NU141- Chapter 54 Drugs Acting on the Upper Respiratory Tract
A nursing student is researching which antihistamine drug that elicits its antihistamine effects by selectively binding to peripheral H1 receptors?
Desloratadine
Decongestants should be used cautiously in clients with which conditions? (Select all that apply.)
Diabetes Glaucoma
A nurse is describing the action of a prescribed antihistamine to a client. The nurse is describing which medication, by explaining that the drug elicits its antihistamine effects by nonselectively binding to central and peripheral H1 receptors?
Diphenhydramine
A female client is prescribed a first-generation antihistamine for her allergies. The nurse would expect her to experience what adverse effect?
Dry mouth
The pharmacology instructor is discussing the adverse effects of diphenhydramine. Which is not one of these effects?
Excessive salivation
A group of nursing students are reviewing information about expectorants. The students demonstrate understanding when they identify which medication as an example?
Guaifenesin
When teaching a patient who is receiving pseudoephedrine about possible adverse effects, what would the nurse include? (Select all that apply.)
Hypertension Anxiety Restlessness
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 Nervousness
The nurse is providing education to a client diagnosed with the common cold. What measure should the nurse recommend implementing to help liquefy cold-related secretions?
Increasing fluid intake
A client has been suffering from repeated sinus infections. The client is diagnosed with allergic rhinitis. The client is prescribed a daily antihistamine. What is the mechanism of action in the antihistamine medications?
It prevents histamine from acting on target tissues.
A client reports increased sedation after the initiation of chlorpeniramine to treat her allergies. Which antihistamines could the nurse recommend to the client to treat her allergy symptoms that would result in less sedation? (Select all that apply.)
Loratadine (Claritin) Cetirizine (Zyrtec)
What should be observed during ongoing assessment of a client taking an antitussive? (Select all that apply.)
Lung sounds Frequency of cough Therapeutic effect Pain assessment
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 airway clearance
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.
Some antihistamines can produce significant sedation. Which drug is most likely to cause this adverse effect?
Promethazine
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
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
A critically ill client with a diagnosis of ventilator-associated pneumonia has been administered acetylcysteine. The inhalation of acetylcysteine helps to liquefy secretions in the respiratory tract by what mechanism?
Breaking the protein bonds that exist in mucus
When providing health education to an adult who is taking an over-the-counter (OTC) combination cold and cough remedy, the nurse should encourage the client to implement what intervention to best assure medication safety?
Carefully read the label and adhere to the guidelines for use.
Which of the following would a nurse identify as a first generation antihistamine? Select all that apply.
Clemastine Dimenhydrinate
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."
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."
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."
Which statement by the clinet would alert the nurse that more educatin is needed regarding a client receiving an antitussive?
"I should keep the room warm."
After teaching a client who is receiving an antitussive about the drug, which statement indicates the need for additional teaching?
"I'll keep the room warm and toasty."
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."
A client is prescribed an antitussive agent with codeine. Which statement by the client indicates that the nurse's teaching has been effective?
"This medication will cause drowsiness, and I will not drive."
The health care provider suggests that a client use guaifenesin to help his cough. The nurse instructs the client to call the health care provider if he continues to have a productive cough after which amount of time?
1 week
A patient receives dextromethorphan. The nurse would expect this drug to begin acting within which time frame?
25 to 30 minutes
A patient receives guaifenesin. The nurse would expect the drug to begin acting within which time frame?
30 minutes
A nurse administers an antitussive agent cautiously to a client with asthma for which reason?
A loss of respiratory reserve can occur.
A client is admitted after overdose with acetaminophen. What medication would the nurse expect to be administered?
Acetylcysteine
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.
A client, recovering from a cold and now experiencing a hacking cough, asks if taking an antihistamine would be helpful. What response demonstrates the nurse's understanding of the effective use of antihistamines? Select all that apply.
"Antihistamines are not recommended because they tend to worsen your cough." "Antihistamines are used for allergy-related coughs."
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."
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."
Fexofenadine (Allegra) is prescribed for a client with seasonal allergies. What should the nurse teach the client about the side effects of this medication?
"Less drowsiness occurs with this medication compared to other antihistamines."
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 Importance of reading the label for ingredients and dosage Need to follow the directions for how often to give the drug
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
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
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
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
Common adverse effects associated with the use of topical nasal steroids would include which conditions? a. Local burning and stinging b. Dryness of the mucosa c. Headache d. Constipation and urinary retention e. Fungal infections f. Osteonecrosis
a. Local burning and stinging b. Dryness of the mucosa c. Headache e. Fungal infections
What medication should be prescribed to minimize the risk associated with a blood transfusion for a client with a history of a previous transfusion reaction?
diphenhydramine
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
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.
