NUR333 PrepU Ch. 54

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

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

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? Brompheniramine Promethazine Meclizine Loratadine

Loratadine Explanation: Loratadine is a second-generation antihistamine. Brompheniramine, promethazine, and meclizine are considered first-generation antihistamines.

After teaching a client who is receiving an antitussive about the drug, which statement indicates the need for additional teaching? "I'll get a humidifier for my bedroom." "I'll keep the room warm and toasty." "I can use some lozenges for comfort." "I need to increase the amount of fluids I drink."

"I'll keep the room warm and toasty." Measures to assist with cough control when using antitussives include cool temperatures, humidification, lozenges, and increased fluids.

The pharmacology instructor is discussing the adverse effects of diphenhydramine. Which is not one of these effects? Dry mouth Blurred vision Excessive salivation Drowsiness

Excessive salivation Adverse effects of first-generation antihistamines include urinary retention, drowsiness or sedation, dry mouth, blurred vision, and gastrointestinal distress.

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 likely contains what classification of drug? A nasal decongestant A benzodiazepine An antihistamine A narcotic analgesic

A nasal decongestant Explanation: "Nondrowsy" or "daytime" cold formulas typically contain a nasal decongestant but not an antihistamine. Such medications would contain neither a narcotic nor a benzodiazepine.

The nursing instructor is teaching about antitussives and their side effects. What ingredient found in some antitussives does the instructor tell students can cause drowsiness? eucalyptus antihistamine acetaminophen Advil

Antihistimine Antitussives that contain an antihistamine may cause drowsiness. The others are not found in antitussives and therefore do not cause the adverse reaction of drowsiness.

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.

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 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.

A gerontological nurse has encouraged a group of caregivers who work with older adults to avoid administering first-generation H1 receptor antagonists to their clients. The nurse's cautionary message is an acknowledgment of what possible nursing diagnosis? Risk for infection related to adverse effects of antihistamines Risk for falls related to sedation Risk for deficient fluid volume related to diuresis Risk for impaired skin integrity related to urticaria

Risk for falls related to sedation Explanation: First-generation antihistamines cause drowsiness and impaired cognition that can result in falls. These drugs are not known to cause diuresis, impaired skin integrity, or infection.

A male client presents to the health care provider's office for his annual visit. When questioned about over-the-counter medication use, he states that he uses echinacea to prevent colds. What statement is true about echinacea? He is healthier because he uses the echinacea. Echinacea is the OTC drug of choice for prevention of viral infections. To be effective, echinacea must be taken daily regardless of symptoms. There is limited or no support for the use of echinacea to prevent or treat symptoms of the common cold.

There is limited or no support for the use of echinacea to prevent or treat symptoms of the common cold. There is limited or no support for the use of dietary or herbal supplements to prevent or treat symptoms of the common cold.

Which nursing diagnosis would provide the clearest indication for the administration of inhaled acetylcysteine? ineffective airway clearance impaired tissue perfusion ineffective breathing pattern risk for infection

ineffective airway clearance Explanation: Acetylcysteine reduces the viscosity of mucous secretions with the ultimate goal of allowing the client to establish and maintain a clear airway. This drug does not directly influence the pattern of breathing. Impaired tissue perfusion can have multiple causes, many of which are unrelated to the presence of mucus secretions.

A client asks the nurse how long to use oxymetazoline (Afrin) nasal spray for nasal congestion. What is the nurse's best response? "Over-the-counter medications are safe for long-term use." "Consult with your primary care provider." "Afrin can be used as long as nasal burning and stinging do not occur." "Use the medication until your symptoms are completely relieved."

"Consult with your primary care provider." Overuse of topical nasal decongestants, such as Afrin, can make the symptoms worse, causing rebound congestion. The client should consult with the primary care provider. Not all over-the-counter medications are safe for long-term use. Afrin should not be used long term without nasal burning or stinging, or until symptoms are relieved. The primary care provider should be notified to provide medication use information.

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? "I will blow my nose before using the nasal spray." "I will rinse the spray tip off after each use." "I can take over-the-counter pseudoephedrine, too." "The drug is used no longer than 3 days."

"I can take over-the-counter pseudoephedrine, too." Explanation: The nurse needs to clarify the statement that the client made regarding taking pseudoephedrine PO in addition to the nasal spray the prescriber provided. The client has a history of hypertension and coronary artery disease, both contraindications for the adrenergic drug, pseudoephedrine. Pseudoephedrine would increase blood pressure, heart rate, and cause heart muscle irritability. Topical decongestants are chosen for clients with cardiovascular disease for this reason. The other statements are correct. Blowing the nose clears the passage, so the drug is more effective. The spray tip needs rinsed off after each use. The drug causes rebound congestion if used more often than recommended on the package or longer than 3 days.

