(Pharm/Jacques) Chapter 54: Drugs Acting on the Upper Respiratory Tract

A client, recovering from a cold and now experiencing a hacking cough, asks if taking an antihistamine would be helpful. What response demonstrates the nurse's understanding of the effective use of antihistamines? Select all that apply.

"Antihistamines are not recommended because they tend to worsen your cough." "Antihistamines are used for allergy-related coughs." Explanation: Antihistamines are clearly useful in allergic conditions (e.g., allergic rhinitis), but their use to relieve cold symptoms is controversial. Although antihistamines are popular over-the-counter drugs because they dry nasal secretions, they are not recommended because they can also dry lower respiratory secretions and worsen secretion retention and cough. Antibiotics are not recommended for the treatment of a cold. The remaining options do not present with accurate statements.

A client asks the nurse how long to use oxymetazoline (Afrin) nasal spray for nasal congestion. What is the nurse's best response?

"Consult with your primary care provider." Explanation: 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.

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." 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 client diagnosed with the common cold asks the nurse about taking an over-the-counter (OTC) cold medications. What statement should the nurse include in client teaching?

"Follow the instructions on the label so that you don't end up making the congestion worse." Explanation: When taken according to their instructions, OTC medications can often be as safe and effective as prescribed medications and are sometimes suggested by the primary health care prescriber. However, clients should be informed that excessive or prolonged use may damage nasal mucosa and produce chronic nasal congestion. Over-the-counter (OTC) cold remedies should not be used longer than 1 week, and clients should be instructed not to use nose drops or sprays more often or longer than recommended on the label. While OTC medications may be cheaper in some cases, they will not cause more side effects. The length of the therapy is dependent on many factors, including the type and dose of the medication.

An older adult client has reported "seeing things that aren't there" after starting to take over-the-counter dextromethorphan for a nonproductive cough associated with a cold. What assessment question will provide the most relevant information regarding the possible cause of this adverse effect?

"How much dextromethorphan have you been taking each day?" Explanation: At normal doses, dextromethorphan is known to cause nausea, drowsiness, rash, and difficulty breathing but doses exceeding recommendations can produce hallucinations and disassociation. The question concerning dosage is the most relevant regarding the cause of hallucinations.

Which statement by the client would alert the nurse that more education is needed regarding a client receiving an antitussive?

"I should keep the room warm." Explanation: Increased fluids are important to maintain hydration, thin secretions, and keep the mucous membranes moist. Humidification is helpful in relieving cough. Cool temperatures help to reduce coughing, keeping the room warm may cause more coughing. Lozenges are comforting to an irritated throat from a cough.

After teaching a client who is receiving an antitussive about the drug, which statement indicates the need for additional teaching?

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

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." Explanation: Drug allergies can develop later in life, though many appear at a young age. All the other options contain accurate statements.

A client is receiving dornase alfa at home. Which would the nurse instruct the client to do?

"Protect the drug from light." Explanation: Clients receiving dornase alfa should be cautioned to store the drug in the refrigerator, protected from light. The nurse also needs to review how to administer the drug using a nebulizer.

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." 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.

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?

"The drug will suppress my cough so I can sleep easier." Explanation: The nurse needs to clarify the statement that the client made regarding that the drug suppresses a cough. The drug liquefies respiratory secretions, so it is easier for the client to expectorate or cough the mucous out of the respiratory tract. The other statements are correct. The client needs to ask a pharmacist before using any over-the-counter preparation to prevent drug interactions, or overdosing drug ingredients that are the same or similar. Drinking adequate amounts of water will help loosen the mucous making it easier to expectorate. The drug absorption is not affected by food intake, so it may be taken with or without meals.

After teaching a group of parents about the use of over-the-counter cough and cold products with their children, which statement indicates the need for additional teaching?

"We can use the adult brand, but we just have to decrease the amount." Explanation: Parents should use the children's, pediatric, or infant formulations of the drug. Over-the-counter cough and cold preparations should not be used in children under the age of 2 years. The parents need to read the label carefully to determine the dosage and frequency, and they need to use the device that comes with the drug to ensure a proper dosage.

The health care provider suggests that a client use guaifenesin to help his cough. The nurse instructs the client to call the health care provider if he continues to have a productive cough after which amount of time?

1 week Explanation: Guaifenesin should not be used for more than 1 week; if the cough persists, encourage the client to seek health care.

