Ch 54: Upper Resp Sys Drugs
A client is receiving dornase alfa at home. Which would the nurse instruct the client to do? "Protect the drug from light." "Store the drug at room temperature." "Mix the drug with tap water." "Take the drug orally with meals."
"Protect the drug from light."
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? "If this medicine works, I shouldn't cough at all." "I should take this medicine followed by a glass of water." "This medication might cause drowsiness, so I will avoid driving while I use it." "If my cough doesn't improve right away, I'll increase my dose."
"This medication might cause drowsiness, so I will avoid driving while I use it."
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 25 to 30 minutes 10 to 15 minutes
25 to 30 minutes Dextromethorphan has an onset of action of 25 to 30 minutes.
A client whose daily commute includes travel on a ferry boat has been prescribed diphenhydramine. During client teaching, the nurse should instruct the client to take the medication at what time? as soon as the ferry leaves the dock 30 to 60 minutes before the ferry trip when the client boards the ferry the night before each trip
30 to 60 min before the ferry trip To prevent motion sickness, it is necessary to take diphenhydramine 30 to 60 minutes before the trip begins.
A client has purchased an over-the-counter (OTC) cold remedy that advertises a "nondrowsy" formulation. The nurse explains to the client that such a medication likely contains what classification of drug? A narcotic analgesic A benzodiazepine An antihistamine A nasal decongestant
A nasal decongestant
Which agent acts directly on the medullary cough center? Ephedrine Codeine Benzonatate Tetrahydrozoline
Codeine
A client having an allergic reaction to mold, describes chest tightness and difficulty breathing. Which process is occurring? Decreased secretion of the mucous glands Decreased permeability of the veins and capillaries Contraction of smooth muscle in the bronchi Suppression of the vagus nerve endings producing tachycardia
Contraction of smooth muscle in the bronchi
A client comes to the clinic with what appears to be a cold. What group of upper respiratory drugs cause local vasoconstriction, which decreases blood flow and shrinks swollen membranes to improve air flow? Antitussives Decongestants Mucolytics Expectorants
Decongestants
When describing the benefits of second-generation H1 receptor antagonists to those of first-generation H1 receptor antagonists, the nurse should cite what advantage? Absence of adverse effects Lower cost Once-weekly dosing Decreased sedation
Decreased sedation
Decongestants should be used cautiously in clients with which conditions? (Select all that apply.) Arthritis Diabetes Glaucoma Hypotension Hypothyroidism
Diabetes Glaucoma Clients with diabetes, heart disease, hypertension, hyperthyroidism, benign prostatic hypertrophy, and glaucoma should contact their health care provider before taking over-the-counter decongestants.
A 76-year-old client has been prescribed an oral antihistamine. What adverse effect presents a priority safety concern for older adult clients? Drowsiness Nonproductive cough Dry mouth Nasal burning
Drowsiness
A client with cystic fibrosis may use which type of medication to reduce the viscosity of respiratory secretions? Mucolytic Peripherally acting antitussive Antihistamine Expectorant Centrally acting antitussive
Mucolytic
An older adult client is administered dimenhydrinate. Which is the priority nursing intervention for this client? Maintain IV access. Encourage fluids with this client. Protect from injury. Have the client void after administration.
Protect from injury.
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? "Sometimes a decongestant can sometimes mask the effects of your cold, essentially prolonging it." "Most people find that cold medications are essentially ineffective." "It usually takes between 8 and 10 days for a decongestant to cure affect cold symptoms." "Drugs like this can often relieve some of the symptoms of a cold, but they won't cure it."
"Drugs like this can often relieve some of the symptoms of a cold, but they won't cure it."
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? "No OTC medication, especially sprays or nose drops, should be taken for more than 3-4 days." "You should really consider prescription medications rather than OTC medications." "While OTC medications may be cheaper, they generally result in more side effects." "Follow the instructions on the label so that you don't end up making the congestion worse."
"Follow the instructions on the label so that you don't end up making the congestion worse."
The nurse is educating an older adult client diagnosed with rhinosinusitis in an outpatient clinic about the prescribed topical oxymetazoline. The client has a history of hypertension and coronary artery disease. Which statement made by the client establishes the need for further clarification? "The drug is used no longer than 3 days." "I can take over-the-counter pseudoephedrine, too." "I will blow my nose before using the nasal spray." "I will rinse the spray tip off after each use."
