Adaptive Quizzing Chap 36
During discharge, which instruction should the nurse provide to a patient who is prescribed naphazoline after reconstructive surgery on the nose? 1 "Increase fluids to 3 L/day." 2 "Avoid caffeinated products." 3 "Rest with your head elevated." 4 "Use a humidifier while sleeping."
"Avoid caffeinated products." Naphazoline may be indicated in the postoperative treatment of nasal surgery for short-term hemostasis. The nurse should instruct the patient to avoid caffeinated products to prevent overstimulation of the sympathetic nervous system. Maintaining hydration, elevating the head, and using humidification are prerequisites for nasal surgery to hydrate mucous membranes.
A patient reports to the nurse that after taking guaifenesin for 1 week, the productive cough still persists. What advice should the nurse give to the patient? 1 "Decrease your fluid intake." 2 "Take loratadine twice a day." 3 "Increase the dose of guaifenesin." 4 "Consult your primary health care provider."
"Consult your primary health care provider." The nurse should advise the patient to consult with the primary health care provider so that the patient can be evaluated and the prescription can be changed accordingly. The patient should not take expectorants for more than 1 week, because it may cause drug dependency and drug tolerance. Increasing, not decreasing, fluid intake helps in thinning secretions for easier expectoration. Loratadine is not helpful in treating productive cough. Loratadine is used for the treatment of allergic rhinitis and chronic urticaria. The nurse should not advise the patient to take an increased dose of guaifenesin, because it produces hazardous effects in the patient.
The nurse is caring for a patient who is taking a traditional antihistamine. What is the most important information for the nurse to teach the patient? 1 "Do not drive after taking this medication." 2 "Take this medication on an empty stomach." 3 "Do not take this medication for more than 2 days." 4 "Make sure you drink a lot of liquids while on this medication."
"Do not drive after taking this medication." Traditional antihistamines cause drowsiness. There is no evidence to indicate that the patient should take the medication on an empty stomach, place the medication on hold for any period of time, or force fluids.
A patient is prescribed an antitussive medication. What is the most important instruction for the nurse to include in the patient teaching? 1 "Watch for diarrhea and abdominal cramping." 2 "This medication may cause tremors and anxiety." 3 "Headache and hypertension are common side effects." 4 "This medication may cause drowsiness and dizziness."
"This medication may cause drowsiness and dizziness." Antitussive medications also affect the central nervous system, causing drowsiness and dizziness. There is no reason to anticipate that the medication will cause diarrhea, abdominal cramping, tremors and anxiety, or headache and hypertension
The nurse is teaching a patient about the use of an expectorant. What is the most important instruction for the nurse to include in the patient teaching? 1 "Take the medication once a day only, at bedtime." 2 "Restrict your fluids to decrease mucus production." 3 "Increase your fiber and fluid intake to prevent constipation." 4 "Increase your fluid intake to decrease viscosity of secretions."
"Increase your fluid intake to decrease viscosity of secretions." Expectorant drugs are used to decrease viscosity of secretions and allow them to be more easily expectorated. Increasing fluid intake helps this action. The medications should be taken twice daily with extra fluids. It is not necessary to increase fiber.
A patient is prescribed guaifenesin for treatment of productive cough. What instruction should the nurse give to the patient for maximum therapeutic effect? 1 "Increase your fluid intake." 2 "Increase your fiber intake." 3 "Increase your protein intake." 4 "Increase your carbohydrate intake.
"Increase your fluid intake." The nurse should instruct the patient to increase fluid intake, because it helps to liquefy secretions, assists in breaking up thick secretions, and makes it easier to cough up secretions. The nurse may advise an increase in dietary fiber to prevent constipation. The nurse may advise an increase in proteins and carbohydrates in the patient's diet if there is a deficiency of these nutrients.
A patient who underwent coronary artery bypass surgery 2 months ago has an acute upper respiratory infection (URI) and is losing sleep because of a cough. Which instructions should the nurse give to manage the URI if the patient is using codeine as an antitussive? Select all that apply. 1 "Maintain hydration." 2 "Take an expectorant." 3 "Take a decongestant." 4 "Take an antihistamine." 5 "Productively cough."
"Maintain hydration." "Take an expectorant." "Productively cough." The nurse should instruct the patient to continue taking the codeine to diminish the cough, to maintain hydration by drinking water, and to take an expectorant to liquefy and mobilize secretions. The nurse asks the patient to cough out secretions so that the secretions do not occlude airways. The nurse does not instruct the patient to take an antihistamine or a decongestant, because these agents are contraindicated for patients with cardiac disease.