A patient receives dextromethorphan. The nurse would expect this drug to begin acting within which time frame?

25 to 30 minutes Explanation: Dextromethorphan has an onset of action of 25 to 30 minutes.

A patient receives guaifenesin. The nurse would expect the drug to begin acting within which time frame?

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

What home remedies are effective for mouth dryness and cough? (Select all that apply.)

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.

When developing the teaching plan for a client receiving an antihistamine, which would the nurse include? (Select all that apply.)

Advising the client to avoid alcohol consumption Using sugarless candies or lozenges to combat dry mouth Explanation: When taking an antihistamine, the nurse needs to inform the client to take the drug on an empty stomach, 1 hour before or 2 hours after meals, use sugarless candies to combat dry mouth, to read the labels of OTC medications because they may contain the same ingredient or alcohol, which could increase the risk of adverse effects or toxicity, and to avoid alcohol intake to prevent excess CNS effects.

A client is prescribed an antihistamine. The nurse determines that the drug would be contraindicated if the client had which condition? Select all that apply.

Angle-closure glaucoma Cardiovascular shock Explanation: Angle-closure glaucoma is a contraindication for use of antihistamines. The medication is also contraindicated in cardiovascular shock. Antihistamines may be used in clients who have allergic conjunctivitis, nausea, and vomiting and as an adjunct in clients with anaphylactic shock.

Acetylcysteine may be used as a mucolytic agent. What is an additional indication for the drug?

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

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. 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 client is taking pseudoephedrine. The nurse would assess the client for which adverse effect?

Anxiety Explanation: Adverse effects related to the sympathomimetic effects of pseudoephedrine are more likely to occur, including feelings of anxiety, restlessness, hypertension, sweating, tenseness, tremors, arrhythmias, and pallor.

An adult client has asked the nurse to recommend an OTC cold remedy. Before making a recommendation, the nurse should implement which intervention?

Assess the client for health problems that may contraindicate the use of a particular remedy. Explanation: While it is not necessary to consult with a pharmacist or pharmacy technician before recommending a particular product, the nurse needs to assess the intended recipient for conditions or other medications that contraindicate the product's use. Herbal options do not need to precede pharmaceuticals. The client's understanding of the epidemiology of the common cold is not a high priority.

A client is experiencing allergy symptoms after being exposed to environmental dust. This reaction involves the action of histamine, which is released by what cells?

Basophils Explanation: Histamine is discharged from mast cells and basophils in response to certain stimuli, such as allergic reactions, cellular injury, and extreme cold. Lymphocytes and platelets do not release histamine. CD4 cells (often called T cells or T-helper cells) are a type of white blood cells that play a major role in protecting the body from infection.

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. 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.

The nurse is assessing a client who is taking diphenhydramine for relief of seasonal allergies. Which finding should prompt the nurse to suspect that the resident is experiencing an anticholinergic effect of the medication?

Blurry vision Explanation: Anticholinergic effects are produced by the inhibition of cholinergic neurotransmission at muscarinic receptor sites. First-generation H1 receptor antagonists are associated with anticholinergic effects such as dry mouth, urinary retention, constipation, and blurred vision. Wheezing, urticaria, and tinnitus are not anticholinergic effects since they are not related to the cholinergic neurotransmission at muscarinic receptor sites.

A client is prescribed oxymetazoline. Which assessment data would indicate that the drug is effective?

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.

When instructing a client in how to use a topical nasal spray, what would the nurse emphasize to do first?

Clear the nasal passages. Explanation: Before administering the nasal spray, it would be important to clear the nasal passages to ensure that the medication reaches its intended target thereby promoting effectiveness.

Which of the following would a nurse identify as a first generation antihistamine? Select all that apply.

Clemastine Dimenhydrinate Explanation: First generation antihistamines include clemastine and dimenhydrinate.

Which agent acts directly on the medullary cough center?

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.

When describing the benefits of second-generation H1 receptor antagonists to those of first-generation H1 receptor antagonists, the nurse should cite what advantage?

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.

A client calls the clinic and reports symptoms of a cold. The client is most concerned because the cold symptoms are preventing him from sleeping. The nurse would inform the client that what medication relieves cold symptoms and aids sleep?

