverse effects from drug therapy. Sometimes, determining whether an adverse effect has occurred as a result of drug therapy is difficult. Adverse effects may be mistaken for changes associated with aging or disease pathology.

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 -ex:Becoming familiar with classifications of medications helps the nurse to recognize possible adverse effects clients may experience, providing a basis for implementing appropriate nursing actions should undesirable effects occur. The route of administration, body system involved, and protocols are more important to know before medication administration.

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 -ex: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.

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

antibodies.

Preoperative atropine belongs to what classification of drugs?

anticholinergic -ex: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.

A client with a serious Escherichia coli infection is being treated with gentamicin. When monitoring for potential adverse effects, the nurse should prioritize

blood urea nitrogen and creatinine levels.

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 -ex: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.

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 enzyme -ex:A cytotoxic drug reaction involves several effects that are apparent from laboratory testing. These include decreased hematocrit and white cells as well as increased liver enzyme levels. Electrolyte levels would remain relatively unaffected since these are not cells.

The nurse administers a medication and the client has an immediate anaphylactic reaction following injection. What symptoms assessed by the nurse would indicate anaphylaxis? (Select all that apply.)

difficulty breathing increased blood pressure diaphoresis

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

frequent rinsing with cool liquids

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 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." -ex:Allergies generally take place after antibody formation from an initial exposure. For this reason, the client's experience is not likely the result of the brevity of treatment, the dose, or the severity of the underlying illness.

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

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.

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.

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.

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

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 abnormalities central nervous system alterations heart defects limb abnormalities

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

severe sunburn -Ex: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.

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 -ex: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.

A client develops a skin reaction to one of their prescribed medications. This client also has a specific underlying pathology. This underlying pathology might serve as a:

contraindication for the use of certain medications -Explanation:The possibility that the adverse effects can occur also accounts for the contraindications for the use of some drugs in clients with a particular history or underlying pathology. The acute problem would serve as a basis for planning the client's medication regimen and the nursing care plan. The acute problem would also be the most prominent part of client teachin