NURS 317 Unit 7 Pharm Chapter 3

Question 1

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?

A) Poisoning

B) Primary effects

C) Secondary effects

D) Teratogenicity

Answer 1

D) Teratogenicity

Rationale:In a woman of childbearing age, it is important for the nurse to consider the teratogenicity of a medication because teratogens can seriously harm or injure the embryo or fetus. Primary actions, secondary actions, and poisoning would be of no greater concern with a woman of childbearing age than with any client.

Question 2

A client with cancer has been receiving antineoplastics for several weeks. What assessment finding should the nurse interpret as a possible indication of blood dyscrasia?

A) Serum creatinine of 1.2 mg/dL (110 µmol/L)

B) International normalized ratio of 1:1

C) Platelet level of 350,000/ mm3 (350 × 109/L)

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

Answer 2

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

Rationale:Blood dyscrasia is associated with a reduction in some, or all, blood cellular components. This client’s hemoglobin level is significant below reference ranges, while INR, creatinine, and platelets are within norms.

Question 3

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

A) Drugs pose no significant risk of harm if they are used as prescribed.

B) The effects occurring with present-day therapy are much less severe than in previous decades.

C) Several chemical and physiologic processes need to be impacted before a client has an adverse effect.

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

Answer 3

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

Rationale:Even though drugs are carefully screened and tested in animals before being released to use on humans, drug products often cause unexpected or unacceptable reactions when given. Many effects can be seen when just one chemical factor is changed or altered. All drugs have the potential to cause adverse effects whether they are prescribed or over the counter. Today’s potent and amazing drugs can cause a variety of reactions, many of which are more severe than ever seen before.

Question 4

The nurse is preparing to administer antineoplastic medication to a client with cancer who has been receiving them for several days. When monitoring for potential adverse effects of this medication, the nurse should perform what assessments? Select all that apply.

A) Check the client’s blood glucose level every 6 hours.

B) Inspect the client’s mucous membranes.

C) Monitor the client’s potassium levels.

D) Monitor the client’s blood cell counts.

E) Monitor the client’s urine output

Answer 4

B) Inspect the client’s mucous membranes.
C) Monitor the client’s potassium levels.
D) Monitor the client’s blood cell counts.

Rationale:Patients receiving antineoplastic medications are at risk for stomatitis, blood dyscrasias, and hyperkalemia. Hyperglycemia and decreased urine output are not normally associated with administration of antineoplastic medications, although specific cancers could cause these or virtually any symptom depending on the organ involved.

Question 5

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) A client taking oral antibiotics who has experienced nausea after each dose

B) A client whose upper gastrointestinal bleed is attributed to nonsteroidal antiinflammatories

C) A client taking antihypertensives who reports dizziness upon standing

D) A client whose antidepressant has caused sexual dysfunction in the past

Answer 5

C) 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

Question 6

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

A) A client who takes an antihistamine and falls asleep

B) A client who develops diarrhea shortly after beginning a course of antibiotics

C) A client taking anticoagulants who develops a gastrointestinal bleed

D) An older adult client who becomes agitated and disoriented after being given a narcotic analgesic

Answer 6

C) A client taking anticoagulants who develops a gastrointestinal bleed

Rationale:Bleeding associated with anticoagulant therapy is an example of a primary action, the extension of the desired effect. A client taking an antihistamine who experiences drowsiness is an example of a secondary action, an effect in addition to the desired effect of drying up secretions. A client taking an antibiotic who experiences diarrhea is an example of a secondary action, an effect in addition to the desired effect of eradicating the infection. An older person taking a narcotic analgesic who experiences hyperactivity is an example of hypersensitivity, an excessive response to either the primary or secondary effects of a drug.

Question 7

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

A) A 40-year-old male client who has a history of intravenous drug use and who has endocarditis

B) A 6-year-old girl who has a urinary tract infection and who is accompanied by her parents

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

D) A 60-year-old female client who is tetraplegic and who has developed a sacral pressure ulcer

Answer 7

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

Rationale:The risk of teratogenicity is a priority consideration for female clients of childbearing age, not for males or prepubescent girls.

Question 8

The nurse cares for a client with a drug allergy. The nurse understands that the allergy is the result of the client developing which response?

A) Antihistamine

B) Secondary effects

C) Antigens

D) Antibodies

Answer 8

D) Antibodies

Rationale:Antibodies are formed by the body to react with antigens in an allergic reaction. The antigen, in this case, is the drug that the body recognizes as a foreign substance to be eliminated. Antihistamines are administered to reduce the histamines secreted as a result of the allergic reaction. An allergic reaction is distinct and different from a secondary effect.