A patient is prescribed dextromethorphan for treatment of cough. What instruction should the nurse give to the patient for safe administration of the drug? 1 "Use a humidifier while sleeping." 2 "Elevate your bed while sleeping." 3 "Increase your fluid intake to 3000 mL per day." 4 "Restrict activities that require mental alertness."
"Restrict activities that require mental alertness." Dextromethorphan is a nonopioid antitussive drug that may also cause sedation, drowsiness, or dizziness. The nurse should advise the patient to avoid activities that require mental alertness. It helps prevent injury to the patient. Use of a humidifier helps maintain hydration levels, but does not reduce the risk of injury to the patient. Elevating one's head while sleeping helps with lung expansion and promotes breathing. Fluid intake should be increased when decongestants are administered, because fluids help liquefy secretions and make it easier to cough up secretions.
A patient will begin taking diphenhydramine to treat motion sickness. What instruction will the nurse give to the patient to prevent gastrointestinal (GI) upset? 1 "Take the medication with food." 2 "Use a humidifier while sleeping." 3 "Increase fluid intake to up to 3000 mL." 4 "Sleep with your head in an elevated position."
"Take the medication with food." The nurse should instruct the patient to take the medication with food to prevent GI upset. Although food may slightly decrease absorption of the drug, it has the benefit of minimizing the GI upset caused by diphenhydramine. Using a humidifier, increasing fluid intake to up to 3000 mL, and elevating the head while sleeping are helpful for maintaining hydration but not for minimizing the GI upset.
What should the nurse tell a patient who reports feeling drowsy after beginning drug therapy with diphenhydramine? 1 "Use caution when driving." 2 "This may worsen over time." 3 "Stop taking the drug immediately." 4 "Take a stimulant to combat fatigue."
"Use caution when driving." The sedative effects of diphenhydramine can be problematic for patients who are involved in activities such as driving that require mental alertness. The side effect will not worsen over time; the side effects diminish when the medication is terminated. The nurse should not advise the patient to stop taking the drug, because drowsiness is an expected effect of the drug. The nurse should not advise the patient to take a stimulant if it is not prescribed by the primary health care provider.
The nurse is caring for a patient in the clinic who states being afraid of taking antihistamines because of being a truck driver. What is the best information for the nurse to give this patient? 1 "Take the medication only when you are not driving." 2 "You are correct; you should not take antihistamines." 3 "Take a lower dose than normal when you have to drive." 4 "You may be able to safely take a nonsedating antihistamine."
"You may be able to safely take a nonsedating antihistamine." Nonsedating antihistamines may be safer for the patient to take, but the patient should still monitor for signs of sedation. If sedation occurs, the patient should be instructed to avoid taking these drugs while driving. Taking a lower dose will decrease the drug's effectiveness.
A patient is prescribed diphenhydramine for the treatment of an allergic disorder. After reviewing the patient's history, the nurse finds that the patient drinks alcohol. Why should the nurse instruct the patient to stop alcohol consumption? 1 Alcohol diminishes the action of diphenhydramine. 2 Alcohol increases central nervous system depression. 3 Alcohol increases diphenhydramine levels in the body. 4 Alcohol and diphenhydramine interaction produces skin rashes.
Alcohol increases central nervous system depression Diphenhydramine and alcohol show an additive effect and increase central nervous system depression. Therefore, the nurse instructs the patient to stop alcohol consumption to prevent this condition. Alcohol does not diminish the action of diphenhydramine, because they show an additive effect. Alcohol does not inhibit the metabolism of diphenhydramine; therefore, it does not increase its level in the body. Alcohol and diphenhydramine interaction does not produce skin rashes.
Which medication can cause paradoxical reactions in children? 1 Antacid 2 Antitussive 3 Decongestant 4 Antihistamine
Antihistamine An antihistamine can cause paradoxical reaction in children. Dizziness, confusion, sedation, and hypotension are symptoms associated with paradoxical reaction. An antacid may cause constipation or other reactions with an overdose. An antitussive can cause drowsiness or dizziness in the patient. A decongestant can cause rebound congestion with frequent use or overdose.
A patient comes to the emergency department with urticaria after contact with shrubs. Which type of drug should the nurse expect to be included in the treatment plan? 1 Antitussive 2 Expectorant 3 Decongestant 4 Antihistamine
Antihistamine Urticaria after contact with shrubs indicates an allergic reaction. All allergic reactions are mediated by histamines. Therefore, an antihistamine should be included in the treatment plan. Antitussives are medications that help to suppress the cough reflex. Expectorants help in coughing up excessive mucus and clearing the airway. Decongestants usually relieve congestion of the upper and lower respiratory tract.
