A client with seasonal allergies takes diphenhydramine at bedtime to help their symptoms. The client develops low hemoglobin low white blood cell counts which is otherwise unexplained. What type of reaction is the client experiencing?

Hypersensitivity reaction

Paradoxical reaction

Idiosyncratic reaction

Anti-cholinergic reaction

Answer and Explanation

The Correct Answer is C

A) Hypersensitivity reaction: A hypersensitivity reaction typically involves an immune response where the body reacts to a substance as if it were harmful, leading to symptoms like rashes, swelling, or difficulty breathing. However, low hemoglobin and low white blood cell counts are not typical signs of a hypersensitivity reaction. This would involve more common allergic symptoms like itching or swelling, rather than hematologic changes.

B) Paradoxical reaction: A paradoxical reaction refers to when a medication causes an effect opposite to the expected result. For example, a sedative causing agitation instead of sleepiness. While a paradoxical reaction can involve unexpected effects, the hematologic changes (low hemoglobin and white blood cell counts) in this scenario do not align with this type of response.

C) Idiosyncratic reaction: An idiosyncratic reaction is an unusual or unexpected response to

a medication that is not related to the drug's pharmacologic properties or the dose given. It may be related to genetic factors or other individual differences in how a person metabolizes or responds to the drug. The low hemoglobin and low white blood cell counts in this case are unusual effects of diphenhydramine and suggest an idiosyncratic response, where the client’s body is reacting in an unexpected way to the medication.

D) Anti-cholinergic reaction: Anti-cholinergic reactions are typically related to symptoms caused by the blocking of acetylcholine, such as dry mouth, blurred vision, urinary retention, or constipation. While diphenhydramine has anti-cholinergic properties, the symptoms described (low hemoglobin and white blood cell counts) are not typical of an anti-cholinergic reaction.

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Correct Answer is D

Explanation

A) Metoprolol XL: Metoprolol XL (extended-release) should not be crushed. Crushing extended-release formulations can result in the rapid release of the drug, leading to an overdose or adverse effects due to the immediate release of the full dose. The nurse should advise the client to swallow this medication whole.

B) Ibuprofen EC (enteric-coated): Enteric-coated medications should not be crushed. The enteric coating is designed to protect the stomach lining by preventing the medication from being released in the stomach. Crushing the tablet would destroy this protective mechanism and could irritate the stomach lining, leading to discomfort or ulceration.

C) Morphine ER (extended-release): Extended-release formulations of morphine should never be crushed. Crushing extended-release formulations can lead to a potentially fatal overdose because it releases the entire dose of medication at once. This can cause respiratory depression and other life-threatening effects.

D) Acetaminophen: Acetaminophen in its regular tablet form can be safely crushed if needed. Crushing acetaminophen does not affect its effectiveness or safety, and it is a non-extended-release formulation, making it safe for manipulation when necessary, such as for clients with difficulty swallowing. However, it's essential to verify with the specific prescription, as acetaminophen is also available in extended-release formulations, which should not be crushed.

A. The client flushes the medication down the toilet. B. The client removes identifying information from the medication container. C. The client reads the medication insert to determine the disposal method. D. The client mixes the medication with coffee grounds.

Correct Answer is A

Explanation

A) The client flushes the medication down the toilet: Flushing medication down the toilet is not recommended unless it is explicitly stated on the medication packaging or insert. Many medications, especially controlled substances, may be harmful to the environment if disposed of in this way. Environmental regulations discourage flushing medications unless instructed by the manufacturer, as it can contribute to water contamination. Therefore, this action indicates a need for additional education on proper medication disposal.

B) The client removes identifying information from the medication container: This is an appropriate action. Removing identifying information from the medication container before disposal helps ensure privacy and confidentiality, preventing unauthorized individuals from accessing personal health information. This is part of safe and secure medication disposal practices.

C) The client reads the medication insert to determine the disposal method: This is an appropriate action. Reading the medication insert is the best way for a client to understand the recommended disposal method for their specific medication. Many medications have detailed instructions on how to dispose of them safely and environmentally.

D) The client mixes the medication with coffee grounds: This is an appropriate action. Mixing medications with coffee grounds, cat litter, or dirt is recommended for medications that should not be flushed or thrown in the trash. This helps make the medication less appealing to children, pets, or others who may come across it and ensures safe disposal. This action is consistent with the guidance for non-hazardous medications.

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A client with seasonal allergies takes diphenhydramine at bedtime to help their symptoms. The client develops low hemoglobin low white blood cell counts which is otherwise unexplained. What type of reaction is the client experiencing?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which prescribed medication can the nurse instruct the client to crush if needed?

Correct Answer is D

Explanation

A client is preparing a medication for administration and is disposing the remaining medication. Which action by the client indicates the need for additional education?

Correct Answer is A

Explanation

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