PREPU Chapter 3 Toxic Effects of Drugs

A client with recurrent urinary tract infections was prescribed sulfamethoxazole-trimethoprim and experienced an allergic reaction. The client states, "I don't understand. I had a two-day course of the same drug last year with no problems." What is the nurse's best response?

"Allergic reactions happen after your body has been sensitized to a drug in the past." Allergies generally take place after antibody formation from an initial exposure. For this reason, the client's experience is not likely the result of the brevity of treatment, the dose, or the severity of the underlying illness.

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? "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." "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." Antibiotics are commonly associated with superinfections because they destroy the normal flora. Diuretics or water pills would be associated with electrolyte imbalances. Aspirin is often linked to tinnitus and eighth cranial nerve function. In addition, its antiplatelet activity increases the risk for bleeding problems. Stress and fatigue suppress the immune system, but do not cause superinfections.

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." "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." "The sexual dysfunction is caused by an allergic reaction to the medication. We need to stop this drug immediately." "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."

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

"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 preparing to administer antineoplastic medication to a client with cancer who has been receiving these medications for several days. When monitoring for potential adverse effects of this medication, the nurse should perform what assessments? (Select all that apply.)

- inspect the client's mucous membranes. - Monitor the client's blood cell counts. - Monitor the client's potassium levels. Clients receiving antineoplastic medications are at risk for stomatitis, blood dyscrasias, and hyperkalemia. Hyperglycemia and decreased urine output are not normally associated with administration of antineoplastic medications, although specific cancers could cause these or virtually any symptom depending on the organ involved

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

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

A client with a recent history of peripheral edema has been taking hydrochlorothiazide 75 mg PO daily. The client reports increased appetite and restlessness to the nurse and inspection reveals warm, flushed skin. What is the nurse's best action? Measure the client's abdominal girth and weight. Encourage fluid intake. Assess the client's blood glucose level. Assess the client's blood pressure.

Assess the client's blood glucose level. Explanation: Some medications, such as thiazide diuretics, cause hyperglycemia. Symptoms of hyperglycemia include polyphagia, restlessness and flushed skin. Abdominal girth and weight would help the nurse track the client's edema but would not address the possibility of hyperglycemia. The client's blood pressure is less likely to be affected and increasing fluid intake would be of no clear benefit.

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 hesitancy Urinary incontinence

Decreased bowel motility Explanation: 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. Reference:

A client develops a cytotoxic reaction to a drug. What would the nurse expect to do?

Discontinue the drug immediately as ordered.

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

Discontinue the drug immediately as ordered.

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.

A client is suspected of having a liver injury as a result of drug therapy. What laboratory finding would best support this diagnosis? Elevated aspartate aminotransferase (AST) level Elevated blood urea nitrogen (BUN) Elevated serum creatinine level Sudden drops in hemoglobin, hematocrit and red cell count

Elevated aspartate aminotransferase (AST) level Liver enzymes such as AST and alanine aminotransferase (ALT) would be elevated with liver injury. Elevated BUN and creatinine levels would be seen with renal injury. Sudden drops in hemoglobin, hematocrit and red cell count are suggestive of bleeding, not liver damage.

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?

Inspect the client's mucous membranes. Monitor the client's blood cell counts. Monitor the client's potassium levels.

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

Monitor laboratory blood values.

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? Hepatotoxicity Nephrotoxicity Neurotoxicity Ototoxicity

Neurotoxicity 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? Check the client's urine output. Assess the client's level of orientation. Review the client's most recent potassium level. 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 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? The importance of sitting upright while eating and for 30 minutes afterwards The rationale for taking probiotics for the duration of treatment The rationale for prophylactic antibiotics Techniques for providing safe and effective mouth care

Techniques for providing safe and effective mouth care

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.

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

The client's blood urea nitrogen level and creatinine clearance rate

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 liver toxicity from the aspirin The man may be experiencing a paradoxical effect of 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?

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

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

Toxicity

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 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 an 88-year-old client with chronic heart failure and peripheral edema

a 29-year-old client receiving prenatal care in her first trimester of pregnancy

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 yellowing of the skin visual disturbances

a decrease in urine output Explanation: 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 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

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 adverse effects route of administration body system affected

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.

