Ch 3 Pharm

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

"Do you remember what happened the last time you received penicillin?" 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 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? Educate the client about antibiotics that are alternatives to 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?" Ask the client, "What happens when you take a dose of tetracycline?"

Ask the client, "What happens when you take a dose of tetracycline?" 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.

A client with urinary urgency and frequency has been prescribed an anticholinergic medication. The nurse should educate the client about what potential adverse effects related to secondary actions? Decreased bowel motility Anaphylaxis Urinary incontinence Urinary hesitancy

Decreased bowel motility Decreased bowel motility would be an example of a secondary action that is unrelated to the drug's desired effects. In this case, decreased bowel motility is an anticholinergic effect that is unrelated to the desired decrease in urinary urgency. Anaphylaxis is a possible adverse effect that is not a secondary action of the drug. Hesitancy would be an excessive primary action of the drug.

When assessing a client who has developed an anaphylactic reaction, what would the nurse expect to find?

Difficulty breathing Difficulty breathing, increased blood pressure, dilated pupils, diaphoresis, and a panic feeling are associated with an anaphylactic reaction. Decreased hematocrit would be seen with a cytotoxic reaction. Swollen lymph nodes are associated with a serum sickness reaction. Swollen joints are associated with a delayed allergic reaction.

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

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 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? Encourage the use of a MedicAlert identification. Discontinue the drug immediately as ordered. Administer topical corticosteroids. Administer prescribed epinephrine subcutaneously.

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 recent nursing graduate is preparing to enter the workforce. What principle should guide the nurse's administration of medications? Several chemical and physiologic processes need to be affected before a client has an adverse effect. Drugs can cause unexpected reactions even after thorough screening and testing. The effects occurring with present-day therapy are much less severe than in previous decades. Drugs pose no significant risk of harm if they are used as prescribed.

Drugs can cause unexpected reactions even after thorough screening and testing. Even though drugs are carefully screened and tested in animals before being released to use on humans, drug products often cause unexpected or unacceptable reactions when given. Many effects can be seen when just one chemical factor is changed or altered. All drugs have the potential to cause adverse effects whether they are prescribed or over-the-counter. Today's potent and amazing drugs can cause a variety of reactions, many of which are more severe than ever seen before.

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

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

What does the nurse need to do when there is any indication of an allergic reaction in clients? Increase the effectiveness of a specific medication. Reduce the risk of adverse effects during drug therapy. Maintain the client's safety during drug therapy. Obtain early warning of noncompliance in drug therapy.

Maintain the client's safety during drug therapy. Being alert to adverse effects, such as what to assess and how to intervene appropriately, can increase the effectiveness of a drug regimen, provide for client safety, and improve client compliance. Indications of allergic reactions would not indicate noncompliance or improve effectiveness of a specific medication. Indications of allergic reaction would indicate an adverse effect and would not reduce the risk.

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. Monitor laboratory blood values. Prepare the client for dialysis. Place the client on protective isolation.

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.

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. anaphylaxis. hypersensitivity. allergies.

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.

A client receiving drug therapy develops numbness and tingling in the extremities and muscle cramps. What assessment should the nurse perform? Assess the client's level of orientation. Review the client's most recent potassium level. Check the client's urine output. Check the client's blood glucose level.

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 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. 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.

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

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 client on a multimedication therapy regimen is demonstrating elevated liver enzymes that suggest hepatotoxicity. What is the most likely explanation for the elevation of the client's liver enzymes? The liver is always the first organ of the body to be affected by any toxic substance. The cells in the liver filter, concentrate, and eliminate toxic as well as nontoxic materials, increasing the chances of damaging the organ. The liver cannot metabolize hepatotoxic drugs and paradoxical reactions occur. The liver is exposed to relatively large concentrations of ingested drugs or other potentially toxic substances due to the hepatic anatomy.

The liver is exposed to relatively large concentrations of ingested drugs or other potentially toxic substances due to the hepatic anatomy. Hepatotoxicity is damage to the liver. Manifestations of hepatotoxicity include elevated liver enzyme levels. Hepatic anatomy and hepatic function both contribute greatly to the high susceptibility of the liver to toxins. Blood draining from the stomach and small intestines is delivered directly to the liver by the hepatic portal vein. As a result, the liver is exposed to relatively large concentrations of ingested drugs or other potentially toxic substances. The cells of the renal system, or kidneys, filter and eliminate toxic and nontoxic materials, but not the liver cells. Since the drug that was absorbed and is now present in Mrs. Armin's blood is hepatotoxic, liver damage will likely occur because of the large number of drug molecules presented to the liver. The liver is also responsible for metabolizing most drugs. If liver damage occurs, the drug will not be metabolized as efficiently, leaving more circulating drug to cause further liver 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? The man may be experiencing nephrotoxic effects of aspirin The man may be experiencing a paradoxical effect of aspirin The man may be experiencing liver toxicity from the aspirin The man may be allergic to aspirin

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.

