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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."

cefuroxime

2nd generation cephalosporin

Drugs can affect the special senses, including the eyes and ears. Alterations in seeing and hearing can pose safety problems for clients. What are examples of sensory effects of drugs? (Select all that apply.)

A 45-year-old taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis A 4-year-old admitted after taking too many aspirin

Which client is receiving a drug that is an agonist? A client who takes insulin several time daily for type 1 diabetes A client whose depression is treated with a monoamine oxidase inhibitor (MAOI) A client who is taking a selective serotonin -reuptake inhibitor A client who takes a beta blocker for hypertension

A client who takes insulin several time daily for type 1 diabetes Explanation: Insulin is considered an agonist because it reacts with specific receptor sites to change the cell membrane permeability, interacting directly with the receptor sites to cause the same activity that the natural chemical would cause. A monoamine oxidase inhibitor blocks the breakdown of norepinephrine by the enzyme MAO, thus being an enzyme inhibitor. A selective serotonin reuptake inhibitor is considered an enzyme inhibitor because this group of drugs acts similarly to MAO inhibitors, blocking the removal of serotonin from receptor sites. A beta blocker is an antagonist; it "blocks" receptors.

transdermal patches

A method for taking a drug where the drug is absorbed into the bloodstream through the skin.

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? You Selected: Stevens-Johnson syndrome

All drugs have adverse effects associated with them. Drugs can act directly or indirectly to cause many types of adverse effects in various tissues, structures, and organs. Meprobamate (Miltown), a drug used to treat anxiety, is associated with an itchy, red rash and in some clients has caused the serious to potentially fatal Stevens-Johnson syndrome. All the other choices are examples of neurological effects.

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. You Selected: an anaphylactic reaction to seafood a pregnant client who takes phenytoin and delivers a child with birth defects A client on postoperative day 2 from a prostatectomy who takes ipratropium A client who has chronic renal failure and is taking diphenhydramine

Correct response: A client who has chronic renal failure and is taking diphenhydramine A client on postoperative day 2 from a prostatectomy who takes ipratropium Explanation: Hypersensitivity occurs when clients are excessively responsive to either the primary or secondary effects of a drug. It also can occur if a client has an underlying condition (i.e., chronic renal failure) that makes the drug's effects especially unpleasant or dangerous, such as with a kidney problem or prostate cancer. An anaphylactic reaction is an allergic response with symptoms of difficulty breathing and hives. Birth defects caused by drugs are called teratogenicity.

A client has been prescribed a tricyclic antidepressant and the nurse recognizes the client's associated risk for anticholinergic effects. What should the nurse teach the client about preventing and managing these adverse effects? (Select all that apply.) Maintain good oral hygiene to minimize dry mouth. Void before taking the medication so urinary hesitation is less problematic. Avoid situations where bruising or lacerations are a possibility. Eat several small meals daily rather than three larger meals. Use caution in situations where it may be possible to become overheated.

Correct response: Maintain good oral hygiene to minimize dry mouth. Void before taking the medication so urinary hesitation is less problematic. Use caution in situations where it may be possible to become overheated. Explanation: Anticholinergic effects include dry mouth, decreased sweating, and urinary hesitation. However, they do not include an increased risk for bleeding. Changing the pattern of food intake has no appreciable effect on the incidence or severity of anticholinergic effects.

Warfarin

Coumadin, Jantoven Anticoagulant

When researching information about a drug, the nurse finds that the drug tightly binds to protein. The nurse would interpret this to mean that the drug will:

Drugs that are tightly bound to protein are released very slowly and have a very long duration of action because they are not free to be broken down or excreted. Drugs that are loosely bound tend to act quickly and to be excreted quickly. Drugs that compete with each other for protein binding sites alter the effectiveness or cause toxicity when the two drugs are given together.

anticholinergic effect

Drugs with anticholinergic effects often cause dry mouth, constipation, dehydration, and decreased sweating. The client should be instructed to drink fluids to prevent dehydration and to avoid overly warm or hot environments. Avoiding exercise to affect calorie intake is not necessary. A high-fiber diet would be indicated to prevent constipation.

The nurse is preparing to administer a prescribed drug to a client with a history of renal disease. Why should the nurse anticipate administering a lower dose than for a client with healthy kidneys?