The nurse observes a mild cough in a patient after hernia repair. Which medication should the nurse expect the provider to prescribe for this patient? 1 Antitussive 2 Expectorant 3 Decongestant 4 Antihistamine
Antitussive Antitussives are used to suppress cough. A patient who has undergone hernia repair needs to keep the abdominal muscles relaxed, and coughing can strain the abdominal muscles and worsen the hernia. Expectorants are used to thin secretions and promote coughing out secretions. Decongestants are used to relieve congestion of the upper and lower respiratory tract. Antihistamines are used to treat allergic symptoms
What are the adverse effects of echinacea? Select all that apply. 1 Dizziness 2 Headache 3 Dermatitis 4 Mucosal ulceration 5 Emotional instability
Dizziness Headache Dermatitis Echinacea is an herbal medicine commonly used for stimulation of the immune system and antisepsis and to treat viral infections, influenza-like respiratory tract infections, and chronic ulcerations. Dizziness, headache, and dermatitis are adverse effects of echinacea. Mucosal ulceration and emotional instability are adverse effects of goldenseal.
A patient presenting with cough is prescribed diphenhydramine. The nurse instructs the patient to avoid consuming alcohol. Which consequence of drug interaction with alcohol would be prevented if the patient follows the nurse's instructions? 1 Allergic rhinitis 2 Motion sickness 3 Nighttime insomnia 4 Central nervous system (CNS) depression
Central nervous system (CNS) depression Diphenhydramine interacts with alcohol, causing CNS depression and leading to a decrease in respiratory rate and heart rate and loss of consciousness. Therefore, the nurse should instruct the patient to avoid alcohol consumption. Allergic rhinitis, motion sickness, and nighttime insomnia are indications for the use of diphenhydramine. These conditions are not the result of an interaction between diphenhydramine and alcohol.
Which drugs are peripherally acting antihistamines? Select all that apply. 1 Cetirizine 2 Loratadine 3 Fexofenadine 4 Diphenhydramine 5 Brompheniramine
Cetirizine Loratadine Fexofenadine Cetirizine, loratadine, and fexofenadine are peripherally acting antihistamines. These drugs work peripherally to block the actions of histamine and do not readily cross the blood-brain barrier. Therefore, these drugs have less effect on the central nervous system. Hence, these drugs are called peripherally acting antihistamines. Diphenhydramine and brompheniramine are traditional antihistamines and work both peripherally and centrally
Which first-generation histamine (H1) antagonist is less likely than diphenhydramine to induce sleep? 1 Hydroxyzine 2 Promethazine 3 Dimenhydrinate 4 Chlorpheniramine
Chlorpheniramine Alkylamine antihistamines, including chlorpheniramine, are among the least-sedating first-generation H1 blockers. Hydroxyzine is used as a sedative in the treatment of motion sickness. Promethazine has high sedative effects and is used as an antipsychotic. Dimenhydrinate has a high sedative effect and is used as an antiemetic.
The health care provider indicates that a patient will be prescribed an opioid antitussive. Which medication should the nurse anticipate the provider will order? 1 Codeine 2 Benzonatate 3 Levocetirizine 4 Promethazine with dextromethorphan
Codeine Codeine is classified as an opioid antitussive. Benzonatate and promethazine with dextromethorphan are both nonopioid antitussives. Levocetirizine is an antihistamine
Which is the best antitussive to administer to a patient with peripheral arterial disease (PAD)? 1 Codeine 2 Benzonatate 3 Diphenhydramine 4 Dextromethorphan
Codeine Codeine is the best choice of antitussive for a patient with PAD, because it does not have the side effect profile of the nonopioid antitussive agents. It is less sedating and, therefore, less likely to result in a fall or patient injury from sedation. Benzonatate is a nonopioid antitussive and is less effective than opioid drugs. Diphenhydramine is a first-generation histamine1 (H1) blocker that can help relieve a cough caused by postnasal drip or upper respiratory congestion but has no antitussive effect. Dextromethorphan is a nonopioid antitussive.