"I can take over-the-counter pseudoephedrine, too."
First-generation antihistamines may be effective against what symptoms? (Select all that apply.) Cough Congestion Fever Sneezing Rhinorrhea
Sneezing Rhinorrhea Cough First-generation antihistamines (e.g., chlorpheniramine, diphenhydramine) have anticholinergic effects that may reduce sneezing, rhinorrhea, and cough. They do not have antipyretic effects.
What home remedies are effective for mouth dryness and cough? (Select all that apply.) Sucking on hard candy or throat lozenges Swishing the mouth with astringent mouthwash. Administration of over-the-counter antihistamine Adequate fluid intake Humidification of the environment
Sucking on hard candy or throat lozenges Adequate fluid intake Humidification of the environment 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 group of students demonstrate understanding of topical decongestants, identifying them as: Sympathomimetics Sympatholytics Parasympathomimetics Parasympatholytics
Sympathomimetics
A client administers diphenhydramine to their 9-year-old child, who experiences seasonal allergies, before a baseball game. What may the child experience if a paradoxical effect to the medication occurs? exacerbation of allergic symptoms excitation decreased mental alertness poor reflexes
excitation First-generation antihistamines (e.g., diphenhydramine) commonly cause drowsiness and decreased mental alertness. Excitation is a paradoxical effect that occasionally occurs, especially in children. Diphenhydramine isn't associated with exacerbation of allergic symptoms or an effect on reflexes.
Which condition would contraindicate the use of oxymetazoline? hypertension nasal congestion skin rash cough
hypertension
A client reports experiencing severe nasal congestion since starting to use an over-the-counter (OTC) nasal decongestant spray a week ago. This symptomology most supports what possible medical condition? bronchitis rebound congestion a drug allergy sinusitis
rebound congestion
The nursing instructor is discussing the use of nasal decongestants and shares what reason for their effectiveness? They are absorbed systemically. They come into direct contact with nasal mucosa. Their effects last for 48 to 72 hours. They treat multiple symptoms in a cost-effective manner.
They come into direct contact with nasal mucosa.
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 guaifenesin prednisone acetylcysteine
acetylcysteine
What medication should be prescribed to minimize the risk associated with a blood transfusion for a client with a history of a previous transfusion reaction? epinephrine cetirizine diphenhydramine clemastine
diphenhydramine
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? acute kidney injury respiratory depression hepatotoxicity hypertension
hypertension
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? antibiotic monoamine oxidase inhibitor (MAOI) proton pump inhibitor (PPI) an inhaled steroid
monoamine oxidase inhibitor (MAOI) Clients who take tricyclic or monoamine oxidase inhibitor antidepressants should not receive pseudoephedrine.
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? CD4 T cells Platelets Basophils Lymphocytes
Basophils Histamine is discharged from mast cells and basophils in response to certain stimuli, such as allergic reactions, cellular injury, and extreme cold. Lymphocytes and platelets do not release histamine. CD4 cells (often called T cells or T-helper cells) are a type of white blood cells that play a major role in protecting the body from infection.
A 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? Antihistamine Diphenhydramine Epinephrine Phenergan
Diphenhydramine
A nurse is describing the action of a prescribed antihistamine to a client. The nurse is describing which medication, by explaining that the drug elicits its antihistamine effects by non-selectively binding to central and peripheral H1 receptors? Loratadine Cetirizine Diphenhydramine Fexofenadine
Diphenhydramine
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? Loratadine Olopatadine Promethazine Diphenhydramine
Diphenhydramine
A group of nursing students are reviewing information about expectorants. The students demonstrate understanding when they identify which medication as an example? Benzonatate Dextromethorphan Guaifenesin Acetylcysteine
Guaifenesin
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? Promethazine Loratadine Meclizine Brompheniramine
Loratadine
A client is prescribed oxymetazoline, a decongestant, for the treatment of hay fever. What should the nurse evaluate to assess the efficacy of therapy? Maintenance of effective hydration of the skin Maintenance of effective airway clearance Maintenance of an effective heart rate Maintenance of an effective urine output
Maintenance of effective airway clearance Evaluation of the maintenance of effective airway clearance helps in assessing the efficacy of oxymetazoline, which is a decongestant drug. The hydration of the skin, the heart rate and the urine output are usually not changed in decongestant therapy.
