Pharm Chapter 3: Toxic Effects of Drugs

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" Antibiotics are commonly associated with superinfections because they destroy the normal flora 39

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 4-year-old admitted after taking too many aspirin -A 45-year-old taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis 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 41

The nurse is caring for a client who has been admitted after an acetaminophen overdosage. Which of the nurse's assessment findings suggest liver damage? (Select all that apply.)

-The client's skin and eyes are visibly jaundiced. -The client's AST and ALT levels are elevated. -The client's temperature is 102.5° F (39.2° C). 39

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 42

The nurse administers a medication and the client has an immediate anaphylactic reaction following injection. What symptoms assessed by the nurse would indicate anaphylaxis? (Select all that apply.)

-difficulty breathing -increased blood pressure -diaphoresis 37

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.

-drowsiness after taking an antihistamine -diarrhea after taking an antibiotic 36

What factors can potentially contribute to a hypersensitivity reaction? (Select all that apply.)

-pathological condition -unique receptors and cellular responses -age-related changes 36

Many drugs that reach the developing fetus or embryo can cause death or congenital defects. What are examples of congenital defects? Select all that apply.

-skeletal and limb abnormalities -central nervous system alterations -heart defects 42

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 This client is likely experiencing anaphylaxis and requires epinephrine 37

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 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 35

Preoperative atropine belongs to what classification of drugs?

Anticholinergic Atropine, a drug used preoperatively to dry up secretions, is the prototype anticholinergic drug. Many cold remedies and antihistamines also cause anticholinergic effects. 41

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 NSAID's 36

What would the nurse include in the teaching plan for a client who is to receive a drug thfat is associated with anticholinergic effects?

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. 41

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

Discontinue the drug immediately as ordered 37

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 37

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 Glipizide (Glucotrol) is an antidiabetic agent with the desired action of lowering the blood glucose level. 40

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 36

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 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. 41

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 Extreme restlessness or jitters are associated with Parkinson-like syndrome that may occur with antipsychotic agents. 42

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

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. 36

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 40

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 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. 41

Which drug classification is used to treat superinfections?

antifungals An intervention for a superinfection is to administer antifungal therapy as appropriate. In severe cases, the drug responsible for the superinfection is discontinued. 39

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 manifestations exhibited reflect Parkinson-like syndrome commonly associated with many of the antipsychotic and neuroleptic drugs 42

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. 37

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 fact that the client began taking a loop diuretic recently coupled with the client's presentation suggests hypokalemia. 40

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 37

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 36

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. 36

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 42

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 40

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?

Assess the client's blood glucose level Some medications, such as thiazide diuretics, cause hyperglycemia. Symptoms of hyperglycemia include polyphagia, restlessness and flushed skin 40

What would the nurse expect to assess if a client develops neuroleptic malignant syndrome?

Hypertensions 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. 42

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 37

A client is experiencing central nervous system effects related to drug therapy. Which would be most important for the nurse to emphasize in the teaching plan?

Safety measures For central nervous system effects such as confusion, delirium, and drowsiness, safety measures would be a priority to prevent injury. 41

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

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. 38

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 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 38

Which client is experiencing a secondary action of a medication?

a client who is drowsy after taking antihistamine 36

A parent brings a child to the clinic for an earache. The child receives a prescription for amoxicillin. The parent calls the clinic the next day and says the child has been taking the medicine and now has a rash. The nurse should give the parent instructions about which type of response?

allergic response 36

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 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 41

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 Teratogenicity is when drugs that reach the developing fetus or embryo cause death or congenital defects, which can include skeletal and limb abnormalities, central nervous system alterations, heart defects, and the like. 42

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 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.

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 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 pharmcokinetics. The client's hepatic status would primarily affect metabolism, not excretion. 39

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 39

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 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. 39

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

frequent rinsing with cool liquids 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. 38

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

Decreased glomerular filtration rate 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. 39

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 Hyperkalemia presents an acute threat to normal cardiac function due to the effect on cardiac action potentials. For this reason, cardiac monitoring is necessary 41

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 value 39

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 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. 35

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?" 36

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 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. 40

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 39

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 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. 37

A client with a diagnosis of bipolar disorder has begun lithium therapy. What is the primary rationale for the nurse's instructions regarding the need for regular monitoring of the client's serum drug levels?

It is necessary to 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. 36

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 37

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 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 42