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Chapter 07: Adverse Drug Reactions and Medication Errors
Burchum: Lehne’s Pharmacology for Nursing Care, 10th Edition
MULTIPLE CHOICE
1. A patient is given a new medication and reports nausea within an hour after taking the drug.
The nurse consults the drug information manual and learns that nausea is not an expected
adverse effect of this drug. When the next dose is due, what will the nurse do?
a. Administer the drug and tell the patient to report further nausea.
b. Hold the drug and notify the provider of the patient’s symptoms.
c. Report the symptoms of nausea to the MEDWATCH program.
d. Request an order for an antiemetic to counter this drug’s effects.
ANS: A
Not all adverse drug reactions (ADRs) can be detected during clinical trials, and nurses should
be alert to any effects that may result from drug administration. Because nausea is not a
serious effect and because it is not yet known whether the drug is the cause of this patient’s
nausea, the nurse should administer the medication and observe the patient for recurrence of
the symptom. It is not necessary to hold the drug, because nausea is not a serious side effect.
The MEDWATCH program should be notified when there is a greater suspicion that the drug
may have caused the nausea if the nausea occurs with subsequent doses. Until there is greater
suspicion that the drug actually caused this patient’s nausea, giving an antiemetic is not
indicated.
2. A patient is being discharged after surgery. During the admission history, the nurse learned
that the patient normally consumes 2 or 3 glasses of wine each day. The prescriber has
ordered hydrocodone with acetaminophen [Lortab] for pain. What will the nurse do?
a. Request an order for acetaminophen without hydrocodone for pain.
b. Suggest that the patient use ibuprofen for pain.
c. Tell the patient not to drink wine while taking Lortab.
d. Tell the patient to limit wine intake to 1 or 2 glasses per day.
ANS: C
Combining a hepatotoxic drug with certain other drugs may increase the risk of
hepatotoxicity. When even therapeutic doses of acetaminophen are taken with alcohol, the
acetaminophen can cause liver damage. Patients should be cautioned not to drink alcohol;
even 2 drinks with acetaminophen can produce this effect. Hydrocodone does not contribute
to hepatotoxicity. Ibuprofen is not indicated for postoperative pain unless the pain is mild.
Limiting wine to 1 or 2 glasses per day still increases the risk of hepatotoxicity.
3. A nurse is reviewing a medication administration record before administering medications.
Which order will the nurse implement?
a. Furosemide [Lasix] 20 mg QD PO
b. Furosemide [Lasix] 20 mg qd PO
c. Furosemide [Lasix] 20 mg daily
d. Furosemide [Lasix] 20 mg PO daily
ANS: D
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The correct answer is a complete order; it contains the medication, dose, route, and time. “qd”
is no longer an accepted abbreviation; it should be written out as “daily” or “every day.” The
order of “20 mg daily” does not specify the route to be used.
4. A patient is given a drug for the first time and develops shortness of breath. The patient’s
heart rate is 76 beats/min, the respiratory rate is 20 breaths per minute, and the blood pressure
is 120/70 mm Hg. The nurse checks a drug administration manual to make sure the correct
dose was given and learns that some patients taking the drug experience shortness of breath.
The nurse will contact the provider to report what?
a. An allergic reaction
b. An idiosyncratic effect
c. An iatrogenic response
d. A side effect
ANS: D
A side effect is a secondary drug effect produced at therapeutic doses. This patient received
the correct dose of the drug and developed shortness of breath, which, in this case, is a drug
side effect. To experience an allergic reaction, a patient must have prior exposure to a drug
and sensitization of the immune response. An idiosyncratic effect results from a genetic
predisposition to an uncommon drug response. An iatrogenic response occurs when a drug
causes symptoms of a disease.
5. A nurse is preparing to give an antibiotic to a patient who reports being allergic to antibiotics.
Before giving the medication, what will the nurse do first?
a. Ask whether the patient has taken this antibiotic for other infections.
b. Question the patient about allergies to other medications.
c. Request an order for a lower dose of the antibiotic.
d. Request an order for an antihistamine.
ANS: A
The nurse needs to assess whether the patient is truly allergic to this drug. Allergic reactions
require previous exposure to the drug, so the nurse should ask whether the patient has taken
this antibiotic before. If a patient is allergic to a drug, lowering the dose will not decrease the
risk of allergic reaction. Antihistamines sometimes are given when patients must take a drug
to which they are allergic.
6. A nurse is preparing to administer a drug. Upon reading the medication guide, the nurse notes
that the drug has been linked to symptoms of Parkinson disease in some patients. What will
the nurse do?
a. Ask the patient to report these symptoms, which are known to be teratogenic
effects.
b. Observe the patient closely for such symptoms and prepare to treat them if needed.
c. Request an order to evaluate the patient’s genetic predisposition to this effect.
d. Warn the patient about these effects and provide reassurance that this is expected.
ANS: B
A drug that causes disease-like symptoms is known to be iatrogenic. Nurses should be
prepared for this possibility and be prepared to withdraw the drug if necessary and treat the
symptoms. Such effects are not teratogenic. Patients with a genetic predisposition to respond
differently to drugs are known to have idiosyncratic effects. Iatrogenic effects, even when
known, are not typically expected side effects.
