PrepU Chapter 31

A group of nursing students are reviewing information about expectorants. The students demonstrate understanding when they identify which medication as an example? • Benzonatate • Acetylcysteine • Dextromethorphan • Guaifenesin

Guaifenesin Guaifenesin is an example of an expectorant. Acetylcysteine is a mucolytic. Dextromethorphan is an antitussive. Benzonatate is an antitussive

A group of nursing students are reviewing information about expectorants. The students demonstrate understanding when they identify which medication as an example? • Benzonatate • Guaifenesin • Dextromethorphan • Acetylcysteine

Guaifenesin Explanation: Guaifenesin is an example of an expectorant. Acetylcysteine is a mucolytic. Dextromethorphan is an antitussive. Benzonatate is an antitussive.

If a client taking metoprolol (Lopressor) 50 mg one tablet twice daily begins taking pseudoephedrine (Sudafed) over the counter, which of the following might occur? Select all that apply: • Rebound congestion • Hyperglycemic episode • Hypoglycemic episode • Hypertensive episode • Bradycardic episode

Hypertensive episode, bradycardic episode Explanation: A client taking a beta-adrenergic blocker, such as metoprolol, and a decongestant, such as pseudoephedrine, may develop an initial hypertensive episode followed by bradycardia.

A 29-year-old client has sinusitis and has been prescribed a topical nasal decongestant. What instructions should the nurse provide? • Use two forms of birth control until treatment is complete. • Increase fluids to 2 L/d. • Take the medication with meals. • Temporarily avoid high-sodium foods.

Increase fluids to 2 L/d. Explanation: Increasing fluid intake helps relieve the discomfort of congestion. The medication does not need to be taken with meals. There is no need to limit fluid intake. Caution is required if the client is pregnant, but requiring two forms of birth control is excessive.

What is an adverse reaction commonly experienced by people taking nasal decongestants? • Headache • Diarrhea • Rebound congestion • Rash

Rebound congestion An adverse effect that accompanies frequent or prolonged use of these drugs is a rebound congestion, officially called rhinitis medicamentosa

A male client is diagnosed with chronic bronchitis. What would the nurse expect to be one of his physical reports? • Retention of secretions • Rhinorrhea • Chronic nasal swelling • Rhinitis

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.

Which should be observed during ongoing assessment of a client taking a decongestant? (Select all that apply.) • Pain assessment • Heart sounds • Therapeutic effect • Level of congestion • Blood pressure

Therapeutic effect • Level of congestion • Blood pressure The ongoing assessment for a client taking a decongestant should include blood pressure, pulse, and asking about level of congestion, therapeutic effect, and adverse reactions

The instructor is teaching about the use of mucolytics. The nursing student demonstrates an understanding of the action of the mucolytic drugs when stating which? • They are used to break down the thickness of secretions. • They are used to relieve a nonproductive cough. • They are used to relieve a productive cough. • They are used to depress the cough center in the medulla.

They are used to break down the thickness of secretions. Explanation: Mucolytics are agents that break down the thickness of secretions for easier removal. An antitussive is used to relieve coughing for nonproductive coughs only. They are not used for non-productive coughs and do not work on the medulla.

The effects of nasal decongestants are increased by concomitant use of which of the following drugs? • Thyroid preparations • Thiazide diuretics • Oral antibiotics • Proton-pump inhibitors

Thyroid preparations Thyroid preparations may increase the effects of nasal decongestants.

Which nursing diagnosis would provide the clearest indication for the administration of inhaled acetylcysteine? • impaired tissue perfusion • risk for infection • ineffective breathing pattern • ineffective airway clearance

ineffective airway clearance Acetylcysteine reduces the viscosity of mucous secretions with the ultimate goal of allowing the client to establish and maintain a clear airway. This drug does not directly influence the pattern of breathing. Impaired tissue perfusion can have multiple causes, many of which are unrelated to the presence of mucus secretions.

The nurse has taught a client to self-administer a topical decongestant. What statement should the nurse follow up with further education? • "I'll put the tip of the bottle about half an inch into my nostril." • "I won't take the drug if I've got a sore inside my nose." • "I'll sit upright when I give myself the drug." • "I'll squeeze the bottle to get the medication up into my sinuses."