A 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. The medication is contraindicated for the child's symptoms. The medication is contraindicated for viral infections. The medication is not effective for croup.
Misuse could result in overdose. Several OTC cough and cold medicines for use in infants have been recalled voluntarily due to concerns about possible misuse that could result in overdoses.
Which would contraindicate the use of a topical nasal decongestant? Diabetes Glaucoma Nasal ulceration Hypertension
Nasal ulceration Any lesion or erosion in the mucous membranes is a contraindication because of the increased risk for systemic drug absorption. Topical nasal decongestants should be used cautiously in patients with hypertension. Topical nasal decongestants should be used cautiously in patients with diabetes. Topical nasal decongestants should be used cautiously in patients with glaucoma.
The health care provider has ordered promethazine (Phenergan) for a client who is having a severe allergic reaction. The nurse is aware that this medication is also used to treat what condition? Hypotension Central nervous system depression Nausea and vomiting Joint pain
Nausea and vomiting Promethazine is most commonly used in the treatment of nausea and vomiting.
Which would the nurse expect to administer as a nasal spray? Dextromethorphan Hydrocodone Benzonatate Oxymetazoline
Oxymetazoline
Which is classified as a decongestant? Dextromethorphan (Delsym) Levocetirizine (Xyzal) Azelastine (Astelin) Oxymetazoline (Afrin)
Oxymetazoline (Afrin)
Some antihistamines can produce significant sedation. Which drug is most likely to cause this adverse effect? Cetirizine Loratidine Promethazine Fexofenadine
Promethazine
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? Ephedrine Phenylephrine Epinephrine Pseudoephedrine
Pseudoephedrine
What is an adverse reaction commonly experienced by people taking nasal decongestants? Rebound congestion Headache Rash Diarrhea
Rebound congestion
A male client presents to the health care provider's office with reports of inability to breathe freely. When the nurse reviews his use of over-the-counter medications, it is discovered that the client routinely uses nasal spray three times a day for 1 year. The nurse knows that what may be causing this client's continuous nasal congestion? Damage of the nasal concha Rebound nasal swelling Burning of the nares secondary to chronic use of nasal sprays Chronic nasal polyps
Rebound nasal swelling
When the use of antihistamines result in dryness of the mouth, the nurse should recommend which to relieve the dryness? Select all that apply. Suck on sugarless hard candy. Use a dehumidifier in the home. Take frequent sips of water. Offer ice chips. Administer intravenous fluid bolus.
Suck on sugarless hard candy. Take frequent sips of water. Offer ice chips. Offering the client frequent sips of water or ice chips, and suggesting use of sugarless gum or candy are appropriate suggestions to relieve dry mouth. An intravenous fluid bolus is invasive and not a first-line suggestion to relieve dryness. The client should run a humidifier, not a dehumidifier, to add moisture to the air at home and help relieve dryness.
An instructor is describing topical decongestants as belonging to which class? Anticholinergics Sympathomimetics Antihistamines Adrenergic antagonists
Sympathomimetics
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? Drink ample water before taking the tablet. Take the tablet one hour before food. Take an antacid before the tablet. Take the tablet with food.
Take the tablet with food. 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 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. Consult the physician immediately. Medication needs to be stopped immediately. Dose of the medication needs reduction.
This sensation usually disappears with continued use. The nurse needs to assure the patient that the mild stinging sensation usually disappears with continued use. The drug needs to be stopped only if the stinging sensation is severe. The dose of the medication need not be altered. The physician need not be consulted immediately in the presence of a mild stinging sensation.
