NURS 1141 practice questions exam 4 new content

A pt was prescribed an oral leukotriene receptor antagonist (LTRA) 1 month ago At today's follow-up appointment, he tells the nurse, "I don't think this pill works. I took it when I was short of breath, but it did not help." What is the nurse's priority action when answering the pt's concerns?

. A patient has to understand that leukotriene receptor antagonists are used for prophylaxis in asthmatic attacks when taken on a long-term basis. They are not used to treat acute attacks. The priority answer is to discuss with the patient that this medication must be taken regularly for best effects, even if the symptoms improve and the patient is feeling better. In addition, it takes several weeks for full therapeutic effects to occur. In addition, the nurse needs to review with the patient that this medication is for prevention of asthma attacks, and review which medications are indicated for acute asthma attacks.

The nurse is discussing use of antihistamines for allergic rhinitis. Which medications would be included in the list of H1 antagonists used in the treatment of allergic rhinitis? (Select all that apply.) a Nizatidine (Axid) b Cetirizine (Zyrtec) c Ranitidine (Zantac) d Loratadine (Claritin) e Fexofenadine (Allegra)

Cetirizine Loratadine Fexofenadine Antihistamines are drugs that directly compete with histamine for specific receptor sites. For this reason, they are also called histamine antagonists. H1 antagonists include drugs such as diphenhydramine (Benadryl), chlorpheniramine (generic), fexofenadine (Allegra), loratadine (Claritin), and cetirizine (Zyrtec).

A pt is recovering from an emergency exploratory laparotomy b/c of an abd mass. He had a cold before his surgery and is now coughing up large amounts of whitish sputum. He is receiving IV fluids. He asks the nurse for something to make him stop coughing. The nurse reviews the medication sheet and sees both and expectorant and an antitussive ordered. Which medication would be the best choice at this time? Explain your answer

In these situations it may enhance patient comfort and reduce respiratory distress to inhibit the cough by the use of an antitussive drug. Severe coughing may cause his abdominal incision to weaken and perhaps rupture. The nurse needs to ensure that the patient is well hydrated and given the antitussive drug to help reduce the severity of the cough during this immediate postoperative period.

A 13-yr-old pt is taken to the school clinic b/c he started to have an asthma attack while running outside in the cold air. The school nurse has two metered-dose inhalers on file for hime: fluticason and albuterol. Which inhaler is the priority at this time? Explain your answer.

The appropriate inhaler is the albuterol inhaler because it is a rapid-acting bronchodilator. Fluticasone is an inhaled corticosteroid and is used for prevention of asthma attacks, but it does not cause bronchodilation. It is not appropriate for use as a rescue inhaler.

Which statement by a client best indicates an understanding of the teaching on flunisolide (AeroBid)? a "I will rinse my mouth with water after each use." b "I will wash the plastic inhaler casing once a month." c "I will take two puffs to treat an acute asthma attack." d "I will not use my albuterol inhaler while I am taking AeroBid."

a "I will rinse my mouth with water after each use." Flunisolide is an inhaled corticosteroid. Rinsing the mouth immediately after each use of the inhaler or nebulizer will help prevent oral candidal infections. It is not used to treat an acute asthma attack and should be taken with the client's bronchodilator medications. The plastic inhaler casing is washed in warm, soapy water every week.

What is the role of corticosteroids in the treatment of acute respiratory disorders? a They decrease inflammation. b They directly dilate the bronchi. c They stimulate the immune system. d They increase gas exchange in the alveoli.

a - They decrease inflammation Corticosteroids can suppress the immune system. They do not directly affect bronchodilation but rather prevent bronchoconstriction as a response to inflammation.

Which laboratory value would the nurse assess before administering zafirlukast (Accolate) to a client? a Liver enzymes b Cardiac enzymes c Renal function tests d Complete blood count

a - liver enzymes Because use of zafirlukast may lead to liver dysfunction, liver enzyme levels should be monitored regularly, especially early in the course of therapy.

Discharge teaching to a patient receiving a beta-agonist bronchodilator should emphasize reporting which side effect? a Tachycardia b Nonproductive cough c Hypoglycemia d Sedation

a - tachycardia A beta-agonist bronchodilator stimulates the beta receptors of the sympathetic nervous system, resulting in tachycardia, bronchodilation, hyperglycemia, and increased alertness.

