The patient is to receive oral guaifenesin (Mucinex) twice a day.

Today, the nurse was busy and gave the medication 2 hours after the scheduled dose was due.
What type of problem does this represent?

Choice A rationale

Tolerance is a physiological adaptation to a drug, characterized by a decreased response to the same dose, or a need for increased doses to achieve the same effect. In this case, the increased dosage of morphine over several weeks indicates that the client's body has adapted to the drug's effects, requiring more to manage pain.

Choice B rationale

An adverse reaction is an undesirable and unintended effect of a drug, occurring at normal doses. While an increased dosage might lead to adverse effects, the described scenario specifically highlights the need for a higher dose to maintain efficacy, which is characteristic of tolerance, not simply an adverse reaction.

Choice C rationale

Idiosyncrasy refers to an unpredictable, uncharacteristic, or exaggerated response to a drug that is not an allergic reaction. It is typically a genetically determined abnormal response that occurs with initial exposure or after a few doses, unlike tolerance which develops over time with repeated exposure.

Choice D rationale

Polypharmacy refers to the concurrent use of multiple medications by a patient, often more than medically necessary. While the client is receiving medication, the scenario specifically describes a change in dosage of a single medication due to a diminished response, which is characteristic of tolerance, not polypharmacy.

Choice A rationale

Cranial nerve X, the vagus nerve, plays a crucial role in innervating the pharynx and larynx, influencing speech and swallowing. Observing the movement of the soft palate and uvula when the patient says "ahh" assesses the motor function of the vagus nerve, as its bilateral innervation is essential for the symmetrical elevation of these structures.

Choice B rationale

Having the patient stick out the tongue and observing for tremors or pulling to one side assesses the function of cranial nerve XII, the hypoglossal nerve. This nerve controls the intrinsic and extrinsic muscles of the tongue, and abnormalities can indicate nerve damage or neurological issues affecting tongue movement.

Choice C rationale

Using a wisp of cotton to brush over the eyelashes and observing for blinking assesses the corneal reflex, which involves both cranial nerve V (trigeminal, sensory) and cranial nerve VII (facial, motor). This test evaluates the integrity of the reflex arc rather than solely cranial nerve X.

Choice D rationale

With eyes closed, touching various areas on the face with a wisp of cotton and having the patient identify where touched assesses the sensory function of cranial nerve V, the trigeminal nerve. This nerve is responsible for transmitting touch, pain, and temperature sensations from the face.