Question 9

A client presents to the clinic complaining of ringing in the ears and difficulty hearing. What medication in the client’s current regimen should the nurse suspect?

A) Erythromycin

B) Acetaminophen with codeine

C) Hydrochlorothiazide

D) Insulin

Answer 9

A) Erythromycin

Rationale:Macrolide antibiotics such as erythromycin can cause severe auditory nerve damage manifested by ringing in the ears and hearing loss. The other listed medications normally pose no risk to the auditory nerve.

Question 10

A client is receiving antibiotics for treatment of infection. The nurse should assess for what potential indications of superinfection? Select all that apply.

A) Difficulty swallowing

B) Fever

C) Joint pain

D) Epistaxis (nosebleeds)

E) Glossitis (swollen tongue)

Answer 10

B) Fever
E) Glossitis (swollen tongue)

Rationale:Use of antibiotics can lead to superinfections manifested by fever, diarrhea, black or hairy tongue, inflamed and swollen tongue, mucous membrane lesions, and vaginal discharge with or without itching. Joint pain, dysphagia, and nosebleeds are atypical.

Question 11

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

A) Elevated serum creatinine level

B) Elevated aspartate aminotransferase (AST) level

C) Sudden drops in hemoglobin, hematocrit, and red cell count

D) Elevated blood urea nitrogen (BUN)

Answer 11

B) Elevated aspartate aminotransferase (AST) level

Rationale:Liver enzymes such as AST and alanine aminotransferase (ALT) would be elevated with liver injury. Elevated BUN and creatinine levels would be seen with renal injury. Sudden drops in hemoglobin, hematocrit, and red cell count are suggestive of bleeding, not liver damage.

Question 12

Which client is experiencing a secondary action of a medication that he or she has taken?

A) A client who is drowsy after taking antihistamine

B) A client who has developed hives and a rash after taking an antibiotic

C) A client who is lethargic after taking an antianxiety medication

D) A client who is in respiratory distress with elevated blood pressure after taking an antiviral medication

Answer 12

A) A client who is drowsy after taking antihistamine

Rationale:A secondary action is the development of adverse effects in addition to the desired effects. Drowsiness from an antihistamine is an example. A primary action is the development of adverse effects, an extension of the desired effect, from simple overdosage. Excessive relaxation after taking an antianxiety medication is an example. Drug allergies and hypersensitivities are not examples of secondary actions

Question 13

The nurse is conducting an admission assessment of a new client. When asked about any food or drug allergies, the client states that he or she is allergic to tetracycline. What action should the nurse next perform?

A) Ask the client, “Are you allergic to any other antibiotics, or just tetracycline?”

B) Document an allergy to tetracycline in the client’s health record.

C ) Educate the client about antibiotics that are alternatives to tetracycline.

D) Ask the client, “What happens when you take a dose of tetracycline?”

Answer 13

D) Ask the client, “What happens when you take a dose of tetracycline?”

Rationale:Clients often characterize a wide variety of medication reactions as “allergies.” The nurse should assess further, not because of mistrust for the client but because there is a need for further detail. Documentation of the client’s allergy status should occur at the completion of assessment. Education about alternatives would be premature.

Question 14

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 1 hour after that. The nurse should assess the client for which possibility?

A) Poisoning

B) Anaphylaxis

C) Allergies

D) Hypersensitivity

Answer 14

A) Poisoning

Rationale:Poisoning occurs when an overdose of a drug damages multiple body systems, leading to the potential for fatal reactions. Hypersensitivity, allergies, and anaphylaxis would not be indicated by an overdosage of the medication

Question 15

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

A) Deep tendon reflexes

B) Oxygen saturation

C) Cognition

D) Temperature

Answer 15

D) Temperature

Rationale:Neuroleptic malignant syndrome is manifested by hyperthermia, and extrapyramidal symptoms such as slowed reflexes, involuntary movements, and autonomic disturbances. Slowed reflexes would be seen with neuroleptic malignant syndrome, but hyperthermia is a priority assessment. Decreased oxygenation is less common. Cognition is not commonly affected.

Question 16

A client presents to the clinic reporting vaginal discharge with itching. Which statement would alert the nurse to the possibility that the client’s complaints are related to a superinfection?

A) “For the last 2 months, I have been taking a water pill that the doctor prescribed.”

B) “I’ve been exhausted and overworked for the past several weeks.”

C) “I’ve been taking aspirin several times a day for the past few months for my back pain.”

D) “I just completed a course of antibiotics prescribed by my dentist to treat a tooth abscess.”

Answer 16

D) “I just completed a course of antibiotics prescribed by my dentist to treat a tooth abscess.”

