Prep U 3

frequent rinsing with cool liquids

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

Stevens-Johnson syndrome

All drugs have adverse reactions when taken. Organ and tissue damage is one such adverse reaction. Which is an example of organ and tissue damage caused by a drug?

cardiac monitoring

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?

anticholinergic

Preoperative atropine belongs to what classification of drugs?

epinephrine Epinephrine, 0.3 mL of a 1:1,000 solution, subcutaneously should be given to adults having an anaphylactic reaction.

Which prescribed medications should the nurse administer to an adult having an anaphylactic reaction?

ototoxicity from the ibuprofen

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?

"I just completed a course of antibiotics prescribed by my dentist to treat a tooth abscess." Antibiotics are commonly associated with superinfections because they destroy the normal flora. Diuretics or water pills would be associated with electrolyte imbalances. Aspirin is often linked to tinnitus and eighth cranial nerve function. In addition, its antiplatelet activity increases the risk for bleeding problems. Stress and fatigue suppress the immune system, but do not cause superinfections.

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?

Discontinue the drug immediately as ordered. 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 a cytotoxic reaction to a drug. What would the nurse expect to do?

Hemoglobin of 6.0 g/dL (60.0 g/L)

A client diagnosed with cancer has been receiving antineoplastics for several weeks. What assessment finding should the nurse interpret as a possible indication of blood dyscrasia?

antipsychotic agent

A client exhibits muscular tremors, drooling, gait changes, and spasms. When reviewing the client's medication history, which would the nurse most likely find?

Safety measures

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?

The client is having photosensitivity and this can occur even with brief exposure to the sun or UV rays. 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 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?

Assess the client's blood glucose level.

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?

Parkinsonian symptoms

A client with a longstanding diagnosis of schizophrenia has taken antipsychotic drugs for several decades. For what adverse effect should the nurse assess?

skeletal abnormalities central nervous system alterations heart defects limb abnormalities

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.

spontaneous bleeding after taking an anticoagulant dizziness after starting an antihypertensive

One of the most common occurrences in drug therapy is the development of adverse effects from simple overdose. In such cases, the client suffers from effects that are merely an extension of the desired effect. Which are examples of this primary action? (Select all that apply.)

rash and hives inflammation of the mucous membranes bone marrow suppression poisoning Drugs can act directly or indirectly to cause many types of adverse effects in various tissues, structures, and organs. Dermatological reactions (rash and hives), stomatitis (inflammation of the mucous membranes), superinfections, poisoning, and blood dyscrasias (bone marrow suppression) are all examples of tissue and organ damage.

Organ and tissue damage is one adverse reaction caused by drugs. Which are examples of such organ and tissue damage? Select all that apply.

urinary hesitancy

The nurse administers an anticholinergic medication to the client. When assessing this client, what finding should the nurse interpret as a secondary effect of the drug?

teratogenicity

The nurse at a campus medical clinic is administering a new medication to a 22-year-old female client. The nurse should educate the client about what potential risk of drug therapy?

protecting and maintaining the patency of the client's airway

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?

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

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?

poisoning. 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 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:

asking the client what the client's response is to taking NSAIDs The nurse should ask additional questions of clients who state that they have a drug allergy to ascertain the exact nature of the response and whether or not it is a true drug allergy. This would be a priority over exploring alternatives or determining the client's pain tolerance.

The nurse is assessing a new client who states being allergic to nonsteroidal anti-inflammatories (NSAIDs. What subsequent assessment should the nurse prioritize?

a decrease in urine output

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?

antibodies.

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

potassium levels.

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:

inspect the client's mucous membranes. Monitor the client's blood cell counts. Monitor the client's potassium levels.

The nurse is preparing to administer antineoplastic medication to a client with cancer who has been receiving these medications for several days. When monitoring for potential adverse effects of this medication, the nurse should perform what assessments? (Select all that apply.)

renal injury 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).

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?

