Karch's PrepU CH. 54 Drugs Acting on the Upper Respiratory Tract

A client has hypertension and wants to take a nasal decongestant for cold symptoms. Which statement by the nurse indicates the effect of hypertensive medications on hypertension? "The administration of a nasal decongestant will increase blood pressure due to vasoconstriction of blood vessels." "The administration of a nasal decongestant will cause bradycardia and increase peripheral blood pressure gastric reflux." "The administration of a nasal decongestant will decrease the thyroid pro

"The administration of a nasal decongestant will increase blood pressure due to vasoconstriction of blood vessels." Explanation: "The administration of nasal decongestants will increase blood pressure due to vasoconstriction of blood vessels" is indicative of good client teaching. Nasal decongestants do not cause bradycardia to increase blood pressure. The administration of nasal decongestants will not decrease thyroid production and increase blood pressure. The administration of a nasal decongestant does not act on the central nervous system.

A client asks the nurse about using dextromethorphan to relieve a cough. What type of cough would the nurse explain is best treated with the drug? An occasional, productive cough A cough that is associated with an allergy to ragweed A cough that occurs when the client is exposed to airborne irritants A dry, nonproductive cough

A dry, nonproductive cough Explanation: The major clinical indication for use of dextromethorphan is a dry, hacking, nonproductive cough that interferes with rest and sleep. It is not desirable to suppress a productive cough because the secretions need to be removed. The character, not cause, of the cough is relevant to its treatment with dextromethorphan.

What home remedies are effective for mouth dryness and cough? (Select all that apply.) Administration of over-the-counter antihistamine Adequate fluid intake Humidification of the environment Sucking on hard candy or throat lozenges Swishing the mouth with astringent mouthwash.

Adequate fluid intake Humidification of the environment Sucking on hard candy or throat lozenges Explanation: An adequate fluid intake, humidification of the environment, and sucking on hard candy or throat lozenges can help relieve mouth dryness and cough. The use of astringent mouthwash will only increase mouth dryness.

Acetylcysteine may be used as a mucolytic agent. What is an additional indication for the drug? Conversion of cardiac arrhythmias Treatment of peptic ulcer disease Antidote for acetaminophen poisoning Treatment of bronchospasm

Antidote for acetaminophen poisoning Explanation: Oral acetylcysteine is widely used in the treatment of acetaminophen overdosage.

A client is prescribed oxymetazoline. Which assessment data would indicate that the drug is effective? Breathing pattern is regular and without difficulty. Skin is effectively hydrated. Heart rate is maintained at a regular rate and rhythm. Urine output is at least 30 mL/hr.

Breathing pattern is regular and without difficulty. Explanation: A regular breathing pattern without difficulty would indicate that the drug is effective because oxymetazoline is a decongestant drug. Hydration of the skin, heart rate, and urine output are usually not affected by this drug.

A female client is diagnosed with type 2 diabetes mellitus, hyperlipidemia, and mild hepatic impairment. She presents to the emergency department after taking promethazine, obtained from a friend, for motion sickness. The nurse would expect what adverse effect? Hypotension Cholecystitis Cholestatic jaundice Abnormal hemoglobin

Cholestatic jaundice Explanation: Clients with hepatic impairment who take promethazine should be aware that cholestatic jaundice has been reported and the drug should be used with caution.

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? Depression of the cough center in the medulla oblongata Vasodilation of the alveolar capillaries Stimulation of the reticular activating system (RAS) Desensitization of the cough receptors in the sinuses and trachea

Depression of the cough center in the medulla oblongata Explanation: Antitussives such as codeine suppress cough by depressing the cough center in the medulla oblongata. They do not influence blood flow or desensitize peripheral cough receptors. The RAS is not involved in the cough reflex.

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 non-selectively binding to central and peripheral H1 receptors? Diphenhydramine Cetirizine Fexofenadine Loratadine

Diphenhydramine Explanation: Diphenhydramine is a first-generation antihistamine. First-generation antihistamines elicit their antihistamine effects by non-selectively binding to central and peripheral H1 receptors. Second-generation antihistamines, such as cetirizine, fexofenadine, and loratadine, elicit their effects by being selective for peripheral H1 receptors only.

