CH 31 Drugs for Nasal Congestion and Cough (E2)
A client has expressed frustration stating, "I've been taking an over-the-counter (OTC) decongestant for several days and it still hasn't really cured my cold." What teaching point should the nurse convey to the client? A) "Drugs like this can often relieve some of the symptoms of a cold, but they won't cure it." B) "Most people find that cold medications are essentially ineffective." C) "It usually takes between 8 and 10 days for a decongestant to affect cold symptoms." D) "Sometimes a decongestant can mask the effects of your cold, essentially prolonging it."
A
A common mucolytic used to liquefy mucus in the respiratory tract is A) acetylcysteine B) ipratropium C) dextromethorphan D) pseudoephedrine
A
What assessment finding is suggestive of an overdose of dextromethorphan? A) hallucinations B) dysrhythmias C) Kussmaul's respirations D) profound diaphoresis
A
A nurse is teaching a client who has a new prescription for diphenhydramine for allergic rhinitis. The nurse should instruct the client to monitor for which of the following manifestations as an adverse effect of this medication? SELECT ALL THAT APPLY. A) Dry mouth B) Nonproductive cough C) Skin rash D) Drowsiness E) Urinary hesitation
A, D, E
A nurse is caring for a client who has been taking phenylephrine nasal drops for the past 10 days for sinusitis. The nurse should assess the client for which of the following manifestations as an adverse effect of this medication? A) Sedation B) Nasal congestion C) Productive cough D) Constipation
B
A nurse is teaching the family of a child who has cystic fibrosis and a new prescription for acetylcysteine. Which of the following information should the nurse include in the instructions? A) Expect this medication to suppress your child's cough. B) Expect this medication to smell like rotten eggs. C) Expect this medication to cause euphoria. D) Expect this medication to turn your child's urine orange.
B
A critically ill client with a diagnosis of ventilator-associated pneumonia has been administered acetylcysteine. The inhalation of acetylcysteine helps to liquefy secretions in the respiratory tract by what mechanism? A) increasing the osmolality of mucus B) decreasing the osmolality of mucus C) breaking the protein bonds that exist in mucus D) drawing increased amounts of water from interstitial spaces into mucus
C
A client has self-medicated with an over-the-counter (OTC) decongestant nasal spray for several weeks to help prevent "getting the common cold." The nurse should educate the client concerning the risk for which result of long-term use of OTC cold remedies? SELECT ALL THAT APPLY. A) chronic epistaxis B) anticholinergic effects C) chronic nasal congestion D) damage to the nasal mucosa E) hepatotoxicity
C, D
A 55-year-old client diagnosed with type 1 diabetes has begun to experience diabetic nephropathy over the past year. How will this client's current health status influence the possible use of pseudoephedrine in the treatment of cold symptoms? A) The client should monitor his or her blood glucose levels more frequently when taking pseudoephedrine. B) The use of pseudoephedrine is absolutely contraindicated by the fact that the client has diabetes and takes insulin. C) The client may require a higher-than-average dose of pseudoephedrine because of excess fluid volume secondary to renal failure. D) The client should use caution and will likely require a lower dose of pseudoephedrine because of his or her impaired renal function.
D
In caring for a patient with nasal congestion, the nurse knows that adrenergic drugs are used as nasal decongestants to relieve symptoms by A) constricting arterioles and reducing blood flow to nasal mucosa B) stimulating air movement in the lungs C) stabilizing mast cells D) initiating the cough reflex
A
The FDA pediatric safety labeling changes, warning against the use of prescription opioid cough and cold medicines in children younger than 18 years, are based on available data and expert opinion that supports which of the following statements? SELECT ALL THAT APPLY. A) A cough should not be suppressed unless it is causing clinical consequences, such as consecutive nights of poor sleep and/or vomiting, rib fractures, or hypoxia. B) The safety labeling changes should protect children from unnecessary exposure to opioids. C) The risks for prescription opioid cough products typically outweigh the potential benefits in children of all ages. D) Addiction or abuse potential is a concern regarding the use of hydrocodone or codeine in children.
A, B, C, D
What medication will be administered to counteract the effect of the acetaminophen? A) oxymetazoline hydrochloride B) acetylcysteine C) daptomycin D) darbepoetin alfa
B
Which of the following herbal preparations appears to play a role in the defense mechanisms of the respiratory system in adults? A) echinacea B) vitamin C C) zinc gluconate D) valerian
B
The nurse prepares to administer acetylcysteine by nebulization to an adult client diagnosed with chronic bronchitis. Which measures would the nurse provide for safe and effective drug administration? SELECT ALL THAT APPLY. A) Instruct client that the drug irritates gastric vagal receptors to stimulate respiratory tract fluid. B) Administer prescribed bronchodilator aerosolized treatment 10 to 15 minutes before the acetylcysteine treatment. C) Provide drug after meals and before bedtime to remove mucous, which causes difficulties in breathing. D) Assess for improvement in coughing up increased amounts of mucous, respirations less than 26, and SaO2 greater than 90%. E) Report dyspnea, chest tightness, bronchospasms, and inability to expel secretions to the prescriber.
