Pharm (Chapter 3-Toxic Effects of Drugs)

The nurse provides health education for a diverse group of clients. For which client should the nurse emphasize the risk of teratogenic drug effects? 40-year-old male client who has a history of intravenous drug use and who has endocarditis 60-year-old female client who is tetraplegic and who has developed a sacral pressure ulcer 6-year-old girl who has a urinary tract infection and who is accompanied by her parents 20-year-old female client who has been diagnosed with a chlamydial infection

20-year-old female client who has been diagnosed with a chlamydial infection Explanation: The risk of teratogenicity is a priority consideration for female clients of child-bearing age, not for males or prepubescent girls.

A client develops a cytotoxic reaction to a drug. What would the nurse expect to do? Administer prescribed epinephrine subcutaneously. Discontinue the drug immediately as ordered. Encourage the use of MedicAlert identification. Administer antipyretics as ordered.

Discontinue the drug immediately as ordered. Explanation: For a client experiencing a cytotoxic reaction, the prescriber is notified and the drug is discontinued. Subcutaneous epinephrine is used to treat an anaphylactic reaction. The client is also encouraged to wear some type of MedicAlert identification denoting the allergy. Antipyretics would be used to treat serum sickness reaction.

A client develops bone marrow suppression related to a drug's effects. What would be most important for the nurse to do? Facilitate cardiac monitoring. Prepare the client for dialysis. Place the client on protective isolation. Monitor laboratory blood values.

Monitor laboratory blood values. Explanation: Monitoring blood counts would be most important for the client with bone marrow suppression. Protective isolation would be appropriate if the client were immunocompromised. Bone marrow suppression does not pose an immediate threat to cardiovascular status. Frequent mouth care would be appropriate if the client develops stomatitis. Dialysis would be indicated if the client develops renal injury due to drug therapy.

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. Check the client's urine output. Assess the client's level of orientation. Check the client's blood glucose level.

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.

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 Blood dyscrasia Stomatitis Cytotoxic reactions

Teratogenicity Explanation: Teratogenicity is when drugs that reach the developing fetus or embryo cause death or congenital defects, which can include skeletal and limb abnormalities, central nervous system alterations, heart defects, and the like. Stomatitis and blood dyscasia are examples of tissue and organ damage. Cytotoxic reaction is an example of an allergic reaction to a drug.

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? ringing noise in the ears a decrease in urine output yellowing of the skin visual disturbances

a decrease in urine output Explanation: Decreased urinary output, elevated blood urea nitrogen, increased serum creatinine, altered acid-base balance, and electrolyte imbalances can occur with nephrotoxicity. Ringing noise in the ears (tinnitus) is an indication of possible ototoxicity. Visual disturbances can suggest neurotoxicity, and yellowing of the skin (jaundice) is a sign of hepatotoxicity.

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?" Document an allergy to tetracycline in the client's health record Ask the client, "Are you allergic to any other antibiotics, or just tetracycline?" Educate the client about antibiotics that are alternatives to tetracycline.

Ask the client, "What happens when you take a dose of tetracycline?" Explanation: Clients often characterize a wide variety of medication reactions as "allergies." The nurse should assess further, not because of mistrust for the client but because there is a need for further detail. Documentation of the client's allergy status should occur at the completion of assessment. Education about alternatives would be premature.

An instructor is preparing a class that describes the toxic effects of drugs. Which effect would the instructor expect to include? Most reactions occurring with present-day therapy are less severe than before. Many drugs are potentially harmless if used correctly. Any effect results from the alteration of several chemical factors. Drugs cause unexpected or unacceptable reactions despite screening and testing.

Drugs cause unexpected or unacceptable reactions despite screening and testing. Explanation: 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.

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: affect the kidneys of the fetus. affect the eighth cranial nerve of the fetus. affect the liver of the fetus. damage the immature nervous system of the fetus.

damage the immature nervous system of the fetus. Explanation: Neurotoxicity can occur as a result of exposure to drugs and other chemicals and gases, such as industrial vapors. Immature nervous systems such as those of the fetus and neonate can easily be damaged by drugs that produce neurotoxicity. Hence, the client has been advised not to expose herself to chemical or industrial vapors and specific drugs. The liver and kidney functions and the eighth cranial nerve of the fetus are not directly affected as a result of exposure to neurotoxic substances.

