Chapter 3: Toxic Effects of Drugs - ML5

Which client is experiencing a secondary action of a medication?

A client who is drowsy after taking antihistamine Explanation: A secondary action is the development of adverse effects in addition to the desired effects. Drowsiness from an antihistamine is an example of secondary action. A primary action is the development of adverse effects, an extension of the desired effect, from simple overdosage. Excessive relaxation after taking an antianxiety medication is an example of primary action. Drug allergies and hypersensitivities are not examples of secondary actions

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?

Assess the client's blood glucose level. Explanation: The client may be experiencing drug-induced hypoglycemia, so the nurse should check the client's blood glucose level. There is no indication that cardiac monitoring is necessary, since the client's heart rate is nominally tachycardic. Mental status examination does not address the most likely adverse effect of treatment. This client's medications and presentation do not suggest hyperkalemia or hypokalemia.

A client is receiving an antineoplastic medication for treatment of breast cancer and begins having tonic-clonic seizure activity. What type of toxicity does the nurse recognize that this client is experiencing?

Neurotoxicity Explanation: Neurotoxicity, sometimes referred to as central nervous system toxicity, is a drug's ability to harm or poison a nerve cell or nerve tissue. Signs and symptoms of neurotoxicity include drowsiness, auditory and visual disturbances, restlessness, nystagmus, and tonic-clonic seizures. Neurotoxicity can occur after exposure to drugs and other chemicals and gases.

A client receiving drug therapy develops numbness and tingling in the extremities and muscle cramps. What assessment should the nurse perform?

Review the client's most recent potassium level. Explanation: 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 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 Explanation: 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.

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?

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

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

a 29-year-old client receiving prenatal care in her first trimester of pregnancy a 37-year-old client who is taking fertility drugs Explanation: A teratogen is a drug that can harm the fetus or embryo so the nurse would consider the teratogenic properties of medications when caring for woman of child-bearing age including adolescents and young adult women. Teratogens have no impact on clients who are not pregnant and who may not become pregnant.

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 Explanation: 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.

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?

anaphylactic Explanation: A client exhibiting hives, rash, increased blood pressure, dilated pupils, diaphoresis, increased heart rate, and respiratory arrest after administration of penicillin is having an anaphylactic reaction.

Preoperative atropine belongs to what classification of drugs?

anticholinergic Explanation: 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 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. Explanation: 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:

damage the immature nervous system of the fetus. Explanation: 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.

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

frequent rinsing with cool liquids Explanation: 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.

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

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

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. Explanation: 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.

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

severe sunburn Explanation: 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.

All drugs can cause adverse reactions. What is an example of an adverse reaction?

tissue and organ damage Explanation: 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. Prescription issues are not adverse reactions to medications. Antihistamines are a type of drug used to treat allergic responses, which signify an adverse reaction.

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?

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

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." Explanation: 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.

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. Explanation: 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

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 Explanation: 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

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

asking the client what the client's response is to taking NSAIDs Explanation: 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 should consider teratogenic effects when caring for what clients? (Select all that apply.) an 88-year-old client with chronic heart failure and peripheral edema a 51-year-old post-menopausal client who is immunocompromised following bone marrow transplant a 65-year-old client being treated in the intensive care unit for multi-organ dysfunction syndrome a 29-year-old client receiving prenatal care in her first trimester of pregnancy a 37-year-old client who is taking fertility drugs

a 29-year-old client receiving prenatal care in her first trimester of pregnancy a 37-year-old client who is taking fertility drugs Explanation: A teratogen is a drug that can harm the fetus or embryo so the nurse would consider the teratogenic properties of medications when caring for woman of child-bearing age including adolescents and young adult women. Teratogens have no impact on clients who are not pregnant and who may not become pregnant.

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:

an allergic response. Explanation: 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.

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?

"Have you been taking aspirin on a regular basis?" Explanation: Aspirin is a relatively common cause of tinnitus and auditory nerve damage. As well, the fact that the client has an inflammatory disease makes it possible that the client is self-medicating with aspirin. Corticosteroids are not as commonly associated with tinnitus. Similarly, hypertension and hypotension do not normally cause this problem. Herbs and supplements have widely varying effects, but aspirin is a more likely cause due to the client's diagnosis and the wide availability and use of aspirin

An older adult client has an elevated serum creatinine level. This client is at greatest risk for which medication-related effect?

Toxicity Explanation: 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.

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. skeletal abnormalities central nervous system alterations birth at 40 weeks' gestation heart defects limb abnormalities

skeletal abnormalities central nervous system alterations heart defects limb abnormalities Explanation: Many drugs that reach the developing fetus or embryo can cause death or congenital defects, which can include skeletal and limb abnormalities, central nervous system alterations, heart defects, and the like. Birth at 40 weeks' gestation is a normal pregnancy outcome.

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: 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?

Maintain the client's safety during drug therapy. Explanation: 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 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?

Provide supportive care to manage fever and inflammation. Explanation: 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 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.

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 having photosensitivity and this can occur even with brief exposure to the sun or UV rays. Explanation: 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.

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 is an example of hypersensitivity? (Select all that apply.) a client who reports difficulty breathing and hives soon after taking an antibiotic a pregnant client who needs to take antiseizure medication and is at risk for her fetus developing defects a client with kidney problems who may not be able to excrete the drug, which may accumulate in the body, resulting in toxicity a client with an enlarged prostate who takes an anticholinergic drug and may develop urinary retention or even bladder paralysis when the drug's effects block the urinary sphincters

a client with kidney problems who may not be able to excrete the drug, which may accumulate in the body, resulting in toxicity a client with an enlarged prostate who takes an anticholinergic drug and may develop urinary retention or even bladder paralysis when the drug's effects block the urinary sphincters 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 that makes the drug's effects especially unpleasant or dangerous, such as a kidney problem or prostate cancer. Anaphylactic reaction is an allergic response with difficulty breathing and hives, and birth defects caused by drugs is teratogenicity

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

decreased glomerular filtration rate. Explanation: 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 Explanation: 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.