Excretion is likely to take place slowly. Explanation: If the kidneys are not functioning properly, a drug may not be excreted properly and could accumulate in the body. Metabolism may be altered if the client has liver disease, not kidney disease. Distribution would be most impacted by alteration in cardiovascular function causing reduced perfusion of the tissues. Absorption is most impacted by gastrointestinal alterations.

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

Gentamicin is an example of a drug that holds the potential for renal toxicity. This drug is not associated with hepatic damage, electrolyte disturbances or disruptions of skin integrity.

Gentamicin

Gentocin

e.g., the widely used "statin" group of cholesterol-lowering drugs

Grapefruit contains a substance that strongly inhibits the metabolism of drugs normally metabolized by the cytochrome P450 CYP3A4 enzyme. This effect greatly increases the blood levels of some drugs (e.g., the widely used "statin" group of cholesterol-lowering drugs), and the effect lasts for several days. Clients who take medications metabolized by the CYP3A4 enzyme should be advised against eating grapefruit or drinking grapefruit juice.

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.

regular monitoring of the client's serum drug levels

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.

anaphylactic shock

Rapidly developing systemic anaphylaxis that produces life-threatening acute airway obstruction followed by vascular collapse within minutes after exposure to an antigen.

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 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.

secondary actions.

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.

glipizide

Take 30 min before meals, follow diet closely, avoid alcohol diabetes Glucotrol

benzodiazepine

a category of anxiolytic drugs; an indirect agonist for the GABAa receptor a central nervous system depressant that is often used to reduce anxiety or promote sleep

The nurse is assessing a diverse group of clients, all of whom are being treated with medications. Which clients are experiencing adverse effects related to the primary actions of their medications? (Select all that apply.) a client whose diuretic causes episodes of dizziness a client whose benzodiazepine causes sedation a client who experiences nausea after taking an oral antibiotic a client who finds that a hypnotic causes an unpleasant metallic taste a client whose vitamin B supplement changes the color of his urine

a client whose diuretic causes episodes of dizziness a client whose benzodiazepine causes sedation Explanation: Diuretics lower blood pressure, which can lead to dizziness. Benzodiazepines depress the central nervous system, causing sedation. In both cases, the adverse effect is an extension of the intended effect; these are examples of adverse effects resulting from primary actions. In contrast, each of the other clients are experiencing adverse effects related to secondary actions, since nausea, unpleasant tastes and urinary changes are not extensions of each drug's intended effects.

Atropine,

a drug used preoperatively to dry up secretions, is the prototype anticholinergic drug. Many cold remedies and antihistamines also cause anticholinergic effects.

A parent brings a child to the clinic for an earache. The child receives a prescription for amoxicillin. The parent calls the clinic the next day and says the child has been taking the medicine and now has a rash. The nurse should give the parent instructions about which type of response?

allergic response Explanation: An allergic response is an immune system response. If the body interprets the drug as a foreign substance and forms antibodies against the drug, the immune system initiates the antigen-antibody response when the drug is taken again.

genetic engineering

animal product the process of altering DNA---permits scientists to produce human insulin by alterning E. coli bacteria, making insulin a better product without some of the impurities that come with animal products.

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

antibodies. Explanation: Antibodies are formed by the body to react with antigens in an allergic reaction. The antigen, in this case, is the drug that the body recognizes as a foreign substance to be eliminated. Antihistamines are administered to reduce the histamines secreted as a result of the allergic reaction. An allergic reaction is distinct and different from a secondary effect.

Atropine, which is used preoperatively, is considered which drug classification?

anticholinergic

warfarin

anticoagulant

amlodipine

antihypertensive

teratogenicity

any drug that causes harm to the developing fetus or embryo

The blood-brain barrier and the placental barrier

are protective mechanisms in the body that protect the brain or fetus from toxins. In order for a medication to pass through these barriers, the medications must be lipophilic, nonionized, and unbound to protein.

tetracycline

avoid milk

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.

canthus

corner of the eye

agonist

drug that mimics or strengthens the effects of a neurotransmitter

anticholinergic effects

dry mouth, blurred vision, photophobia, urinary retention, constipation, tachycardia.