The nurse is assessing a pt w/ a mucosal ulceration. While conducting medical reconciliation, the nurse finds that the pt has developed this disorder as a result of long-term use of an herbal product containing goldenseal (Hydrastis canadensis). What other complications may the nurse find in this pt? a. HTN b. motion sickness c. nasal congestion d. urinary infections

a. HTN Goldenseal (Hydrastis canadensis) is an herbal supplement that is used for the treatment of upper respiratory tract infections. It has an antihistaminic and anticholinergic action. However, it increases gastric acid production and causes vasoconstriction, which may cause mucosal ulcers and hypertension if it is consumed for a long time. Because the drug has an anticholinergic effect, the patient will not have motion sickness. Because of the antihistaminic and anticholinergic actions, goldenseal reduces the constriction of bronchioles and nasal secretion. Therefore, the patient may not have nasal congestion. The drug has antifungal and antibacterial properties. Therefore, the patient may not have urinary infections.

The nurse is teaching a pt about the inhaler Advair (salmeterol/fluticasone). Which statements by the pt indicate a correct understanding of this medication? (SATA) a. I will rinse my mouth with water after each dose b. I need to use this inhaler whenever I feel short of breath, but not less than 4 hours between doses c. This medication is taken twice a day, every 12 hours d. I can take this inhaler if I get short of breath while exercising e. I will call my doctor if I notice white patches inside my mouth

a. I will rinse my mouth with water after each dose c. This medication is taken twice a day, every 12 hours e. I will call my doctor if I notice white patches inside my mouth

The nurse is providing teaching to a group of individuals w/ COPD at a community center. Which statement by one of the attendees indicates tat further teaching is needed? a. If I develop a puffy face, I will stop taking methylprednisolone (Medrol) immediately b. I will inform my prescriber of any weight gain of 2 lb or more in 24 hrs or 5 lb or more in a week c. I use omalizumab (Xolair) to control my asthma but not for an acute asthma attack d. When taking theophylline (Theo-Dur), I will advise my prescriber if I experience epigastric pain.

a. If I develop a puffy face, I will stop taking methylprednisolone (Medrol) immediately

A pt who has a history of asthma is experiencing an acute episode of shortness of breath and neesds to take a medication for immediate relief. The nurse will choose which medication that is appropriate for this situation? a. a beta agonist, such as albuterol b. a leukotriene receptor antagonist, such as montelukast c. a corticosteroid, such as fluticasone d. an anticholinergic, such as ipratropium

a. a beta agonist, such as albuterol

After a nebulizer treatment with the albuterol, the pt complains of feeling a little "shaky", with slight tremors of the hands. The pt's heart rate is 98 beats/min, increased from the pretreatment rate of 88 beats/ min. the nurse knows that this reaction is an: a. expected adverse effect of the medication b. allergic reaction to the medication c. indication that he has received an overdose of the medication d. idiosyncratic reaction to the medication

a. expected adverse effect of the medication

When assessing a pt who is to receive a decongestant, the nurse will recognize that a potential contraindication to this drug would be which condition? a. glaucoma b. fever c. PUD d. allergic rhinitis

a. glaucoma

What advantage does loratadine (Claritin) have compared with traditional antihistamines such as diphenhydramine (Benadryl)? a. less sedative effect b. increase in bronchodilation c. minimal GI upset d. decreased risk of cardiac dysrhythmias

a. less sedative effect Loratadine is a nonsedating antihistamine and it does not readily distribute into the CNS, which diminishes the sedative effects assoc. w/ traditional antihistamines

The nurse is discussing with the client the management of symptoms of an upper respiratory tract infection. Which classes of medications are often used in treating the symptoms of upper respiratory tract infections? (Select all that apply.) a Antibiotics b Antitussives c Expectorants d Antihistamines e Nasal decongestants

antitussives, expectorants, antihistamines, nasal decongestants Treatment of the common symptoms of upper respiratory tract infections involves the combined use of antihistamines, nasal decongestants, antitussives, and expectorants. Upper respiratory tract infections are often viral or allergic in nature and the symptoms would not be managed with antibiotics.

Which statement by the nurse should be included when teaching a client about the proper use of metered-dose inhalers? a "After you inhale the medication once, repeat until you obtain relief." b "Wait 1 to 2 minutes before you take a second puff of the same drug." c "Make sure that you puff out air several times after you inhale the medication." d "Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler."

b "Wait 1 to 2 minutes before you take a second puff of the same drug." If a second puff of the same drug is ordered, instruct the client to wait 1 to 2 minutes between puffs. If a second type of inhaled drug is prescribed, instruct the client to wait 2 to 5 minutes between the medications or to take as prescribed.