When describing the action of decongestants, a nurse integrates knowledge of this class of drugs, identifying which mechanism? Vasoconstriction of small blood vessels of the nasal membranes Anesthetizing stretch receptors in the respiratory passages Non-selectively binding to central and peripheral H1 receptors Selectively binding to peripheral H1 receptors
Vasoconstriction of small blood vessels of the nasal membranes
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 bronchodilators by nebulizer administration of contrast media for diagnostic tests
administration of contrast media for diagnostic tests
The nursing instructor is teaching about antitussives and their side effects. What ingredient found in some antitussives does the instructor tell students can cause drowsiness? eucalyptus Advil antihistamine acetaminophen
antihistamine
A client has just been admitted for an overdose of pseudoephedrine. The nurse's assessment of the client should prioritize what system? renal gastrointestinal cardiovascular neurological
cardiovascular
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? allergic rhinitis (hay fever) sinusitis acute bronchitis common cold
common cold
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 antihistamine antitussant expectorant
decongestant
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 administration of guaifenesin supplemental oxygen administration of pseudoephedrine
deep breathing and coughing exercises 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.
The nurse is providing education about over-the-counter (OTC) cold remedies to a client who currently takes several medications for typical cold symptoms. What statement by the client demonstrates an understanding of risk reduction techniques associated with medication overdosing to maximize his or her safety? "I'll be sure to take the medications with food when the label suggests I do so." "Being aware of the active ingredients in my medications is important." "I'm very careful about taking just the medication at the recommended times." "If I still have symptoms in a week, I'll call my primary health care provider."
"Being aware of the active ingredients in my medications is important."
A client who recently starting taking over-the-counter dextromethorphan is concerned about experiencing adverse effects from the medication. Which statement(s) made by the nurse demonstrates an understanding of assessing for the most common possible effects? Select all that apply. "Would you say you are experiencing heart palpations?" "Drowsiness is commonly experienced." "There have been reports associating dextromethorphan and visual hallucinations." "Are you having difficulty breathing?" "The medication can make you feel nauseous."
"Drowsiness is commonly experienced." "Are you having difficulty breathing?" "The medication can make you feel nauseous." At normal doses, dextromethorphan is known to cause nausea, drowsiness, rash, and difficulty breathing. Doses exceeding recommendations can produce hallucinations and disassociation. There is no current research to support cardiac involvement associated with this drug.
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? "Are you out in the sun much during a typical day?" "Are you a smoker?" "Do you tend to exercise before going to bed?" "How much coffee, tea, and soda do you drink daily?"
"How much coffee, tea, and soda do you drink daily?"
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? "Have you been nauseated as well since taking the dextromethorphan?" "Is the dextromethorphan making you dizzy?" "Have you been taking the dextromethorphan at bedtime?" "How much dextromethorphan have you been taking each day?"
"How much dextromethorphan have you been taking each day?"
A nurse is teaching a 55-year-old client about fexofenadine prescribed to treat allergic symptoms. Which client statement suggests an understanding of this teaching? "I should avoid driving after taking this medication." "This medication has no serious side effects." "It's safe to take this medication with the nighttime sinus medication that I've been using." "Taking this medication shouldn't stop me from having my after-dinner drink."
"I should avoid driving after taking this medication." 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."
Which statement by the client would alert the nurse that more education is needed regarding a client receiving an antitussive? "I can use a humidifier." "I should keep the room warm." "I can use lozenges." "It will be helpful to Increase fluids."
"I should keep the room warm." 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 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." "I will not eat or drink for 30 minutes after taking a dose." "The drug should only be taken as directed on the package." "If I raise mucous, I will stop taking the drug and call my prescriber."
"I will dilute the drug syrup with an equal amount of water." 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.
After teaching a client who is receiving an antitussive about the drug, which statement indicates the need for additional teaching? "I'll get a humidifier for my bedroom." "I need to increase the amount of fluids I drink." "I can use some lozenges for comfort." "I'll keep the room warm and toasty."
"I'll keep the room warm and toasty." Measures to assist with cough control when using antitussives include cool temperatures, humidification, lozenges, and increased fluids.
The 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 know these can be a bit expensive, but hopefully it will be worth it for me." "I'm really hoping that these pills will cure my allergies before summer starts." "It's handy that I don't necessarily have to take these pills at bedtime." "I'll check with my health care provider to make sure that the diet supplements I'm taking are okay to take at the same time as these pills."
"I'm really hoping that these pills will cure my allergies before summer starts."
