prep u 29 30 31 for April 4

"Drink at least two liters of fluids each day."

A 25-year-old female client presents at the clinic with bronchitis. The physician orders guaifenesin. Which of the following instructions should the clinic nurse offer when teaching the client about the medication?

Use of nicotine

A 70-year-old male is being treated for COPD with theophylline (Theo-Dur). What will be a priority assessment by the nurse?

Histamine

A client experiences bronchospasm with asthma. The nurse understands that this is due to which of the following?

Gastric lavage

A male client is brought to the emergency department by his son with alteration in consciousness. The physician suspects theophylline overdose. What would the nurse expect the physician to order

Inhalation

A patient is prescribed salmeterol. The nurse would expect this drug to be administered by which route?

False

A patient with a productive cough should always be treated with an antitussive to relieve the cough.

"The medication that has been ordered for you is to help relieve the inflammation and promote dilation of the bronchi."

A patient, newly diagnosed with COPD, calls the clinic and asks the nurse why they have to take the medications the physician ordered if their lungs don't work right. What would be an appropriate response by the nurse?

• Instilled into a tracheostomy • Inhalation

Acetylcysteine (Mucomyst) is primarily administered by which of the following routes when being used to thin secretion? Select all that apply:

Antidote for acetaminophen poisoning

Acetylcysteine may be used as a mucolytic agent. Which of the following is an additional indication for the drug?

"I'll keep the room warm and toasty."

After teaching a client who is receiving an antitussive about the drug, which statement indicates the need for additional teaching?

"We can use the adult brand, but we just have to decrease the amount."

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?

• Follows ingestion of a drug, especially one known to produce allergic reactions • Is unpredictable and occurs in only a few patients when many patients receive the suspected drug • Occurs minutes or hours after a second or subsequent exposure • Increases eosinophils in blood or tissue

Allergic drug reactions should be considered when new signs and symptoms develop or when they differ from the usual manifestations of the illness being treated. Which of the following are reactions needing special attention? Select all that apply.

True

Allergic rhinitis is inflammation of the nasal mucosa caused by a type I hypersensitivity reaction to inhaled allergens. True or false?

• Allergic rhinitis • Anaphylaxis • Premedication blood transfusions • Drug allergies

Antihistamines are used for various allergic and nonallergic disorders to prevent or reverse target organ inflammation and its effects on organ function. Which of the following disorders are treated using antihistamines? Choose all that apply.

Medulla oblongata

Breathing is controlled by what part of the central nervous system?

Respiratory depression

Combining first-generation antihistamines with sedating agents can can result in what adverse effect?

Soothing irritated pharyngeal mucosa

Cough syrups serve as vehicles for antitussive drugs and also may exert antitussive effects of their own by doing what?

True

Cromolyn should not be used during an acute asthmatic attack.

Vasoconstriction of small blood vessels of the nasal membranes

Decongestants elicit their effect by which of the following mechanisms? (Choose one)

Perfusion

During the oxygenation process, unoxygenated blood is received from the right ventricle by the alveoli. The delivery of this blood is referred to as what?

Albuterol

During the summer, a female client experiences increased periods of acute symptoms of her asthma. The physician increases the dose frequency of which of her medications?

relief of cough

Guaifenesin 200 mg PO every 4 hours as needed is ordered for a patient with a respiratory ailment. The nurse understands that this medication is given for which of the following reasons?

First exposure to inhaled antigens Formation of immunoglobulin E (IgE) antibody molecules IgE binds to and sensitizes the surface membranes of mast cells Re-exposure to inhaled pollens or other antigens Release of histamine and other chemical mediators Nasal mucosa produces characteristic symptoms of allergic rhinitis

Hypersensitivity reactions are grouped into four types according to the mechanisms by which they are produced. Type I hypersensitivity reaction for allergic rhinitis follows a specific pattern. Please place the following in order as they would occur.

To provide relief of the nasal congestion

Katie, 14 years old, is seen by the physician today due to increased nasal congestion and a sore throat lasting 2 days. Katie reports to the physician that every fall at this time she has increased nasal congestion and pressure. Upon examination, the physician notes enlarged turbinates with excessive mucus in the nose and at the back of the throat and a reddened throat. The physician prescribes pseudoephedrine. Why is Katie being prescribed this medication?

True

Leukotriene receptor antagonists are administered orally.

• Hypertension • Glaucoma • Hyperthyroidism • Diabetes

Long-acting beta 2 agonists should be used cautiously in clients with which of the following conditions? Select all that apply:

Albuterol causes relaxation of the bronchial smooth muscles.