Which is the most effective antitussive? 1 Codeine 2 Benzonatate 3 Diphenhydramine 4 Dextromethorphan
Codeine Codeine is the most effective opioid antitussive drug, because it is effective in suppressing the cough reflex and does not cause dependency in patients. Benzonatate and dextromethorphan are nonopioid antitussives; diphenhydramine is a first-generation histamine blocker that can help relieve a cough caused by postnasal drip or upper respiratory congestion but has no antitussive effect.
The nurse makes a home visit to a middle-aged patient who has a history of asthma. The patient's spouse purchased an over-the-counter antihistamine. However, the nurse instructs the spouse not to administer the drug to the patient. Which complication is the nurse trying to prevent? 1 Paradoxical reactions 2 Collapse of lung alveoli 3 Decrease in respiratory rate 4 Allergic reactions to the drug
Collapse of lung alveoli Antihistamines tend to dry up secretions. These dried-up secretions may be difficult for an asthma patient to expectorate. As a result, the secretions can pool in the lungs, causing atelectasis or collapse of pulmonary alveoli. Therefore, antihistamines should be avoided in patients with asthma. Paradoxical reactions occur in older adults and are characterized by dizziness, confusion, sedation, and hypotension. Decrease in respiratory rate happens only in the case of overdose, or if the antihistamine is taken along with other central nervous system depressants such as alcohol. There is no evidence of drug allergy in the patient; therefore, allergic reaction to antihistamines is unlikely.
Which drug will the primary health care provider prescribe for a patient who has nighttime insomnia and motion sickness? 1 Cetirizine 2 Loratadine 3 Fexofenadine 4 Diphenhydramine
Diphenhydramine Diphenhydramine should be prescribed for the patient, because this drug is useful for treating nighttime insomnia as well as motion sickness. Diphenhydramine s a traditional antihistamine and works both peripherally and centrally. It has anticholinergic and sedative effects. Cetirizine, loratadine, and fexofenadine are nonsedating antihistamines. These drugs work peripherally and do not have a sedating effect. Therefore, these drugs are not helpful in treating nighttime insomnia.
Which antihistamine causes sedation an adverse drug effect? 1 Loratadine 2 Fexofenadine 3 Desloratadine 4 Diphenhydramine
Diphenhydramine The most common adverse effects with diphenhydramine include sedation and antimuscarinic effects, including dry mouth, urinary retention, and constipation. The newer antihistamines such as loratadine, fexofenadine, and desloratadine are usually less sedating because of reduced distribution to the central nervous system.
An older adult who presents with a cough is instructed not to use diphenhydramine. What is the possible reason for this? 1 Diphenhydramine causes seizures. 2 Diphenhydramine causes constipation. 3 Diphenhydramine causes lightheadedness. 4 Diphenhydramine causes a "hangover" effect.
Diphenhydramine causes a "hangover" effect Diphenhydramine is not administered to older adults because it produces a "hangover" effect and increases the risk for falls, which may cause severe injury. Diphenhydramine does not produce seizure, constipation, or lightheadedness. Seizure is a side effect of over-the-counter cough and cold products. Constipation and lightheadedness are side effects of codeine and hydrocodone.
Which anticholinergic effect is seen in a patient who takes brompheniramine? 1 Frequent urination 2 Dry mouth 3 Blue-green vision 4 Excessive watering of eyes
Dry mouth Antihistamines such as brompheniramine cause reduced salivary flow, leading to dry mouth. Anticholinergic effects of antihistamines, such as blurred vision, are common, not colored vision. They may also cause urinary retention, not frequent urination. Antihistamines help relieve excessive watering of eyes.
A patient with motion sickness is prescribed diphenhydramine. For which side effect will the nurse watch in the patient? 1 Pruritus 2 Headache 3 Dry mouth 4 Lightheadedness
Dry mouth Diphenhydramine is an H1 antagonist. It has anticholinergic action and reduces secretions. Therefore, the nurse should watch for dry mouth in the patient. Pruritus and headache are side effects of benzonatate. Lightheadedness is a side effect of codeine and hydrocodone
Which side effect of a histamine (H1) antagonist is used therapeutically for patients with allergic rhinitis? 1 Dryness 2 Drowsiness 3 Palpitations 4 Constipation
Dryness H1 antagonists exert anticholinergic effects, including constipation, dry mouth, and blurred vision. The drugs' capacity for drying the mucous membranes makes them useful in treating upper respiratory infections and allergic rhinitis. Drowsiness, palpitations, and constipation are adverse effects of H1 antagonists that should be reported immediately to the primary health care provider.
