Ch 54: Drugs Acting on the Upper Respiratory Tract
A male client asks the nurse whether antihistamines will help him cope with the symptoms of the common cold. What is the nurse's best response?
"Antihistamines do not relieve symptoms." Explanation: For treatment of the common cold, studies have demonstrated that antihistamines do not relieve symptoms and are not recommended. However, an antihistamine is often included in prescription and OTC combination products for the common cold.
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 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. 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 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.
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 the nurse expect to administer as a nasal s
Oxymetazoline Explanation: Oxymetazoline is administered by nasal spray. Hydrocodone is administered orally. Dextromethorphan is administered orally. Benzonatate is administered orally.
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.
A 16-year-old boy is prescribed cromolyn sodium nasal spray to treat a nasal allergy. To maximize the therapeutic effects of the drug, which will the nurse include in instructions to the patient?
Take the drug for one full week before coming in contact with allergens. Explanation: To maximize the therapeutic effects of the drug, the patient should take cromolyn sodium for one full week before coming in contact with allergens. Taking the drug on a full stomach is inappropriate, since the drug is in the form of a nasal spray. Neither avoiding high noise levels nor drinking plenty of fluids would help maximize the therapeutic effects of the drug.
After teaching a group of nursing students about the uses of acetylcysteine, the instructor determines that the teaching was successful when the students identify which of the following? Select all that apply.
Tracheostomy care Atelectasis due to mucus obstruction Pulmonary complications of cystic fibrosis Posttraumatic chest conditions Acetylcysteine is used to treat a variety of pulmonary conditions such as tracheostomy care, atelectasis due to mucous obstruction, pulmonary complications of cystic fibrosis, and posttraumatic chest conditions, but is not indicated in the treatment of ibuprofen overdose. Reference:
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?
antihistamine Explanation: 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.
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.
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 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.
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.
The nurse is aware that clients who use OTC fexofenadine would use which class of antibacterial that would cause an increased plasma concentration of the fexofenadine?
Macrolides Explanation: Macrolides increase the plasma concentration of fexofenadine.
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.
he nurse is caring for a client with cystic fibrosis who is receiving dornase alfa by nebulizer to help thin secretions. What statement by the client indicates a need for further instruction?
"I'm glad that this medication will address all of my symptoms." Explanation: Cystic fibrosis clients who receive dornase alfa should be cautioned about the need to continue all therapies for their cystic fibrosis because dornase alfa is only a palliative therapy that improves respiratory symptoms, and other therapies, such as coughing, postural drainage, and enzymes, are still needed. This medication will not relieve all of the client's symptoms.
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.
The nursing instructor is teaching their lab students the best position for the administration of nasal sprays. What position would the instructor teach the students?
High Fowler's Explanation: Teach the patient to sit upright and press a finger over one nare to close it.
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.
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.
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 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 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.
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.
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.
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.
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.
The pharmacology instructor is discussing the adverse effects of diphenhydramine. Which is not one of these effects?
Excessive salivation Explanation: Adverse effects of first-generation antihistamines include urinary retention, drowsiness or sedation, dry mouth, blurred vision, and gastrointestinal distress.
Acetylcysteine is the antidote for aspirin toxicity.
False Explanation: Acetylcysteine is used to protect the liver from acetaminophen toxicity.
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.
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.
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.
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
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
Which agent would the nurse instruct a client to use orally?
Pseudoephedrine Explanation: Pseudoephedrine is the only oral decongestant. Phenylephrine, tetrahydrozoline, and xylometazoline are topical decongestants.
When describing the effects of second-generation antihistamines, which would the nurse address as being decreased?
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.
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.
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.
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.
A client is taking pseudoephedrine to reduce nasal congestion. The nurse should caution the client against use of this decongestant if the client is currently taking what other type of drug?
Thyroid preparations Explanation: Thyroid preparations should be prescribed cautiously to clients being concurrently prescribed nasal decongestants. Thyroid preparations have the tendency to increase the intended effects of decongestants. PPIs, anti-infectives, and anti-inflammatories do not have this synergistic effect.