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: anaphylaxis. hypersensitivity. allergies. poisoning.

poisoning. Explanation: Poisoning occurs when an overdose of a drug damages multiple body systems, leading to the potential for fatal reactions. Hypersensitivity, allergies, and anaphylaxis would not be indicated by an overdosage of the medication.

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?" "Are there other antibiotics that have worked well for you in the past?" "We'll make sure that none of your antibiotics are similar to penicillin." "I'll make sure to pass that information along to the pharmacy."

"Do you remember what happened the last time you received penicillin?" Explanation: Any report of an allergy should be documented and communicated clearly. However, the nurse also has a responsibility to gather as much data as possible, especially since clients may classify a wide range of adverse effects as allergies. It would be premature for the nurse to state which antibiotics the client may or may not receive.

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? body system affected adverse effects protocols route of administration

adverse effects Explanation: 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.

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 idiosyncratic response. a hepatotoxic response. an allergic response. a paradoxical response.

an allergic response. Explanation: An allergic response is an immune system response. If the body interprets the drug as a foreign substance (antigen) and forms antibodies against the drug, the antigen-antibody response of the immune system is initiated when the drug is taken again. This response involves the release of histamine, which is responsible for many symptoms of allergy—redness, itching, swelling, rash, and hives. Idiosyncratic responses are related to an individual's unique response to a drug, rather than to the dose of a drug. Idiosyncratic responses are unusual and in fact may be the opposite of what is anticipated, which is sometimes called a paradoxical response.

What is an example of a secondary action? anticoagulant that leads to excessive and spontaneous bleeding. an antihistamine causes the client to experience drowsiness dizziness and weakness with a recommended dose of antihypertensive urinary retention develops in a client with an enlarged prostate who is taking an anticholinergic

an antihistamine causes the client to experience drowsiness Explanation: 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.

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? hypoglycemia renal injury liver injury hyperkalemia

renal injury Explanation: Renal injury is reflected by elevated blood urea nitrogen and creatinine concentration. Liver injury would be reflected by elevated liver enzymes such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Hypoglycemia would be indicated by decreased blood glucose levels. Hyperkalemia would be reflected by elevated potassium levels (greater than 5.0 mEq/L).

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. birth at 40 weeks' gestation heart defects skeletal and limb abnormalities central nervous system alterations

skeletal and limb abnormalities central nervous system alterations heart defects

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 additive synergistic toxic

anaphylactic shock Explanation: Anaphylactic shock occurs shortly after administration of a drug to which the client is sensitive. It may be life-threatening and must be treated immediately. The client may experience respiratory, cardiovascular, integumentary, and gastrointestinal symptoms.

An older adult client has an elevated serum creatinine level. This client is at greatest risk for which medication-related effect? idiosyncratic effects delayed gastric emptying increased absorption toxicity

toxicity Explanation: An elevated creatinine level is indicative of diminished kidney function, which will result in serum drug toxicity. The creatinine level indicates kidney function, does not affect absorption, and has no effect on gastric emptying. Idiosyncratic effects are reactions that occur rarely and unpredictably among the population.

Preoperative atropine belongs to what classification of drugs? anticholinergic diuretic cholinergic benzodiazepine

anticholinergic Explanation: 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.

Which drug allergy involves antibodies bound to specific white blood cells? delayed allergic reaction serum sickness reaction anaphylactic reaction cytotoxic reaction

delayed allergic reaction Explanation: Delayed allergic reaction occurs several hours after exposure and involves antibodies bound to specific white blood cells. Anaphylactic reaction is an allergy that involves an antibody that reacts with specific sites in the body to cause the release of chemicals. Cytotoxic reaction involves antibodies that circulate in the blood and attack antigens (the drug) on cell sites, causing death of that cell. Serum sickness reaction involves antibodies that circulate in the blood and cause damage to various tissues by depositing in blood vessels.