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

Dry mouth Explanation: First-generation antihistamines have substantial anticholinergic effects; therefore, they may cause dry mouth, urinary retention, constipation, and blurred vision.

What is the chemical mediator released in immune and inflammatory response to allergic reactions? Norepinephrine Mast cells Epinephrine Histamine

Histamine Explanation: Histamine is the chemical mediator released in immune and inflammatory responses. Histamine is discharged from mast cells and basophils in response to certain stimuli (e.g., allergic reactions, cellular injury, extreme cold). This histamine is discharged by mast cells. Epinephrine is the drug of choice for treating severe anaphylaxis. Norepinephrine is a chemical released from the sympathetic nervous system in response to stress.

The nurse is providing education to a client diagnosed with the common cold. What measure should the nurse recommend implementing to help liquefy cold-related secretions? Reducing salt intake Deep breathing Gargling with normal saline Increasing fluid intake

Increasing fluid intake Explanation: Drinking plenty of water while taking guaifenesin may help loosen mucus in the lungs. Deep breathing, gargling with normal saline, and reducing salt intake do not necessarily help liquefy and mobilize secretions.

A client who has been suffering from repeated sinus infections is diagnosed with allergic rhinitis and prescribed a daily antihistamine. What is the mechanism of action in the antihistamine medications? It depletes norepinephrine and serotonin. It prevents histamine from acting on target tissues. It catalyzes the enzymatic oxidation of uric acid. It raises the seizure threshold by impairing vitamin D.

It prevents histamine from acting on target tissues. Explanation: Antihistamines prevent histamine from acting on target tissues. Antihypertensive agents deplete norepinephrine and serotonin. Antigout medications catalyze the enzymatic oxidation of uric acid. Antiseizure medications, such as primidone, impair vitamin D metabolism.

A client is prescribed oxymetazoline, a decongestant, for the treatment of hay fever. What should the nurse evaluate to assess the efficacy of therapy? Maintenance of effective hydration of the skin Maintenance of an effective heart rate Maintenance of effective airway clearance Maintenance of an effective urine output

Maintenance of effective airway clearance Explanation: Evaluation of the maintenance of effective airway clearance helps in assessing the efficacy of oxymetazoline, which is a decongestant drug. The hydration of the skin, the heart rate and the urine output are usually not changed in decongestant therapy.

Which agent would a nurse expect the health care provider to prescribe for a client experiencing motion sickness? Clemastine Meclizine Cyproheptadine Hydroxyzine

Meclizine Explanation: Meclizine is used to relieve the nausea and vomiting associated with motion sickness. Clemastine, cyproheptadine, and hydroxyzine are used to provide relief of seasonal and perennial allergic rhinitis.

A female client calls the pediatrician's office for a suggestion regarding the best over-the-counter cough and cold medicine for her 6-month-old child. The pediatrician advises against the medication for what reason? The medication is not effective for croup. Misuse could result in overdose. The medication is contraindicated for the child's symptoms. The medication is contraindicated for viral infections.

Misuse could result in overdose. Explanation: Several OTC cough and cold medicines for use in infants have been recalled voluntarily due to concerns about possible misuse that could result in overdoses.

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? Central nervous system depression Hypotension Nausea and vomiting Joint pain

Nausea and vomiting Explanation: Promethazine is most commonly used in the treatment of nausea and vomiting.

A client is questioning the use of eucalyptus as a decongestant. The nurse should point out that eucalyptus is contraindicated for which clients? Select all that apply. Pregnant females Children younger than 2 years Lactating females Postmenopausal females Men

Pregnant females Children younger than 2 years Lactating females Explanation: The use of eucalyptus is contraindicated during pregnancy and lactation, as well as in people who are hypersensitive to eucalyptus and in children younger than 2 years. Eucalyptus is generally considered safe for postmenopausal females and men.

Which agent would the nurse instruct a client to use orally? Pseudoephedrine Phenylephrine Tetrahydrozoline Xylometazoline

Pseudoephedrine Explanation: Pseudoephedrine is the only oral decongestant. Phenylephrine, tetrahydrozoline, and xylometazoline are topical decongestants.