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?
Rebound nasal swelling
A male client is diagnosed with chronic bronchitis. What would the nurse expect to be one of his physical reports?
Retention of secretions
First-generation antihistamines may be effective against what symptoms? (Select all that apply.)
Sneezing Rhinorrhea Cough
A group of students demonstrate understanding of topical decongestants, identifying them as:
Sympathomimetics
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.
Expectorants elicit their effect by which mechanism?
Thinning respiratory secretions
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
Nasal decongestants would be contraindicated for which client?
a client with a history of coronary artery disease
Rebound congestion
a process that occurs when the nasal passages become congested as the effect of a decongestant drug wears off; patients tend to use more drug to decrease the congestion, and a vicious circle of congestion, drug, and congestion develops, leading to abuse of the decongestant; also called rhinitis medicamentosa
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
A patient is not getting a response to the antihistamine that was prescribed. Appropriate action might include a. switching to a decongestant. b. stopping the drug and increasing fluids. c. trying a different antihistamine. d. switching to a corticosteroid.
c. trying a different antihistamine
The nurse's assessment should prioritize what system when caring for a client who has just been admitted for an overdose of pseudoephedrine?
cardiovascular
Mucolytics
drugs that increase or liquefy respiratory secretions to aid the clearing of the airways
Expectorants
drugs that increase productive cough to clear the airways
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?
rebound congestion
When the use of antihistamines result in dryness of the mouth, the nurse should recommend which to relieve the dryness? Select all that apply.
Suck on sugarless hard candy. Offer ice chips. Take frequent sips of water.
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."
The nurse is educating an older adult client diagnosed with rhinosinusitis in an outpatient clinic about the prescribed topical oxymetazoline. The client has a history of hypertension and coronary artery disease. Which statement made by the client establishes the need for further clarification?
"I can take over-the-counter pseudoephedrine, too."
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."
A client reports a hacking cough. The client asks if taking an antihistamine would be helpful. The nurse's best response is:
Antihistamines are not recommended because they can dry lower respiratory secretions and worsen secretion retention and cough.
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.
A client is prescribed oxymetazoline. Which assessment data would indicate that the drug is effective?
Breathing pattern is regular and without difficulty.
When instructing a client in how to use a topical nasal spray, what would the nurse emphasize to do first?
Clear the nasal passages.
Which agent acts directly on the medullary cough center?
Codeine
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
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
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.
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
A 76-year-old client has been prescribed an oral antihistamine. What adverse effect presents a priority safety concern for older adult clients?
Drowsiness
A female client presents at the clinic with a dry, nonproductive cough. The client is diagnosed with bronchitis, and it is determined that she will need help thinning sputum so that the cough can become productive. What does the nurse expect will be prescribed for the client?
Guaifenesin
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
Which agent would a nurse expect the health care provider to prescribe for a client experiencing motion sickness?
Meclizine
A client with cystic fibrosis may use which type of medication to reduce the viscosity of respiratory secretions?
Mucolytic
Which agent would the nurse instruct a client to use orally?
Pseudoephedrine
What is an adverse reaction commonly experienced by people taking nasal decongestants?
Rebound congestion
The instructor is discussing adverse effects associated with nasal decongestants. What is an effect of excessive use of these products when admnistered correctly?
Rebound nasal congestion
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.
Meclizine is used to relieve the nausea and vomiting that occurs with motion sickness.
True
A patient with sinus pressure and pain related to seasonal rhinitis would benefit from taking a. an antitussive. b. an expectorant. c. a mucolytic. d. a decongestant.
d. a decongestant
Patients with seasonal rhinitis experience irritation and inflammation of the nasal passages and passages of the upper airways. Treatment for these patients might include a. systemic corticosteroids. b. mucolytic agents. c. an expectorant. d. topical nasal steroids.
d. topical nasal steroids
Antitussives
drugs that block the cough reflex
Which condition would contraindicate the use of or oxymetazoline?
hypertension
Rhinitis medicamentosa
reflex reaction to vasoconstriction caused by decongestants; a rebound vasodilation that often leads to prolonged overuse of decongestants; also called rebound congestion
When should a client prescribed diphenhydramine take the medication to prevent motion sickness during a ferry boat ride?
30 to 60 minutes before the ferry trip
Acetylcysteine may be used as a mucolytic agent. What is an additional indication for the drug?
Antidote for acetaminophen poisoning
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.