• "I'll squeeze the bottle to get the medication up into my sinuses." The client should not squeeze too forcefully, which could send the drug up into the sinuses; the goal is to keep the drug in the nares. Each of the client's other three statements reflect safe and effective medication delivery

A client is prescribed oxymetazoline. Which assessment data would indicate that the drug is effective? • Heart rate is maintained at a regular rate and rhythm. • Breathing pattern is regular and without difficulty. • Urine output is at least 30 mL/hr. • Skin is effectively hydrated.

• Breathing pattern is regular and without difficulty. Explanation: A regular breathing pattern without difficulty would indicate that the drug is effective because oxymetazoline is a decongestant drug. Hydration of the skin, heart rate, and urine output are usually not affected by this drug.

A group of nursing students are reviewing information about expectorants. The students demonstrate understanding when they identify which medication as an example? • Guaifenesin • Dextromethorphan • Benzonatate • Acetylcysteine

• Guaifenesin Explanation: Guaifenesin is an example of an expectorant. Acetylcysteine is a mucolytic. Dextromethorphan is an antitussive. Benzonatate is an antitussive.

A male client is diagnosed with chronic bronchitis. What would the nurse expect to be one of his physical reports? • Chronic nasal swelling • Retention of secretions • Rhinitis • Rhinorrhea

• Retention of secretions Retention of secretions commonly occurs with influenza, pneumonia, upper respiratory infections, acute and chronic bronchitis, emphysema, and acute attacks of asthma

The nursing instructor is teaching students about the administration of nasal sprays. According to the instructor, the correct patient position for administering the sprays is closest to • high Fowler's position. • semi-Fowler's position. • supine. • side-lying position.

• high Fowler's position. Explanation: The patient should be standing or sitting during administration of nasal sprays. This is closest to high Fowler's position.

A client has been diagnosed with chronic pharyngitis. The client is most likely to benefit from what medication category? • Oral decongestants • Antitussives • Mucolytics • Nasal sprays

• Antitussives Antitussives are drugs that suppress the cough reflex. Many disorders involving the respiratory tract, including the common cold, sinusitis, pharyngitis, and pneumonia are accompanied by an uncomfortable, nonproductive cough. Persistent coughing can be exhausting and can cause muscle strain and further irritation of the respiratory tract. However, nasal sprays, oral decongestants, and mucolytics are not generally prescribed for chronic pharyngitis

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? • Tetrahydrozoline • Ephedrine • Pseudoephedrine • Xylometazoline

• Pseudoephedrine The patient can take an oral preparation of pseudoephedrine. Xylometazoline, ephedrine, and tetrahydrozoline are usually available only in the form of nasal sprays or drops for topical use.

A 76-year-old man has a history of heart disease, and has been prescribed an oral decongestant. The nurse is concerned with this prescription because of the risk for which? • serious cardiovascular effects. • insomnia. • severe constipation. • increased salivation and choking.

• serious cardiovascular effects. Explanation: Oral decongestants are contraindicated or (at minimum) used with caution in clients with severe cardiovascular disease or severe hypertension because of the risks for increased heart rate, blood pressure, and myocardial contractile force. History of constipation, insomnia and increased salivation/choking are not contraindications.

The nursing instructor is teaching students about the administration of nasal sprays. According to the instructor, the correct patient position for administering the sprays is closest to • side-lying position. • high Fowler's position. • supine. • semi-Fowler's position.

•high Fowler's position. The patient should be standing or sitting during administration of nasal sprays. This is closest to high Fowler's position.

Before administering a mucolytic drug to a client with an upper respiratory infection, which would the nurse need to assess? • Frequency of coughing • Therapeutic effectiveness • Evidence of productive cough • Degree of dyspnea

• Degree of dyspnea. It is important for the nurse to document the degree of dyspnea as a preadministration assessment in a client who is prescribed a mucolytic drug for the treatment of an upper respiratory infection. Measuring the frequency of coughing and observing for therapeutic effect are ongoing assessments a nurse should perform in a client who is being administered antitussive drugs. Assessing for a productive cough should be completed before the nurse administers an antitussive drug.

The nursing instructor is teaching students about the administration of nasal sprays. According to the instructor, the correct patient position for administering the sprays is closest to • side-lying position. • high Fowler's position. • supine. • semi-Fowler's position.