A client is diagnosed with hypercholesterolemia and is prescribed a statin. As part of client education, the nurse should teach the client to avoid eating:

grapefruit.

coincidental

happening by chance

hypoglycemia

hypoglycemia has the greatest impact on the brain, which explains why hypoglycemia has so many neurological signs and symptoms including fatigue, drowsiness, anxiety, headache, shaking, lack of coordination, numbness and tingling of the mouth, tongue, and /or lips; confusion, and in severe cases, seizures or coma may occur because the brain cannot function without adequate supplies of glucose.

photosensitivity

increased reaction of the skin to exposure to sunlight

outcomes of metanolism

increased renal excretion of medication' inactivation of medications increased therapeutic effect activation of pro-medications (also called pro-drugs) into active forms decreased toxicity when active forms of medications become inactive forms increased toxicity when inactive forms of medications become active forms

stomatitis

inflammation of the mucosa of the mouth

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. None of the other options are relevant to client safety regarding this drug characteristic.

hypoglycemia

low serum blood glucose concentration. some drugs affect metabolism and the use of glucose, causing a low serum blood glucose concentration, or hypoglycemia

statin

lowers cholesterol

Clients who have liver disorders

may require decreased doses of medication because almost all medications are metabolized in the liver.

ointment

n. A fatty preparation with a butter-like consistency in which a medicinal substance exists. oint

nullified

nullify取消；废弃；使无价值；抹杀

superinfection

overgrowth of normal microbiota that is resistant to antibiotics

A nurse is reading an article that describes predictable differences in the effects of drugs in people of particular culture backgrounds due to their genetic makeup. The nurse is reading about: pharmacogenomics. pharmacodynamics. pharmacokinetics. pharmacology.

pharmacogenomics. Explanation: Pharmacogenomics is a new area of study that explores unique differences in response to drugs that an individual possesses based on genetic makeup. Pharmacodynamics refers to how the drug affects the body; pharmacokinetics refers to how the body acts on drugs. Pharmacology refers to the study of the biologic effects of chemicals.

teratogenic

producing malformations (in the developing embryo)

Pharmacokinetics

refers to the actions of drugs.

tinnitus

ringing in the ears

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.

A client, prescribed a drug that has an exceptionally narrow margin of safety, should be educated about the need for what intervention?

serum drug level monitoring

anaphylactic reaction

severe allergic reaction lead to respiratory distress and even respiratory arrest

hyperglycemia

some drugs stimulate the breakdown of glycogen or alter metabolism in such a way as to cause high serum glucose levels, or hyperglycemia. Ephedrine(generic), a drug used as bronchodilator and antiasthma drug and to relieve nasal congestion, can break down stored glycogen and cause an elevation of blood glucose by its effects on the sympathetic nervous system.

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. spontaneous bleeding after taking warfarin dizziness after starting amlodipine drowsiness after taking diphenyhydramine diarrhea after taking cefuroxime

spontaneous bleeding after taking warfarin dizziness after starting amlodipine Explanation: Primary action is when the client suffers from effects that are merely an extension of the desired effect. For example, an anticoagulant may act so effectively that the client experiences excessive and spontaneous bleeding. In the same way, a client taking an antihypertensive drug may become dizzy, weak, or faint when taking the "recommended dose" but will be able to adjust to the drug therapy with a reduced dose. The other two are examples of secondary action.

pharmaceutical house

that produces the drug

apply transdermal patch

the client should wash his skin with soap and water and dry it thoroughly before applying a transdermal patch. the client should apply the patch to a hairless area of skin to promote absorption of the medication. the client should rotate application sites daily to prevent skin irritation.

conjunctival sac

the space formed between the inner eyelid and the surface of the eyeball

receiving glipizide

to treat hyperglycemia

Synergism occurs

when two drugs with different sites or mechanisms of action produce greater effects when taken together. This does not mean that potential toxicity or adverse effects are "canceled out." The two drugs would not individually affect different aspects of pharmacokinetics.

ribbon

挤出来一圈圈的样子， 及眼药膏那种

Glipizide(Glucotrol) glyburide(DiaBeta)

格列吡嗪 优降糖 both have the desired action of lowering the blood glucose level but can lower glucose too far, causing hypoglycemia.

licorice

甘草

lithium

锂元素 Li mood stabilizer

nasolacerimal sac

鼻骨与泪骨的