A patient who is a taxi driver is diagnosed with allergic rhinitis. Which antihistamine should the nurse expect to be included in the treatment plan? 1 Clemastine 2 Fexofenadine 3 Promethazine 4 Diphenhydramine
Fexofenadine The patient needs nonsedating antihistamines for treatment to prevent drowsiness while driving. Fexofenadine should be prescribed to the patient, because it acts peripherally on histamine receptors and does not cross the blood-brain barrier. As a result, it does not cause drowsiness. Clemastine has moderate sedative effect and should be avoided in this patient. Promethazine and diphenhydramine have high sedative action and should be avoided.
The nurse observes that a patient who is taking phenylephrine and vitamin C tablets has developed rebound congestion. What is the probable reason for rebound congestion? 1 Drug-drug interaction 2 Phenylephrine tolerance 3 Allergic reaction to vitamin C 4 Frequent use of phenylephrine
Frequent use of phenylephrine Rebound congestion results from frequent, long-term use or overdose of decongestants. Phenylephrine and vitamin C do not cause any drug-drug interaction. Rebound congestion does not indicate that the patient has phenylephrine tolerance. Rebound congestion is not associated with allergy to vitamin C.
The health care provider indicates that the patient will be prescribed an expectorant. Which medication does the nurse anticipate the provider will prescribe? 1 Guaifenesin 2 Brompheniramine maleate 3 Chlorpheniramine maleate 4 Dexchlorpheniramine maleate
Guaifenesin Guaifenesin is classified as an expectorant. Brompheniramine, chlorpheniramine, and dexchlorpheniramine are classified as traditional antihistamines
A patient with chronic paranasal sinusitis and cough is found to have glaucoma. What is the best choice of treatment for management of cough in this situation? 1 Loratadine 2 Naphazoline 3 Guaifenesin 4 Fexofenadine
Guaifenesin Guaifenesin is the best choice of treatment for management of cough associated with chronic paranasal sinusitis. It works by loosening and thinning the secretions and facilitating expectoration of the secretions. Loratadine, naphazoline, and fexofenadine are contraindicated in patients with glaucoma. Loratadine is used for the treatment of allergic rhinitis and chronic urticaria. Naphazoline is used to treat nasal congestion. Fexofenadine is a nonsedating antihistamine and is useful for the treatment of allergic rhinitis and urticaria.
The nurse is assessing a patient with respiratory congestion and finds that the patient is pregnant. Which medicine should the nurse expect the health care provider to prescribe for this patient? 1 Loratadine 2 Fexofenadine 3 Guaifenesin 4 Diphenhydramine
Guaifenesin Guaifenesin should be prescribed to the patient, because it is an expectorant and pregnancy category C drug. It is safe to use during pregnancy. Loratadine, fexofenadine, and diphenhydramine are antihistamines and are pregnancy category B drugs that are unsafe to use during pregnancy. These drugs are not helpful for treatment of respiratory congestion. These drugs are used for perennial allergic rhinitis allergic reactions, motion sickness, and nighttime insomnia.
Which patient conditions indicate the need for a nasal decongestant? Select all that apply 1 Hay fever 2 Dust allergy 3 Nasal surgery 4 Chronic rhinitis 5 Productive cough
Hay fever Dust allergy Nasal surgery Chronic rhinitis Nasal decongestants are used to relieve nasal congestion that is caused by hay fever, dust allergy, or chronic rhinitis. Nasal decongestants are also used to reduce swelling of the nasal passages and to facilitate visualization of the nasal and pharyngeal membranes before surgery. Expectorants are used for the relief of productive cough
What are the side effects associated with naphazoline? Select all that apply. 1 Pruritus 2 Headache 3 Dizziness 4 Drowsiness 5 Nervousness
Headache Dizziness Nervousness Naphazoline is an intranasal decongestant. Topically applied adrenergic nasal decongestants may be absorbed into the circulation; however, the dosage amount absorbed is usually too small to cause systemic effects. If there are excessive dosages (e.g., excessive use or amounts), these may precipitate cardiovascular effects such as increase in blood pressure and CNS stimulation with headache, nervousness, or dizziness. Pruritus and lightheadedness are not side effects of naphazoline. Pruritus is side effect of benzonatate. Drowsiness may occur with the use of antitussives
Which drug is contraindicated in a patient who has Addison's disease? 1 Naphazoline 2 Benzonatate 3 Fexofenadine 4 Hydrocodone
Hydrocodone Hydrocodone is contraindicated in a patient who has Addison's disease, because administration of hydrocodone may worsen the disease condition. Naphazoline, fexofenadine, and benzonatate can be administered to the patient, because they do not worsen the symptoms of Addison's disease.
