Chapter 32 Prep U

The nurse is providing education to a client regarding the use of an over-the-counter (OTC) antihistamine. Which client statement demonstrates a need for additional teaching?

"When I feel a cold coming on, I know to take an antihistamine."

A client whose daily commute includes travel on a ferry boat has been prescribed diphenhydramine. During client teaching, the nurse should instruct the client to take the medication at what time?

30 to 60 minutes before the ferry trip

A client exhibiting signs and symptoms of the common cold asks the nurse if taking an antihistamine would be helpful. What is the nurse's best response?

Antihistamines are not recommended for treating a cold.

A client is in the clinic for seasonal allergic rhinitis. Loratadine (Claritin) is prescribed. Which statement will the nurse include when providing education concerning this drug?

"Determine if the drug is going to make you drowsy before you drive."

A client has begun taking an antihistamine for the treatment of seasonal allergies. What dietary guidelines should the nurse provide to the client?

Avoid drinking alcohol while taking antihistamines

The nursing instructor is describing the four types of hypersensitivity reactions. What alternate name might the instructor use to identify type IV hypersensitivity?

Delayed hypersensitivity

A male client presents to the emergency department with symptoms of a gastrointestinal bleed. The health care provider orders a blood transfusion. The client has a history of anaphylaxis. The provider orders the administration of what drug before the blood transfusion?

Diphenhydramine

The health care provider has ordered promethazine (Phenergan) for a client who is having a severe allergic reaction. The nurse is aware that this medication is also used to treat what condition?

Nausea and vomiting

Pseudoephedrine (Sudafed) is prescribed for a client suffering from nasal and sinus congestion. What is the most important assessment the nurse should complete before the client leaves the clinic to purchase the medication?

Obtain the client's blood pressure.

An older adult client is administered dimenhydrinate. Which is the priority nursing intervention for this client?

Protect from injury.

The nurse is teaching a group of clients with allergic rhinitis about the use of their medications. What would be the most essential information to give these clients about preventing possible drug interactions?

Read drug labels before taking OTC medications.

Combining first-generation antihistamines with sedating agents can result in what adverse effect?

Respiratory depression

What type of antihistamine is typically preferred for older adults?

Second-generation

When describing the effects of second-generation antihistamines, which would the nurse address as being decreased?

Sedation

A 15-year-old patient is prescribed an antihistamine for allergic rhinitis. However, antihistamines used to treat allergic reactions may themselves cause allergy. The nurse needs to educate the patient to be aware of symptoms suggesting allergy. Which of the following is an allergic reaction to antihistamines?

Skin rash and urticaria

A 62-year-old client has been prescribed an antihistamine to alleviate vasomotor rhinitis. The client reports gastric irritation after taking the tablet. Which instructions should the nurse provide to help alleviate the client's condition?

Take the tablet with food.

The nurse is providing medication education to the client who has been prescribed fexofenadine. What information will the nurse provide if the client expresses concern about medication induced drowsiness?

The medication does not cross the blood-brain barrier

Second-generation H1 antagonists cause less CNS depression because they are selective for peripheral H1 receptors and because of which other property?

They do not cross the blood-brain barrier.

What is one of the benefits related to second generation antihistamine administration in older adults?

They do not impair thinking.

A 41-year-old patient with an allergy to tree pollen and grasses plans to mow the lawn. When is the best time for the patient to self-administer fexofenadine?

Three hours before mowing the lawn

What medication should be prescribed to minimize the risk associated with a blood transfusion for a client with a history of a previous transfusion reaction?

diphenhydramine

A client administers diphenhydramine to their 9-year-old child, who experiences seasonal allergies, before a baseball game. What may the child experience if a paradoxical effect to the medication occurs?

excitation

The nursing instructor is explaining the four types of allergic reaction to the nursing students. The instructor explains that allergic rhinitis is a

type I hypersensitivity reaction.

The nurse is working with parents who are treating their child's cold and flu symptoms at home using over-the-counter (OTC) medications. What guidance should the nurse provide?

"Read the labels clearly to make sure you're not giving the same drug in two different preparations."

A nursing professor teaching sophomore students conducts a lecture regarding allergic food reactions. Which of the following statements made by the students verifies the lecture was effective? Select all that apply.