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

The nurse is caring for a client with a drug allergy and understands the allergy is the result of the client developing: antigens. antihistamine. secondary effects. antibodies.

antibodies. Antibodies are formed by the body to react with antigens in an allergic reaction. The antigen, in this case, is the drug that the body recognizes as a foreign substance to be eliminated. Antihistamines are administered to reduce the histamines secreted as a result of the allergic reaction. An allergic reaction is distinct and different from a secondary effect.

Preoperative atropine belongs to what classification of drugs?

anticholinergic

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

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

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

central nervous system alterations skeletal abnormalities limb abnormalities heart defects any 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. R

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

decreased glomerular filtration rate.

A client began a new medication 4 days ago and has been reporting increasing malaise for the past 72 hours. The nurse is reviewing the client's most recent laboratory findings. What findings should suggest the possibility of a cytotoxic reaction? (Select all that apply.) decreased hematocrit decreased leukocytes increased liver enzymes decreased potassium

decreased hematocrit decreased leukocytes increased liver enzymes

Drugs can produce a wide variety of effects in addition to the desired pharmacological effect. Sometimes the drug dose can be adjusted so that the desired effect is achieved without producing undesired secondary reactions. Which are examples of this secondary 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

drowsiness after taking an antihistamine diarrhea after taking an antibiotic Secondary action is when drugs produce a wide variety of effects in addition to the desired pharmacological effect. Sometimes the drug dose can be adjusted so that the desired effect is achieved without producing undesired secondary reactions. Sometimes this is not possible, however, and the adverse effects are almost inevitable. For example, many antihistamines are very effective in drying up secretions and helping breathing, but they also cause drowsiness. A client taking an oral antibiotic needs to know that frequently the effects of the antibiotic on the gastrointestinal tract result in diarrhea, nausea, and sometimes vomiting. The other two are primary actions and that is when the client suffers from effects that are merely an extension of the desired effect.

A client develops stomatitis from drug therapy. Which measure would be most appropriate for the nurse to suggest? the use of an astringent mouthwash brushing of teeth with a firm toothbrush consumption of three large meals per day frequent rinsing with cool liquids

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.

What would the nurse expect to assess if a client develops neuroleptic malignant syndrome? mental confusion hypertension hyperactive reflexes hypothermia

hypertension Neuroleptic malignant syndrome is manifested by extrapyramidal symptoms, including slowed reflexes, rigidity, and involuntary movements; hyperthermia; and autonomic disturbances, such as hypertension, fast heart rate, and fever.

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 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.

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. 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 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.

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. primary actions. drug allergy. secondary actions.

secondary actions.

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

serum drug level monitoring

All drugs can cause adverse reactions. What is an example of an adverse reaction? antihistamines mandated photo identification for prescription filling triplicate prescription copies tissue and organ damage

tissue and organ damage 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.

What does the nurse need to do when there is any indication of an allergic reaction in clients? Reduce the risk of adverse effects during drug therapy. Maintain the client's safety during drug therapy. Increase the effectiveness of a specific medication. 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 is experiencing central nervous system effects related to drug therapy. Which would be most important for the nurse to emphasize in the teaching plan? The importance of a low-stimulation environment Educating about the signs and symptoms of stroke The need for follow-up blood tests Safety measures delirium /di li' ri um/ me san

Safety measures 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.

The nurse administers an anticholinergic medication to the client. When assessing this client, what finding should the nurse interpret as a secondary effect of the drug? profuse sweating urinary urgency urinary hesitancy hyperthermia

Urinary hesitancy Explanation: Anticholinergic secondary effects include dry mouth, altered taste perception, dysphagia, heartburn, constipation, bloating, paralytic ileus, urinary hesitancy and retention, impotence, blurred vision, cycloplegia, photophobia, headache, mental confusion, nasal congestion, palpitations, decreased sweating, and dry skin. Tachycardia, hyperthermia, and profuse sweating would not be expected findings or consistent with anticholinergic effects and would require further assessment.

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

The nurse's assessment of a client reveals that the client has been greatly exceeding recommended safe doses of acetaminophen for the past week. When reviewing the client's laboratory results for indications of toxicity, what finding should the nurse prioritize?

aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels

The pharmacology instructor explains to the students that adverse effects can be extensions of: fourth level effects. anaphylaxis. anticholinergic responses to the drug. primary action of a drug.

primary action of a drug. 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: 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. Reference:

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. primary actions. drug allergy. secondary 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.

