NU141- Chapter 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."

The nurse is assessing a client who is being admitted to the healthcare facility. When asked about allergies, the client states, "I'm allergic to penicillin." What is the nurse's best initial response?

"Do you remember what happened the last time you received penicillin?"

A client with diabetes is also taking ephedrine to treat asthma. On occasion, the client notes that the drug causes an increase in blood glucose. What should the nurse teach the client about this phenomenon?

"Stored glycogen is broken down by ephedrine, causing hyperglycemia."

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

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?"

A client with a history of schizophrenia was admitted during a psychotic episode and has received several doses of haloperidol. The client's cognitive status has stabilized but assessment reveals clammy skin, respiratory rate of 31 breaths per minute, and heart rate of 102 beats per minute. What is the nurse's best action?

Assess the client's blood glucose level.

A client develops a cytotoxic reaction to a drug. What would the nurse expect to do?

Discontinue the drug immediately as ordered.

A client with a diagnosis of bipolar disorder has begun lithium therapy. What is the primary rationale for the nurse's instructions regarding the need for regular monitoring of the client's serum drug levels?

It is necessary to ensure that the client's drug levels are therapeutic but not toxic.

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 develops bone marrow suppression related to a drug's effects. What would be most important for the nurse to do?

Monitor laboratory blood values.

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

Hypoglycemia

Some drugs affect metabolism and the use of glucose, causing a low serum blood glucose concentration

Hypokalemia

Some drugs affecting the kidney can cause low serum potassium levels by altering the renal exchange system

Renal injury

Some drugs are excreted from the kidney unchanged; they have the potential to directly irritate the renal tubule and alter normal absorption and secretion processes

Hyperglycemia

Some drugs stimulate the breakdown of glycogen or alter metabolism in such a way as to cause high serum glucose levels

What information from the Kardex is likely to have the greatest implication in educating the client about antihistamine administration?

The client's profession

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

Pregnant women should be advised of the potential risk to the fetus any time they take a drug during pregnancy. What fetal problems can be related to drug exposure in utero? a. Fetal death b. Nervous system disruption c. Skeletal and limb abnormalities d. Cardiac defects e. Low-set ears f. Deafness

a. Fetal death b. Nervous system disruption c. Skeletal and limb abnormalities d. Cardiac defects e. Low-set ears f. Deafness

A patient is taking a drug that is known to be toxic to the liver. The patient is being discharged to home. What teaching points related to liver toxicity and the drug should the nurse teach the patient to report to the physician? a. Fever; changes in the color of urine b. Changes in the color of stool; malaise c. Rapid, deep respirations; increased sweating d. Dizziness; drowsiness; dry mouth e. Rash; black or hairy tongue; white spots in the mouth or throat f. Yellowing of the skin or the whites of the eyes

a. Fever; changes in the color of urine b. Changes in the color of stool; malaise f. Yellowing of the skin or the whites of the eyes

A client is experiencing a reaction to the penicillin injection that the nurse administered approximately ½ hour ago. The nurse is concerned that it might be an anaphylactic reaction. What signs and symptoms would validate her suspicion? a. Rapid heart rate b. Diaphoresis c. Constricted pupils d. Hypotension e. Rash f. Client report of a panicky feeling

a. Rapid heart rate b. Diaphoresis e. Rash f. Client report of a panicky feeling

What is an example of a secondary action?

an antihistamine causes the client to experience drowsiness

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 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

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.

Patients receiving antineoplastic drugs that disrupt cell function often have adverse effects involving cells that turn over rapidly in the body. These cells include a. ovarian cells. b. liver cells. c. cardiac cells. d. bone marrow cells.

d. bone marrow cells.

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 a. a teratogenic effect. b. a skin rash. c. an anticholinergic effect. d. hypoglycemia.

d. hypoglecemia

What changes due to aging in the geriatric client may affect excretion and promote accumulation of drugs in the body?

decreased glomerular filtration rate.

Drug allergy

formation of antibodies to a drug or drug protein; causes an immune response when the person is next exposed to that drug

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.

Superinfections

infections caused by the destruction of normal flora bacteria by certain drugs, which allow other bacteria to grow out of control and cause infection; may occur during the course of antibiotic therapy

A client exhibiting Parkinson-like syndrome would be expected to have which manifestation upon assessment?

muscular tremors

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

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

severe sunburn

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

Dermatological reactions

skin reactions commonly seen as adverse effects of drugs; can range from simple rash to potentially fatal exfoliative dermatitis

An older adult client has an elevated serum creatinine level. This client is at greatest risk for which medication-related effect?

toxicity

Liver injury

Most drugs are metabolized in the liver, so any metabolites that are irritating or toxic will also affect liver integrity.

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 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.

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

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.

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 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

An example of a drug allergy is a. dry mouth occurring with use of an antihistamine. b. increased urination occurring with use of a thiazide diuretic. c. breathing difficulty after an injection of penicillin. d. urinary retention associated with atropine use.

c. breathing difficulty after an injection of penicillin

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 pharmacology instructor explains to the students that adverse effects can be extensions of:

primary action of a drug.

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."

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.

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.

Hyperkalemia

Some drugs that affect the kidney can lead to potassium retention and a resultant increase in serum potassium levels

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 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

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

A client is experiencing a serum sickness reaction to a recent rubella vaccination. Which of the following interventions would be appropriate when caring for this client? a. Administration of epinephrine b. Cool environment c. Positioning to provide comfort d. Ice to joints as needed e. Administration of antiinflammatory agents f. Administration of topical corticosteroids

b. Cool environment c. Positioning to provide comfort d. Ice to joints as needed e. Administration of antiinflammatory agents

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 a. an anaphylactic reaction. b. renal toxicity associated with gentamicin. c. superinfection related to the antibiotic. d. hypoglycemia.

b. renal toxicity associated with gentamicin.

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 a. her bronchitis has moved to the vaginal area. b. she has developed a superinfection, because the antibiotics kill bacteria that normally provide protection. c. she probably has developed a sexually transmitted disease related to her lifestyle. d. she will need to take even more antibiotics to treat this new infection.

b. she has developed a superinfection, because the antibiotics kill bacteria that normally provide protection.

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

Knowing that a patient is taking a loop diuretic and is at risk for developing hypokalemia, the nurse would assess the patient for a. hypertension, headache, and cold and clammy skin. b. decreased urinary output and yellowing of the sclera. c. weak pulse, low blood pressure, and muscle cramping. d. diarrhea and flatulence.

c. weak pulse, low blood pressure, and muscle cramping.

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.

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

Stomatitis

inflammation of the mucous membranes related to drug effects; can lead to alterations in nutrition and dental problems

A client comes to the clinic reporting of a ringing sound in the ears and dizziness. When the nurse takes the client's history, the nurse discovers that the client has been taking several ibuprofen every day for various discomforts. What does the nurse understand has occurred with this client?

ototoxicity from the ibuprofen

Poisoning

overdose of a drug that causes damage to multiple body systems and has the potential for fatal reactions

What factors can potentially contribute to a hypersensitivity reaction? (Select all that apply.)

pathological condition unique receptors and cellular responses age-related changes

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.

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

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)

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.

The nurse is assessing a client who may be experiencing an anaphylactic reaction. What assessment finding is most consistent with this diagnosis?

shortness of breath