What hospital procedure has the greatest potential to cause an anaphylactoid reaction?
administration of contrast media for diagnostic tests Explanation: Contrast media for radiologic diagnostic tests are often implicated in anaphylactoid reactions. The other options present a lesser risk for the development of an anaphylactoid reaction.
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 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.
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 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 minut
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.
Mr. Johnson is prescribed pseudoephedrine to relieve his nasal congestion. What should the nurse include in patient and family education? Select all that apply.
Advise him to avoid excessive and frequent use of the drug. Advise him not to take other OTC drugs.
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 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 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
Ms. James contacts her physician's office and asks if it is safe to use diphenhydramine while breast-feeding. The nurse's answer is based on the fact that diphenhydramine is a pregnancy category B drug and on which characteristic?
It may inhibit lactation. Explanation: First-generation H1 antagonists are not used during breast-feeding, because they may inhibit lactation. In addition, they may induce paradoxical CNS stimulation in neonates or seizures in premature infants. They do not cause gray baby syndrome in neonates.
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.
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.
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.
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.
An instructor is describing topical decongestants as belonging to which class?
Sympathomimetics
The nurse instructs a client who is prescribed a nasal steroid that it may take up to how long before effects may be noted?
7 days Explanation: The onset of nasal steroids is not immediate, and it may take up to 7 days before any changes occur. If no effect occurs within 21 days, the drug should be discontinued.
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.
A nurse is preparing a presentation for a local elementary school parent group about over-the-counter cold medications and their use in children. Which would be most appropriate to include?
Avoidance of use in children under age 2 Importance of reading the label for ingredients and dosage Need to follow the directions for how often to give the drug OTC cough and cold preparations should not be used in children under the age of 4 years. Accurate dosing is essential. Following the directions is essential to prevent inadvertent overdosage. Measuring devices that come with the medication should be used to ensure accurate dosages. Parents should look for the formula for children, infants, or pediatrics.
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 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.
Take the drug for one full week before coming in contact with allergens. Explanation: To maximize the therapeutic effects of the drug, the patient should take cromolyn sodium for one full week before coming in contact with allergens. Taking the drug on a full stomach is inappropriate, since the drug is in the form of a nasal spray. Neither avoiding high noise levels nor drinking plenty of fluids would help maximize the therapeutic effects of the drug.
"I should avoid driving after taking this medication." Explanation: After taking fexofenadine or other antihistamines, clients should avoid activities that require being alert (e.g., driving). They should not combine alcohol or other sedating agents with these drugs, since doing so can result in excessive sedation. To avoid the adverse effects of combining multiple antihistamines, clients should consult the prescriber before taking any other medications, particularly cold remedies and products labelled "nighttime" or "PM."
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 caring for a client with cystic fibrosis who is receiving dornase alfa by nebulizer to help thin secretions. What statement by the client indicates a need for further instruction?
"I'm glad that this medication will address all of my symptoms." Explanation: Cystic fibrosis clients who receive dornase alfa should be cautioned about the need to continue all therapies for their cystic fibrosis because dornase alfa is only a palliative therapy that improves respiratory symptoms, and other therapies, such as coughing, postural drainage, and enzymes, are still needed. This medication will not relieve all of the client's symptoms.
The nurse is teaching a 61-year-old client about the narcotic antitussive syrup that the health care provider has prescribed. Which client statement suggests understanding of what the nurse has taught?
"This medication might cause drowsiness, so I will avoid driving while I use it." Explanation: Although narcotic antitussives include only small doses of narcotics, some of the adverse effects of that drug category (e.g., drowsiness, dizziness) are still possible. To decrease the risk of adverse effects, clients should take antitussives at the prescribed schedule and dosage. They should not dilute the medications with fluids or take them with food because doing so may clear the medications from the pharynx, reducing their benefit. Antitussives are intended to suppress only non-purposeful cough; suppression of all coughing can prevent the clearance of secretions.
A client is instructed to take diphenhydramine after an allergic reaction. Which statement by the client indicates successful teaching concerning the safe and effective use of diphenhydramine?
I should not drive my car after taking this medication." Explanation: The administration of diphenhydramine causes drowsiness, and the client should not operate machinery, such as driving. The client should not combine diphenhydramine with alcohol due to central nervous system depression. The client will not need to limit sodium with this medication. The client should adhere to the dosing schedule and not take the medication every 2 hours.