The nurse is assessing a patient with mucosal ulceration. While conducting medical reconciliation, the nurse finds that the patient has developed this disorder as a result of long-term use of an herbal product containing goldenseal (Hydrastis canadensis). What other complications may the nurse find in this patient? 1 Hypertension 2 Motion sickness 3 Nasal congestion 4 Urinary infections
Hypertension Goldenseal (Hydrastis canadensis) is an herbal supplement that is used for the treatment of upper respiratory tract infections. It has an antihistaminic and anticholinergic action. However, it increases gastric acid production and causes vasoconstriction, which may cause mucosal ulcers and hypertension if it is consumed for a long time. Because the drug has an anticholinergic effect, the patient will not have motion sickness. Because of the antihistaminic and anticholinergic actions, goldenseal reduces the constriction of bronchioles and nasal secretion. Therefore, the patient may not have nasal congestion. The drug has antifungal and antibacterial properties. Therefore, the patient may not have urinary infections.
A patient complains that symptoms of allergic rhinitis are persistent even after taking fexofenadine. After checking the patient's history, the nurse finds that the patient is taking phenytoin for the treatment of seizures. What should the nurse interpret from this information? 1 It indicates drug tolerance. 2 It indicates dystonic reaction. 3 It indicates paradoxical reaction. 4 It indicates drug-drug interaction.
It indicates drug-drug interaction Phenytoin decreases the fexofenadine level in the body. Therefore, the drug does not have the desired therapeutic effect. The persistent allergic rhinitis is caused by drug interaction, not drug tolerance. Dystonic reaction is related to muscle contractions. Twisting and repetitive movements or abnormal postures can be observed in this condition. Paradoxical reaction is observed in older adults and children from the use of antihistaminic drugs.
During the assessment of a patient, the nurse finds symptoms of dizziness, confusion, sedation, and hypotension. After reviewing the patient's medical history, the nurse finds that the patient is taking diphenhydramine for treatment of nighttime insomnia. What should the nurse interpret from the assessment? 1 It is an allergic reaction. 2 It is a dystonic reaction. 3 It is rebound congestion. 4 It is a paradoxical reaction.
It is a paradoxical reaction Diphenhydramine is an antihistaminic drug. Antihistaminic drugs may produce paradoxical reactions such as dizziness, confusion, sedation, and hypotension in older adults. These are not allergic reactions to the drug. In cases of dystonic reaction, sustained muscle contractions cause twisting and repetitive movements or abnormal postures. Rebound congestion results from long-term use, or overdose, of nasal decongestants.
What is the most important thing for the nurse to teach a patient who is switching allergy medications from diphenhydramine to loratadine? 1 Loratadine has fewer sedative effects. 2 Loratadine causes less gastrointestinal upset. 3 Loratadine can potentially cause dysrhythmias. 4 Loratadine has increased bronchodilating effects
Loratadine has fewer sedative effects Loratadine does not affect the central nervous system and, therefore, is nonsedating. There is insufficient evidence to indicate that loratadine causes less gastrointestinal upset than other comparable medications, can cause dysrhythmias, or can act as a bronchodilator.
Which symptom of allergic rhinitis is treated with fluticasone? 1 Bronchospasm 2 Fluid retention 3 Nasal congestion 4 Increased blood pressure
Nasal congestion Fluticasone relieves the symptoms of allergic rhinitis such as nasal congestion and hay fever. Bronchospasm is not a symptom of allergic rhinitis. Release of excessive amounts of histamine can lead to fluid retention because of vasodilatation and increased capillary permeability. Increased blood pressure is not a symptom of allergic rhinitis. Antihypertensives are used to lower blood pressure.
The primary health care provider prescribes oxymetazoline to a patient with sinusitis who complains of nasal congestion and difficulty in breathing. About which possible adverse effect should the nurse teach to the patient? 1 Dry mouth 2 Palpitations 3 Constipation 4 Gastrointestinal irritation
Palpitations Oxymetazoline impairs blood flow and can cause cardiovascular disorders such as palpitations and hypertension. Oxymetazoline does not have anticholinergic action and does not cause dry mouth or constipation. Oxymetazoline does not increase acidic levels of gastric fluid and does not cause gastrointestinal irritation.