When describing the effects of second-generation antihistamines, which would the nurse address as being decreased? Hypersensitivity Dry mouth Gastrointestinal upset Sedation

Sedation Explanation: The adverse effects most often seen with antihistamine use are drowsiness and sedation. However, second-generation antihistamines are less sedating in many people. The anticholinergic effects associated with both generations include drying of the respiratory and gastrointestinal mucous membranes, gastrointestinal upset and nausea, arrhythmias, dysuria, urinary hesitancy, and skin eruption and itching associated with dryness.

When the use of antihistamines result in dryness of the mouth, the nurse should recommend which to relieve the dryness? Select all that apply. Suck on sugarless hard candy. Administer intravenous fluid bolus. Offer ice chips. Take frequent sips of water. Use a dehumidifier in the home.

Suck on sugarless hard candy. Offer ice chips. Take frequent sips of water. Explanation: Offering the client frequent sips of water or ice chips, and suggesting use of sugarless gum or candy are appropriate suggestions to relieve dry mouth. An intravenous fluid bolus is invasive and not a first-line suggestion to relieve dryness. The client should run a humidifier, not a dehumidifier, to add moisture to the air at home and help relieve dryness.

The nursing instructor is discussing the use of nasal decongestants and shares what reason for their effectiveness? They are absorbed systemically. They treat multiple symptoms in a cost-effective manner. They come into direct contact with nasal mucosa. Their effects last for 48 to 72 hours.

They come into direct contact with nasal mucosa. Explanation: With nasal decongestants, topical preparations (i.e., nasal solutions or sprays) are often preferred for short-term use. They are rapidly effective because they come into direct contact with nasal mucosa.

When describing the action of decongestants, a nurse integrates knowledge of this class of drugs, identifying which mechanism? Vasoconstriction of small blood vessels of the nasal membranes Selectively binding to peripheral H1 receptors Non-selectively binding to central and peripheral H1 receptors Anesthetizing stretch receptors in the respiratory passages

Vasoconstriction of small blood vessels of the nasal membranes Explanation: Vasoconstriction of small blood vessels of the nasal membranes is the mechanism of action for decongestants. First-generation antihistamines act to non-selectively bind to peripheral H1 receptors; the mechanism of action for second-generation antihistamines is to selectively bind to peripheral H1 receptors only; and peripherally acting antitussives anesthetize stretch receptors in the respiratory passages.

Which condition would contraindicate the use of oxymetazoline? nasal congestion cough hypertension skin rash

hypertension Explanation: Oxymetazoline is contraindicated in clients with severe hypertension or coronary artery disease because of its cardiac stimulating and vasoconstricting effects. Oxymetazoline is prescribed for nasal congestion. Oxymetazoline is not contraindicated in cases that involve cough or skin rash.

A client has been prescribed a first-generation antihistamine. What adverse effects should the nurse describe during client teaching? Select all that apply. sense of euphoria urinary retention diarrhea blurred vision dry mouth

urinary retention blurred vision dry mouth Explanation: First-generation antihistamines have substantial anticholinergic effects (e.g., cause dry mouth, urinary retention, constipation, blurred vision). These drugs may cause central nervous system (CNS) stimulation (anxiety, agitation) with excessive doses, especially in children. Neither diarrhea nor euphoria is associated with first-generation antihistamine therapy.

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? "Drugs like this can often relieve some of the symptoms of a cold, but they won't cure it." "Most people find that cold medications are essentially ineffective." "It usually takes between 8 and 10 days for a decongestant to cure affect cold symptoms." "Som

"Drugs like this can often relieve some of the symptoms of a cold, but they won't cure it." Explanation: Most people experience some relief, but clients should be made aware that cold medications do not cure the common cold; they only relieve some symptoms. Over-the-counter (OTC) cold remedies should not be used longer than 1 week. Such medications do not inhibit healing by masking symptoms.

A male college student has presented to the campus medical clinic reporting cold symptoms that he has been experiencing for the past 2 weeks. He tells the nurse that he has been taking OTC decongestants twice daily since the onset of the cold. What teaching point should the nurse provide to this student? "It's best to take small doses of decongestants several times daily rather than two larger doses each day." "You can probably expect to get relief within the next few days or a week at t

"You might find yourself more congested than ever as your body compensates for your use of these drugs." Explanation: Frequent, long-term, or excessive use of decongestants induces rebound congestion. Rebound congestion occurs when the nasal passages become congested as the drug effect wears off and the body compensates by vasodilating the same nasal arterioles that the drug constricted. This does not occur because of the ineffectiveness of decongestants, however. Dosing should be based on the instructions provided.