The nurse is teaching a client about the potential for allergic drug reaction. What statement made by a client suggests a need for further teaching? "All drugs have the potential to cause an allergic reaction." "If you didn't have allergies as a child, you won't develop allergies later in life." "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."
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." "The administration of nasal decongestant will act on the central nervous system to cause vasodilation of blood vessels." "The administration of a nasal decongestant will decrease the thyroid production and increase blood pressure." "The administration of a nasal decongestant will cause bradycardia and increase peripheral blood pressure gastric reflux."
"The administration of a nasal decongestant will increase blood pressure due to vasoconstriction of blood vessels."
The nurse is educating an adult client diagnosed with rhinosinusitis with viscous clear mucous about the prescribed guaifenesin 400 mg PO every 4 hours. Which statement made by the client establishes the need for further clarification? "I will drink at least 8 ounces of water with each dose." "The drug is not affected by taking it with or without meals." "The drug will suppress my cough so I can sleep easier." "I will ask my pharmacist before taking any over-the-counters."
"The drug will suppress my cough so I can sleep easier."
After teaching a group of parents about the use of over-the-counter cough and cold products with their children, which statement indicates the need for additional teaching? "We can use over-the-counter products for our 5-year-old but not for our 18-monthold." "We should use the cup that comes with the drug to measure it out." "We can use the adult brand, but we just have to decrease the amount." "We need to read the label carefully to see how often and how much to give."
"We can use the adult brand, but we just have to decrease the amount." Parents should use the children's, pediatric, or infant formulations of the drug. Over-the-counter cough and cold preparations should not be used in children under the age of 2 years (4 years!). The parents need to read the label carefully to determine the dosage and frequency, and they need to use the device that comes with the drug to ensure a proper dosage.
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? "It's best to take small doses of decongestants several times daily rather than two larger doses each day." "You can probably expect to get relief within the next few days or a week at the longest." "Over-the-counter decongestants don't normally work; you'll likely need to get a prescription for something more effective." "You might find yourself more congested than ever as your body compensates for your use of these drugs."
"You might find yourself more congested than ever as your body compensates for your use of these drugs."
A patient is receiving a topical nasal decongestant. The nurse instructs the patient to stop using the drug after which length of time? 4 days 6 days 3 days 5 days
5 days A topical nasal decongestant should not be used for longer than 5 days to prevent rebound congestion. Also, if the condition persists longer than 5 days, medical care should be sought.
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 4 days 21 days 2 days
7 days 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 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 A cough that is associated with an allergy to ragweed An occasional, productive cough A cough that occurs when the client is exposed to airborne irritants
A dry, nonproductive cough
Acetylcysteine may be used as a mucolytic agent. What is an additional indication for the drug? Antidote for acetaminophen poisoning Conversion of cardiac arrhythmias Treatment of peptic ulcer disease Treatment of bronchospasm
Antidote for acetaminophen poisoning
A client exhibiting signs and symptoms of the common cold asks the nurse if taking an antihistamine would be helpful. What is the nurse's best response? Antihistamines are not recommended for treating a cold. Antihistamines can be helpful when they're combined with an antibiotic. Yes, but be sure to use a brand that mentions 'cold remedy' on the packaging. Yes, but it's important to monitor for adverse effects.
Antihistamines are not recommended for treating a cold. Although antihistamines are popular over-the-counter drugs, studies have demonstrated that they are not successful or recommended for the treatment of the common cold. An antibiotic should not be prescribed for the treatment of the common cold, which is a viral disorder.
A client is taking pseudoephedrine. The nurse would assess the client for which adverse effect? Lethargy Dry skin Anxiety Hypotension
Anxiety Adverse effects related to the sympathomimetic effects of pseudoephedrine are more likely to occur, including feelings of anxiety, restlessness, hypertension, sweating, tenseness, tremors, arrhythmias, and pallor.
