NUR Pharmacology II Chapter 3: Toxic Effects of Drugs
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 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."
Which client is experiencing a secondary action of a medication?
A client who is drowsy after taking antihistamine
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.
Preoperative atropine belongs to what classification of drugs?
Anticholinergic
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?"
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 with a longstanding diagnosis of schizophrenia has taken antipsychotic drugs for several decades. For what adverse effect should the nurse assess?
Parkinsonian symptoms
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 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
A client is believed to be developing neuroleptic malignant syndrome. What is the nurse's assessment priority?
Temperature
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?
The client reports feeling unusually drowsy and fatigued.
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.
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 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
What is an example of a secondary action?
an antihistamine causes the client to experience drowsiness
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 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 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?
blood dyscrasia
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 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.
What would the nurse expect the prescribing health care provider to order for a client with a delayed allergic reaction?
topical corticosteroid
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
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.
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 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 exhibits muscular tremors, drooling, gait changes, and spasms. When reviewing the client's medication history, which would the nurse most likely find?
antipsychotic agent
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.
What changes due to aging in the geriatric client may affect excretion and promote accumulation of drugs in the body?
decreased glomerular filtration rate.
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
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
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.
Before administering a macrolide antibiotic, the nurse should question the order for what client?
a 12-year-old boy with hearing loss
A client develops a cytotoxic reaction to a drug. What would the nurse expect to do?
Discontinue the drug immediately as ordered.
The nurse is caring for a client with a drug allergy and understands the allergy is the result of the client developing:
antibodies.
The pharmacology instructor explains to the students that adverse effects can be extensions of:
primary action of a drug.
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:
sodium polystyrene sulfonate as prescribed.
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 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
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 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.
Anaphylactic reactions involve an antibody that causes the release of histamine. Anaphylactic reactions can lead to respiratory distress and even respiratory arrest. Histamines produce immediate reactions.
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
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.
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
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.
limb abnormalities central nervous system alterations skeletal abnormalities heart defects
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.
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
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
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 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 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.
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.
