Karch: Ch 3 - Toxic effects of drugs

The nurse provides health education for a diverse group of clients. For which client should the nurse emphasize the risk of teratogenic drug effects? 20-year-old female client who has been diagnosed with a chlamydial infection 40-year-old male client who has a history of intravenous drug use and who has endocarditis 60-year-old female client who is tetraplegic and who has developed a sacral pressure ulcer 6-year-old girl who has a urinary tract infection and who is accompanied by her parents

20-year-old female client who has been diagnosed with a chlamydial infection

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? Ask the client, "What happens when you take a dose of tetracycline?" Ask the client, "Are you allergic to any other antibiotics, or just tetracycline?" Document an allergy to tetracycline in the client's health record Educate the client about antibiotics that are alternatives to tetracycline.

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

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

Drugs cause unexpected or unacceptable reactions despite screening and testing.

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. Administer subcutaneous epinephrine as prescribed. Initiate emergency resuscitation measures. Administer naloxone as prescribed.

Provide supportive care to manage fever and inflammation.

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. Check the client's blood glucose level. Assess the client's level of orientation. Check the client's urine output.

Review the client's most recent potassium level.

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. What is the name of the adverse reaction that can cause birth defects? Teratogenicity Stomatitis Blood dyscrasia Cytotoxic reactions

Teratogenicity

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

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? visual disturbances yellowing of the skin a decrease in urine output ringing noise in the ears

a decrease in urine output

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? route of administration body system affected adverse effects protocols

adverse effects

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: a hepatotoxic response. an idiosyncratic response. a paradoxical response. an allergic response.

an allergic response.

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

decreased glomerular filtration rate.

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.) teratogenicity neuroleptic malignant syndrome Parkinson-like syndrome atropine-like (anticholinergic) effects

neuroleptic malignant syndrome Parkinson-like syndrome atropine-like (anticholinergic) effects

The nurse is caring for a client with hypertension who was prescribed a loop diuretic one week ago. The client reports malaise and weakness and the nurse's assessment reveals an irregular heart rate. The nurse should prioritize assessment of the client's: potassium levels. liver enzyme levels. cognition. renal function.

potassium levels.

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? liver injury hypoglycemia hyperkalemia renal injury

renal injury

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

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

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? "For the last 2 months I have been taking a water pill that the doctor prescribed." "I just completed a course of antibiotics prescribed by my dentist to treat a tooth abscess." "I've been taking aspirin several times a day for the past few months for my back pain." "I've been exhausted and overworked for the past several weeks."

"I just completed a course of antibiotics prescribed by my dentist to treat a tooth abscess."

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

Drugs can cause unexpected reactions even after thorough screening and testing.

A client with a history of schizophrenia has developed severe drug-induced parkinsonism from treatment with antipsychotic medications. What nursing diagnosis should the nurse identify? Risk for aspiration related to impaired swallowing Impaired memory related to brain atrophy Risk for self-directed violence related to personality changes Impaired spontaneous ventilation related to medullary hypoxia

Risk for aspiration related to impaired swallowing

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 The importance of sitting upright while eating and for 30 minutes afterwards The rationale for prophylactic antibiotics The rationale for taking probiotics for the duration of treatment

Techniques for providing safe and effective mouth care

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 The client's body mass index and hydration status 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

The nurse is called to a client's room 15 minutes after the client has received a new medication. The client reports pruritus as well as nausea. The nurse notes that the client appears pale, is sweating, and has begun to cough and wheeze. The nurse determines that the client is experiencing what type of reaction related to the new medication? toxic anaphylactic shock additive synergistic

anaphylactic shock

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 asking if the client has tolerated narcotics and acetaminophen in the past assessing the client for signs and symptoms of inflammation assessing the client's pain tolerance and expectations for pain control

asking the client what the client's response is to taking NSAIDs

Which prescribed medications should the nurse administer to an adult having an anaphylactic reaction? norepinephrine atropine epinephrine histamine

epinephrine

The nurse is caring for a client in the intensive care unit. This client took an overdose of acetaminophen 3 days previously and now has jaundice. Laboratory results show elevated liver enzymes. The nurse understands that the client: has ototoxicity and may suffer permanent deafness. is experiencing neurotoxicity that will result in permanent neurological damage. is experiencing hepatotoxicity and may have permanent liver damage. is reacting to the medications that were given to counteract the acetaminophen.

is experiencing hepatotoxicity and may have permanent liver damage.

A client comes to the clinic reporting of a ringing sound in the ears and dizziness. When the nurse takes the client's history, the nurse discovers that the client has been taking several ibuprofen every day for various discomforts. What does the nurse understand has occurred with this client? ototoxicity from the ibuprofen immunotoxicity from the ibuprofen allergic reaction to the ibuprofen anaphylactic reaction to the ibuprofen

ototoxicity from the ibuprofen

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. hypersensitivity. allergies. anaphylaxis.

poisoning.

A client, prescribed a drug that has an exceptionally narrow margin of safety, should be educated about the need for what intervention? half-life analysis serum drug level monitoring regular changes to the administration route frequent administration of scheduled "drug holidays"

serum drug level monitoring

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

skeletal and limb abnormalities central nervous system alterations heart defects

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 an anticoagulant dizziness after starting an antihypertensive drowsiness after taking an antihistamine diarrhea after taking an antibiotic

spontaneous bleeding after taking an anticoagulant dizziness after starting an antihypertensive

A nurse is preparing to administer an adrenergic agent for shock. Which nursing assessment should be completed quickly and accurately? vital signs urinary output pain evaluation physical assessment

vital signs

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

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 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. The client is having photosensitivity and this can occur even with brief exposure to the sun or UV rays. The client had a reaction to something in the environment while working in the yard and should take an antihistamine. This is a normal reaction for anyone who takes antibiotics and is nothing to be concerned about.

The client is having photosensitivity and this can occur even with brief exposure to the sun or UV rays.

An older adult client has an elevated serum creatinine level. This client is at greatest risk for which medication-related effect? toxicity increased absorption delayed gastric emptying idiosyncratic effects

Toxicity

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

protecting and maintaining the patency of the client's airway

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? "The sexual dysfunction is caused by an allergic reaction to the medication. We need to stop this drug immediately." "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." "This is an idiosyncratic response to the medication, not an expected result. Such responses are genetically predetermined so you will not be able to take this medication." "This is a toxic reaction to the medication and can cause permanent damage. We need to take you off this medication immediately."

"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."

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

Discontinue the drug immediately as ordered.

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

Discontinue the drug immediately as ordered.

A client comes to the clinic reporting tinnitus and difficulty hearing. What medication in the client's current regimen should the nurse suspect as causing the symptoms? Hydrochlorothiazide Insulin Erythromycin Acetaminophen with codeine

Erythromycin Explanation: Macrolide antibiotics such as erythromycin can cause severe auditory nerve damage manifested by ringing in the ears and hearing loss. The other listed medications normally pose no risk to the auditory nerve.

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 eighth cranial nerve of the fetus. affect the liver of the fetus. affect the kidneys of the fetus. damage the immature nervous system of the fetus.

damage the immature nervous system of the fetus.

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. cheese. chicken. corn.

grapefruit.

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 regularly test for blood-drug incompatibilities that may develop during treatment. It is necessary to ensure that the client's drug levels are therapeutic but not toxic. It is needed to determine if additional medications will be needed to potentiate the effects of lithium. It is needed in order to confirm the client's adherence to the drug regimen.

It is necessary to ensure that the client's drug levels are therapeutic but not toxic.