The nurse at a campus medical clinic is administering a new medication to a 22-year-old female client. The nurse should educate the client about what potential risk of drug therapy?

teratogenicity Explanation: In a woman of childbearing age, it is important for the nurse to consider the teratogenicity of a medication because teratogens can seriously harm or injure the embryo or fetus. Primary actions, secondary actions, and poisoning would be of no greater concern with a woman of childbearing age than with any client.

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 fasting blood glucose level The client's albumin, bilirubin, AST and ALT levels

The client's blood urea nitrogen level and creatinine clearance rate

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?"

Which client is experiencing a secondary action of a medication? A client who is lethargic after taking an antianxiety medication A client who is in respiratory distress with elevated blood pressure after taking an antiviral medication A client who has developed hives and a rash after taking an antibiotic A client who is drowsy after taking antihistamine

A client who is drowsy after taking antihistamine 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.

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

Difficulty breathing

When reviewing the medication list of a client being seen in the clinic, the nurse notes that the client is receiving glipizide. Based on the nurse's understanding, this drug is used to treat:

hyperglycemia.

What issues is gentamycin, a potent antibiotic, associated with? (Select all that apply.) respiratory neurotoxicity renal toxicity liver toxicity ototoxicity

renal toxicity ototoxicity Gentamycin, a potent antibiotic, is frequently associated with renal toxicity and ototoxicity.

Which skin condition would be most likely to cause increased systemic absorption of a topical medication? multiple nevi rosacea port wine stain of the face severe sunburn

severe sunburn 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.

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

Anaphylactic shock Explanation: Anaphylactic shock occurs shortly after administration of a drug to which the client is sensitive. It may be life-threatening and must be treated immediately. The client may experience respiratory, cardiovascular, integumentary, and gastrointestinal symptoms.

What would the nurse include in the teaching plan for a client who is to receive a drug that is associated with anticholinergic effects? Avoid strenuous exercise to minimize calorie loss Try to stay as warm as possible to prevent chilling. Eat a low-fiber diet to prevent constipation. Be sure to drink plenty of fluids to prevent dehydration.

Be sure to drink plenty of fluids to prevent dehydration. Be sure to drink plenty of fluids to prevent dehydration. 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.

An instructor is preparing a class that describes the toxic effects of drugs. Which effect would the instructor expect to include? Most reactions occurring with present-day therapy are less severe than before. Any effect results from the alteration of several chemical factors. 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. 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.

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 self-directed violence related to personality changes Risk for aspiration related to impaired swallowing Impaired memory related to brain atrophy Impaired spontaneous ventilation related to medullary hypoxia

Risk for aspiration related to impaired swallowing Parkinson-like symptoms include impaired swallowing, which in turn creates a risk for aspiration. Memory, personality and ventilation are not normally affected by these particular adverse effects.

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 stomatitis/sờ tô ma tái dis/ viem

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.

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. 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

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

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 is receiving a drug to lower blood glucose level. What would lead the nurse to suspect that the client's blood glucose level was too low? loss of appetite increased urination cold, clammy skin fruity breath odor

cold, clammy skin Signs of hypoglycemia, or low blood glucose level, include fatigue; drowsiness; hunger; anxiety; headache; cold, clammy skin; shaking and lack of coordination (tremulousness); increased heart rate; increased blood pressure; numbness and tingling of the mouth, tongue, and/or lips; confusion; and rapid and shallow respirations. In severe cases, seizures and/or coma may occur. Increased urination, fruity breath odor, and increased hunger are signs of hyperglycemia.

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 Ototoxicity is damage to the eighth cranial nerve. It may or may not be reversible. Signs and symptoms of ototoxicity include tinnitus, which is a buzzing or ringing sound in the ear, and sensorineural hearing loss. Other signs and symptoms, particularly of vestibular toxicity, include light-headedness, vertigo, a spinning sensation from a seated position, and nausea and vomiting.

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? monitoring the client's vital signs at least every five minutes providing reassurance to the client protecting and maintaining the patency of the client's airway administering intravenous antihistamines as prescribed

protecting and maintaining the patency of the client's airway Explanation: 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.