Which patients are the best candidates to receive antitussive cough medication? 1 Patients with pharyngitis and rhinitis 2 Patients with chronic paranasal sinusitis 3 Patients who have undergone hernia surgery 4 Patients with bronchitis with productive cough
Patients who have undergone hernia surgery Antitussives are administered to patients who have recently undergone hernia surgery to enhance their comfort and reduce respiratory distress. Expectorants are used to relieve productive cough in patients with pharyngitis and bronchitis. Nasal decongestants are used to relieve nasal congestion in patients with rhinitis. In patients with chronic paranasal sinusitis, expectorants are used for cough suppression
The nurse is providing care for multiple patients who are prescribed nasal decongestants. For which patients does the nurse need to obtain a change of prescription? Select all that apply. 1 Patients with skin disease 2 Patients with hypertension 3 Patients with hyperthyroidism 4 Patients with genitourinary disease 5 Patients with narrow-angle glaucoma
Patients with hypertension Patients with hyperthyroidism Patients with narrow-angle glaucoma Nasal decongestants are contraindicated in patients who have hypertension, hyperthyroidism, or narrow-angle glaucoma. Nasal decongestants act on alpha-adrenergic receptors and increase blood pressure. In hypertension, hyperthyroidism, and narrow-angle glaucoma conditions, blood pressure is high; if nasal decongestants are administered, these conditions may worsen. Nasal decongestants can be administered to patients with skin or genitourinary diseases, because they do not worsen these conditions
Which clinical finding is seen in a patient with nasal congestion caused by allergic rhinitis? 1 Increase in body secretions 2 Increase in capillary permeability 3 Inhibition of histamine production 4 Release of inflammatory mediators
Release of inflammatory mediators Allergic rhinitis begins when airborne allergens bind to antibodies on mast cells, triggering the release of inflammatory mediators, including histamine, leukotrienes, and prostaglandins. Once released, the inflammatory mediators dilate and engorge regional blood vessels, causing nasal congestion. Antihistamines inhibit histamine production by blocking the histamine receptors on the surfaces of basophils and mast cells. The release of excessive amounts of histamine may lead to an increased capillary permeability and an increase in body secretions.
The use of fexofenadine is contraindicated in patients with which conditions? 1 Skin rashes 2 Renal impairment 3 Vitamin C deficiency 4 Vitamin A deficiency
Renal impairment Fexofenadine is contraindicated in patients with renal impairment, because it may be accumulated in the patient's body and cause complications from overdose. Fexofenadine is not contraindicated in patients with skin rashes or vitamin C or A deficiency, because it does not cause any interaction in those cases.
A patient is prescribed naphazoline for the treatment of hay fever. During an assessment, the nurse finds that the patient has hypertension. Which action by the nurse is correct? 1 Lower the dose of naphazoline. 2 Report this finding to the primary health care provider. 3 Request a prescription to give naphazoline with methyldopa. 4 Request a prescription to give naphazoline with a monoamine oxidase inhibitor.
Report this finding to the primary health care provider. Naphazoline is a decongestant. Decongestants may increase blood pressure and heart rate. If a decongestant is administered to a patient who has hypertension, it will worsen the patient's condition. Therefore, the nurse should report it to the primary health care provider immediately and obtain another drug prescription. The nurse should not lower the dose without consulting with the health care provider. The nurse should not administer naphazoline with methyldopa or a monoamine oxidase inhibitor, because they produce drug-drug interactions.
The nurse is assessing a toddler who is unconscious after consumption of over-the-counter cold medication. What other assessment findings should the nurse expect to see in this child? Select all that apply. 1 Seizures 2 Tachycardia 3 Hypocalcemia 4 Hyperuricemia 5 Hyperglycemia
Seizures Tachycardia Young children do not have a well-developed metabolism. Over-the-counter cold medications generally have antihistaminic effects. Therefore, when these drugs are administered to children, they cause oversedation, which may lead to unconsciousness, tachycardia, and seizures. Hypocalcemia is not a complication associated with cold medications, because they do not alter calcium reabsorption and metabolism. Unlike nonsteroidal antiinflammatory medication, the antihistamines do not alter the excretion of uric acid. Therefore, hyperuricemia is not a complication associated with them. Most cold medications do not affect insulin regulation and production; hence they do not cause hyperglycemia.