- "They usually are an immune response to the ingestion of a protein." - "Shellfish and eggs are examples of allergens that may have a high risk for anaphylaxis."

The term antihistamine generally indicates classic or traditional drugs. These drugs prevent or reduce most of the physiologic effects that histamine normally induces at H1 receptor sites. Which of the following are direct results of H1 antagonists? Choose all that apply.

- Inhibit smooth muscle constriction in blood vessels and the respiratory and GI tracts - Decrease capillary permeability - Decrease salivation and tear formation

Which systemic response of anaphylaxis may be successfully treated with antihistamine therapy? Select all that apply.

- appearance of hives on the trunk and neck - development of an itchy skin rash - watery nasal discharge

A 76-year-old client has been prescribed an oral antihistamine. What adverse effect presents a priority safety concern for older adult clients?

Drowsiness

Which statement accurately describes an aspect of serum sickness?

Is a delayed hypersensitivity reaction.

A client has an important presentation to make in 4 hours, and he needs relief from the congestion of seasonal rhinitis. The client calls the nurse, explains the situation, and tells the nurse that he cannot afford to be drowsy. What medication is most likely to meet this client's needs?

Loratadine

A group of students are reviewing information about antihistamines. The students demonstrate understanding of the information when they identify which agent as a second generation antihistamine?

Loratadine

A patient with vasomotor rhinitis has been prescribed an antihistamine. The patient is eager to know whether the prescribed antihistamine may cause excessive sedation. Which of the following antihistamines has very little sedative effect?

Loratadine

A client reports nasal congestion, sneezing, watery drainage from the nose, and itching of the throat, eyes, and ears. The nurse recognizes that these are consistent with what disorder?

allergic rhinitis

Which drug is commonly implicated in anaphylactic reactions? Select all that apply.

penicillin cisplatin aspirin

The nurse regularly assesses clients for risk of anaphylactic reaction to prescribed medications. The nurse is aware that such reactions most commonly occur with what type of medication?

penicillins

The nurse is providing instructions to a client who will be taking second-generation antihistamines at home. Which statement by the client indicates a need for further instruction?

"I will take this medication with apple juice."

The nurse is teaching a client about the potential for allergic drug reaction. What statement made by a client suggests a need for further teaching?

"If you didn't have allergies as a child, you won't develop allergies later in life."

A nursing professor is teaching a class on use of antihistamines in older adults. Which of the following statements made by students indicates an understanding of the lecture? Choose all that apply.

- "First-generation antihistamines may cause confusion." - "Sedation effects may be misinterpreted as senility or mental depression." - "Diphenhydramine is sometimes used as a sleep aid for older adults."

What are some advantages of using a second-generation antihistamine over a first-generation antihistamine? (Select all that apply.)

- Less sedation - Fewer anticholinergic effects

A nurse is describing the action of a prescribed antihistamine to a client. The nurse is describing which medication, by explaining that the drug elicits its antihistamine effects by nonselectively binding to central and peripheral H1 receptors?

Diphenhydramine

The health care provider has prescribed medication to prevent posttransfusion reaction in a client with a history of the disorder. Which medication would the nurse anticipate being administered?

Diphenhydramine

A female client is prescribed a first-generation antihistamine for her allergies. The nurse would expect her to experience what adverse effect?

Dry mouth

The pharmacology instructor is discussing the adverse effects of diphenhydramine. Which is not one of these effects?

Excessive salivation

Antihistamines are used frequently in the home care setting for the treatment of allergies. Which of the following is most likely to be a responsibility of the nurse caring for a patient who is taking antihistamines for this indication?

Helping the patient identify environmental allergens

What causes the inflammation of nasal mucosa that is seen in allergic rhinitis?

Type I hypersensitivity reaction to Inhaled allergens

A 20-year-old woman calls the clinic at 5 PM and reports to the nurse that she forgot to take her morning dose of fexofenadine (Allegra). She usually takes her evening dose at 8 PM. She wants to know what she should do. The nurse will instruct her to

forget about the morning dose and take the evening dose.

Antihistamines are not routinely used in the critically ill client population. Diphenhydramine, however, may be administered to a critically ill client for which reason?

prior to a blood transfusion.