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 Primary action is when the client suffers from effects that are merely an extension of the desired effect. For example, an anticoagulant may act so effectively that the client experiences excessive and spontaneous bleeding. In the same way, a client taking an antihypertensive drug may become dizzy, weak, or faint when taking the "recommended dose" but will be able to adjust to the drug therapy with a reduced dose. The other two options are examples of secondary action.

What would the nurse include in the teaching plan for a client who is to receive a drug that is associated with anticholinergic effects? Avoid strenuous exercise to minimize calorie loss Be sure to drink plenty of fluids to prevent dehydration. Try to stay as warm as possible to prevent chilling. Eat a low-fiber diet to prevent constipation.

Be sure to drink plenty of fluids to prevent dehydration. 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 client with a longstanding diagnosis of schizophrenia has taken antipsychotic drugs for several decades. For what adverse effect should the nurse assess? Parkinsonian symptoms Dry mouth and urinary hesitation Hyperthermia Hypoglycemia

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.

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." "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 idiosyncratic response to the medication, not an expected result. Such responses are genetically predetermined so you will not be able to take this medication." "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." 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.

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

an allergic response. 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.

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? cytotoxic delayed anaphylactic serum sickness

anaphylactic 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.

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.

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

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

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 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? additive toxic synergistic anaphylactic shock pruritus/ piu ra'i tis/

anaphylactic shock Anaphylactic shock occurs shortly after administration of a drug to which the client is sensitive. It may be life-threatening and must be treated immediately. The client may experience respiratory, cardiovascular, integumentary, and gastrointestinal symptoms.

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. affect the liver of the fetus. affect the eighth cranial nerve of the fetus. affect the kidneys 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 nurse administers typical antipsychotic medications to the client who has taken these same drugs for many years. What signs and symptoms should the nurse attribute to secondary actions of the drug? Select all that apply. changes in gait fine red rash on the trunk muscular tremors drooling yellow discoloration of the skin and sclera

muscular tremors drooling changes in gait Drugs that affect the dopamine levels in the brain (e.g., typical antipsychotic drugs), cause a syndrome that resembles Parkinson disease including lack of activity, akinesia, muscular tremors, drooling, changes in gait, rigidity, extreme restlessness or "jitters" (akathisia), or spasms (dyskinesia). Yellow discoloration of the skin and sclera indicate jaundice and would suggest liver damage. A fine red rash on the trunk would be a dermatologic reaction unrelated to an antipsychotic agent's secondary effects.

What client is experiencing an adverse effect that is a result of primary action? A client who develops diarrhea shortly after beginning a course of antibiotics A client taking anticoagulants who develops a gastrointestinal bleed A client who takes an antihistamine and falls asleep An older adult client who becomes agitated and disoriented after being given a narcotic

A client taking anticoagulants who develops a gastrointestinal bleed Bleeding associated with anticoagulant therapy is an example of a primary action, the extension of the desired effect. A client taking an antihistamine who experiences drowsiness is an example of a secondary action, an effect in addition to the desired effect of drying up secretions. A client taking an antibiotic who experiences diarrhea is an example of a secondary action, an effect in addition to the desired effect of eradicating the infection. An older person taking a narcotic analgesic who experiences hyperactivity is an example of hypersensitivity, an excessive response to either the primary or secondary effects of a drug. Reference:

A client is being discharged from the emergency department (ED) after being treated for an anaphylactic reaction to shrimp the client ate for dinner. The client asks the nurse to explain food reactions. Which would be correct responses? Select all that apply. Anaphylactic reactions involve an antibody that causes the release of histamine. Histamines produce immediate reactions. This allergy involves antibodies that circulate in the blood and cause damage to various tissues by depositing in blood vessels. Anaphylactic reactions can lead to respiratory distress and even respiratory arrest. This reaction occurs several hours after exposure and involves antibodies that are bound to specific white blood cells.

