Pharmacology Chapter 3

Erythromycin

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

Monitor laboratory blood values.

A client develops bone marrow suppression related to a drug's effects. What would be most important for the nurse to do?

frequent rinsing with cool liquids

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

Hemoglobin of 6.0 g/dL (60.0 g/L)

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?

antipsychotic agent

A client exhibits muscular tremors, drooling, gait changes, and spasms. When reviewing the client's medication history, which would the nurse most likely find?

Review the client's most recent potassium level.

A client receiving drug therapy develops numbness and tingling in the extremities and muscle cramps. What assessment should the nurse perform?

Discontinue the drug immediately as ordered.

A client who is being treated for cancer developed a serum sickness reaction. The care team has been notified, and the client is being stabilized. What is the nurse's priority action?

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

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?

Parkinsonian symptoms

A client with a longstanding diagnosis of schizophrenia has taken antipsychotic drugs for several decades. For what adverse effect should the nurse assess?

Assess the client's blood glucose level.

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?

Educate the client about strategies for managing this primary action.

A client with an anxiety disorder has been prescribed alprazolam 0.5 mg PO t.i.d. During a follow-up assessment, the client tells the nurse that the medication causes drowsiness that interferes with the client's work performance. What is the nurse's best action?

"Stored glycogen is broken down by ephedrine, causing hyperglycemia."

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?

Techniques for providing safe and effective mouth care

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?

Decreased bowel motility

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?

Promptly inform the prescriber of the client's status.

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?

buzzing or ringing sound in the ears (tinnitus)

A nurse is administering gentamicin, an antibiotic that is ototoxic. Which report or sign would indicate that the client is suffering from ototoxicity?

a 12-year-old boy with hearing loss

Before administering a macrolide antibiotic, the nurse should question the order for what client?

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.

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.

skeletal and limb abnormalities central nervous system alterations heart defects

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.

blindness central nervous system defects heart anomalies limb deformities facial defects

Many drugs, if taken during pregnancy, can cause adverse effects to the fetus. It is important for nurses to teach women the potential risks of fetal drug exposure. What are some potential risks? (Select all that apply.)

rash and hives inflammation of the mucous membranes bone marrow suppression poisoning

Organ and tissue damage is one adverse reaction caused by drugs. Which are examples of such organ and tissue damage? Select all that apply.

anticholinergic

Preoperative atropine belongs to what classification of drugs?

primary action of a drug.

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

serum sickness

There are four main classifications of drug allergies. Which classification would be described as an immune system reaction to injected proteins used to treat immune conditions?

topical corticosteroid

What would the nurse expect the prescribing health care provider to order for a client with a delayed allergic reaction?

dilated pupils feeling of panic difficulty breathing

What would the nurse expect to assess in a client experiencing an anaphylactic reaction? (Select all that apply.)

Be sure to drink plenty of fluids to prevent dehydration.

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

Maximize therapeutic effects. Minimize adverse effects and drug interactions. Provide appropriate drug education for the client and family.

When administering drug therapy for a client, how can the nurse ensure beneficial outcomes? (Select all that apply.)

secondary actions.

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:

antibiotics antineoplastics

Which medication classifications have the potential to cause dyscrasias? (Select all that apply.)

epinephrine

Which prescribed medications should the nurse administer to an adult having an anaphylactic reaction?

severe sunburn

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

hives difficulty breathing panicked feeling

Which symptoms are indicators that the client is having an anaphylactic reaction? (Select all that apply.)

elevated blood urea nitrogen (BUN) elevated creatinine level elevated potassium level

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.)

The liver is exposed to relatively large concentrations of ingested drugs or other potentially toxic substances due to the hepatic anatomy.

A client on a multimedication therapy regimen is demonstrating elevated liver enzymes that suggest hepatotoxicity. What is the most likely explanation for the elevation of the client's liver enzymes?

drowsiness after taking an antihistamine diarrhea after taking an antibiotic

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

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 warfarin dizziness after starting amlodipine

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.

dermatological reactions stomatitis blood dyscrasia poisoning

Organ and tissue damage is one adverse reaction caused by drugs. What are examples of such organ and tissue damage? 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

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.

decreased hematocrit decreased leukocytes increased liver enzymes

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.)

potassium

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?

Urinary hesitancy

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?

ototoxicity from the ibuprofen

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?

Anaphylactic reactions involve an antibody that causes the release of histamine. Histamines produce immediate reactions. Anaphylactic reactions can lead to respiratory distress and even respiratory arrest.

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.

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

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?

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

A recent nursing graduate is preparing to enter the workforce. What principle should guide the nurse's administration of medications?

antibodies.

The nurse is caring for a client with a drug allergy and understands the allergy is the result of the client developing:

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

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?

Provide supportive care to manage fever and inflammation.

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?

measures to alleviate any discomfort associated with adverse effects

A nurse is instructing a client concerning a newly prescribed drug. What should be included to help improve client compliance and safety?

Teratogenicity

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?

Monitoring the international normalized ratio (INR) of a client taking warfarin

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?