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

The nurse provides health education for a diverse group of clients. For which client should the nurse emphasize the risk of teratogenic drug effects?

a 29-year-old client receiving prenatal care in her first trimester of pregnancy a 37-year-old client who is taking fertility drugs

The nurse should consider teratogenic effects when caring for what clients? (Select all that apply.)

antibiotics Superinfection is caused by several kinds of drugs, especially antibiotics (which destroy the normal flora). Antihistamines, antihypertensives, and antineoplastics are not typically associated with superinfection.

The nurse would assess a client receiving which medication for possible superinfection?

primary action of a drug. Adverse effects can be extensions of the primary action of a drug or secondary effects that are not necessarily desirable but are unavoidable.

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

anaphylactic

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?

Maintain the client's safety during drug therapy.

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

an antihistamine causes the client to experience drowsiness

What is an example of a secondary action?

renal toxicity ototoxicity

What issues is gentamycin, a potent antibiotic, associated with? (Select all that apply.)

Be sure to drink plenty of fluids to prevent dehydration.

What would the nurse include in the teaching plan for a client who is to receive a drug that is associated with anticholinergic effects?

secondary actions.

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:

A client who is drowsy after taking antihistamine

Which client is experiencing a secondary action of a medication?

antifungals

Which drug classification is used to treat superinfections?

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

Anaphylactic 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.

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.

It is necessary to ensure that the client's drug levels are therapeutic but not toxic. Measuring serum drug levels is useful when drugs with a narrow margin of safety are given, because their therapeutic doses are close to their toxic doses. This is the case during lithium therapy. Serum levels are not commonly taken to monitor adherence to treatment. Blood-drug incompatibilities are not a relevant consideration.

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?

blood urea nitrogen and creatinine levels.

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

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

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?

Drugs cause unexpected or unacceptable reactions despite screening and testing.

An instructor is preparing a class that describes the toxic effects of drugs. Which effect would the instructor expect to include?

A client who has chronic renal failure and is taking diphenhydramine A client on postoperative day 2 from a prostatectomy who takes ipratropium

Some clients are excessively responsive to either the primary or secondary effects of a drug. This is known as hypersensitivity, and it may result from a pathological or underlying condition. Which are examples of hypersensitivity? Select all that apply.

difficulty breathing increased blood pressure diaphoresis During an anaphylactic reaction nurses can expect to assess hives, rash, difficulty breathing, increased BP, dilated pupils, diaphoresis, "panic" feeling, increased heart rate, and respiratory arrest.

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.)

"Have you been taking aspirin on a regular basis?"

The nurse is assessing a community-dwelling client with a history of rheumatoid arthritis. During the interview, the client states, "The last few months, I have this ringing in my ears that I just cannot seem to get away from." What assessment question should the nurse ask?

hypertension

What would the nurse expect to assess if a client develops neuroleptic malignant syndrome?

The man may be experiencing nephrotoxic effects of aspirin 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.

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?

Provide supportive care to manage fever and inflammation. 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 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?

contraindication for the use of certain medications.

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:

an allergic response. 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.

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:

cold, clammy skin 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 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?

Elevated aspartate aminotransferase (AST) level

A client is suspected of having a liver injury as a result of drug therapy. What laboratory finding would best support this diagnosis?

Review the client's most recent potassium level. 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 receiving drug therapy develops numbness and tingling in the extremities and muscle cramps. What assessment should the nurse perform?

"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." 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 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?

Discontinue the drug immediately as ordered. If serum sickness occurs, the prescriber is notified and the drug is discontinued. Epinephrine is given for an anaphylactic reaction and requires a prescriber's order. A MedicAlert identification may be indicated, but is not the nurse's first concern. Topical corticosteroids may be used to treat dermatological symptoms such as rash, but would not be the nurse's first concern.

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?

Maximize therapeutic effects. Minimize adverse effects and drug interactions. Provide appropriate drug education for the client and family. When administering drug therapy, the nurse's main focus is ensuring a beneficial outcome by maximizing therapeutic effects, minimizing adverse effects and drug interactions, and providing appropriate drug education for the client and family.

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?

Risk for aspiration related to impaired swallowing Parkinson-like symptoms include impaired swallowing, which in turn creates a risk for aspiration. Memory, personality and ventilation are not normally affected by these particular adverse effects.

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?

Techniques for providing safe and effective mouth care

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?