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Chapter 07: Adverse Drug Reactions and Medication Errors
Burchum: Lehne’s Pharmacology for Nursing Care, 10th Edition
MULTIPLE CHOICE
1. A patient is given a new medication and reports nausea within an hour after taking the drug.
The nurse consults the drug information manual and learns that nausea is not an expected
adverse effect of this drug. When the next dose is due, what will the nurse do?
a. Administer the drug and tell the patient to report further nausea.
b. Hold the drug and notify the provider of the patient’s symptoms.
c. Report the symptoms of nausea to the MEDWATCH program.
d. Request an order for an antiemetic to counter this drug’s effects.
ANS: A
Not all adverse drug reactions (ADRs) can be detected during clinical trials, and nurses should
be alert to any effects that may result from drug administration. Because nausea is not a
serious effect and because it is not yet known whether the drug is the cause of this patient’s
nausea, the nurse should administer the medication and observe the patient for recurrence of
the symptom. It is not necessary to hold the drug, because nausea is not a serious side effect.
The MEDWATCH program should be notified when there is a greater suspicion that the drug
may have caused the nausea if the nausea occurs with subsequent doses. Until there is greater
suspicion that the drug actually caused this patient’s nausea, giving an antiemetic is not
indicated.
2. A patient is being discharged after surgery. During the admission history, the nurse learned
that the patient normally consumes 2 or 3 glasses of wine each day. The prescriber has
ordered hydrocodone with acetaminophen [Lortab] for pain. What will the nurse do?
a. Request an order for acetaminophen without hydrocodone for pain.
b. Suggest that the patient use ibuprofen for pain.
c. Tell the patient not to drink wine while taking Lortab.
d. Tell the patient to limit wine intake to 1 or 2 glasses per day.
ANS: C
Combining a hepatotoxic drug with certain other drugs may increase the risk of
hepatotoxicity. When even therapeutic doses of acetaminophen are taken with alcohol, the
acetaminophen can cause liver damage. Patients should be cautioned not to drink alcohol;
even 2 drinks with acetaminophen can produce this effect. Hydrocodone does not contribute
to hepatotoxicity. Ibuprofen is not indicated for postoperative pain unless the pain is mild.
Limiting wine to 1 or 2 glasses per day still increases the risk of hepatotoxicity.
3. A nurse is reviewing a medication administration record before administering medications.
Which order will the nurse implement?
a. Furosemide [Lasix] 20 mg QD PO
b. Furosemide [Lasix] 20 mg qd PO
c. Furosemide [Lasix] 20 mg daily
d. Furosemide [Lasix] 20 mg PO daily
ANS: D
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The correct answer is a complete order; it contains the medication, dose, route, and time. “qd”
is no longer an accepted abbreviation; it should be written out as “daily” or “every day.” The
order of “20 mg daily” does not specify the route to be used.
4. A patient is given a drug for the first time and develops shortness of breath. The patient’s
heart rate is 76 beats/min, the respiratory rate is 20 breaths per minute, and the blood pressure
is 120/70 mm Hg. The nurse checks a drug administration manual to make sure the correct
dose was given and learns that some patients taking the drug experience shortness of breath.
The nurse will contact the provider to report what?
a. An allergic reaction
b. An idiosyncratic effect
c. An iatrogenic response
d. A side effect
ANS: D
A side effect is a secondary drug effect produced at therapeutic doses. This patient received
the correct dose of the drug and developed shortness of breath, which, in this case, is a drug
side effect. To experience an allergic reaction, a patient must have prior exposure to a drug
and sensitization of the immune response. An idiosyncratic effect results from a genetic
predisposition to an uncommon drug response. An iatrogenic response occurs when a drug
causes symptoms of a disease.
5. A nurse is preparing to give an antibiotic to a patient who reports being allergic to antibiotics.
Before giving the medication, what will the nurse do first?
a. Ask whether the patient has taken this antibiotic for other infections.
b. Question the patient about allergies to other medications.
c. Request an order for a lower dose of the antibiotic.
d. Request an order for an antihistamine.
ANS: A
The nurse needs to assess whether the patient is truly allergic to this drug. Allergic reactions
require previous exposure to the drug, so the nurse should ask whether the patient has taken
this antibiotic before. If a patient is allergic to a drug, lowering the dose will not decrease the
risk of allergic reaction. Antihistamines sometimes are given when patients must take a drug
to which they are allergic.
6. A nurse is preparing to administer a drug. Upon reading the medication guide, the nurse notes
that the drug has been linked to symptoms of Parkinson disease in some patients. What will
the nurse do?
a. Ask the patient to report these symptoms, which are known to be teratogenic
effects.
b. Observe the patient closely for such symptoms and prepare to treat them if needed.
c. Request an order to evaluate the patient’s genetic predisposition to this effect.
d. Warn the patient about these effects and provide reassurance that this is expected.
ANS: B
A drug that causes disease-like symptoms is known to be iatrogenic. Nurses should be
prepared for this possibility and be prepared to withdraw the drug if necessary and treat the
symptoms. Such effects are not teratogenic. Patients with a genetic predisposition to respond
differently to drugs are known to have idiosyncratic effects. Iatrogenic effects, even when
known, are not typically expected side effects.
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