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 nurse should not be concerned. Medication is not the cause of the client's confusion. The client probably has the onset of Alzheimer disease. 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.

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 older adult client has an elevated serum creatinine level. This client is at greatest risk for which medication-related effect? Increased absorption Delayed gastric emptying Idiosyncratic effects Toxicity

Toxicity 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.

An older adult client has an elevated serum creatinine level. This client is at greatest risk for which medication-related effect? Toxicity Delayed gastric emptying Idiosyncratic effects Increased absorption

Toxicity 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.

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 ringing noise in the ears visual disturbances yellowing of the skin

a decrease in urine output 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.

Many drugs can affect the functioning of the nerves in the periphery and central nervous system. Which are examples of potential neurologic effects of drugs? Select all that apply. a postoperative client who had atropine and exhibits dry mouth, altered taste perception, dysphagia, heartburn, constipation, and bloating a client taking an antipsychotic who exhibits akinesia, muscular tremors, drooling, changes in gait, jitters (akathisia), or spasms (dyskinesia) a postoperative client with extrapyramidal symptoms, hyperthermia, and autonomic disturbances a pregnant woman who takes tamoxifen (Nolvadex) and delivers a baby with birth defects

a postoperative client with extrapyramidal symptoms, hyperthermia, and autonomic disturbances a client taking an antipsychotic who exhibits akinesia, muscular tremors, drooling, changes in gait, jitters (akathisia), or spasms (dyskinesia) a postoperative client who had atropine and exhibits dry mouth, altered taste perception, dysphagia, heartburn, constipation, and bloating Many drugs can affect the functioning of the nerves in the periphery and central nervous system. Nerves function by using a constant source of energy to maintain the resting membrane potential and allow excitation. Neuroleptic malignant syndrome, Parkinson-like syndrome, and atropine-like (anticholinergic) effects are all examples. Teratogenicity is when a drug causes birth defects.

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? protocols body system affected adverse effects route of administration

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.

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? expected response idiosyncratic response hepatotoxic response allergic response

allergic response 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.

The nurse would assess a client receiving which medication for possible superinfection? antihypertensives antineoplastics antihistamines antibiotics

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.

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

anticholinergic 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.

The nurse is assessing a new client who states being allergic to nonsteroidal anti-inflammatories (NSAIDs. What subsequent assessment should the nurse prioritize? assessing the client for signs and symptoms of inflammation asking if the client has tolerated narcotics and acetaminophen in the past asking the client what the client's response is to taking NSAIDs assessing the client's pain tolerance and expectations for pain control

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 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? blood dyscrasia dermatologic reaction electrolyte imbalance superinfection

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.

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

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. damage the immature nervous system 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. 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.

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

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.

A nurse is instructing a client concerning a newly prescribed drug. What should be included to help improve client compliance and safety? measures to alleviate any discomfort associated with adverse effects statistics related to phase III of testing for the prescribed drug a list of pharmacies where the drug can be obtained the cost of the brand-name drug compared with the generic form

measures to alleviate any discomfort associated with adverse effects If clients are aware of certain adverse effects and how to alleviate or decrease the discomfort, they are more likely to continue taking the medication and providing for safe administration. A list of pharmacies can be useful information, but will not improve safety or compliance. Knowing the cost of the brand versus the generic could also be helpful to the client. However, a substitution may not be allowed, and the cost of a drug does not improve client safety. Most clients are not concerned with statistics regarding drug testing, and the testing is usually not discussed with clients.

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 providing reassurance to the client administering intravenous antihistamines as prescribed monitoring the client's vital signs at least every five minutes

protecting and maintaining the patency of the client's airway This client's presentation is suggestive of anaphylaxis. In the care team's immediate treatment, maintaining the airway is a priority. Epinephrine is administered in the short term, not antihistamines. The nurse should reassure the client, if possible, but the patency of the airway is the highest priority. Similarly, this would supersede the need for vital signs monitoring, even though this should be done.

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 hypoglycemia hyperkalemia liver injury

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).

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

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.