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.

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.

A client, scheduled to receive one unit of packed red blood cells, has a history of an allergic reaction to a transfusion in the past. What class of medication will assist in preventing a reaction to the packed red blood cell transfusion? Antipyretics Antimicrobials Antianginals Antihistamines

Antihistamines Explanation: Premedication with an antihistamine may be used to prevent allergic reactions with the administration of a transfusion of packed red blood cells. The administration of antimicrobial or antianginal is not recommended for a transfusion reaction. An antipyretic is used to treat the symptom of fever.

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 taken more frequently than prescribed if needed.

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.

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.

A client has self-medicated with an over-the-counter (OTC) decongestant nasal spray for several weeks in order 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. Chronic epistaxis Anticholinergic effects Chronic nasal congestion Damage to the nasal mucosa Hepatotoxicity

Damage to the nasal mucosa Chronic nasal congestion Over-the-counter (OTC) cold remedies should not be used longer than 1 week. Do not use nose drops or sprays more often or longer than recommended. Excessive or prolonged use may damage nasal mucosa and produce chronic nasal congestion. These drugs are not associated with chronic epistaxis, anticholinergic effects, or hepatotoxicity.

A client comes to the clinic with what appears to be a cold. What group of upper respiratory drugs cause local vasoconstriction, which decreases blood flow and shrinks swollen membranes to improve air flow? Antitussives Decongestants Expectorants Mucolytics

Decongestants Decongestants cause local vasoconstriction that decrease blood flow to irritated and dilated capillaries of the mucous membranes lining the nasal passages and sinus cavities. The vasoconstriction leads to a shrinking of swollen membranes and opens clogged nasal passages promoting drainage of secretions and improved air flow. Antitussives either work directly on the medullary cough center of the brain or act as a local anesthetic on the respiratory passages blocking the effectiveness of the stretch receptors that stimulate a cough reflex. Expectorants liquefy the lower respiratory tract secretions, reducing the viscosity of the secretions and making it easier to cough them up. Mucolytics break down mucus to aid a person in coughing up thick tenacious secretions by separating cells that hold mucus material together.

When describing the benefits of second-generation H1 receptor antagonists to those of first-generation H1 receptor antagonists, the nurse should cite what advantage? Lower cost Decreased sedation Absence of adverse effects Once-weekly dosing

Decreased sedation Explanation: Unlike the first-generation H1 receptor antagonists, the second-generation H1 receptor antagonists do not readily enter the brain from the blood. This selectivity significantly reduces the occurrence of adverse drug reactions, such as drowsiness and sedation, while still providing effective relief of allergic conditions. Adverse effects are not wholly absent, however. Duration of action is 12 to 24 hours, and these drugs are more expensive than first-generation drugs.

Before administering a mucolytic drug to a client with an upper respiratory infection, which would the nurse need to assess? Degree of dyspnea Frequency of coughing Therapeutic effectiveness Evidence of productive cough

Degree of dyspnea Explanation: It is important for the nurse to document the degree of dyspnea as a preadministration assessment in a client who is prescribed a mucolytic drug for the treatment of an upper respiratory infection. Measuring the frequency of coughing and observing for therapeutic effect are ongoing assessments a nurse should perform in a client who is being administered antitussive drugs. Assessing for a productive cough should be completed before the nurse administers an antitussive drug.

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 female client presents at the clinic with a dry, nonproductive cough. The client is diagnosed with bronchitis, and it is determined that she will need help thinning sputum so that the cough can become productive. What does the nurse expect will be prescribed for the client? Codeine Guaifenesin Dextromethorphan Aspirin

Expectorants, such as guaifenesin, are agents given orally to liquefy respiratory secretions and allow for easier removal. Dextromethorphan and codeine are antitussives used to suppress coughing.

A male client presents to the health care provider's office with reports of inability to breathe freely. When the nurse reviews his use of over-the-counter medications, it is discovered that the client routinely uses nasal spray three times a day for 1 year. The nurse knows that what may be causing this client's continuous nasal congestion? Chronic nasal polyps Burning of the nares secondary to chronic use of nasal sprays Rebound nasal swelling Damage of the nasal concha

Rebound nasal swelling Rebound nasal swelling can occur with excessive or extended use of nasal sprays.