Diphenhydramine Explanation: Antihistamines are clearly useful in allergic conditions, but their use to relieve cold symptoms is controversial. First-generation antihistamines (e.g., chlorpheniramine, diphenhydramine) have anticholinergic effects that may reduce sneezing, rhinorrhea, and cough. Also, their sedative effects may aid sleep. Many multi-ingredient cold remedies contain an antihistamine.

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 Explanation: Diphenhydramine is a first-generation antihistamine. First-generation antihistamines elicit their antihistamine effects by nonselectively 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.

An adult client has reported experiencing a dry mouth and urinary retention after several nights of taking an over-the-counter (OTC) sleep aid. The nurse should suspect that this medication contains what antihistamine?

Diphenhydramine Explanation: The active ingredient in OTC sleep aids is a sedating antihistamine, usually diphenhydramine. This medication may create substantial anticholinergic effects (e.g., dry mouth, urinary retention, constipation, blurred vision). None of the other medications have such an anticholinergic effect.

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

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

The nurse is teaching a community group about prevention measures to protect against the common cold. Which preventive measure is most important to teach?

Frequent handwashing Explanation: Because of the way cold viruses are spread, frequent and thorough hand hygiene is the most important protective and preventive measure. There is no vaccine against the common cold. Neither the ingestion of vitamin C nor of Echinacea has been proven to be the most effective preventive measure for the common cold.

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

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

What is the chemical mediator released in immune and inflammatory response to allergic reactions?

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.

Mr. Zee is prescribed an inhaled nasal steroid to relieve his symptoms associated with seasonal allergies. What is true about inhaled nasal steroids?

Inhaled nasal steroids are more effective than oral medications in treating the global symptoms associated with allergies. Explanation: Inhaled nasal steroidal preparations are used to treat seasonal or perennial allergic rhinitis. In fact, studies indicate that they are superior to oral antihistamines for alleviating nasal, eye, and global allergy symptoms. Common adverse effects of inhaled nasal steroids include a burning or itching sensation and a drying effect on the nasal mucosa. By delivering steroids directly to the nasal passage, inhaled nasal steroids maximize the beneficial therapeutic effects of corticosteroids while minimizing their potential systemic adverse effects, although systemic adverse effects may still occur during long-term or high-dose therapy.

Acetylcysteine is primarily administered by which route when being used to thin secretion? (Select all that apply.)

Instilled into a tracheostomy Inhalation Explanation: While acetylcysteine can be administered orally in the treatment of acetaminophen overdose, it is primarily given by nebulizer or instilled into tracheostomy to thin secretions.

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

A client reports increased sedation after the initiation of chlorpheniramine to treat her allergies. Which antihistamines could the nurse recommend to the client to treat her allergy symptoms that would result in less sedation? (Select all that apply.)

Loratadine (Claritin) Cetirizine (Zyrtec) Explanation: Loratadine and cetirizine are second-generation antihistamines, which can be less sedating than first-generation antihistamines like chlorpheniramine, diphenhydramine, and clemastine. Phenylephrine is a decongestant used to treat nasal congestion.

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

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?

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.

Which would contraindicate the use of a topical nasal decongestant?

Nasal ulceration Explanation: Any lesion or erosion in the mucous membranes is a contraindication because of the increased risk for systemic drug absorption. Topical nasal decongestants should be used cautiously in patients with hypertension. Topical nasal decongestants should be used cautiously in patients with diabetes. Topical nasal decongestants should be used cautiously in patients with glaucoma.

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

Codeine containing antitussives should be used cautiously in clients with which conditions? (Select all that apply.)

Pregnancy Convulsive disorders Prostatic hypertrophy Explanation: Codeine-containing antitussives should be used cautiously during pregnancy, labor, COPD, acute asthma attack, preexisting respiratory disorders, acute abdominal conditions, head injury, increased intracranial pressure, convulsive disorders, hepatic or renal impairment, and prostatic hypertrophy.

A client reports anxiety, restlessness, nausea, and vomiting after using a nasal decongestant. Which drug should the nurse consider as the cause for these side effects?

Pseudoephedrine Explanation: The side effects of pseudoephedrine include anxiety, restlessness, nausea and vomiting. The drugs ephedrine, epinephrine, and phenylephrine do not cause these side effects. Their side effects include nasal burning, stinging, dryness, and a rebound nasal congestion.