The nurse is providing care to a client prescribed a nonselective adrenergic agonist bronchodilator. Which condition documented in the client's medical history would alert the nurse to question this prescription? a Thrombocytopenia b Coronary artery disease c Mycobacterium tuberculosis d Chronic obstructive pulmonary disease

b - Coronary artery disease Nonselective adrenergic agonist bronchodilators stimulate beta1 receptors in the heart and beta2 receptors in the lungs. Stimulation of beta1 receptors can increase heart rate and contractility, increasing oxygen demand. This increased oxygen demand may lead to angina or myocardial ischemia in clients with coronary artery disease.

A 94-yr-old pt has a severe dry cough. He has coughed so hard that the muscles in his chest are hurting. He is unsteady on his feet and slightly confused. Which drug would be the best choice for this pt's cough? a. Benzonatate (Tessalon Perles) b. Dextromethorphan (Robitussin-DM) oral solution c. Codeine cough syrup d. guaifenesin (Mucinex)

b Dextromethorphan (Robitussin-DM) oral solution

The nurse receives laboratory values for a client with a theophylline level of 14 mcg/mL. How does the nurse interpret this theophylline level? a Toxic b Therapeutic c Subtherapeutic d Life threatening

b therapeutic The therapeutic theophylline level is 10 to 20 mcg/mL. But most providers now recommend 5-15 mcg/mL

A pt is prescribed two different types of inhaled medications for treatment of COPD. After administering the first medication, how long should the nurse wait to administer the second medication? a. 1 min b. 5 min c. 10 min d. 15 min

b. 5 min 1 min in between puffs of the same medication

A client is making an appointment for allergy testing. The nurse instructs the client not take what class of medications at least 4 days before allergy testing? a Antitussives b Antihistamines c Decongestants d Bronchodilators

b. Antihistamines An allergist will usually recommend discontinuation of antihistamine drug therapy at least 4 days before allergy testing.

Which herbal product, when taken with theophylline, can decrease theophylline's serum drug levels? a Garlic b Echinacea c Peppermint oil d St. John's wort

d - St. John's wort St. John's wort has been shown to enhance the rate of theophylline metabolism, thus decreasing serum levels.

On of the attendees expresses concern regarding her granddaughter's asthma. The attendee tells the nurse that she is afraid that she will not know which of her granddaughter's medications to give first in case of an asthma attack. Which medication should the nurse inform the attendee to administer first for an acute asthma attack? a. ipratropium (Atrovent) b. albuterol (Proventil) c. budesonide (Pulmicort Turbuhaler) d. montekulast (Singulair)

b. albuterol - Proventil

The nurse makes a home visit to a middle-aged pt who has a history of asthma. The pt's spouse purchased an OTC antihistamine. However, the nurse instructs the spouse not to administer the drug to the pt. Which complication is the nurse trying to prevent? a. paradoxical reactions b. collapse of lung alveoli c. decrease in resp rate d. allergic reaction to the drug

b. collapse of lung alveoli Antihistamines tend to dry up secretions. These dried-up secretions may be difficult for an asthma patient to expectorate. As a result, the secretions can pool in the lungs, causing atelectasis or collapse of pulmonary alveoli. Therefore, antihistamines should be avoided in patients with asthma. Paradoxical reactions occur in older adults and are characterized by dizziness, confusion, sedation, and hypotension. Decrease in respiratory rate happens only in the case of overdose, or if the antihistamine is taken along with other central nervous system depressants such as alcohol. There is no evidence of drug allergy in the patient; therefore, allergic reaction to antihistamines is unlikely.

The nurse is discussing use of antitussive medications with a client. What common adverse effect does the nurse include in the client teaching? a. tremors and palpitations b. drowsiness and dizziness c. diarrhea and abdominal cramping d. flushing and decreased heart rate

b. drowsiness and dizziness Antitussive medications suppress cough through its action on the CNS, thus causing drowsiness and dizziness

A pt who takes several medications experiences a troublesome cough assoc. w/ allergic rhinitis. Which is the best choice of treatment to manage the cough? a. loratadine b. guaifenesin c. benzonatate d. dextromethorphan

b. guaifenesin Guaifenesin is the best treatment for a patient who takes many medications, because it can help thin secretions when taken with sufficient water and facilitates expectoration of the secretions to stop the cough. Loratadine, benzonatate, and dextromethorphan have more adverse effects and potential drug interactions than guaifenesin, which could be especially problematic for a patient who takes many medications.

