Chapter 3 pharmacology

What client is experiencing an adverse effect that is a result of primary action?

A client taking anticoagulants who develops a gastrointestinal bleed

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

Be sure to drink plenty of fluids to prevent dehydration.

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

Drugs can act directly or indirectly to cause many types of adverse effects in various tissues, structures, and organs. Dermatological reactions, stomatitis, superinfections, poisoning and blood dyscrasias are all examples of tissue and organ damage.

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

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

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

Frequent rinsing with cool liquids For stomatitis, the nurse should recommend frequent mouth care with a nonirritating solution. This may include frequent rinsing with cool liquids. The client should consume frequent small meals rather than three large meals. An astringent mouthwash or a firm toothbrush would be too irritating.

an idiosyncratic response.

Idiosyncratic responses are related to an individual's unique response to a drug, rather than to the dose of a drug

a paradoxical response.

Opposite of an intended drug response

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

Parkinsonian symptoms 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

Cholinergic

Referring to cells that use acetylcholine as their synaptic transmitter. Cholinergic medications are a category of pharmaceutical agents that act upon the neurotransmitter acetylcholine, the primary neurotransmitter within the parasympathetic nervous system (PNS). There are two broad categories of cholinergic drugs: direct-acting and indirect-acting.

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

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

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 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. \

The nurse is caring for a client who is receiving an antidiabetic agent. What assessment finding should the nurse attribute to a possible adverse reaction?

The client reports feeling unusually drowsy and fatigued. antidiabetic agents can lead to low serum blood glucose levels manifested by fatigue, drowsiness, hunger, cold clammy skin, and lack of coordination. Polyuria, increased thirst, and Kussmaul respirations would indicate hyperglycemia, the very reason the client is receiving the antidiabetic agent.

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 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 exposed to relatively large concentrations of ingested drugs or other potentially toxic substances due to the hepatic anatomy.

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? You Selected:

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.

What is an example of a secondary action?

an antihistamine causes the client to experience drowsiness

anticholinergic

blocks parasympathetic nerve impulses; decreases oral and respiratory secretions (atropine, Artane)

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

blood urea nitrogen and creatinine levels. 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.

Rosacea

chronic inflammatory skin condition that usually affects the face. People may mistake rosacea for acne, eczema, or an allergic skin reaction. The main symptoms of rosacea are facial flushing, irritated skin, and pimples. Other symptoms include blushing easily and eye problems.

port wine stain of the face

is a type of birthmark. It got its name because it looks like maroon wine was spilled or splashed on the skin.

Glipizide (Glucotrol)

is an antidiabetic agent with the desired action of lowering the blood glucose level.

multiple nevi

moles

The nurse administers a loop diuretic to the client. In addition to sodium and water, what other electrolyte would the nurse expect to be excreted in significant amounts?

potassium

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

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

severe sunburn

What would the nurse expect the prescribing health care provider to order for a client with a delayed allergic reaction?

topical corticosteroid

Kussmaul respirations

Deep, rapid breathing; usually the result of an accumulation of certain acids when insulin is not available in the body.

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?

Hemoglobin Blood dyscrasia is associated with a reduction in some, or all, blood cellular components. This client's hemoglobin level is significant below reference ranges, while INR, creatinine, and platelets are within norms.

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?

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.

The nurse is assessing a client who has developed shortness of breath, a rash, panic, and a blood pressure of 189/106 mm Hg after being administered a new medication. In addition to promptly informing the care team, the nurse should:

This client is likely experiencing anaphylaxis and requires epinephrine. There is no indication that CPR is needed. Supplementary oxygen is likely needed, but nasal cannula would likely be insufficient. Monoclonal antibodies are not used to treat anaphylaxis.

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?

adverse effects

Preoperative atropine belongs to what classification of drugs?

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.

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

antipsychotic agent

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

hypertension

The nurse administers a loop diuretic to the client. In addition to sodium and water, what other electrolyte would the nurse expect to be excreted in significant amounts?

Loop diuretics increase excretion of sodium, water, and potassium most significantly. Although other electrolytes may be excreted, loss of magnesium, calcium, and zinc are usually not significant. Reference:

A client develops bone marrow suppression related to a drug's effects. What would be most important for the nurse to do?

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 is believed to be developing neuroleptic malignant syndrome. What is the nurse's assessment priority?

Neuroleptic malignant syndrome is manifested by hyperthermia and extrapyramidal symptoms such as slowed reflexes, involuntary movements, and autonomic disturbances. Slowed reflexes would be seen with neuroleptic malignant syndrome, but hyperthermia is a priority assessment. Decreased oxygenation is less common. Cognition is not commonly affected.

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 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."