A patient receives guaifenesin. The nurse would expect the drug to begin acting within which time frame? 30 minutes 15 minutes 45 minutes 60 minutes

30 minutes Explanation: Guaifenesin has an onset of action of 30 minutes.

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? Yes, but be sure to use a brand that mentions 'cold remedy' on the packaging. Yes, but it's important to monitor for adverse effects. Antihistamines can be helpful when they're combined with an antibiotic. Antihistamines are not recommended for treating a cold.

Antihistamines are not recommended for treating a cold. Explanation: Although antihistamines are popular over-the-counter drugs, studies have demonstrated that they are not successful or recommended for the treatment of the common cold. An antibiotic should not be prescribed for the treatment of the common cold, which is a viral disorder.

A nurse is preparing a presentation for a local elementary school parent group about over-the-counter cold medications and their use in children. Which would be most appropriate to include? (Select all that apply.) Avoidance of use in children under age 2 Importance of reading the label for ingredients and dosage Need to follow the directions for how often to give the drug Using household measuring devices for dosage measurements Using adult formulation with smaller doses

Avoidance of use in children under age 2 Importance of reading the label for ingredients and dosage Need to follow the directions for how often to give the drug Explanation: OTC cough and cold preparations should not be used in children under the age of 4 years. Accurate dosing is essential. Following the directions is essential to prevent inadvertent overdosage. Measuring devices that come with the medication should be used to ensure accurate dosages. Parents should look for the formula for children, infants, or pediatrics.

The nurse determines the appropriate nursing diagnosis for a client is Ineffective Airway Clearance. Which instructions will the nurse prioritize for this client? Select all that apply. Encouraging increased fluid intake Assisting the client in taking deep, diaphragmatic breaths Discouraging client movement Instructing the client to avoid coughing Encouraging the client to change positions

Encouraging increased fluid intake Assisting the client in taking deep, diaphragmatic breaths Encouraging the client to change positions Explanation: Clients should be encouraged to change positions frequently, breathe deeply, and increase fluid intake to aid in effectively clearing the airway of sputum. Coughing helps to move mucus. Discouraging movement and coughing will contribute to the collection of secretions and result in this diagnosis.

The nurse reviews the client's medical history before providing medications. Which antihistamine would the nurse question before providing a dose to the client? cetirizine azelastine fexofenadine diphenhydramine

diphenhydramine Explanation: Antihistamines block the release or action of histamine to reduce secretions and prevent airway constriction. Special care should be taken when some of the first-generation antihistamines are used by a client with a history of dysrhythmias. Diphenhydramine is a first-generation antihistamine and the nurse should question giving the medication to the client. Cetirizine, azelastine, and fexofenadine are all second-generation antihistamines and are not contraindicated for cardiac dysrhythmias.

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? "All drugs have the potential to cause an allergic reaction." "The additives that are in drugs can also cause allergic reactions." "Virtually any drug may induce an immunologic response in a susceptible person." "If you didn't have allergies as a child, you won't develop allergies later in life."

"If you didn't have allergies as a child, you won't develop allergies later in life." Explanation: Drug allergies can develop later in life, though many appear at a young age. All the other options contain accurate statements.

Which agent acts directly on the medullary cough center? Benzonatate Codeine Ephedrine Tetrahydrozoline

Codeine Explanation: Codeine, a centrally acting antitussive, works directly on the medullary cough center. Benzonatate provides local anesthetic action on the respiratory passages, lungs, and pleurae. Ephedrine and tetrahydrozoline are topical nasal decongestants.

A client having an allergic reaction to mold, describes chest tightness and difficulty breathing. Which process is occurring? Contraction of smooth muscle in the bronchi Suppression of the vagus nerve endings producing tachycardia Decreased permeability of the veins and capillaries Decreased secretion of the mucous glands

Contraction of smooth muscle in the bronchi Explanation: An allergic reaction produces contraction of the smooth muscle in the bronchi and bronchioles. The client will have stimulation, not suppression, of the vagus nerve endings. The client will have increased, not decreased, permeability of the veins and capillaries. The client will have increased secretion from the mucous glands, producing nasal congestion.