What is an adverse reaction commonly experienced by people taking nasal decongestants?

Rebound congestion Explanation: An adverse effect that accompanies frequent or prolonged use of these drugs is a rebound congestion, officially called rhinitis medicamentosa.

The instructor is discussing adverse effects associated with nasal decongestants. What is an effect of excessive use of these products when administered correctly?

Rebound nasal congestion Explanation: Rebound nasal congestion, chronic rhinitis, and ulceration of nasal mucosa are possible adverse effects of long-term or excessive use of nasal decongestants. They do not cause diarrhea or rash. If administered properly they will not cause headache, however, if forceful administration causes the medication to enter the sinuses this can result in a headache.

A male client is diagnosed with chronic bronchitis. What would the nurse expect to be one of his physical reports?

Retention of secretions Explanation: Retention of secretions commonly occurs with influenza, pneumonia, upper respiratory infections, acute and chronic bronchitis, emphysema, and acute attacks of asthma.

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 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 group of students demonstrate understanding of topical decongestants, identifying them as:

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

After teaching a group of students about topical nasal steroid decongestants, the instructor determines the need for additional teaching when the students identify which as an example?

Tetrahydrozoline Explanation: Tetrahydrozoline is a topical nasal decongestant, not a topical nasal steroid decongestant.

A client informs the nurse about taking pseudoephedrine for the relief of nasal congestion due to the common cold. In which situation should the nurse suggest that the client not use this medication since it is a contraindication for this health care concern?

The client is being treated for severe hypertension. Explanation: Contraindications to pseudoephedrine use include severe hypertension or coronary artery disease because of the drug's cardiac stimulating and vasoconstricting effects. Cataracts are not a contraindication for use, but narrow-angle glaucoma is. Caution should be used in clients with hyperthyroidism, not hypothyroidism. The duration of the cold symptoms does not have any relevance to the use of pseudoephedrine.

The nursing instructor is discussing the use of nasal decongestants and shares what reason for their effectiveness?

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.

Expectorants elicit their effect by which mechanism?

Thinning respiratory secretions Explanation: Thinning respiratory secretions is the mechanism of action for expectorants. Breaking down thick mucus in the lower lungs is the mechanism of action of mucolytics. Depressing the cough center in the brain is the mechanism of action for centrally acting antitussives. Anesthetizing stretch receptors in the respiratory passages is the mechanism of action for peripherally acting antitussives.

A 21-year-old patient reports a mild stinging sensation on using a nasal spray containing a nasal decongestant. Which information should the nurse provide the patient?

This sensation usually disappears with continued use. Explanation: The nurse needs to assure the patient that the mild stinging sensation usually disappears with continued use. The drug needs to be stopped only if the stinging sensation is severe. The dose of the medication need not be altered. The physician need not be consulted immediately in the presence of a mild stinging sensation.

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 Explanation: Vasoconstriction of small blood vessels of the nasal membranes is the mechanism of action for decongestants. First-generation antihistamines act to nonselectively 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.

While providing a medication history, the client reports taking a nebulized drug to liquefy respiratory secretions but cannot recall the name. The nurse suspects the client is taking which medication? prednisone guaifenesin acetylcysteine pseudoephedrine

acetylcysteine Explanation: Mucolytics, like acetylcysteine, are administered by inhalation to liquefy mucus in the respiratory tract. Solutions of mucolytic drugs may be nebulized into a face mask or mouthpiece or instilled directly into the respiratory tract through a tracheostomy. Sodium chloride solution and acetylcysteine are the only agents recommended for use as mucolytics. Guaifenesin is an expectorant. Pseudoephedrine is a nasal decongestant. Prednisone is a synthetic corticosteroid drug that is particularly effective as an immunosuppressant drug. It is used to treat certain inflammatory diseases.

A client reports to the nurse, "My head is stuffed up and I can't breathe through my nose." Nasal discharge is noted upon examination. The client is diagnosed with a common cold. The nurse should prepare to provide medication instructions related to what classification of medication directed at the client's nasal mucosa?

decongestant Explanation: Nasal decongestants relieve nasal congestion and swelling by constricting arterioles and reducing blood flow to nasal mucosa. Antihistamines refer to a type of medication that treats allergy symptoms. The goal of antitussive therapy is to suppress nonpurposeful coughing. Expectorants are agents given orally to liquefy respiratory secretions and allow for their easier removal.