Anaphylactic reactions involve an antibody that causes the release of histamine. Histamines produce immediate reactions. naphylactic reactions can lead to respiratory distress and even respiratory arrest. his allergy involves an antibody that reacts with specific sites in the body to cause the release of chemicals, including histamine, that produce immediate reactions (i.e., mucous membrane swelling and constricting bronchi). These reactions can lead to respiratory distress and even respiratory arrest. Serum sickness reaction involves antibodies that cause tissue damage and a delayed allergic reaction can occur several hours after exposure. Ref

Drugs can affect the special senses, including the eyes and ears. Alterations in seeing and hearing can pose safety problems for clients. What are examples of sensory effects of drugs? Select all that apply. Aspirin, one of the most commonly used drugs, is often linked to auditory ringing and eighth cranial nerve effects. A drug used to treat some rheumatoid diseases can cause retinal damage and even blindness. Beta-blockers can cause feelings of anxiety, insomnia, and nightmares. Drugs that directly or indirectly affect dopamine levels in the brain can cause a syndrome that resembles Parkinson's disease.

Aspirin, one of the most commonly used drugs, is often linked to auditory ringing and eighth cranial nerve effects. A drug used to treat some rheumatoid diseases can cause retinal damage and even blindness. Ocular damage may occur when some drugs are deposited into the tiny arteries of the eyes, causing inflammation and tissue damage. Auditory damage can occur because the tiny vessels and nerves in the eighth cranial nerve are easily irritated and damaged by certain drugs. Anxiety, insomnia, and nightmares are examples of generalized neurological effects of drugs. Parkinson-like syndrome is when a drug directly or indirectly affects dopamine levels. Reference:

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

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 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 needed in order to confirm the client's adherence to the drug regimen. 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 necessary to ensure that the client's drug levels are therapeutic but not toxic. Measuring serum drug levels is useful when drugs with a narrow margin of safety are given, because their therapeutic doses are close to their toxic doses. This is the case during lithium therapy. Serum levels are not commonly taken to monitor adherence to treatment. Blood-drug incompatibilities are not a relevant consideration.

A client in the ambulatory care clinic is experiencing shortness of breath and facial and throat edema while receiving a pegloticase infusion. What is the nurse's best action? Reassure the client that the symptoms will subside soon. Connect the infusion to an alternate intravenous access site. Notify emergency personnel. Start a new intravenous line.

Notify emergency personnel. Should an anaphylactic reaction (throat and facial edema, shortness of breath) occur during a pegloticase infusion, the nurse should prepare to start resuscitative measures and notify emergency personnel. The infusion should be stopped, not continued in another line. If the intravenous line is patent, the infusion can be stopped and flushed with normal saline, then used for emergency medications as needed. An anaphylactic reaction can be progressively life-threatening. Emergency action should be taken rather than reassuring the client that symptoms will subside.

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? Administer naloxone as prescribed. Initiate emergency resuscitation measures. Provide supportive care to manage fever and inflammation. Administer subcutaneous epinephrine as prescribed.

Provide supportive care to manage fever and inflammation. 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 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 albumin, bilirubin, AST and ALT levels The client's blood urea nitrogen level and creatinine clearance rate 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.

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 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. The nurse should not be concerned. Medication is not the cause of the client's confusion. 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. coincidental /ko in sờ dén tồ/ occuring or existing at the same time tình cờ

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's pain tolerance and expectations for pain control assessing the client for signs and symptoms of inflammation

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.

A nurse is administering gentamicin, an antibiotic that is ototoxic. Which report or sign would indicate that the client is suffering from ototoxicity? irregularities in cardiac rhythms and conduction buzzing or ringing sound in the ears (tinnitus) increased incidence of bacterial and viral infections altered acid-base balance

buzzing or ringing sound in the ears (tinnitus) Buzzing or ringing sounds in the ears (tinnitus) and sensorineural deafness are the major effects of ototoxicity. Other symptoms of ototoxicity include vestibular toxicity, vertigo, and light-headedness. Irregularities in cardiac rhythms and conduction are results of cardiotoxicity, whereas altered acid-base balance is a result of nephrotoxicity. Immunotoxicity causes an increased incidence of bacterial and viral infections.

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. basis for planning the medication regimen. prominent part of client teaching. basis for the nursing care plan.

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.

What changes due to aging in the geriatric client may affect excretion and promote accumulation of drugs in the body? decreased gastric motility. decreased glomerular filtration rate. decreased activity. decreased cognition. glomerular filtration rate.- GFR - A blood test measures how much blood your kidneys filter each minute

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.

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 providing reassurance to the client administering intravenous antihistamines as prescribed

protecting and maintaining the patency of the client's airway Explanation: 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.