Chapter 3
List four types of allergic responses to drug therapy.
-anaphylactic reactions -cytotoxic reactions -serum sickness reaction -delayed allergic reaction
Define the term adverse drug reaction and explain the clinical significance of this reaction.
Adverse effects are undesired effects that may be unpleasant or even dangerous. They can occur for many reasons, including the following: -The drug may have other effects on the body besides the therapeutic effect. -The patient may be sensitive to the drug being given. -The drug's action on the body may cause other responses that are undesirable or unpleasant. -The patient may be taking too much or too little of the drug, leading to adverse effects.
cytotoxic reactions
CD8 T cells kills virally-infected cells and neoplastic cells
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.
anaphylactic reactions
Hypersensitive condition induced by contact with certain antigens. flushing, hives, nausea
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 clients safety during drug therapy
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
serum sickness reaction
This allergy involves antibodies that circulate in the blood and cause damage to various tissues by depositing in blood vessels. This reaction may occur up to 1 wk or more after exposure to the drug
delayed allergic reaction
This reaction occurs several hours after exposure and involves antibodies that are bound to specific white blood cells.
poison
a substance that causes illness, injury or death if taken into the body or produced within the body.
blood dyscrasia
bone marrow depression caused by drug effects on the rapidly multiplying cells of the bone marrow; lower-than-normal levels of blood components can be seen
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.
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 changes due to aging in the geriatric client may affect excretion and promote accumulation of drugs in the body?
decreased glomerular filtration rate.
drug allergy
formation of antibodies to a drug or drug protein; causes an immune response when the person is next exposed to that drug
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
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.
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?"
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?"
A client with hypertension has been taking spironolactone, a potassium-sparing diuretic, 75 mg PO daily for several weeks. What assessment findings should prompt the nurse to suspect hyperkalemia? (Select all that apply.)
-Reports thigh and calf cramps -Heart rate of 58 beats per minute -Blood pressure is 88/63 mmHg -Urine output of 375 mL over the past 24 hours
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 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
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.)
-reports of drowsiness after taking an diphenhydramine (Benadryl) -diarrhea after taking cefuroxime (Ceftin)
Many drugs that reach the developing fetus or embryo can cause death or congenital defects. What are examples of congenital defects? Select all that apply.
-skeletal abnormalities -central nervous system alterations -heart defects -limb abnormalities
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
A client with a history of schizophrenia was admitted during a psychotic episode and has received several doses of haloperidol. The client's cognitive status has stabilized but assessment reveals clammy skin, respiratory rate of 31 breaths per minute, and heart rate of 102 beats per minute. What is the nurse's best action?
Assess the client's blood glucose level.
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.
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.
The nurse is caring for a client who appears to be developing anaphylactic shock. What drug does the nurse anticipate the health care practitioner will order to treat this condition?
Epinephrine (Adrenalin)
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.
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.
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 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 blood urea nitrogen level and creatinine clearance rate
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 should have basic knowledge of drug classifications in order to administer medications safely to clients. What drug information is instrumental in determining nursing actions following drug administration?
adverse effects
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.
The nurse would assess a client receiving which medication for possible superinfection?
antibiotics
poisoning
overdose of a drug that causes damage to multiple body systems and has the potential for fatal reactions
Discuss five common examples of drug-induced tissue damage.
rash/hives, stomatitis, superinfections, sensory effects, blood dyscrasia, glucose levels, electrolyte imbalance
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?
renal injury
dermatological reactions
skin reactions commonly seen as adverse effects of drugs; can range from simple rash to potentially fatal exfoliative dermatitis
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."
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.
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.
superinfections
infections caused by the destruction of normal flora bacteria by certain drugs, which allow other bacteria to grow out of control and cause infection; may occur during the course of antibiotic therapy
stomatitis
inflammation of the mucous membranes related to drug effects; can lead to alterations in nutrition and dental problems
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
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
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 nurse administers a loop diuretic to the client. In addition to sodium and water, what other electrolyte would the nurse expect to be excreted in significant amounts?
potassium
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."
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 is receiving an antineoplastic medication for treatment of breast cancer and begins having tonic-clonic seizure activity. What type of toxicity does the nurse recognize that this client is experiencing?
Neurotoxicity
A client with cancer is taking the prescribed dose of morphine sulfate and a family member informs the nurse that the client is extremely sedated. What finding by the nurse would indicate the causative factor of the increased sedation experienced by the client?
There is a bottle of St. John's wort the client is taking for depression.
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
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
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.
hypersensitivity
excessive responsiveness to either the primary or the secondary effects of a drug; may be caused by a pathological condition or, in the absence of one, by a particular patient's individual response
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
The pharmacology instructor explains to the students that adverse effects can be extensions of:
primary action of a drug.
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
An older adult client has an elevated serum creatinine level. This client is at greatest risk for which medication-related effect?
toxicity
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?"
The most serious allergic response is called anaphylaxis. Which clients exhibit possible symptoms of anaphylaxis? (Select all that apply.)
-A client showing signs of acute respiratory distress. -A client with marked hypotension and experiences convulsions. -A client with laryngeal edema and pale, cool skin.
A client with diabetes is also taking ephedrine to treat asthma. On occasion, the client notes that the drug causes an increase in blood glucose. What should the nurse teach the client about this phenomenon?
"Stored glycogen is broken down by ephedrine, causing hyperglycemia."
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.
-A client who has chronic renal failure and is taking diphenhydramine -A client on postoperative day 2 from a prostatectomy who takes ipratropium
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 recognizes that the client may be experiencing what condition related to the overdose?
Hepatotoxicity
A client develops bone marrow suppression related to a drug's effects. What would be most important for the nurse to do?
Monitor laboratory blood values.