What is the rationale for administering a medication in the same class as chlorpheniramine and clemastine to a patient with an upper respiratory infection? 1 Inhibition of the cough reflex 2 Promotion of patient sleepiness 3 Suppression of mucus secretion 4 Shrinkage of mucous membranes
Suppression of mucus secretion Chlorpheniramine and clemastine are alkylamine and ethanolamine antihistamines, respectively, and are used in upper respiratory infections for their anticholinergic properties. The drugs help dry mucous membranes and diminish histamine-mediated inflammation, resulting in less mucus secretion. Opioid antitussives inhibit cough reflex. The antihistamines belonging to the same class as chlorpheniramine and clemastine have low sedative effects; hence, they do not cause sleepiness. Nasal decongestants shrink mucous membranes.
A patient who presents with cough and difficulty breathing is prescribed decongestants and antitussives. Which assessment findings in the follow-up visit will the nurse immediately report to the primary health care provider? Select all that apply. 1 Temperature of 100.8° F 2 Change in color of the sputum 3 Increased expectoration of mucus 4 Respiratory rate of 30 breaths/min 5 Clear breath sounds on auscultation
Temperature of 100.8° F Change in color of the sputum Respiratory rate of 30 breaths/min After the treatment of cough and difficulty breathing, the nurse should look for signs of worsening during the follow-up visit. Temperature of 100.8° F indicates fever and is a sign of infection. A change in color of the sputum indicates infection and should be immediately reported. The normal respiratory rate is 12 to 20 breaths/min. The respiratory rate of 30 breaths/min indicates dyspnea and difficulty breathing. Increased expectoration of mucus indicates treatment effectiveness. Clear breath sounds indicate that lungs are clear of secretions.
A patient who reports nasal congestion is prescribed naphazoline, 2 drops in each nostril, every 6 hours, for 5 days. The patient reports increased nasal congestion after 10 days. On assessment the nurse learns that the patient had increased the drug frequency to every 3 hours for 10 days. What should the nurse interpret from this information? 1 The patient has developed an allergic reaction. 2 The patient has developed rebound congestion. 3 The patient has developed paradoxical reaction. 4 The patient has experienced a side effect of the drug
The patient has developed rebound congestion Nasal decongestants should be used as directed, in the prescribed dose, and for the prescribed time period. Frequent, long-term use or overdose may lead to rebound congestion. When the patient stops the drug, the symptoms may worsen, so the patient may overdose to get relief from symptoms. Allergic reactions rarely occur with decongestants, and rebound congestion is not a symptom of allergic reaction. Paradoxical reactions are related to antihistamine use in older adults and pediatric patients. Side effects of decongestants include nervousness, insomnia, palpitations, and tremor.
A patient who has allergic rhinitis comes to the clinic for a scheduled allergy test. After performing a health history, the nurse informs the patient that the allergy test will have to be rescheduled. What may be the reason for this? 1 The patient is afraid of injections. 2 The patient has severe symptoms of rhinitis. 3 The patient is being treated with antihistamine drugs. 4 The patient is being treated with oral antibiotic drugs.
The patient is being treated with antihistamine drugs Allergic rhinitis is usually treated with antihistamines. The drug may give false results in an allergy test, because allergic reactions are also mediated by histamines. All antihistamines should be stopped 4 days before the scheduled allergy test. A fear of injections cannot be resolved by postponing the allergy test. Severe symptoms of rhinitis are unrelated to the allergy test, and hence cannot be a reason for rescheduling the test. Oral antibiotics do not interfere with the allergy test and are not a reason for postponing the test.
The nurse is instructing a patient on the use of beclomethasone dipropionate. Which statement by the patient indicates an understanding of the teaching? 1 "I need to take this medication only when my symptoms get bad." 2 "I will need to taper off the medication to prevent acute adrenal crisis." 3 "I will need to monitor my blood sugar more closely, because it may increase." 4 "This medication will help prevent the inflammatory response of my allergies."
This medication will help prevent the inflammatory response of my allergies." Beclomethasone dipropionate is a steroid spray administered nasally. It is used to prevent allergy symptoms. Its effect is localized, and therefore the patient does not have systemic side effects with normal use and does not have to worry about weaning off the medication as with oral corticosteroids. Because the medication has a localized effect, it will not produce the changes in blood sugar that would be generated by systemic steroids.
For which adverse drug effect is the nurse alert in an older adult patient taking diphenhydramine? 1 Hay fever 2 Insomnia 3 Hypertension 4 Urinary retention
Urinary retention The most common adverse effects with diphenhydramine include sedation and antimuscarinic effects, including dry mouth, urinary retention, and constipation. Insomnia is an adverse effect of adrenergic drugs. Hay fever is a symptom of allergic rhinitis and not a side effect of diphenhydramine. Hypertension is a side effect of excessive dosages of topically applied adrenergic nasal decongestants.
