ch. 54: drugs acting on the upper respiratory tract
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? "The additives that are in drugs can also cause allergic reactions." "Virtually any drug may induce an immunologic response in a susceptible person." "If you didn't have allergies as a child, you won't develop allergies later in life." "All drugs have the potential to cause an allergic reaction."
"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 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 can probably expect to get relief within the next few days or a week at the longest." "You might find yourself more congested than ever as your body compensates for your use of these drugs." "Over-the-counter decongestants don't normally work; you'll likely need to get a prescription for something more effective." "It's best to take small doses of decongestants several times daily rather than two larger doses each day."
"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. Reference: Chapter 54: Drugs Acting on the Upper Respiratory Tract - Page 941
A patient receives dextromethorphan. The nurse would expect this drug to begin acting within which time frame? 15 to 20 minutes 20 to 25 minutes 10 to 15 minutes 25 to 30 minutes
25 to 30 minutes Explanation: Dextromethorphan has an onset of action of 25 to 30 minutes. Reference: Chapter 54: Drugs Acting on the Upper Respiratory Tract - Page 940
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 2 days 21 days 4 days
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. Reference: Chapter 54: Drugs Acting on the Upper Respiratory Tract - Page 946
When instructing a client in how to use a topical nasal spray, what would the nurse emphasize to do first? Spray the medication with the bottle upright. Clear the nasal passages. Close the opposite nares. Lie down to tilt the head back.
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. Reference: Chapter 54: Drugs Acting on the Upper Respiratory Tract - Page 944
Which would contraindicate the use of a topical nasal decongestant? Nasal ulceration Hypertension Diabetes Glaucoma
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. Reference: Chapter 54: Drugs Acting on the Upper Respiratory Tract - Page 941
First-generation antihistamines may be effective against what symptoms? (Select all that apply.) Cough Rhinorrhea Congestion Fever Sneezing
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. Reference: Chapter 54: Drugs Acting on the Upper Respiratory Tract - Page 948
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 used only to treat seasonal allergies. Inhaled nasal steroids do not have any adverse effects. Inhaled nasal steroids are more effective than oral medications in treating the global symptoms associated with allergies. Inhaled nasal steroids produce a significant systemic effect.
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 2 days 21 days 4 days
Expectorants elicit their effect by which mechanism? Depressing the cough center in the brain Breaking down thick mucus in the lower lungs Thinning respiratory secretions Anesthetizing stretch receptors in the respiratory passages
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. Reference: Chapter 54: Drugs Acting on the Upper Respiratory Tract - Page 954
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? pseudoephedrine acetylcysteine prednisone guaifenesin
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. Reference: Chapter 54: Drugs Acting on the Upper Respiratory Tract - Page 955
What hospital procedure has the greatest potential to cause an anaphylactoid reaction? administration of intravenous fluids rapidly administration of low molecular weight heparin administration of contrast media for diagnostic tests administration of bronchodilators by nebulizer
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.
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? Advil antihistamine eucalyptus acetaminophen
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. Reference: Chapter 54: Drugs Acting on the Upper Respiratory Tract - Page 948
The nurse is planning care for a client who is experiencing excessive respiratory tract secretions. What intervention should the nurse include? supplemental oxygen administration of guaifenesin administration of pseudoephedrine deep breathing and coughing exercises
deep breathing and coughing exercises Explanation: With excessive respiratory tract secretions, mechanical measures (e.g., coughing, deep breathing, ambulation, chest physiotherapy, forcing fluids) are more likely to be effective than expectorant drug therapy. Research studies do not support guaifenesin's overall effectiveness, and many authorities do not recommend its use. Pseudoephedrine is not an expectorant, and supplemental oxygen will not loosen secretions.
A 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 history of controlled hypertension history of diet-controlled diabetes mellitus pulse rate of 58 beats/min
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. Reference: Chapter 54: Drugs Acting on the Upper Respiratory Tract - Page 944
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 respiratory depression hepatotoxicity acute kidney injury
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. Reference: Chapter 54: Drugs Acting on the Upper Respiratory Tract - Page 945