Mr. Ashum is prescribed an albuterol inhaler as part of his treatment regimen for asthma. What is the mechanism of action for this medication?

• Advise him to avoid excessive and frequent use of the drug. • Advise him not to take other OTC drugs.

Mr. Johnson is prescribed pseudoephedrine to relieve his nasal congestion. What should the nurse include in patient and family education? (Choose all that apply.)

contain at least 21% oxygen

Normal respiration requires that breathing gases

False

Promethazine (phenergan) is the only antihistamine formulated as a nasal spray for topical use. True or false.

diffusion.

Respiration consists of four components: ventilation, regulation, perfusion, and

False

Second generation antihistamines are associated with a higher risk of sedation than first generation antihistamines. true or false

• Azelastine (Astelin) • Cetirizine (Zyrtec) • Fexofenadine (Allegra) • Loratadine (Claritin)

Second-generation H1 antagonists (also called selective or nonsedating agents) were developed mainly to produce less sedation than the first-generation drugs. Which of the following are examples of these drugs? Choose all that apply.

They do not cross the blood-brain barrier.

Second-generation H1 antagonists cause less CNS depression because they are selective for peripheral H1 receptors and because of which other property?

Fexofenadine

Second-generation antihistamines were developed to remove the sedation of first generation drugs. Which of the following antihistamines is a second-generation drug?

Contact the health care provider to obtain adjunctive medications.

Shane, a 25-year-old man, is diagnosed with asthma. He began an albuterol MDI 2 weeks ago. He complains that his symptoms persist in spite of using his albuterol MDI as prescribed. What advice must he be given?

Type II alveolar cell

The alveolar cells that synthesize pulmonary surfactant is the:

Albuterol first, wait five minutes and then follow with flunisolide

The asthmatic client is being treated with two inhalers, albuterol and flunisolide. The nurse teaches the client that the two medications should be administered in what order?

Coffee

The client's theophylline levels are increased. The nurse questions the client about his intake of which of the following?

They are used to break down the thickness of secretions.

The nurse demonstrates an understanding of the action of the mucolytic drugs when stating which of the following?

They come into direct contact with nasal mucosa.

The nursing instructor is discussing the use of nasal decongestants and shares what reason for their effectiveness?

Antihistamine

The nursing instructor is teaching the students about antitussives and their side effects. What ingredient found in some antitussives does the instructor tell students sometimes can cause drowsiness?

"Inhaled steroids will not affect the growth of your child."

The parent of a child taking inhaled corticosteroids states she has not been routinely administering the medication because she is concerned about her child not growing properly. What is the nurse's best response?

500 mL

Tidal volume is defined as the volume of air that is inspired and expired during one normal breath. What is the approximate tidal volume for the average adult?

The patient holds his breath for several seconds after releasing the medication

What action by the patient would indicate that the patient is obtaining maximum benefit from their inhaler

Drowsiness

What adverse effect of most oral antihistamines presents a priority safety concern for older adult clients?

Type I hypersensitivity reaction to Inhaled allergens

What causes the inflammation of nasal mucosa that is seen in allergic rhinitis?

Rebound congestion

What is an adverse reaction commonly experienced by people taking nasal decongestants?

Antihistamines irritate subcutaneous tissue

Why are antihistamines administered intramuscularly instead of subcutaneously?

Skin rash and urticarial

A 15-year-old patient is prescribed an antihistamine for allergic rhinitis. However, antihistamines used to treat allergic reactions may themselves cause allergy. The nurse needs to educate the patient to be aware of symptoms suggesting allergy. Which of the following is an allergic reaction to antihistamines?

forget about the morning dose and take the evening dose.

A 20-year-old woman calls the clinic at 5 PM and reports to the nurse that she forgot to take her morning dose of fexofenadine (Allegra). She usually takes her evening dose at 8 PM. She wants to know what she should do. The nurse will instruct her to

Increase fluids to 2 L per day

A 29-year-old female client has sinusitis, so the physician orders a topical nasal decongestant. What instructions should be given?

Irritation to receptors in the bronchi

A 39-year-old teacher with bronchitis has been up all night with intense coughing jags and asks the nurse how all this coughing is related to her bronchitis. The nurse tells the patient that a cough is initiated by what?

Smoking decreases the size of the tubes leading to the lungs

A 42-year-old male client has a history of smoking for 20 years. The client states he is feeling fine and asks why stopping smoking is necessary. What information might the nurse share with the client about smoking?

stop taking the medication and come to the clinic as ordered by the physician.

