Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
,TEST BANK
Question 1
Item Type
MCQ
Clinical Scenario
A nurse is preparing to administer the first dose of an
intravenous antibiotic to a hospitalized patient with pneumonia.
The patient states, "I've had allergic reactions to antibiotics
before, but I don't remember which one."
Question Stem
What is the nurse's priority action before administering the
medication?
Answer Options
A. Administer the medication while closely monitoring for
adverse reactions.
B. Review the patient's allergy history and clarify the reported
reaction before administering the medication.
C. Contact the pharmacy to request a different antibiotic.
,D. Delay the medication until family members can verify the
allergy history.
Correct Answer
B. Review the patient's allergy history and clarify the reported
reaction before administering the medication.
Comprehensive Rationale
Assessment is the first step of the nursing process and provides
essential information for safe medication administration. A
reported history of antibiotic allergy requires clarification
regarding the specific medication, type of reaction (e.g., rash,
anaphylaxis, gastrointestinal upset), timing, and severity. This
assessment helps determine whether the prescribed antibiotic
poses a significant risk and whether additional provider
consultation is necessary before administration.
Administering medication without adequate assessment
increases the risk of preventable adverse drug reactions. Safe
medication administration depends on integrating patient
history, allergy status, current clinical condition, laboratory
data, and the medication order.
Pharmacologic Principles
• Previous hypersensitivity reactions may recur upon re-
exposure.
, • Immune-mediated allergic reactions can range from mild
urticaria to life-threatening anaphylaxis.
• Prevention is safer than treating medication-induced harm.
Nursing Monitoring
• Allergy documentation
• Previous medication history
• Signs of hypersensitivity
• Availability of emergency medications if indicated
Patient Teaching
• Encourage patients to report all drug allergies.
• Distinguish side effects from true allergic reactions.
• Carry updated allergy information.
Distractor Analysis
A. Administer while monitoring
Why Incorrect
Monitoring does not replace a complete assessment.
Common Misconception
Believing observation alone prevents adverse events.