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 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.

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 Explanation: A client who is having a blood transfusion or a diagnostic test may receive diphenhydramine, often by injection and usually as a single dose, to prevent allergic reactions. Epinephrine is the drug of choice for treating severe anaphylaxis once it has occurred. Clemastine is prescribed for allergic rhinitis and urticaria. Cetirizine is prescribed for the management of seasonal allergies.

Which condition would contraindicate the use of oxymetazoline?

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 who is unsure whether symptoms are attributable to a cold or to allergies is taking pseudoephedrine as well as an antihistamine. This combination of drugs creates a risk for what adverse effect?

hypertension Explanation: The combination of antihistamines and pseudoephedrine increase the risk of hypertension due to vasoconstriction. This combination does not result in respiratory depression or damage to the liver or kidneys.

Which nursing diagnosis would provide the clearest indication for the administration of inhaled acetylcysteine?

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 has been prescribed a first-generation antihistamine. What adverse effects should the nurse describe during client teaching? Select all that apply.

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 is currently taking pseudoephedrine to help manage the nasal congestion resulting from seasonal allergies. When the client reports being extremely restless and having difficulty getting to sleep at night, what assessment question will the nurse ask to best provide interventions to minimize those effects?

"How much coffee, tea, and soda do you drink daily?" Explanation: Caffeine can enhance the adverse effects of pseudoephedrine. The client's coffee, tea, and soda consumption would tend to increase the client's risk for insomnia and restlessness. None of the other options are known to have this effect on those taking the decongestant.

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 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 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 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.

The nurse is providing education for a client who has been prescribed a second-generation antihistamine. Which client statement suggests a need for additional teaching?

"I'm really hoping that these pills will cure my allergies before summer starts." Explanation: Antihistamines mitigate the signs and symptoms of allergies, but they do not cure the problem. Second-generation antihistamines are more expensive than earlier drugs. It is prudent to screen for potential interactions with herbal remedies. Because second-generation drugs do not cause sedation, they may generally be taken at any time.

The nurse is discussing the use of pseudoephedrine with parents of children of various ages. What statement made by a parent demonstrates an understanding of the safe administration of a decongestant?

"Only my children who are 12 years of age or older can be given the extended-release form of pseudoephedrine." Explanation: The extended-release tablets of pseudoephedrine should not be administered to children younger than 12 years of age. Overall, pseudoephedrine appears to be effective in children older than 4 years of age, but the Food and Drug Administration (FDA) does not recommend OTC use of the drug in this age group due to the risk of serious and life-threatening adverse effects, including seizures, decreased level of consciousness, tachycardia, and death. This information makes all the other options incorrect.

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?

"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 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?

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.

A client is admitted after overdose with acetaminophen. What medication would the nurse expect to be administered?

Acetylcysteine Explanation: Acetylcysteine is effective in the treatment of acetaminophen overdose. Oxymetazoline hydrochloride is used for nasal congestion, not acetaminophen overdose. Daptomycin is an antibiotic that fights bacteria in the body and used to treat bacterial infections of the skin and underlying tissues. Darbepoetin alfa injection causes the bone marrow to produce red blood cells.

A client asks, "What is the difference between antitussive medications and expectorants?" What information should the nurse's response be based upon?

Antitussives suppress coughing while expectorants loosen bronchial secretions. Explanation: Antitussive agents suppress cough by depressing the cough center in the medulla oblongata or the cough receptors in the throat, trachea, or lungs. Expectorants are agents given orally to liquefy respiratory secretions and allow for their easier removal.

A nurse is caring for a patient who has been prescribed a nasal decongestant. Which of the following factors should the nurse assess before administering the drug?

Blood pressure Explanation: As a pre-administration assessment before giving a nasal decongestant, the nurse should assess the patient's blood pressure, pulse, and respiratory rates. Assessments for disturbed coordination, blurred vision, or auditory tests may be done as an ongoing assessment to check for signs of adverse effects.

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 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 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?

Decongestants Explanation: 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.

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 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 45-year-old female client is being seen in the health care provider's office for a dry, hacking cough that is keeping her up at night. The provider prescribes dextromethorphan for the cough. Which statement is true about dextromethorphan?