A 43-year-old man is taking pseudoephedrine (Sudafed) for sinusitis. He calls the clinic to report that it feels like his heart is racing and that he can "feel his heart beating fast." The nurse will instruct him to

Dextromethorphan works in the medulla to suppress the cough reflex.

A 45-year-old female client is being seen in the physician's office for a dry, hacking cough that is keeping her up at night. The physician prescribes dextromethorphan for the cough. Which statement is true about dextromethorphan?

Take the tablet with food.

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?

serious cardiovascular effects

A 76-year-old man with a history of heart disease has been prescribed an oral decongestant. The nurse is concerned with this prescription because of the risk for

"Consult with your primary care provider."

A client asks the nurse how long he should use oxymetazoline (Afrin) nasal spray for nasal congestion. What is the nurse's best response?

Virus

A client expresses her belief that the common cold is caused by exposure to very cold air. The nurse would correct the client by stating that the common cold is caused by which type of microorganism?

Antihistamines are not recommended because they can dry lower respiratory secretions and worsen secretion retention and cough.

A client reports a hacking cough. The client asks if taking an antihistamine would be helpful. The nurse's best response is:

• Cetirizine (Zyrtec) • Loratadine (Claritin)

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.)

rebound nasal congestion

A client reports severe nasal congestion for the last 8 days. The client has been using an OTC nasal decongestant spray. The nurse knows that this is indicative of:

Nicotine

A client with COPD takes theophylline. The nurse identifies that the client is still experiencing severe dyspnea. Upon review of labs, the theophylline level remains nontherapeutic. The nurse evaluates the client for which of the following drugs that may cause decreased theophylline levels?

Mucolytic

A client with cystic fibrosis may use which type of medication to reduce the viscosity of respiratory secretions? (Choose one)

Cholestatic jaundice

A female client is diagnosed with type 2 diabetes mellitus, hyperlipidemia, and mild hepatic impairment. She presents to the emergency department after taking promethazine, obtained from a friend, for motion sickness. The nurse would expect what adverse effect?

Dry mouth

A female client is prescribed a first-generation antihistamine for her allergies. The nurse would expect her to experience what adverse effect?

Diffusion

A group of students are reviewing the mechanics of oxygen and carbon dioxide exchange in the alveoli. The students demonstrate understanding when they identify which mechanism as being responsible?

Sympathomimetics

A group of students demonstrate understanding of topical decongestants, identifying them as which of the following?

Diphenhydramine

A male client presents to the emergency department with symptoms of a gastrointestinal bleed. The physician orders a blood transfusion. The client has a history of anaphylaxis. The physician orders the administration of what drug before the blood transfusion?

There is limited or no support for the use of Echinacea to prevent or treat symptoms of the common cold

A male client presents to the physician'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?

Rebound nasal swelling

A male client presents to the physician'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?

Obtain a complete drug history

A male client presents to the physician's office with symptoms of a common cold. He asks the nurse to suggest over-the-counter drugs to alleviate his symptoms. Before recommending an over-the-counter medication, what action should the nurse take?

Hydrocodone 5 mg orally q6h for a 4 year-old

A nurse in a pediatric clinic has received medication orders for four children. Which medication order should she question?

Blood pressure

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?

Purulent cough

A nurse is caring for a patient with chronic bronchiectasis. The nurse should assess the patient for which of the following clinical manifestations?

• Importance of reading the label for ingredients and dosage • Need to follow the directions for how often to give the drug • Avoidance of use in children under age 2

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 of the following would be most appropriate to include? Select all that apply.

"I should avoid driving after taking this medication."

A nurse is teaching a 55-year-old patient about fexofenadine after the physician prescribed the medication to treat allergic symptoms. Which patient statement suggests that the patient understands this teaching?

Extremely cold temperatures

A nurse is teaching a patient newly diagnosed with asthma about the disease. Which of the following should the nurse instruct this patient to avoid because it may cause bronchoconstriction?

Cigarette smoking

A nurse would expect to increase the dosage of theophylline if the client has a current history of which of the following?

• "Promethazine may cause cholestatic jaundice." • "Little information is available about this special population of patients." • "With cetirizine and loratadine, smaller-than-usual doses are recommended."

A nursing professor is teaching the class regarding the use of antihistamines in patients with hepatic impairment. Which of the following statements made by students indicates an understanding of the lecture? Choose all that apply.

• "With diphenhydramine, the dosing interval should be extended to 12 to 18 hours." • "For some antihistamines, doses for initial use are approximately one half of those used for young and middle-aged adults." • "Azelastine may be the drug of choice because it is metabolized in the liver."