After the pt takes a dose of an inhaled corticosteroid, such as fluticasone (Flovent), what is the most important action the pt needs to do next? a. hold the breath for 60 secs b. rinse out the mouth w/ water c. follow the corticosteroid w/ a bronchodilator inhaler, if needed d. repeat the dose in 15 min if the pt feels short of breath.

b. rinse out the mouth w/ water

A pt has been receiving an aminophylline infusion for 24 hrs. The nurse will assess for which adverse effect when assessing the pt during the infusion? a. CNS depression b. sinus tachycardia c. increased appetite d. temporary urinary retention

b. sinus tachycardia

A pt complains of worsening nasal congestion despite the use of oxymetazoline (Afrin) nasal spray every 2-4 hrs for the past 5 days. The nurse's response is based on the knowledge that: a. oxymetazoline is not an effective nasal decongestant b. sustained use of nasal decongestants over several days may result in rebound congestion c. oxymetazoline should be administered in an hourly reginmen for severe congestion d. the patient is probably displaying an idiosyncratic reaction to oxymetazoline

b. sustained use of nasal decongestants over several days may result in rebound congestion Oxymetazoline is an effective nasal decongestant, but overuse results in worsening or "rebound" congestion. It should not be used more than every 4 hrs.

the common cold is treated w/ empiric therapy, which means... a. the medications cure the cold b. the medications only treat the symptoms c. herbal medications are useful to eliminate symptoms d. it is prevented w/ careful use of medications

b. the medications only treat the symptoms

A pt w/ chronic bronchitis calls the office for a refill of his albuterol inhaler. He just had the prescription filled 2 weeks ago, but he says it is empty. When asked, he tell the nurse, "I use it whenever I need it, but now when I use it, I feel so sick. I've been needing to use it more often." What is the most appropriate action by the nurse? a. the nurse should confirm the pharmacy location for the needed refill. b. The nurse should ask the pt to come to the office for an evaluation of his respiratory status. c. The nurse should tell the pt no to use the drug too often d. The nurse should consult the prescriber for a different inhaler prescription

b. the nurse should ask the pt to come to the office for an evaluation of his respiratory status

The nurse performs discharge teaching with a client who is prescribed the anticholinergic inhaler ipratropium bromide (Atrovent). Which statement by the client indicates to the nurse that teaching has been successful? a "I will not drink grapefruit juice while taking this drug." b "I may gain weight as a result of taking this medication." c "This inhaler is not to be used alone to treat an acute asthma attack." d "Nausea and vomiting are common adverse effects of this medication."

c "This inhaler is not to be used alone to treat an acute asthma attack." Although ipratropium works to prevent bronchoconstriction and thus secondarily leads to bronchodilation, a direct-acting bronchodilator is needed to treat an acute asthma attack.

Client teaching regarding the use of leukotriene receptor antagonists (LTRAs) drugs such as zafirlukast (Accolate) would include which statement by the nurse? a "It will take about 3 or 4 weeks before you notice a therapeutic effect." b "Take the medication when you are short of breath and begin wheezing." c "This medication works by preventing the inflammation that causes your asthma attack." d "Increase fiber and fluid in your diet to prevent the common adverse effect of constipation."

c "This medication works by preventing the inflammation that causes your asthma attack." LTRAs drugs block the inflammatory response of leukotrienes and thus the trigger for asthma attacks. Response to these drugs is usually noticed within 1 week. They are not used to treat acute asthma attacks. Diarrhea, not constipation, is a common adverse effect of montelukast and zafirlukast

What body system will the nurse assess for known common adverse effects of traditional antihistamines? a. respiratory b. cardiovascular c. CNS d. GI

c. CNS The most common adverse effect of antihistamines is drowsiness, but the sedative effects vary among the antihistamine drug class

Before administering an adrenergic decongestant, it is most important for the nurse to assess the patient for a history of: a. cataracts b. gastric ulcer c. diabetes mellitus d. hypothyroidism

c. DM contraindications are: - DM, narrow-angle glaucoma, CV disease, HTN, hyperthyroidism

