Chapter 03 - Toxic Effects of Drugs |Test Bank - Focus on Nursing Pharmacology (8th Edition by Karch)

1. A nurse is planning patient teaching about a newly prescribed drug. What is a priority teaching point included by the nurse to improve compliance and safety? a. List of pharmacies where the drug can be obtained b. Measures to alleviate any discomfort associated with adverse effects c. The cost of the brand name drug compared with the generic form d. Statistics related to Phase III testing for the prescribed drug Ans: B Feedback: If a patient is aware of certain adverse effects and how to alleviate or decrease the discomfort, he or she is more likely to continue taking the medication. A list of pharmacies can be useful information but will not improve safety or compliance. Knowing the cost of the brand name versus the generic form could also be helpful to the patient. However, a substitution may not be allowable and the cost of a drug does not improve patient safety. Most patients are not concerned with the statistics related to drug testing and it would not improve compliance or safety even if the patient was interested in the information. 2. A patient presents at the clinic complaining of vaginal itching and a clear discharge. The patient reports to the nurse that she has been taking an oral antibiotic for 10 days. The nurse is aware that the patient is experiencing what? a. An adverse reaction from the antibiotic b. A drug toxicity effect of the antibiotic c. An overdose of the drug that is damaging to more than one body system d. A superinfection caused by the antibiotic, which has destroyed normal flora Ans: D Feedback: Superinfections often occur with antibiotic use because the drug kills normal bacterial flora. This is not a result of toxic levels of the antibiotic, but rather an effect of the medication that has killed normal flora, which it is designed to do. Vaginal itching and a clear discharge are not considered adverse effects of an antibiotic. An overdose of a drug that damages more than one body systems is considered drug poisoning. 3. A 42-year-old male patient is brought to the emergency department by ambulance. The patient is in distress. The nurse suspects an anaphylactic reaction resulting from taking oral penicillin. What assessment findings are important in making this diagnosis? a. Blood pressure (BP): 186/100, difficulty breathing b. Hematocrit (Hct): 32%, decreased urine output c. Temperature: 102º, swollen joints d. Profuse sweating, Blood Pressure: 92/58 Ans: A Feedback: An anaphylactic reaction is an immune reaction that causes a massive release of histamine, which results in edema and swelling that can lead to respiratory distress and increased blood pressure. A decreased hematocrit and decreased urine output suggests a cytotoxic reaction. An increased temperature and swollen joints could suggest serum sickness. Profuse sweating and decreased blood pressure may indicate cardiac-related issues. 4. A patient with seasonal allergies is taking an antihistamine to relieve itchy, watery eyes, and a runny nose. When planning teaching for this patient, the nurse would include what teaching point? a. Advise the patient to limit fluid intake to dry out mucous membranes. b. Advise the patient to avoid driving or operating machinery. c. Advise the patient to report strange dreams or nightmares. d. Advise the patient to decrease dietary fat. Ans: B Feedback: An adverse effect of antihistamines is drowsiness, so that injury to the patient or others can occur if driving or operating machinery. An increase in fluids would be indicated to help keep nasal membranes moist. It is common for dreams to occur when taking medication and it is not necessary to report them. Dietary fat should not interfere with the drug metabolism of antihistamines. 5. A nurse is providing teaching to a group of patients who are beginning drug therapy for acquired immunodeficiency syndrome (AIDS). What should be included in her instructions to the group? a. Take your medications as directed. Poisoning occurs with overdosage causing damage to more than one body system. b. Renal injury results from first-pass effect when the drug is excreted from the system. c. A blood dyscrasia due to drug therapy can be serious. Call us if your skin looks yellowish or you experience itching. d. Most drugs are metabolized in the liver and the first indication of damage is dark red papules, which should be reported immediately. Ans: A Feedback: Poisoning resulting from overdosage can lead to the potential for fatal reactions when more than one body system is affected. Liver, not kidney, injury can be caused by the first-pass effect and can cause the skin to have a yellow appearance. Most drugs are metabolized in the liver but liver damage causes jaundice, manifested as a yellow tinge to the skin and sclera. Dark red papules appearing on limbs are characteristic of Stevens-Johnson syndrome, a potentially fatal erythema multiforme exudativum, which should be reported but is not due to liver damage. 6. The pharmacology instructor is talking to the nursing students about potassium-sparing diuretics and how they can lead to hyperkalemia, indicated by what assessment finding? a. Urine output of 1,500 mL/24 hours b. Blood pressure of 98/60 c. Potassium level of 5.9 mEq/L d. Calcium level of 11.4 mg/dL