Karch's Focus on Pharmacology 8th Ed. | Chapter 3
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?" Rationale: Aspirin is a relatively common cause of tinnitus and auditory nerve damage. As well, the fact that the client has an inflammatory disease makes it possible that the client is self-medicating with aspirin. Corticosteroids are not as commonly associated with tinnitus. Similarly, hypertension and hypotension do not normally cause this problem. Herbs and supplements have widely varying effects, but aspirin is a more likely cause due to the client's diagnosis and the wide availability and use of aspirin.
Which client is experiencing a secondary action of a medication?
A client who is drowsy after taking antihistamine
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?
Educate the client about strategies for managing this primary action.
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?
Erythromycin
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 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."
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?"
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 45-year-old taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis A 4-year-old admitted after taking too many aspirin
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 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
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?
Serum sickness: An immune system reaction to certain medications, injected proteins used to treat immune conditions, or antiserum, the liquid part of blood that contains antibodies that help protect against infectious or poisonous substances. An allergic reaction can occur with any drug, not just those containing protein. Anaphylaxis is an acute, systemic, life-threatening allergic reaction. A cytotoxic reaction is one in which antibodies circulate and attack antigens on cell sites, causing death of that cell.
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 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 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?
assessment of visual acuity
The pharmacology instructor explains to the students that adverse effects can be extensions of:
primary action of a drug.
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
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?
Stevens-Johnson syndrome
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."
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.
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.
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.
Which skin condition would be most likely to cause increased systemic absorption of a topical medication?
Severe sunburn
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.
What does the nurse need to do when there is any indication of an allergic reaction in clients?
To maintain the client's safety during drug therapy
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?
a client taking antihypertensives who reports dizziness upon standing Rationale: Dizziness is the result of low blood pressure, which is a primary action of an antihypertensive. Nausea, sexual dysfunction and GI bleeding are secondary actions of the medications in question
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.
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
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:
antibodies
Preoperative atropine belongs to what classification of drugs?
anticholinergic
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 develops stomatitis from drug therapy. Which measure would be most appropriate for the nurse to suggest?
frequent rinsing with cool liquids
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 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.
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
What would the nurse expect the prescribing health care provider to order for a client with a delayed allergic reaction?
topical corticosteroid
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
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
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
Organ and tissue damage is one adverse reaction caused by drugs. Which are examples of such organ and tissue damage? Select all that apply.
rash and hives inflammation of the mucous membranes bone marrow suppression poisoning