Rationale:Antibiotics are commonly associated with superinfections because they destroy the normal flora. Diuretics or water pills would be associated with electrolyte imbalances. Aspirin is often linked to tinnitus and eighth cranial nerve function. In addition, its antiplatelet activity increases the risk for bleeding problems. Stress and fatigue suppress the immune system but do not cause superinfections.

Question 17

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?

A) The client states, “I just can’t seem to quench my thirst.”

B) The client reports feeling unusually drowsy and fatigued.

C) The nurse’s assessment reveals Kussmaul respirations.

D) The client has voided three times in the past hour.

Answer 17

B) The client reports feeling unusually drowsy and fatigued.

Rationale:Antidiabetic agents can lead to low serum blood glucose levels manifested by fatigue, drowsiness, hunger, cold clammy skin, and lack of coordination. Polyuria, increased thirst, and Kussmaul respirations would indicate hyperglycemia, the very reason the client is receiving the antidiabetic agent.

Question 18

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

A) Dry mouth and urinary hesitation

B) Hypoglycemia

C) Hyperthermia

D) Parkinsonian symptoms

Answer 18

D) Parkinsonian symptoms

Rationale:Extreme restlessness or jitters are associated with Parkinson-like syndrome that may occur with antipsychotic agents. Hyperthermia is unrelated to antipsychotic therapy but is associated with neuroleptic malignant syndrome such as from general anesthetics. Hypoglycemia is unrelated to antipsychotic therapy, but it is associated with the use of antidiabetic agents, which lowers blood glucose levels. Dry mouth and urinary hesitation are unrelated to antipsychotic use but is associated with anticholinergic agents such as atropine or cold remedies and antihistamines.

Question 19

A client with a serious Escherichia coli infection is being treated with gentamicin. When monitoring for potential adverse effects, the nurse should prioritize what assessment?

A) Skin integrity

B) AST, ALT, and bilirubin levels

C) Sodium, potassium, and chloride levels

D) Blood urea nitrogen and creatinine levels

Answer 19

D) Blood urea nitrogen and creatinine levels

Rationale:Gentamicin is an example of a drug that holds the potential for renal toxicity. This drug is not associated with hepatic damage, electrolyte disturbances, or disruptions of skin integrity.

Question 20

The nurse is assessing a client who is distress and may be experiencing an anaphylactic reaction. What assessment finding is most consistent with this diagnosis?

A) Swollen joints

B) Shortness of breath

C) Sudden somnolence

D) Swollen cervical lymph nodes

Answer 20

B) Shortness of breath

Rationale:Difficulty breathing, increased blood pressure, dilated pupils, diaphoresis, and a panicky feeling are associated with an anaphylactic reaction. Somnolence does not occur. Swollen lymph nodes are associated with a serum sickness reaction. Swollen joints are associated with a delayed allergic reaction.

Question 21

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

A) Assess the client’s pupillary reflex.

B) Assess the client’s visual acuity.

C) Assess the client’s recent bowel pattern.

D) Assess the moisture level of the client’s skin.

E) Auscultate the client’s breath sounds.

Answer 21

B) Assess the client’s visual acuity.
C) Assess the client’s recent bowel pattern.
D) Assess the moisture level of the client’s skin.

Rationale:Findings suggesting anticholinergic effects may include dry mouth, dry skin, constipation, blurred vision, urinary hesitancy, and mental confusion. Respiration and pupillary reflexes are normally unaffected.

Question 22

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

A) Check the client’s urine output.

B) Assess the client’s level of orientation.

C) Check the client’s blood glucose level.

D) Review the client’s most recent potassium level.

Answer 22

D) Review the client’s most recent potassium level.

Rationale:Hypokalemia is suggested by numbness and tingling in the extremities, muscle cramps, weakness, and irregular pulse. Fatigue, drowsiness, hunger, tremulousness, and cold clammy skin would suggest hypoglycemia. Renal injury would be manifested by elevated BUN and creatinine concentration, decreased hematocrit, and electrolyte imbalances, fatigue, malaise, decreased urine output, and irritability. Neurologic dysfunction would most likely be manifested by confusion, delirium, insomnia, drowsiness, and changes in deep tendon reflexes.

Question 23

A client develops bone marrow suppression related to a drug’s effects. What is the nurse’s priority action?

A) Place the client on protective isolation.

B) Facilitate cardiac monitoring.

C) Prepare the client for dialysis.

D) Monitor laboratory blood values.

Answer 23

D) Monitor laboratory blood values.

Rationale:Monitoring blood counts would be most important for the client with bone marrow suppression. Protective isolation would be appropriate if the client was immunocompromised. Bone marrow suppression does not pose an immediate threat to cardiovascular status. Frequent mouth care would be appropriate if the client develops stomatitis. Dialysis would be indicated if the client develops renal injury due to drug therapy.