The nurse prepares to administer acetylcysteine by nebulization to an adult client diagnosed with chronic bronchitis. Which measures would the nurse provide for safe and effective drug administration? Select all that apply. Assess for improvement in coughing up increased amounts of mucous, respirations less than 26, and SaO2 greater than 90%. Provide drug after meals and before bedtime to remove mucous, which causes difficulties in breathing. Instruct client that the drug irritates gastric vagal receptors to stimulate respiratory tract fluid. Report dyspnea, chest tightness, bronchospasms, and inability to expel secretions to the prescriber. Administer prescribed bronchodilator aerosolized treatment 10 to 15 minutes before the acetylcysteine treatment.
Assess for improvement in coughing up increased amounts of mucous, respirations less than 26, and SaO2 greater than 90%. Report dyspnea, chest tightness, bronchospasms, and inability to expel secretions to the prescriber. Administer prescribed bronchodilator aerosolized treatment 10 to 15 minutes before the acetylcysteine treatment. The nurse should instruct the client that the mucolytic drug attacks protein bonds in mucous and liquefies it, so it is easier to expel the mucous. Guaifenesin, an expectorant, irritates gastric vagal receptors stimulating respiratory tract fluid to increase and liquifies the mucous. The bronchodilator is administered first to dilate the bronchi so that the mucolytic will be more effective. The optimal times to administer the drug are upon rising, before meals, and at bedtime to effectively remove mucous that causes problems with breathing. Providing the drug after meals will increase nausea and vomiting, potential adverse effects. Therapeutic effects the nurse assesses includes increase in mucous raised from the lungs, a decrease of respirations to a normal range, and stabilization of SaO2 at 90% or greater. The nurse would report adverse effects to the prescriber that reflect the drug is not therapeutic, including chest tightness, bronchospasm, and inability to expel mucous.
An adult client has asked the nurse to recommend an OTC cold remedy. Before making a recommendation, the nurse should implement which intervention? Consult with a pharmacist or pharmacy technician. Ensure that the client has tried some of the more common herbal and natural remedies. Assess the client for health problems that may contraindicate the use of a particular remedy. Assess the client's understanding of the epidemiology of the common cold and upper respiratory infections.
Assess the client for health problems that may contraindicate the use of a particular remedy.
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? (Select all that apply.) Avoidance of use in children under age 2 Using household measuring devices for dosage measurements Need to follow the directions for how often to give the drug Importance of reading the label for ingredients and dosage Using adult formulation with smaller doses
Avoidance of use in children under age 2 Need to follow the directions for how often to give the drug Importance of reading the label for ingredients and dosage 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 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? Vision Motor coordination Auditory tests Blood pressure
Blood pressure 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.
The nurse is assessing a client who is taking diphenhydramine for relief of seasonal allergies. Which finding should prompt the nurse to suspect that the resident is experiencing an anticholinergic effect of the medication? Blurry vision Wheezing on expiration Tinnitus Urticaria
Blurry vision
The nurse is providing health education to an adult client who is taking an over-the-counter combination cold and cough remedy. What guidance should the nurse include to best assure medication safety? Take the medication with an additional dose of acetaminophen to potentiate therapeutic effects. Carefully read the label and adhere to the guidelines for use. Stop taking the medication until you get a prescription from your primary health care provider. Start with a low dose and gradually increase it until symptoms are relieved.
Carefully read the label and adhere to the guidelines for use.
When instructing a client in how to use a topical nasal spray, what would the nurse emphasize to do first? Close the opposite nares. Spray the medication with the bottle upright. Lie down to tilt the head back. Clear the nasal passages.
Clear the nasal passages. 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? Stimulation of the reticular activating system (RAS) Desensitization of the cough receptors in the sinuses and trachea Depression of the cough center in the medulla oblongata Vasodilation of the alveolar capillaries
Depression of the cough center in the medulla oblongata
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 by inhibiting allergen response. Dextromethorphan works on the receptors in the throat to prevent a cough. Dextromethorphan works by relaxing the smooth muscles in the bronchioles. Dextromethorphan works in the medulla to suppress the cough reflex.
Dextromethorphan works in the medulla to suppress 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 by inhibiting allergen response. Dextromethorphan works on the receptors in the throat to prevent a cough. Dextromethorphan works in the medulla to suppress the cough reflex. Dextromethorphan works by relaxing the smooth muscles in the bronchioles.
Dextromethorphan works in the medulla to suppress the cough reflex.
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? Codeine Aspirin Guaifenesin Dextromethorphan
Guaifenesin 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.