When giving decongestants, the nurse must remember that these drugs have alpha-adrenergic-stimulating effects that may result in which effect a. fever b. bradycardia c. HTN d. CNS depression

c. HTN

The nurse would question a prescription for pseudoephedrine (Sudafed) in a client with a history of which condition? a. Pneumonia b. Osteoporosis c. Hypertension d. Peptic ulcer disease

c. HTN Adrenergic drugs are contraindicated in clients w/ HTN, narrow-angle glaucoma, diabetes, uncontrolled CV disease, hyperthyroidism, prostatitis, or known hypersensitivity to such drugs

A pt who is taking a xanthine derivative for chronic bronchitis asks the nurse, "I miss my morning coffee. I can't wait to go home and have some." What is the nurses's best response? a. I know how you feel. I'd miss my coffee too. b. I can get some coffee for you. I'll be right back\ c. It's important not to take coffee or other caffeinated products w/ this medicine as it may cause an increased heart rate as well as other problems. d. You've been on this medicine for a few days. I can call your prescriber to ask whether you can have some coffee.

c. It's important not to take coffee or other caffeinated products w/ this medicine as it may cause an increased heart rate as well as other problems.

Which statement by the client demonstrates an understanding about beclomethasone diproprionate (Beconase) mechanism of action? a. I only need to take this medication when my symptoms get bad b. I will need to taper off the medication to prevent acute adrenal crisis c. This medication will help prevent the inflammatory response of my allergies d. I will monitor my blood sugar b/c I may develop drug-induced diabetes

c. This medication will help prevent the inflammatory response of my allergies Beclamethason diproprionate is a steroid spray administered nasally. It is used to prevent and treat allergy symptoms. Its effect is localized, and therefore the client does not have systemic adverse effects with the recommended does. There is no need to taper off gradually as with oral corticosteroids

The nurse knows that an antitussive cough medication would be the best choice for which pt? a. a pt w/ a productive cough b. a pt w/ a chronic paranasal sinusitis c. a pt who has had recent abd surgery d. a pt who has influenza

c. a pt who has had recent abd surgery

A pt w/ chronic paranasal sinusitis and cough is found to have glaucoma. What is the vest choice of treatment for mgmt of cough in this situation? a. loratadine b. naphazoline c. guaifenesin d. fexofenadine

c. guaifenesin Guaifenesin is the best choice of treatment for management of cough associated with chronic paranasal sinusitis. It works by loosening and thinning the secretions and facilitating expectoration of the secretions. Loratadine, naphazoline, and fexofenadine are contraindicated in patients with glaucoma.

Which instruction should the nurse include when teaching a client who is prescribed an expectorant? a. take the medication once a day at bedtime b. restrict fluids to decrease mucus production c. increase fluid intake to decrease viscosity of secretions d. take the drug with oral codeine when cough worsens

c. increase fluid intake to decrease viscosity of secretions Expectorant drugs are used to decrease viscosity of secretions and allow them to be more easily expectorated. Increasing fluid intake helps this action

During a teaching session for a pt who will be receiving a new prescription for the LTRA montelukast (Singulair), the nurse will tell the pt hat the drug has which therapeutic effect? a. improves the respiratory drive b. loosens and removes thickened secretions c. reduces inflammation in the airway d. stimulates immediate bronchodilation

c. reduces inflammation in the airway

Before administering an antihistamine to a pt, it is most important for the nurse to assess the pt for a history of which condition? a. chronic urticaria b. motion sickness c. urinary retention d. insomnia

c. urinary retention

The nurse notes in a pt's medication history that the pt is taking benzonatate (Tessalon Perles) as needed. Based on this finding, the nurse interprets that the pt has which problem? a. cough b. seasonal allergies c. chronic rhinitis d. motion sickness

cough

ID: 10068745085 A nurse is providing education to a client taking two different bronchodilator medications. The nurse identifies which characteristic as the advantage of salmeterol (Serevent) over other beta2 agonists such as albuterol (Proventil)? a Quicker peak action b Shorter onset of action c Extended time of action d Longer duration of action

d - longer duration of action Salmeterol has a longer duration of action, requiring the client to use it only twice a day instead of three or four times a day with albuterol.

When providing general education on use of over-the-counter (OTC) medications for allergies, which instruction should the nurse to include? a. Discontinue use 4 days before allergy testing. b. It may cause dry mouth and difficulty urinating. c. The medication treats the signs and symptoms but is not a cure. d. Do not use in children younger than 2 years of age unless prescribed.

d. Do not use in children younger than 2 yrs of age unless prescribed. OTC medications for allergies are not recommended for children younger than 2 years of age unless prescribed by a health care provider.