What are some advantages of using a second-generation antihistamine over a first-generation antihistamine? (Select all that apply.) Less sedation Fewer anticholinergic effects Less nausea Can be used during pregnancy Can be used during lactation

Less sedation Fewer anticholinergic effects Explanation: Second-generation antihistamines cause less sedation and fewer anticholinergic effects because they selectively bind to peripheral rather than central H1 receptors. Some first-generation antihistamines can be used as antiemetics. Use of any antihistamine is contraindicated during pregnancy and lactation.

A group of students demonstrate understanding of topical decongestants, identifying them as: Sympathomimetics Sympatholytics Parasympathomimetics Parasympatholytics

Sympathomimetics Explanation: Topical decongestants are sympathomimetics, imitating the effects of the sympathetic nervous system to cause vasoconstriction.

The nurse is planning care for a client who is experiencing excessive respiratory tract secretions. What intervention should the nurse include? deep breathing and coughing exercises administration of pseudoephedrine supplemental oxygen administration of guaifenesin

deep breathing and coughing exercises Explanation: With excessive respiratory tract secretions, mechanical measures (e.g., coughing, deep breathing, ambulation, chest physiotherapy, forcing fluids) are more likely to be effective than expectorant drug therapy. Research studies do not support guaifenesin's overall effectiveness, and many authorities do not recommend its use. Pseudoephedrine is not an expectorant, and supplemental oxygen will not loosen secretions.

A nurse caring for a client in the hospital is being discharged today with a prescription for benzonatate (Tessalon Perles) 200 mg one capsule 3 times daily. What would the nurse tell the client about this prescription during discharge counseling? (Select all that apply.) Benzonatate can cause GI upset and sedation. The client should drink plenty fluids. Benzonatate capsules should be sucked on like a lozenge. Consumption of alcohol is okay while taking benzonatate. Benzonatate can be take

Benzonatate can cause GI upset and sedation. The client should drink plenty fluids. Explanation: The adverse effects of benzonatate include sedation, headache, dizziness, constipation, nausea, GI upset, pruritus, and nasal congestion. It is recommended that patients with cough drink plenty of fluids (1500 to 2000 mL daily) unless fluids are contraindicate due to another disease state. Benzonatate should not be crushed or chewed due to a local anesthetic effect resulting in possible choking. Consumption of alcohol while taking benzonatate can increase CNS depression and increased sedation. The maximum daily dose of benzonatate is 600 mg daily.

Which client, acknowledging the regular use of pseudoephedrine, should be assessed further for the possible risk of contraindications to the use of this medication? a client with a history of breast cancer a client currently recovering from hip replacement surgery a client currently being treated for depression a client with an allergy to dairy products

a client currently being treated for depression Explanation: Clients who take tricyclic or monoamine oxidase inhibitor antidepressants should not receive pseudoephedrine. None of the other options presents a known contraindication to pseudoephedrine.

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? "I will not eat or drink for 30 minutes after taking a dose." "I will dilute the drug syrup with an equal amount of water." "If I raise mucous, I will stop taking the drug and call my prescriber." "The drug should only be taken as directed on the package."

"I will dilute the drug syrup with an equal amount of water." Explanation: The nurse needs to clarify the statement that the client made regarding diluting the drug with equal amount of water because this would decrease the soothing effect on pharyngeal mucosa. The other statements are correct. Eating or drinking decreases effectiveness of drug to soothe mucosa of the pharynx. The drug is only to be taken for nonproductive dry, hacking cough. If the cough becomes productive, the client should stop the drug and notify the prescriber. The drug should be taken only as directed on the package or by prescriber because exceeding the dosage can result in hallucinations.

A group of nursing students are reviewing information about expectorants. The students demonstrate understanding when they identify which medication as an example? Guaifenesin Acetylcysteine Dextromethorphan Benzonatate

Guaifenesin Explanation: Guaifenesin is an example of an expectorant. Acetylcysteine is a mucolytic. Dextromethorphan is an antitussive. Benzonatate is an antitussive.