Which would the nurse expect to administer as a nasal spray?
Oxymetazoline
A gerontological nurse has encouraged a group of caregivers who work with older adults to avoid administering first-generation H1 receptor antagonists to their clients. The nurse's cautionary message is an acknowledgment of what possible nursing diagnosis?
Risk for falls related to sedation
When describing the effects of second-generation antihistamines, which would the nurse address as being decreased?
Sedation
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.
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?
There are concerns among health professionals about how safe and effective these medications are.
A client is prescribed epinephrine for the treatment of anaphylaxis. This client is experiencing what type of hypersensitivity reaction?
Type I
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
Antihistamines
drugs that block the release or action of histamine, a chemical released during inflammation that increases secretions and narrows airways
A 59-year-old client is unsure whether his or her symptoms are attributable to a cold or to allergies, so he/she is taking pseudoephedrine as well as an antihistamine. This combination of drugs creates a risk for what adverse effect?
hypertension
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."
What statement made by a client suggests a need for further teaching on the risk factors associated with drug allergies?
"If you didn't have allergies as a child, you won't develop allergies later in life."
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."
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
What is the chemical mediator released in immune and inflammatory response to allergic reactions?
Histamine
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
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.
A male client presents to the health care provider's office for his annual visit. When questioned about over-the-counter medication use, he states that he uses echinacea to prevent colds. What statement is true about echinacea?
There is limited or no support for the use of echinacea to prevent or treat symptoms of the common cold.
Additional nursing interventions for clients receiving antihistamines would probably include which recommendations? a. Using a humidifier b. Advising the client to suck sugarless lozenges to help relieve the dry mouth c. Limiting fluid intake to decrease swelling d. Providing safety measures to prevent falls or injury e. Encouraging pushing fluids, if allowed f. Leaving bowls of water around the house to increase humidity
a. Using a humidifier b. Advising the client to suck sugarless lozenges to help relieve the dry mouth d. Providing safety measures to prevent falls or injury e. Encouraging pushing fluids, if allowed f. Leaving bowls of water around the house to increase humidity
Antihistamines should be used cautiously in patients with a. histories of arrhythmias or prolonged QT intervals. b. COPD or bronchitis. c. asthma or seasonal rhinitis. d. angioedema or low blood pressure.
a. histories of arrhythmias or prolonged QT intervals
A patient taking a behind-the-counter cold medication and a behind-the-counter allergy medicine is found to be taking double doses of pseudoephedrine. As a result, the patient might exhibit a. ear pain and eye redness. b. restlessness and palpitations. c. sinus pressure and ear pain. d. an irritating cough and nasal drainage.
b. restlessness and palpitations
Antitussives are useful in blocking the cough reflex and preserving the energy associated with prolonged, nonproductive coughing. Antitussives are best used with a. postoperative patients. b. asthma patients. c. patients with a dry, irritating cough. d. COPD patients who tire easily.
c. patients with a dry, irritating cough
Dornase alfa (Pulmozyme), because of its mechanism of action, is reserved for use in a. clearing secretions before diagnostic tests. b. facilitating the removal of secretions postoperatively. c. protecting the liver from acetaminophen toxicity. d. relieving the buildup of secretions in cystic fibrosis.
d. relieving the buildup of secretions in cystic fibrosis
Decongestants
drugs that decrease the blood flow to the upper respiratory tract and decrease the overproduction of secretions
Which nursing diagnosis would provide the clearest indication for the administration of inhaled acetylcysteine?
ineffective airway clearance
After teaching a group of parents about the use of over-the-counter cough and cold products with their children, which statement indicates the need for additional teaching?
"We can use the adult brand, but we just have to decrease the amount."
Mucolytics are often used for patients with cystic fibrosis, COPD, or tuberculosis.
True
The nurse is giving discharge instructions to a client with an upper respiratory infection. The client has been advised to take an over-the-counter (OTC) topical nasal decongestant. What should the nurse teach the client in order to prevent rhinitis medicamentosa?
Use the medication for as short a time as possible
An antihistamine would be the drug of choice for treating which conditions? a. Itchy eyes b. Irritating cough c. Nasal congestion d. Runny nose e. Idiopathic urticaria f. Thick, tenacious secretions
a. Itchy eyes c. Nasal congestion d. Runny nose e. Idiopathic urticaria
The client states that he/she once needed medication to liquefy secretions in the respiratory tract. However, the client cannot recall the name of the medication but states that the medication is added to a nebulizer. The nurse suspects the client is taking which medication?
acetylcysteine