Question 24

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.

A) The client’s skin and eyes are visibly jaundiced.

B) The client’s AST and ALT levels are elevated.

C) The client’s temperature is 102.5°F (39.2°C).

D) The client’s eyes are sensitive to light.

E) Elevated red blood cell count.

Answer 24

A) The client’s skin and eyes are visibly jaundiced.
B) The client’s AST and ALT levels are elevated.
C) The client’s temperature is 102.5°F (39.2°C).

Rationale:Symptoms of liver injury may include fever, malaise, nausea, vomiting, jaundice, change in color of urine or stools, abdominal pain or colic, elevated liver enzymes (e.g., aspartate aminotransferase [AST], alanine aminotransferase [ALT]), alterations in bilirubin levels, and changes in clotting factors (e.g., partial thromboplastin time). Red cell counts do not rise, and photosensitivity does not result from liver damage.

Question 25

A client is experiencing central nervous system effects related to drug therapy. What is the nurse’s priority teaching point to emphasize in the teaching plan?

A) The importance of a low stimulation environment

B) Need for follow-up blood tests

C) Safety measures

D) Educating about the signs and symptoms of stroke

Answer 25

C) Safety measures

Rationale:For central nervous system effects such as confusion, delirium, and drowsiness, safety measures would be a priority to prevent injury. CNS effects do not normally affect the client’s stroke risk. Blood tests would be appropriate if the client was experiencing bone marrow suppression or electrolyte imbalance. Safety is a priority over maintaining a low stimulation environment.

Question 26

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?

A) Encourage the use of a MedicAlert identification.

B) Administer prescribed epinephrine subcutaneously.

C) Administer topical corticosteroids.

D) Discontinue the drug immediately as ordered.

Answer 26

D) Discontinue the drug immediately as ordered.

Rationale:If serum sickness occurs, the prescriber is notified and the drug is discontinued. Epinephrine is given for an anaphylactic reaction and requires a physician’s order. A MedicAlert identification may be indicated, but is not the nurse’s first concern. Topical corticosteroids may be used to treat dermatological symptoms such as rash but would not be the nurse’s first concern.

Question 27

The nurse is caring for a client who exhibits an excessive response to a secondary effect of a drug, which the nurse classifies as a hypersensitivity response. What factors can potentially contribute to a hypersensitivity reaction? Select all that apply.

A) Age-related changes

B) Infrequent administration of a drug

C) Unique receptors and cellular responses

D) Creation of antibodies

E) Pathological condition

Answer 27

A) Age-related changes
C) Unique receptors and cellular responses
E) Pathological condition

Rationale:Some clients are excessively responsive to either the primary or the secondary effects of a drug resulting in a hypersensitivity reaction that may result from a pathological or underlying condition. Sometimes hypersensitivity reactions result with no definite pathological condition because each person has slightly different receptors and cellular responses. Hypersensitivity response can also be related to a change in receptors with age leading to an increased sensitivity to a drug’s effects. The creation of antibodies to a drug results in an allergic reaction. Infrequent administration does not lead to hypersensitivity.

Question 28

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.

A) Slow heart rate

B) Constricted pupils

C) Increased blood pressure

D) Difficulty breathing

E) Diaphoresis

Answer 28

C) Increased blood pressure
D) Difficulty breathing
E) Diaphoresis

Rationale:During an anaphylactic reaction nurses can expect to assess hives, rash, difficulty breathing, increased BP, dilated pupils, diaphoresis, “panic” feeling, increased heart rate, respiratory arrest.

Question 29

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

A) Drug teaching can address signs and symptoms the client should be alert for.

B) Baseline can be established to help identify adverse effects that occur.

C) Assessments include monitoring for expected or common adverse effects.

D) Decisions can be made about whether or not to administer drug.

E) Adverse effects can be avoided through interventions made before giving the drug.

Answer 29

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

Rationale:This information will direct the nurse’s assessment of the client, helping to focus on particular signs and symptoms that would alert the nurse to adverse effects, and helping to establish a baseline for that client so that the nurse will be able to identify adverse effects that occur. When teaching the client about a drug, it is important to list the adverse effects that should be anticipated, along with the appropriate actions that the client can take to alleviate any discomfort associated with these effects. Being alert to adverse effects—what to assess and how to intervene appropriately—can increase the effectiveness of a drug regimen, provide for client safety, and improve client compliance. Deciding to withhold a drug is outside the nurse’s scope of practice. Adverse effects may not be avoided, but they can be minimized or quickly treated with awareness.