Parents who treat their children's cold and flu symptoms at home, should be reminded to read the labels of medications they use. What is the most important reason for doing so?
To understand proper use, precautions, and contraindications Explanation: Anyone using an over-the-counter medication should read the label to understand ingredients, instructions for use, precautions, contraindications, and drug interactions. Because these labels are frequently confusing, users of these products should contact a healthcare provider if they're unsure whether using a product is safe.
Which agent acts directly on the medullary cough center?
odeine Explanation: Codeine, a centrally acting antitussive, works directly on the medullary cough center. Benzonatate provides local anesthetic action on the respiratory passages, lungs, and pleurae. Ephedrine and tetrahydrozoline are topical nasal decongestants.
A 62-year-old client has been prescribed an antihistamine to alleviate vasomotor rhinitis. The client reports gastric irritation after taking the tablet. Which instructions should the nurse provide to help alleviate the client's condition?
Take the tablet with food. Explanation: If the client has gastric irritation following ingestion of the antihistamine, the nurse should instruct the client to take the tablet with food and not before food. Taking an antacid before the tablet may reduce the absorption of the antihistamine. Drinking ample water before taking the tablet will not help to alleviate the patient's condition.
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, 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?
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.
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 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 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.
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?
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.
An older adult client presents with sneezing, a nonproductive cough, and reports nasal congestion that began 5 days ago. What common, viral respiratory infection is the client likely experiencing?
common cold Explanation: The common cold, a viral infection of the upper respiratory tract, is the most common respiratory tract infection that is associated with a cough, nasal congestion, and sneezing. Sinusitis is an inflammation or swelling of the tissue lining the sinuses, causing a collection of fluid that enables pathogens to grow. The common symptomology of sinusitis includes nasal congestion, rhinorrhea, and facial pain. Allergic rhinitis (hay fever) is associated with an allergic reaction to an inhalant such as dust, animal dander, or pollen. The symptoms include sneezing, runny nose, and red, watery, and itchy eyes. Acute bronchitis is an acute inflammatory injury of the bronchial tubes. Bronchitis presents with a productive cough, shortness of breath, chest discomfort, and slight fever and chills.
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.
The substances released from mast cells are responsible for what physiological response? Select all that apply.
inflammation bronchoconstriction When lung tissues are exposed to causative stimuli, mast cells release substances that cause bronchoconstriction and inflammation. The mast cells substances are not associated with any of the other options.
A 76-year-old client has been prescribed an oral antihistamine. What adverse effect presents a priority safety concern for older adult clients?
Drowsiness Explanation: Older adults are more likely to experience anticholinergic effects (dryness of mouth, nose, throat), dizziness, sedation, hypotension, and confusion from the use of antihistamines. Drowsiness and sedation present the greatest safety concerns compared to other effects such as dry mouth and nonproductive cough. Nasal burning may occur due to nasal spray use.
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.
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.
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.
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. Expectorants increase the production of respiratory secretions, which in turn appear to decrease the viscosity of the mucus. This helps to raise secretions from the respiratory passages. Antitussives are cough suppressants. Antihistamines are used to treat allergic reactions.
A client reports taking pseudoephedrine to relieve nasal congestion. The nurse would instruct the client to stop using the medication if what disorder is documented in the client history?
history of coronary artery disease Explanation: Nasal decongestants are contraindicated in clients with severe hypertension or coronary artery disease because of their cardiac-stimulating and vasoconstricting effects. They must be used with caution in the presence of cardiac dysrhythmias, hyperthyroidism, diabetes mellitus, glaucoma, and prostatic hypertrophy. In clients with diabetes and hypertension that are controlled, they can be used with caution. A client with a pulse rate of 58 beats/min, otherwise symptom free, can be given this medication under observation.
The nurse taking a medical history determines that the client takes a decongestant regularly for a variety of seasonal allergies. What other medication identified in the client's current medication history would constitute an immediate risk to the client's health?
monoamine oxidase inhibitor (MAOI) Explanation: Clients who take tricyclic or monoamine oxidase inhibitor antidepressants should not receive pseudoephedrine.
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.