The nurse is providing education to a client with a history of chronic nasal congestion secondary to allergic rhinitis. Which class of medications should the nurse anticipate the provider would recommend for the client to use on a long-term basis? a Antitussives b Expectorants c Antihistamines d Intranasal steroids

d. Intrnasal steroids Inhaled intranasal steroids and anticholinergic drugs are not associated with rebound congestion and are often used prophylactically to prevent nasal congestion in clients with chronic upper respiratory tract symptoms. Local intranasal steroids would have the least likely possible systemic adverse effects of all the medication classes possible to use for chronic and long term use.

A pt w/ a tracheostomy developed pneumonia. It is very difficult for the pt to cough up the thick, dry secretions he had developed. The nurse identifies which drug as being most effective in helping this pt? a. Benzonatate (Tessalon Perles) b. Dextromethorphan (Robitussin-DM) oral solution c. Codeine cough syrup d. guaifenesin (Mucinex)

d. guaifenesin (Mucinex)

A pt is taking a decongestant to help reduce symptoms of a cold. The nurse will instruct the pt to observe for which possible symptom, which may indicate an adverse effect of this drug? a. increased cough b. dry mouth c. slower heart rate d. heart palpitations

d. heart palpitations

Which drug is contraindicated in a pt who has Addison's disease? a. Naphazoline b. benzonatate c. fexofenadine d. hydrocodone

d. hydrocodone Hydrocodone is contraindicated in a patient who has Addison's disease, because administration of hydrocodone may worsen the disease condition. Naphazoline, fexofenadine, and benzonatate can be administered to the patient, because they do not worsen the symptoms of Addison's disease.

Which clinical finding is seen in a pt w/ nasal congestion caused by allergic rhinitis? a. increase in body secretions b. increase in capillary permeability c. inhibition of histamine production d. release of inflammatory mediators

d. release of inflammatory mediators Allergic rhinitis begins when airborne allergens bind to antibodies on mast cells, triggering the release of inflammatory mediators, including histamine, leukotrienes, and prostaglandins. Once released, the inflammatory mediators dilate and engorge regional blood vessels, causing nasal congestion. Antihistamines inhibit histamine production by blocking the histamine receptors on the surfaces of basophils and mast cells. The release of excessive amounts of histamine may lead to an increased capillary permeability and an increase in body secretions.

The nurse is giving an antihistamine and will observe the pt for which side effects? (SATA) a. HTN b. dizziness c. hangover effect d. drowsiness e. tachycardia f. dry mouth

dizziness hangover effect drowsiness dry mouth

The nurse is reviewing a pt's medication orders for prn medications that can be given to a pt who has bronchitis w/ a productive cough. Which drug will the nurse choose a. antitussive b. expectorant c. antihistamine d. decongestant

expectorant

Before administering an LTRA medication, the nurse would assess the client for allergies to which substance? (Select all that apply.) a Latex b Lactose c Cellulose d Povidone e Chlorhexidine

lactose cellulose povidone Allergies to povidone, lactose, titanium dioxide, or cellulose derivatives are important to note because these are inactive ingredients in LTRAs.

A pt who underwent coronary artery bypass surgery 2 months ago has an acute upper resp infection (URI) and is losing sleep b/c of a cough. Which instructions should the nurse give to manage the URI if the pt is using codeine as an antitussive? (SATA) a. maintain hydration b. take an expectorant c. take a decongestant d. take an antihistamine e. productively cough

maintain hydration take an expectorant productively cough The nurse should instruct the patient to continue taking the codeine to diminish the cough, to maintain hydration by drinking water, and to take an expectorant to liquefy and mobilize secretions. The nurse asks the patient to cough out secretions so that the secretions do not occlude airways. The nurse does not instruct the patient to take an antihistamine or a decongestant, because these agents are contraindicated for patients with cardiac disease.

An older adult pt is dicussing the use of guaifenesin w/ the nurse. He asks, "What else can I do to fight this terrible cold? I don't want to just take a pill." What is the nurse's best answer?

• Report fevers above 100.4° F (38º C) to the prescriber as soon as possible. • Try to cough up the secretions as much as possible; the increase in the intake of fluids and the humidification may help to liquefy and loosen secretions. Force fluids only if not contraindicated (i.e., fluid overload). • If secretions change from a clear color to a yellow or green color, report it immediately to the prescriber because an infection may be developing. The patient may need different treatment at this time to prevent pneumonia and other respiratory complications.