"Allergic reactions happen after your body has been sensitized to a drug in the past." 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.

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?

The client's blood urea nitrogen level and creatinine clearance rate 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 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?

buzzing or ringing sound in the ears (tinnitus) Buzzing or ringing sounds in the ears (tinnitus) and sensorineural deafness are the major effects of ototoxicity. Other symptoms of ototoxicity include vestibular toxicity, vertigo, and light-headedness. Irregularities in cardiac rhythms and conduction are results of cardiotoxicity, whereas altered acid-base balance is a result of nephrotoxicity. Immunotoxicity causes an increased incidence of bacterial and viral infections.

A nurse is administering gentamicin, an antibiotic that is ototoxic. Which report or sign would indicate that the client is suffering from ototoxicity?

measures to alleviate any discomfort associated with adverse effects measures to alleviate any discomfort associated with adverse effects

A nurse is instructing a client concerning a newly prescribed drug. What should be included to help improve client compliance and safety?

a 12-year-old boy with hearing loss Macrolide antibiotics can cause severe auditory nerve damage, so the nurse would question administration of this drug to the child with hearing loss because another antibiotic may be indicated to preserve remaining hearing. This drug is not contraindicated in older adults, although a lower dosage may be indicated. It may safely be given in clients with irritable bowel syndrome and after myocardial infarction.

Before administering a macrolide antibiotic, the nurse should question the order for what client?

Drug teaching can address signs and symptoms the client should be alert for. Assessments include monitoring for expected or common adverse effects. Baseline can be established to help identify adverse effects that occur. This information will direct the nurse's assessment of the client, helping to focus on particular signs and symptoms that would alert you to adverse effects, and helping to establish a baseline for that client so that you will be able to identify adverse effects that occur. When teaching the client about a drug, it is important to list the adverse effects that should be anticipated, along with the appropriate actions that the client can take to alleviate any discomfort associated with these effects. Being alert to adverse effects, and knowing what to assess and how to intervene appropriately, can increase the effectiveness of a drug regimen, provide for client safety, and improve client compliance. Deciding to withhold a drug is outside the nurse's scope of practice. Adverse effects may not be avoided, but they can be minimized or quickly treated with awareness.

How does knowledge of a drug's adverse effects impact the care provided by the nurse? (Select all that apply.)

Hepatotoxicity Acetaminophen can cause hepatotoxicity or damage to the liver. Manifestations of hepatotoxicity include hepatitis, jaundice, elevated liver enzyme levels, and fatty infiltration of the liver. Ototoxicity, hypersensitivity reaction, and neurotoxicity would offer different signs.

The nurse is caring for a client in the intensive care unit. This client took an overdose of acetaminophen 3 days previously and now has jaundice. Laboratory results show elevated liver enzymes. The nurse recognizes that the client may be experiencing what condition related to the overdose?

blood dyscrasia Symptoms of blood dyscrasias include fever, chills, sore throat, weakness, back pain, dark urine, decreased hematocrit (anemia), low platelet count (thrombocytopenia), low white blood cell count (leukopenia), and a reduction of all cellular elements of the complete blood count (pancytopenia). Dermatologic reactions would be reflected in skin alterations, electrolyte imbalances would result in differing symptoms depending on the electrolyte involved but would not cause chills and fever, and a superinfection could cause a fever but would not cause a sore throat, weakness, or back pain unless the infection involved those body parts.

The nurse is caring for a client receiving an antineoplastic medication who reports fever, chills, sore throat, weakness, and back pain. The nurse should recognize the possibility of what adverse effect?

adverse effects 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.

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?

GI motility skin problems hypoglycemia super-infections Tissue damage can include skin problems, mucous membrane inflammation, blood dyscrasia, super-infections, liver or renal toxicity, poisoning, hypoglycemia or hyperglycemia, electrolyte disturbances, various central nervous system problems (ocular damage, auditory damage, atropine-like effects, Parkinson-like syndrome, neuroleptic malignant syndrome), and teratogenicity.

What can the tissue damage noted as an adverse effect of antirheumatoid drugs include? (Select all that apply.)

decreased glomerular filtration rate. 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.

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

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

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