A nursing professor is teaching the class regarding the use of antihistamines in patients with renal impairment. Which of the following statements made by students indicates an understanding of the lecture? Choose all that apply.

• "They usually are an immune response to the ingestion of a protein." • "Shellfish and eggs are examples of allergens that may have a high risk for anaphylaxis."

A nursing professor teaching sophomore students conducts a lecture regarding allergic food reactions. Which of the following statements made by the students verifies the lecture was effective? Select all that apply.

Decongestants

A patient 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?

Pseudoephedrine

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 of the following oral decongestant drugs can be administered to the patient?

"Determine if the drug is going to make you drowsy before you drive.

A patient is in the clinic for seasonal allergic rhinitis. Loratadine (Claritin) is prescribed. Which of the following statements will the nurse include when providing patient education concerning this drug?

"Determine if the drug is going to make you drowsy before you drive."

A patient is in the clinic for seasonal allergic rhinitis. Loratadine (Claritin) is prescribed. Which of the following statements will the nurse include when providing patient education concerning this drug?

"Prescription drugs have been proven effective in treating asthma, and caffeine hasn't been. Since uncontrolled asthma can be deadly, I wouldn't recommend that you switch from your medications to caffeine."

A patient tells you that her friend has recommended using caffeine to treat her asthma. How would you appropriately respond to this patient?

Loratadine

A patient with vasomotor rhinitis has been prescribed an antihistamine. The patient is eager to know whether the prescribed antihistamine may cause excessive sedation. Which of the following antihistamines has very little sedative effect?

• Sedation • Dryness of throat • Confusion

A patient, aged 82 years, is prescribed an antihistamine for the relief of allergic rhinitis. An older age predisposes the patient to a higher risk of adverse effects. Which of following adverse effects is a nurse more likely to observe in the patient? Select all that apply.

blood pressure.

Among the substances released from the lungs is angiotensin-converting enzyme. The enzyme converts angiotensin I to angiotensin II, which is important in regulating

Helping the patient identify environmental allergens

Antihistamines are used frequently in the home care setting for the treatment of allergies. Which of the following is most likely to be a responsibility of the nurse caring for a patient who is taking antihistamines for this indication?

Inhaled nasal steroids are more effective than oral medications in treating the global symptoms associated with allergies

Mr. Zee is prescribed an inhaled nasal steroid to relieve his symptoms associated with seasonal allergies. What is true about inhaled nasal steroids?

She has increased BUN and creatinine levels.

Ms. Carter is prescribed fexofenadine for relief of symptoms associated with allergic rhinitis. Which feature of the patient's medical history would be of concern?

Many of these preparations contain the same active ingredients, and inadvertent overdose is a common problem.

Parents who treat their children's cold and flu symptoms at home should be educated about reading and understanding OTC labels. Why is this statement true?

anti-inflammatory agents

Respiratory symptoms are treated with many types of drugs, including

"I need to shake the inhaler well before taking the medication."

The nurse has just finished teaching a 15-year-old patient how to use an inhaler to treat asthma. What statement, made by the patient, suggests that the patient understands the teaching?

Coffee

The nurse is caring for a client who is receiving IV theophylline for treatment of severe bronchospasm. The nurse will ensure that which item on the client's food tray will be held while the client is receiving theophylline?

Rinse mouth with water after each use.

The nurse is teaching a client how to prevent Candida infections. Which of the following would the nurse include in the instructions?

• Diabetes • Cardiovascular disorders • Glaucoma

The nurse would caution clients with which disorders to avoid the use of over-the-counter pseudoephedrine? (Select all that apply.)

a decongestant, an analgesic, and an antihistamine.

The nursing instructor is discussing over-the-counter cold remedies. According to the instructor, these products typically combine

type I hypersensitivity reaction.

The nursing instructor is explaining the four types of allergic reaction to the nursing students. The instructor explains that allergic rhinitis is a

Excessive salivation

The pharmacology instructor is discussing the adverse effects of diphenhydramine. Which of the following is not one of these effects?

By decreasing airway hyperreactivity to various stimuli

The pharmacology instructor is explaining the difference between bronchodilators and anti-inflammatory drugs. How does an anti-inflammatory drug reduce bronchoconstriction?

Nausea and vomiting

The physician 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?

• Cough • Mucosal congestion • Increased secretions

The pulmonologist sees many patients daily who suffer from a variety of respiratory disorders. What are some of the common signs and symptoms many of these patients present? (Select all that apply.)