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 idiosyncratic response to the medication, not an expected result. Such responses are genetically predetermined so you will not be able to take this medication." "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." "This is a toxic reaction to the medication and can cause permanent damage. We need to take you off this medication immediately." "The sexual dysfunction is caused by an allergic reaction to the medication. We need to stop this drug immediately."

"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." Explanation: An adverse effect of drug therapy is a usually undesirable effect other than the intended therapeutic effect. It may occur even with normal drug dosing. Adverse effects may also occur independently of the dose and be unpredictable. The term adverse effect encompasses all nontherapeutic responses to drug therapy.

A client with a longstanding diagnosis of schizophrenia has taken antipsychotic drugs for several decades. For what adverse effect should the nurse assess? Dry mouth and urinary hesitation Parkinsonian symptoms Hypoglycemia Hyperthermia

Parkinsonian symptoms Explanation: 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 is experiencing central nervous system effects related to drug therapy. Which would be most important for the nurse to emphasize in the teaching plan? Educating about the signs and symptoms of stroke The need for follow-up blood tests Safety measures The importance of a low-stimulation environment

Safety measures Explanation: 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 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 importance of sitting upright while eating and for 30 minutes afterwards The rationale for taking probiotics for the duration of treatment The rationale for prophylactic antibiotics

Techniques for providing safe and effective mouth care Explanation: 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.

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 allergic to the penicillin and should stop taking it immediately. The client is having photosensitivity and this can occur even with brief exposure to the sun or UV rays. This is a normal reaction for anyone who takes antibiotics and is nothing to be concerned about. The client had a reaction to something in the environment while working in the yard and should take an antihistamine.

The client is having photosensitivity and this can occur even with brief exposure to the sun or UV rays. Explanation: The client's environment may increase the likelihood that a certain adverse effect will occur. Some antibiotics can cause the adverse effect of photosensitivity. Even brief exposure to sunlight or strong ultraviolet light can cause severe sunburn, hives, or a rash.

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 body mass index and hydration status The client's albumin, bilirubin, AST and ALT levels The client's blood urea nitrogen level and creatinine clearance rate The client's fasting blood glucose level

The client's blood urea nitrogen level and creatinine clearance rate Explanation: 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.

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 The man may be experiencing liver toxicity from the aspirin The man may be experiencing a paradoxical effect of aspirin The man may be allergic to aspirin

The man may be experiencing nephrotoxic effects of aspirin Explanation: 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? The client probably has the onset of Alzheimer disease. The nurse should not be concerned. Medication is not the cause of the client's confusion. This may be coincidental, and the memory loss may be attributed to changes with aging. All elderly clients have dementia at some point in life, and the medication is making it worse.

This may be coincidental, and the memory loss may be attributed to changes with aging. Explanation: 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.

What changes due to aging in the geriatric client may affect excretion and promote accumulation of drugs in the body? decreased cognition. decreased activity. decreased gastric motility. decreased glomerular filtration rate.

decreased glomerular filtration rate. Explanation: In older adults (65 years and older), physiologic changes may alter all pharmacokinetic processes. Changes in the gastrointestinal tract include decreased gastric acidity, decreased blood flow, and decreased motility. Despite these changes, however, there is little difference in drug absorption. Changes in the cardiovascular system include decreased cardiac output, and therefore slower distribution of drug molecules to their sites of action, metabolism, and excretion. In the liver, blood flow and metabolizing enzymes are decreased. Therefore, many drugs are metabolized more slowly, have a longer action, and are more likely to accumulate with chronic administration. In the kidneys, there is decreased blood flow, decreased glomerular filtration rate, and decreased tubular secretion of drugs; all of these changes tend to slow excretion and promote accumulation of drugs in the body. Impaired kidney and liver function greatly increases the risks of adverse drug effects. In addition, older adults are more likely to have acute and chronic illnesses that require the use of multiple drugs or long-term drug therapy. Therefore, possibilities for interactions among drugs and between drugs and diseased organs are greatly multiplied.

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: drug allergy. primary actions. hypersensitivity. secondary actions.

secondary actions. Explanation: 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.