Unit 5.4: Adverse Drug Reactions and Medication Errors

• Topic 01

  Types of Adverse Drug Reactions

  42 questions
• Topic 02

  Drug Interactions and Contraindications

  53 questions
• Topic 03

  Anaphylaxis Recognition and Emergency Management

  48 questions
• Topic 04

  Medication Error Reporting

  46 questions

A few questions from this unit, with the answer and a full explanation. The complete bank is available when you start practising.

1. A male patient of Nigerian descent with a documented penicillin allergy is admitted with a complicated urinary tract infection. Blood tests show haemoglobin 142 g/L and normal renal function. The microbiologist recommends nitrofurantoin as a culture-guided therapy. Before administering the first dose, a nurse reviews the patient's record and notices a previous hospital note mentioning 'possible G6PD deficiency — not formally tested'. What is the MOST appropriate nursing action?

   • A
     Withhold the nitrofurantoin and contact the prescriber to request formal G6PD testing or an alternative antibiotic, as administering nitrofurantoin in a potentially G6PD-deficient patient risks severe haemolytic anaemia
     Correct answer
   • B
     Contact the pharmacist and ask whether a reduced nitrofurantoin dose is safe in suspected G6PD deficiency
   • C
     Administer the first dose and check the haemoglobin daily; haemolysis usually takes several days to develop, allowing time for monitoring
   • D
     Proceed with nitrofurantoin because the UTI is a clinical urgency that outweighs the theoretical G6PD risk in this patient
   Explanation

   Airborne Precautions are applied for organisms transmitted via droplet nuclei (<5 micrometres) that can remain suspended in air for extended periods and travel beyond 1 metre.

   Airborne Precautions require: negative pressure single room (air pressure lower than corridor, exhausted outside or HEPA-filtered), FFP3 respirator (fit-tested) for staff entering the room, patient to wear a surgical mask when outside the room, minimal patient movement. Airborne Precautions are required for: Mycobacterium tuberculosis (pulmonary/laryngeal TB), measles, varicella-zoster (chickenpox/shingles in non-immune individuals), and aerosol-generating procedures with SARS-CoV-2.

2. What is the primary reason intramuscular adrenaline is preferred over intravenous adrenaline for first-responding nurses?

   • A
     IV adrenaline is slower to act than IM in anaphylaxis because venous blood takes longer to reach the heart than muscle perfusion
   • B
     IV adrenaline has a significantly higher therapeutic dose requirement and is too expensive for routine emergency use
   • C
     IM adrenaline reaches the bloodstream faster than IV adrenaline because muscle tissue has a higher blood flow than venous blood
   • D
     IM adrenaline has a predictable safety profile and reliable absorption; IV adrenaline carries a high risk of fatal cardiac arrhythmia (ventricular fibrillation) without specialist training and continuous cardiac monitoring
     Correct answer
   Explanation

   Tuberculosis (TB) is caused by Mycobacterium tuberculosis and transmitted via airborne droplet nuclei expelled by individuals with pulmonary or laryngeal TB when they cough, sneeze, or speak.

   Airborne Precautions are required: negative pressure single room, FFP3 respirator for staff (fit-tested), minimise patient transport outside the room. TB is a notifiable disease; all suspected and confirmed cases must be reported to the local health protection team within 3 days of clinical diagnosis. Contact tracing and latent TB screening are organised by the health protection team in collaboration with the hospital TB team.

3. Who is eligible to submit a Yellow Card report?

   • A
     Only healthcare professionals who directly administered the drug causing the suspected ADR
   • B
     Only nurses who hold a nurse prescriber qualification
   • C
     Only registered pharmacists and pharmacy technicians
   • D
     Any healthcare professional, patient, carer, or parent/guardian on behalf of a child
     Correct answer
   Explanation

   The Yellow Card Scheme is open to anyone who suspects an adverse drug reaction: all healthcare professionals (nurses, doctors, pharmacists, dentists, allied health professionals), patients and carers, and members of the public.

   This broad eligibility, introduced in 2008 for patients/carers, was designed to capture the patient perspective on ADRs (particularly those that patients experience but may not report to their clinician). Healthcare professionals report via the Yellow Card website or app, while patients and carers can report via the same routes or via their GP/pharmacist.