• Adequate fluid intake • Humidification of the environment • Sucking on hard candy or throat lozenges

What home remedies are effective for mouth dryness and cough? (Select all that apply.)

Peak-flow monitor

What is the most effective method used to monitor clients with asthma that they can use at home?

"This medication can cause drowsiness, so I will avoid driving while I use it."

What statement by a 61-year-old client who is to take an antitussive with codeine indicates that your teaching has been effective?

Second-generation

What type of antihistamine is typically preferred for older adults?

• Offer ice chips. • Take frequent sips of water. • Suck on sugarless hard candy

When antihistamines result in dryness of the mouth, the nurse should recommend which actions to relieve the dryness? Select all that apply.

Stenosing peptic ulcer

When caring for a patient with an allergic reaction following a blood transfusion, which of the following conditions should the nurse consider as a contraindication for antihistamine therapy?

Sedation

When describing the effects of second-generation antihistamines, which of the following would the nurse address as being decreased?

• Advising the patient to avoid alcohol consumption • Using sugarless candies or lozenges to combat dry mouth

When developing the teaching plan for a patient receiving an antihistamine, which of the following would the nurse include? Select all that apply.

Clear the nasal passages

When instructing a patient in how to use a topical nasal spray, which of the following would the nurse emphasize to do first?

• Hypertension • Anxiety • Restlessness

When teaching a patient who is receiving pseudoephedrine about possible adverse effects, which of the following would the nurse include? Select all that apply.

Pseudoephedrine

Which agent would the nurse instruct a client to use orally?

Guaifenesin (Robitussin)

Which drug is classified as an expectorant?

High concentrated oxygen administration

Which of the factors results in increased diffusion of gases in the lungs?

Surfactant

Which of the following allows the alveoli sac to stay open and allows for exchange of gases?

Limiting fluids

Which of the following instructions would the nurse least likely include in the teaching plan for a patient receiving an antitussive?

Warms and humidifies incoming air

Which of the following is a function of the bronchial circulation?

Albuterol

Which of the following is an example of a short acting Beta 2 Agonist (SABA)? (Choose one)

A 34-year-old male with damage to his pons and medulla oblongata following a blow to the back of the head

Which of the following neurological patients is most likely to have abnormalities in breathing regulation?

• Blood pressure • Level of congestion • Therapeutic effect

Which of the following should be observed during ongoing assessment of a client taking a decongestant? Select all that apply:

• Therapeutic effect • Pain assessment • Frequency of cough • Lung sounds

Which of the following should be observed during ongoing assessment of a client taking an antitussive? Select all that apply

Diffusion

While discussing gas exchange, the instructor would tell the students that oxygen and carbon dioxide enter and leave the body by what method?

• Symptoms do not improve in seven days. • A high fever develops.

While using a decongestant, a client should be instructed to call the physician if which of the following occur? Select all that apply:

They act locally to decrease release of inflammatory mediators

Why are inhaled steroids used to treat asthma and COPD?

Heart failure

You are caring for a patient who is taking an adrenergic bronchodilator. In what disease process should adrenergic bronchodilators be used cautiously?

The tendencies to overmedicate and use antibiotics inappropriately with the common cold are widespread and pose significant risk for complications and drug resistance.

You are speaking to a group of clients in a public meeting. They ask you to explain how colds should be treated. You would include which of the following in your explanation?

Read drug labels before taking OTC medications.

You are teaching a group of patients with allergic rhinitis about the use of their medications. What would be the most essential information to give these patients about preventing possible drug interactions?

Antitussives suppress coughing, and expectorants loosen bronchial secretions.

Your client asks, "What is the difference between antitussive medications and expectorants?" Your best response is:

Most states have passed laws to restrict sales of these products because they are being used to manufacture methamphetamine.

Your client complains that he has had difficulty finding OTC nasal decongestants. You know that this is likely because

Inflammatory processes

Your client experiences frequent sinus infections. What is a major cause of the infections?

Benadryl

Your client has a history of post-transfusion reactions. Her medical provider has ordered medication to prevent this. Which of the following medications would you anticipate being ordered for this client?

Allergic rhinitis

Your client is complaining of nasal congestion, itching, sneezing, and watery drainage, including itching of the throat, eyes, and ears. You suspect that your client is suffering from:

Mucomyst

Your client states that he is taking medication to liquefy secretions in his respiratory tract. However, he cannot recall the name of the medication. He states that the medication is added to a nebulizer. You suspect he is taking which of the following medications?