B, D, E
As the nurse caring for a patient with nasal congestion who is using the OTC decongestant oxymetazoline, the nurse counsels the patient that this medication should be used only for the time recommended on the package and no longer because excessive use may produce A) copious lower respiratory tract secretions B) ringing in the ears C) rebound nasal congestion D) a suppressed cough reflex
C
The nurse is educating an adult client diagnosed with rhinosinusitis with viscous clear mucous about the prescribed guaifenesin 400 mg PO every 4 hours. Which statement made by the client establishes the need for further clarification? A) "I will ask my pharmacist before taking any over-the-counters." B) "I will drink at least 8 ounces of water with each dose." C) "The drug will suppress my cough so I can sleep easier." D) "The drug is not affected by taking it with or without meals."
C
The nurse is educating an older adult client diagnosed with rhinosinusitis in an outpatient clinic about the prescribed topical oxymetazoline. The client has a history of hypertension and coronary artery disease. Which statement made by the client establishes the need for further clarification? A) "I will blow my nose before using the nasal spray." B) "I will rinse the spray tip off after each use." C) "I can take over-the-counter pseudoephedrine, too." D) "The drug is used no longer than 3 days."
C
Which condition would contraindicate the use of oral oxymetazoline? A) nasal congestion B) cough C) hypertension D) skin rash
C
Which type of microorganism causes the common cold? A) gram-positive bacteria B) gram-negative bacteria C) virus D) fungus
C
Which medication when taken concurrently can dangerously increase the effects of pseudoephedrine? A) anti-infective agents B) anti-inflammatory agents CD) proton pump inhibitors (PIIs) D) thyroid preparations
D
A client prescribed codeine for a persistent, debilitating cough tells the nurse, "I was sure that codeine was a narcotic that people take for pain." The nurse should cite what mechanism of action when describing this use of codeine? A) depression of the cough center in the medulla oblongata B) vasodilation of the alveolar capillaries C) stimulation of the reticular activating system (RAS) D) desensitization of the cough receptors in the sinuses and trachea
A
What preventive measure is most important to teach parents concerning the prevention of the common cold? A) frequent handwashing B) maintaining vaccinations C) taking 1200 mg of vitamin C D) taking Echinacea daily
A
Cold remedies listed as "nondrowsy" or labeled as "daytime" formulas do not contain A) a nasal decongestant B) a first-generation antihistamine C) a pain reliever D) any of the above
B
A client has purchased an over-the-counter (OTC) cold remedy that advertises a "nondrowsy" formulation. The nurse explains to the client that such a medication is likely what classification of drug? A) a nasal decongestant B) a benzodiazepine C) an antihistamine D) a narcotic analgesic
A
An older client diagnosed with hypertension is requesting a oral nasal decongestant for cold symptoms. Which statement by the nurse best describes the effect of decongestants on blood pressure? A) "The administration of a nasal decongestant will increase blood pressure due to vasoconstriction of blood vessels." B) "The administration of a nasal decongestant will cause bradycardia and increase gastric reflux." C) "The administration of a nasal decongestant will decrease the thyroid production and increase rebound congestion." D) "The administration of nasal decongestant will act on the central nervous system to cause vasodilation of blood vessels."
A
In providing client education, which statement provides the most effective teaching regarding the use of dextromethorphan in children? A) Dextromethorphan suppresses cough in children. B) Dextromethorphan is ineffective in children. C) Dextromethorphan must be combined with codeine. D) Dextromethorphan raises blood pressure in children.
B
The nurse is educating an adult client diagnosed with a nonproductive cough about the prescribed dextromethorphan. Which statement made by the client establishes the need for further clarification? A) "I will not eat or drink for 30 minutes after taking a dose." B) "I will dilute the drug syrup with an equal amount of water." C) "If I raise mucous, I will stop taking the drug and call my prescriber." D) "The drug should only be taken as directed on the package."
B
The use of pseudoephedrine would most likely be contraindicated in which client? A) a woman who is breast-feeding B) a man with a history of severe hypertension C) a man who has diagnoses of chronic obstructive pulmonary disease (COPD) D) a woman who has myasthenia gravis (MS)
B
What information should the nurse provide a mother of a 3-year-old concerning the safety and efficacy of over-the-counter (OTC) cough and cold products containing pseudoephedrine for young children? A) Cough and cold remedies are generally safe and effective for children over the age of 2. B) There are concerns among health professionals about how safe and effective these medications are. C) Media reports about the risks of cough and cold medications in children have greatly exaggerated the fear of risks. D) Risk can be minimized by using age-specific preparations of cough and cold remedies.
B
An adult client has asked the nurse to recommend an OTC cold remedy. Before making a recommendation, the nurse should implement which intervention? A) Consult with a pharmacist or pharmacy technician. B) Assess the client's understanding of the epidemiology of the common cold and upper respiratory infections. C) Assess the client for health problems that may contraindicate the use of a particular remedy. D) Ensure that the client has tried some of the more common herbal and natural remedies.
C
A client is prescribed an antitussive agent with codeine. Which statement by the client indicates that the nurse's teaching has been effective? A) "I will take this medication whenever I am coughing." B) "This medication may make me anxious and nervous." C) "I will call my health care provider if I develop diarrhea when I take it." D) "This medication will cause drowsiness, and I will not drive."
D
To help liquefy cold-related secretions, the nurse should encourage the client to implement which measure? A) reducing salt intake B) deep breathing and exercises C) gargling with normal saline D) increasing fluid intake
D
What type of cough is best treated with dextromethorphan? A) an occasional, productive cough B) a cough that is associated with an allergy to ragweed C) a cough that occurs when the client is exposed to airborne irritants D) a dry, nonproductive cough
D