Dextromethorphan works in the medulla to suppress the cough reflex. Explanation: Dextromethorphan is related chemically to the opiate agonists and can suppress coughing as effectively as narcotics. Cough suppression occurs by several mechanisms, but mainly the drug directly affects the cough center in the medulla. Therapeutic doses do not affect ciliary activity.

Decongestants should be used cautiously in clients with which conditions? (Select all that apply.)

Diabetes Glaucoma Explanation: Clients with diabetes, heart disease, hypertension, hyperthyroidism, benign prostatic hypertrophy, and glaucoma should contact their health care provider before taking over-the-counter decongestants.

Decongestants should be used cautiously in clients with which medical conditions? Select all that apply.

Diabetes Thyroid disease Glaucoma Hypertension Explanation: Decongestants are used cautiously in clients with the following: thyroid disease, diabetes, cardiovascular disease, prostatic hypertrophy, coronary artery disease, peripheral vascular disease, hypertension, and glaucoma. Clients with asthma benefit from the use of decongestants during episode of upper respiratory infections.

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

Guaifenesin Explanation: 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 client with cystic fibrosis may use which type of medication to reduce the viscosity of respiratory secretions?

Mucolytic Explanation: Mucolytic drugs may be used by patients suffering from conditions such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, pneumonia, or tuberculosis to reduce the viscosity of respiratory secretions by direct action on the mucus. Mucolytic drugs increase or liquefy respiratory secretions to aid the clearing of the airways in high-risk respiratory patients who are coughing up thick, tenacious secretions.

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. Explanation: Sudafed is a decongestant. Decongestants are used cautiously in clients with a history of hypertension because of the vasoconstrictive effects of the drug. Swelling of nasal passages is a symptom of congestion. A history of hay fever is not a contraindication to taking decongestants. Nausea and vomiting are potential adverse effects but are not as important as assessing blood pressure.

Which would the nurse expect to administer as a nasal spray?

Oxymetazoline Explanation: Oxymetazoline is administered by nasal spray. Hydrocodone is administered orally. Dextromethorphan is administered orally. Benzonatate is administered orally.

Which is classified as a decongestant?

Oxymetazoline (Afrin) Explanation: Afrin is a decongestant. Xyzal is a second-generation antihistamine. Delsym is a centrally acting antitussive that contains dextromethorphan. Astelin is a second-generation antihistamine.

Some antihistamines can produce significant sedation. Which drug is most likely to cause this adverse effect?

Promethazine Explanation: First-generation antihistamines such as promethazine are capable of causing significant sedation. The other three drugs are second-generation antihistamines, which are less likely to cause sedation.

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

Protect from injury. Explanation: Dimenhydrinate causes drowsiness and sedation, which can increase the risk for falls. Since older adults may already be at higher risk, the nurse should institute precautions to protect the client from injury. There is no indication that fluids should be forced. The client will not require IV access unless fluid replacement is prescribed.

A patient is advised to take a decongestant drug to relieve nasal congestion associated with hay fever. The patient is not comfortable with a nasal spray or drops and prefers an oral tablet. Which oral decongestant drugs can be administered to the patient?

Pseudoephedrine Explanation: The patient can take an oral preparation of pseudoephedrine. Xylometazoline, ephedrine, and tetrahydrozoline are usually available only in the form of nasal sprays or drops for topical use.

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

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.

First-generation antihistamines may be effective against what symptoms? (Select all that apply.)

Sneezing Rhinorrhea Cough Explanation: First-generation antihistamines (e.g., chlorpheniramine, diphenhydramine) have anticholinergic effects that may reduce sneezing, rhinorrhea, and cough. They do not have antipyretic effects.

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. 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.

Why are second-generation H1 receptor antagonists less likely to cause less central nervous system (CNS) depression? Select all that apply.

They do not cross the blood-brain barrier. They are selective for peripheral H1 receptors. Explanation: Second-generation H1 receptor antagonists cause less CNS depression because they are selective for peripheral H1 receptors and do not cross the blood-brain barrier. They are not inotropic and do not affect catecholamines or serotonin levels.

A client has just been admitted for an overdose of pseudoephedrine. The nurse's assessment of the client should prioritize what system?

cardiovascular Explanation: Because pseudoephedrine is a stimulant, cardiac symptoms are a notable adverse effect, especially in the acute stage of the overdose. All the other systems should be monitored, but the cardiac-related adverse reactions have priority.