The nurse is assessing a client suspected of overdose with dextromethorphan. What assessment finding is suggestive of an overdose with the drug? Kussmaul respirations Hallucinations arrhythmias Profound diaphoresis
Hallucinations The nurse observes for excessive suppression of the cough reflex (inability to cough effectively when secretions are present) or hallucinations with dosages that exceed recommendations of dextromethorphan. Kussmaul respirations, arrhythmias, and diaphoresis are not characteristic adverse effects associated with dextromethorphan.
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 Side-lying Supine Semi-Fowler's
High Fowler's Teach the patient to sit upright and press a finger over one nare to close it.
What is the chemical mediator released in immune and inflammatory response to allergic reactions? Mast cells Histamine Epinephrine Norepinephrine
Histamine
A 75-year-old client is self-administering an oral nasal decongestant. The nurse is concerned that the client is at risk for what conditions? (Select all that apply.) Hypertension Somnolence Nervousness Impaired gastric motility
Hypertension Nervousness A major consideration is that older adults are at high risk of adverse effects from oral nasal decongestants (e.g., hypertension, cardiac arrhythmias, nervousness, insomnia).
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 produce a significant systemic effect. Inhaled nasal steroids are more effective than oral medications in treating the global symptoms associated with allergies. 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 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.
The physician has order promethazine (Phenergan) for a client who is nauseated and vomiting. Which would be an appropriate route of administering promethazine to the client? (Select all that apply.) Sublingually Subcutaneously Intravenously Intramuscularly Orally
Intravenously Intramuscularly IM or IV would be the best routes for administration of promethazine for this client. Promethazine can also be given orally as an antiemetic; however, if the client is actively vomiting the tablet might be regurgitated before it can be absorbed to elicit its effect.
A male client is diagnosed with chronic bronchitis. What would the nurse expect to be one of his physical reports? Retention of secretions Chronic nasal swelling Rhinitis Rhinorrhea
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.
After teaching a group of students about topical nasal steroid decongestants, the instructor determines the need for additional teaching when the students identify which as an example? Tetrahydrozoline Fluticasone Flunisolide Triamcinolone
Tetrahydrozoline
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 has had a cold for 3 days. The client is being treated for severe hypertension. The client has hypothyroidism. The client has a history of cataracts.
The client is being treated for severe hypertension.
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 capsules should be sucked on like a lozenge. Consumption of alcohol is okay while taking benzonatate. Benzonatate can be taken more frequently than prescribed if needed. The client should drink plenty fluids. Benzonatate can cause GI upset and sedation.
The client should drink plenty fluids. Benzonatate can cause GI upset and sedation. 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 parent of a toddler asks about giving an over-the-counter (OTC) cough and cold product containing pseudoephedrine to the child. What information regarding safety and efficacy should the nurse offer? Risk can be minimized by using age-specific preparations of cough and cold remedies. Cough and cold remedies are generally safe and effective for children over the age of 2. There are concerns among health professionals about how safe and effective these medications are. Media reports about the risks of cough and cold medications in children have greatly exaggerated the risks.
There are concerns among health professionals about how safe and effective these medications are. Research seems to suggest that pseudoephedrine appears to be effective in children older than 4 years of age, but the drug's effectiveness in younger children is inconclusive. The U.S. Food and Drug Administration (FDA) does not recommend OTC use of the drug in this age group due to the risk of serious and life-threatening adverse effects, including seizures, decreased level of consciousness, tachycardia, and death. The low doses found in children's preparations may be insufficient to produce therapeutic effects. In addition, the risk of adverse effects and overdosing, particularly with liquid preparation, pose significant threats to safety. Extended-release tablets should not be administered to children younger than 12 years of age, and children should not be given drugs that are packaged for adults.
When developing the teaching plan for a client receiving an antihistamine, which would the nurse include? (Select all that apply.) Using sugarless candies or lozenges to combat dry mouth Advising the client to avoid alcohol consumption Stopping the drug after 3 days if no relief is obtained Encouraging the client to engage in usual activities such as driving
Using sugarless candies or lozenges to combat dry mouth Advising the client to avoid alcohol consumption 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.