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

The nurse provides health education for a diverse group of clients. For which client should the nurse emphasize the risk of teratogenic drug effects?

thrombocytopenia anemia sore throat

What would lead the nurse to suspect that a client has developed a blood dyscrasia related to drug therapy? (Select all that apply.)

decreased glomerular filtration rate.

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

A client taking anticoagulants who develops a gastrointestinal bleed

What client is experiencing an adverse effect that is a result of primary action?

an antihistamine causes the client to experience drowsiness

What is an example of a secondary action?

Safety measures

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?

Neurotoxicity

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?

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

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.)

renal injury

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?

The client's profession

What information from the Kardex is likely to have the greatest implication in educating the client about antihistamine administration?

renal toxicity ototoxicity

What issues is gentamycin, a potent antibiotic, associated with? (Select all that apply.)

Temperature

A client is believed to be developing neuroleptic malignant syndrome. What is the nurse's assessment priority?

Toxicity

An older adult client has an elevated serum creatinine level. This client is at greatest risk for which medication-related effect?

a decrease in urine output

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?

blood dyscrasia

The nurse is caring for a client receiving an antineoplastic medication who reports fever, chills, sore throat, weakness, and back pain. The nurse should recognize the possibility of what adverse effect?

potassium levels.

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:

Maintain the client's safety during drug therapy.

What does the nurse need to do when there is any indication of an allergic reaction in clients?

pathological condition unique receptors and cellular responses age-related changes

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

contraindication for the use of certain medications.

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:

a 29-year-old client receiving prenatal care in her first trimester of pregnancy a 37-year-old client who is taking fertility drugs

The nurse should consider teratogenic effects when caring for what clients? (Select all that apply.)

adverse effects

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?

Elevated aspartate aminotransferase (AST) level

A client is suspected of having a liver injury as a result of drug therapy. What laboratory finding would best support this diagnosis?

Stevens-Johnson syndrome

All drugs have adverse reactions when taken. Organ and tissue damage is one such adverse reaction. Which is an example of organ and tissue damage caused by a drug?

cardiac monitoring

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?

Drug teaching can address signs and symptoms the client should be alert for. Assessments include monitoring for expected or common adverse effects. Baseline can be established to help identify adverse effects that occur.

How does knowledge of a drug's adverse effects impact the care provided by the nurse? (Select all that apply.)

The client reports feeling unusually drowsy and fatigued.

The nurse is caring for a client who is receiving an antidiabetic agent. What assessment finding should the nurse attribute to a possible adverse reaction?

teratogenicity

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?

protecting and maintaining the patency of the client's airway

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?

The man may be experiencing nephrotoxic effects of aspirin

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?

anaphylactic

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?

A client who is drowsy after taking antihistamine

Which client is experiencing a secondary action of a medication?

delayed allergic reaction

Which drug allergy involves antibodies bound to specific white blood cells?

antifungals

Which drug classification is used to treat superinfections?

Drugs cause unexpected or unacceptable reactions despite screening and testing.

An instructor is preparing a class that describes the toxic effects of drugs. Which effect would the instructor expect to include?

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.

The most serious allergic response is called anaphylaxis. Which clients exhibit possible symptoms of anaphylaxis? (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 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 client with kidney problems who may not be able to excrete the drug, which may accumulate in the body, resulting in toxicity a client with an enlarged prostate who takes an anticholinergic drug and may develop urinary retention or even bladder paralysis when the drug's effects block the urinary sphincters

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 is an example of hypersensitivity? (Select all that apply.)

Assess the moisture level of the client's skin. Assess the client's recent bowel pattern. Assess the client's visual acuity.

The nurse is assessing a client for anticholinergic effects of a prescribed drug. What assessments should the nurse perform? (Select all that apply.)

administer epinephrine as prescribed.

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:

a client taking antihypertensives who reports dizziness upon standing

The nurse is assessing a number of clients on the acute medicine unit. What client is most likely experiencing an adverse effect from the primary action of the medication?

sodium polystyrene sulfonate as prescribed.

The nurse is providing care for a client whose most recent laboratory results indicate a potassium level of 6.1 mEq/L (6.1 mmol/L). After completing assessment and informing the provider, the nurse should administer:

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

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?

Maintain good oral hygiene to minimize dry mouth. Void before taking the medication so urinary hesitation is less problematic. Use caution in situations where it may be possible to become overheated.

A client has been prescribed a tricyclic antidepressant and the nurse recognizes the client's associated risk for anticholinergic effects. What should the nurse teach the client about preventing and managing these adverse effects? (Select all that apply.)

reports of drowsiness after taking an diphenhydramine (Benadryl) diarrhea after taking cefuroxime (Ceftin)

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.)

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

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.

difficulty breathing increased blood pressure diaphoresis

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.)

assessment of visual acuity

The nurse administers chloroquine to a client to treat rheumatoid disease. The client has been taking this medication for several years. What assessment should the nurse prioritize?

muscular tremors drooling changes in gait

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.

urine output and creatinine clearance

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?

damage the immature nervous system of the fetus.

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:

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

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?

"Have you been taking aspirin on a regular basis?"

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?

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

The nurse is assessing a new client who states being allergic to nonsteroidal anti-inflammatories (NSAIDs. What subsequent assessment should the nurse prioritize?