Chapter 3

c

A client comes to the clinic with ringing in the ears and difficulty hearing. What medication in the client's current regimen should the nurse suspect? a) acetaminophen with codeine b) hydrochlorothiazide c) erythromycin d) insulin

a

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

c

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

b

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

c

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

c, d

Choice Multiple question - Select all answer choices that apply. A client is prescribed a combination of medications to treat the disease process. The client is exhibiting signs of toxicity related to the new drug regimen. A possible cause of the change in the absorption of the medications may be enzyme inhibition. What is true of enzyme inhibition? (Select all that apply.) a) It occurs within seconds or minutes of starting an inhibiting agent. b) It may necessitate the administration of larger doses of the medication. c) It may necessitate the administration of smaller doses of the medication. e. It occurs within seconds or minutes of starting an inhibiting agent. d) It may occur with concurrent administration of two or more drugs that compete for the same metabolizing enzymes. e) It may occur with concurrent administration of two or more drugs that compete for different metabolizing enzymes.

a, c, d

Choice Multiple question - Select all answer choices that apply. Many drugs that reach the developing fetus or embryo can cause death or congenital defects. What are examples of congenital defects? (Choose all that apply.) a) central nervous system alterations b) birth at 40 weeks' gestation c) skeletal and limb abnormalities d) heart defects

a, b, c, d, e

Choice Multiple question - Select all answer choices that apply. Many drugs, if taken during pregnancy, can cause adverse effects to the fetus. It is important for nurses to teach women the potential risks of fetal drug exposure. What are some potential risks? (Select all that apply.) a) blindness b) heart anomalies c) facial defects d) central nervous system defects e) limb deformities

a, d

Choice Multiple question - Select all answer choices that apply. What issues is gentamycin, a potent antibiotic, associated with? (Select all that apply.) a) ototoxicity b) liver toxicity c) respiratory d) renal toxicity e) neurotoxicity

a, c, e

Choice Multiple question - Select all answer choices that apply. When administering drug therapy for a client, how can the nurse ensure beneficial outcomes? (Select all that apply.) a) Provide appropriate drug education for the client and family. b) Make sure the client can explain about the drug classifications. c) Maximize therapeutic effects. d) Order laboratory studies to determine effectiveness of drug therapy. e) Minimize adverse effects and drug interactions.

c

The nurse is administering medications to a client who says, "About 30 minutes after you gave me that medication yesterday, I felt funny." What is the nurse's best response to this client? a) "Let me know if you begin to feel that way today after you take the medication." b) "I will get a medication error reporting form for you to fill out." c) "I'm going to call your health care provider before I give you this medication today." d) "I wouldn't worry because it doesn't sound like it lasted very long."

a

Which client is at greatest risk for adverse effects from drug therapy? a) 76-year-old taking medications for diabetes, hypertension, coronary artery disease, and hypothyroidism b) 58-year-old who has had a uncomplicated myocardial infarction and will be discharged after three days c) 24-year-old pregnant woman being treated for a urinary tract infection d) 32-year-old who has been admitted to the hospital with pneumonia

dermatological reaction

adverse reactions involving the skin, from simple rash to potentially fatal exfoliative dermatitis. drugs are deposited in the skin and cause direct irritation to the tissue

drug allergy types

anaphylactic reactions, cytotoxic reactions, serum sickness, and delayed reactions

superinfections

antibiotics destroy normal floral leading to superinfection developing or infections caused by organisms that are usually controlled by normal flora

secondary action

antihistamines cause drying up secretions AND drowsiness, drug dose might be adjusted to remove the effects but not always

blood dyscrasia

bone marrow depression caused by drug effects on the rapidly multiplying cells of the bone marrow; lower than normal levels of blood components can be seen

adverse effects

caused for many reasons: 1. the drug may have other effects on the body besides the therapeutic effect 2. the patient may be sensitive to the drug being given 3. the drug's action on the body may cause other responses that are undesirable or unpleasant 4. the patient may be taking too much or too little of the drug, leading to adverse effects

cytotoxic reaction

complete blood count showing damage blood-forming cells; liver function tests show elevated liver enzymes; renal function decreased

toxicity

creatinine

nephrotoxicity

decrease urine output

rash intervention

drugs outweigh discomfort of skin lesion, frequent skin care, wear loose clothes, don't rub, topical corticosteroids, antihistamines, and emollients

hypersensitivity

excessive responsiveness to either the primary or the secondary effects of a drug; may be caused by a pathological condition or, in the absence of one, by a particular patient's individual response

superinfection assessment

fever, diarrhea, black/hairy tongue, inflamed and swollen tongue (glossitis), mucous membrane lesions, vaginal discharge with or without itching

drug allergy

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

stomatitis intervention

frequent mouth care with a nonirritating solution, frequent small meals, dental consultation, anti fungal agents/local anesthetics

anaphylactic reaction

hives, rash, difficulty breathing, panic, respiratory arrest

rash assessment

hives, rashes, lesions and exfoliative dermatitis (rash, scaling, fever, enlarged lymph nodes, enlarged liver, potentially fatal erythema multiform exudativum (stevens-johnson syndrome) which has dark red papule appearing on extremities with no pain or itching in rings or dirk patches

superinfections

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

stomatitis

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

stomatitis

inflammation of the mucous membranes, can occur because of direct toxic reaction to the drug deposits in the end capillaries in the mucous membranes, leading to inflammation

serum sickness reaction

itchy rash, high fever, swollen lymph nodes, swollen/painful joints, edema

primary action

most common, from overdose, extension of desired effect, effects caused by individual response to the drug, high/low body weight, age, underlying pathology that alter the effects of the drug

poisoning

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

delayed allergic reaction

rash, hives, swollen joints (think poison ivy)

hypersensitivity reactions

response excessively to primary or secondary effects of the drug, from pathological or underlying condition

discontinue drug

serum sickness priority is

dermatological reactions

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

superinfection interventions

supportive measure (frequent mouth care, skin care, access to bathroom, small/frequent meals), anti fungal therapy, extreme = discontinue the drug responsible

stomatitis assessment

swollen gums, inflamed gums (gingivitis), and swollen and red tongue (glossitis), difficulty swallowing, bad breath, pain in mouth and throat

CNS

vapor = damage to baby's