chapter 3
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."
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 just completed a course of antibiotics prescribed by my dentist to treat a tooth abscess."
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 bestexplanation 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."
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.
-A drug used to treat some rheumatoid diseases can cause retinal damage and even blindness. -Aspirin, one of the most commonly used drugs, is often linked to auditory ringing and eighth cranial nerve effects.
The nurse administers penicillin to a client and monitors the client for an adverse reaction despite the fact that the client claimed not to be allergic to penicillin. What is the rationale for checking for adverse reactions? {Select all that apply.}
-A person can be allergic to any medication at any time. -Medications can react with over-the-counter medications to cause toxicity. -Medications can react with herbal supplements to cause adverse reactions. -Medications can react with other medications prescribed for the client.
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
What client is experiencing an adverse effect that is a result of primary action?
A client taking anticoagulants who develops a gastrointestinal bleed
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?"
A client develops a cytotoxic reaction to a drug. What would the nurse expect to do?
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
A client diagnosed with cancer has been receiving antineoplastics for several weeks. What assessment finding should the nurse interpret as a possible indication of blood dyscrasia?
Hemoglobin of 6.0 g/dL (60.0 g/L)
A client with a diagnosis of bipolar disorder has begun lithium therapy. What is the primaryrationale for the nurse's instructions regarding the need for regular monitoring of the client's serum drug levels?
It is necessary to ensure that the client's drug levels are therapeutic but not toxic.
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.
A client develops bone marrow suppression related to a drug's effects. What would be mostimportant for the nurse to do?
Monitor laboratory blood values.
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?
Notify emergency personnel.
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
A hospital client began taking a newly prescribed antihypertensive 12 hours ago and has developed a full body rash with edema and pruritis. What is the nurse's best action?
Promptly inform the prescriber of the client's status.
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.
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
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.
The nurse is assessing a client who has developed shortness of breath, a rash, panic, and a blood pressure of 189/106 mm Hg after being administered a new medication. In addition to promptly informing the care team, the nurse should:
administer epinephrine as prescribed.
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.
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 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?
anaphylactic shock
The nurse is caring for a client with a drug allergy and understands the allergy is the result of the client developing:
antibodies
Preoperative atropine belongs to what classification of drugs?
anticholinergic
A client exhibits muscular tremors, drooling, gait changes, and spasms. When reviewing the client's medication history, which would the nurse most likely find?
antipsychotic agent
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
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
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.
For several days, a client with hypertension has been inadvertently taking an excessive dose of spironolactone, a potassium-sparing diuretic. The client has presented to the emergency department with signs and symptoms that suggest hyperkalemia. What assessment should the nurse prioritize?
cardiac monitoring
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?
cold, clammy skin
What changes due to aging in the geriatric client may affect excretion and promote accumulation of drugs in the body?
decreased glomerular filtration rate.
What would the nurse expect to assess in a client experiencing an anaphylactic reaction? (Select all that apply.)
dilated pupils difficulty breathing feeling of panic
A client is suspected to have nephrotoxicity from administration of a nephrotoxic medication. What laboratory results may indicate renal damage related to the administration of this medication? (Select all that apply.)
elevated blood urea nitrogen (BUN) elevated creatinine level elevated potassium level
A client develops stomatitis from drug therapy. Which measure would be most appropriate for the nurse to suggest?
frequent rinsing with cool liquids
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
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:
is experiencing hepatotoxicity and may have permanent liver damage.
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.
muscular tremors drooling changes in gait
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.
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
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.
Which skin condition would be most likely to cause increased systemic absorption of a topical medication?
severe sunburn
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
An older adult client has an elevated serum creatinine level. This client is at greatest risk for which medication-related effect?
toxicity
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?
urinary hesitancy
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.
What is an example of a secondary action?
an antihistamine causes the client to experience drowsiness
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 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
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.
The nurse on a busy medical floor is caring for several clients whose medication regimens vary widely. What action best addresses a client's risk for adverse effects related to primary actions?
monitoring the international normalized ratio (INR) of a client taking warfarin
The nurse is providing for a client who is being treated for a Pseudomonas infection in the intensive care unit. The client's medication regimen includes gentamicin 75 mg IV t.i.d. When monitoring the client for adverse effects, what assessment should the nurse prioritize?
urine output and creatinine clearance
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?"
The nurse should consider teratogenic effects when caring for what clients? (Select all that apply.)
a 37-year-old client who is taking fertility drugs a 29-year-old client receiving prenatal care in her first trimester of pregnancy
The nurse is assessing a number of clients on the acute medicine unit. What client is mostlikely experiencing an adverse effect from the primary action of the medication?
a client taking antihypertensives who reports dizziness upon standing