• high Fowler's position. Explanation: The patient should be standing or sitting during administration of nasal sprays. This is closest to high Fowler's position.

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 • sinusitis • rebound congestion • a drug allergy

• rebound congestion

The nurse is reviewing a prescription for pseudoephedrine for a client experiencing nasal congestion. Which assessment question(s) should the nurse ask to confirm that the prescription is appropriate? Select all that apply. "Are you being treated for any form of glaucoma?" "Do you have any problems with urination?" "Do you have sun-sensitive skin?" "Do you consider yourself prone to anxiety or restlessness?" "Do you have any history of cardiac arrhythmias?"

"Are you being treated for any form of glaucoma?" "Do you have any problems with urination?" "Do you consider yourself prone to anxiety or restlessness?" "Do you have any history of cardiac arrhythmias?" Explanation: Some notable significant adverse reactions of pseudoephedrine include hypotension, arrhythmia, impaired coordination, dizziness, excitability, headache, insomnia, restlessness, seizures, vertigo, dysuria, urinary retention, urinary difficulty, and thrombocytopenia. Some people may also experience blurred vision, tinnitus, chest tightness, dry nose, nasal congestion, and wheezing. Contraindications to pseudoephedrine use include severe hypertension or coronary artery disease because of the drug's cardiac-stimulating and vasoconstricting effects. Another contraindication is narrow-angle glaucoma. Caution is necessary with cardiac arrhythmias, hyperthyroidism, diabetes, glaucoma, and prostate hypertrophy. Clients who take tricyclic or monoamine oxidase inhibitors (MAOIs) should not receive pseudoephedrine. Photosensitivity is not associated with pseudoephedrine.

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." • "While OTC medications may be cheaper, they generally result in more side effects." • "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."

"Follow the instructions on the label so that you don't end up making the congestion worse." When taken according to their instructions, OTC medications can often be as safe and effective as prescribed medications and are sometimes suggested by the primary health care prescriber. However, clients should be informed that excessive or prolonged use may damage nasal mucosa and produce chronic nasal congestion. Over-the-counter (OTC) cold remedies should not be used longer than 1 week, and clients should be instructed not to use nose drops or sprays more often or longer than recommended on the label. While OTC medications may be cheaper in some cases, they will not cause more side effects. The length of the therapy is dependent on many factors, including the type and dose of the medication.

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? • Mucolytics • Antitussives • Expectorants • Decongestants

Decongestants Explanation: Decongestants cause local vasoconstriction that decrease blood flow to irritated and dilated capillaries of the mucous membranes lining the nasal passages and sinus cavities. The vasoconstriction leads to a shrinking of swollen membranes and opens clogged nasal passages promoting drainage of secretions and improved air flow. Antitussives either work directly on the medullary cough center of the brain or act as a local anesthetic on the respiratory passages blocking the effectiveness of the stretch receptors that stimulate a cough reflex. Expectorants liquefy the lower respiratory tract secretions, reducing the viscosity of the secretions and making it easier to cough them up. Mucolytics break down mucus to aid a person in coughing up thick tenacious secretions by separating cells that hold mucus material together.

A client is encouraged to take guaifenesin to loosen the secretions due to a viral respiratory infection. What should the nurse suggest to the client to make the medication work more effectively? • Dilute the liquid medication with water prior to administration • Take the medication with food • Increase fluid intake • Take the medication with other over-the-counter medications to enhance the effect

Increase fluid intake Guaifenesin reduces the viscosity of tenacious secretions by irritating the gastric vagal receptors stimulating respiratory tract fluid. Thus, it increases the volume and decreases the viscosity of respiratory tract secretions. By increasing the amount of fluid ingested, the secretions will become thinner and allow an easier passage for removal. The medication should be taken undiluted to increase effectiveness and taken without food for at least 30 minutes. The nurse should educate the client about reading labels on over-the-counter medications that may interact with guaifenesin to prevent complications.

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. Their effects last for 48 to 72 hours. They are absorbed systemically. They treat multiple symptoms in a cost-effective manner.

They come into direct contact with nasal mucosa. With nasal decongestants, topical preparations (i.e., nasal solutions or sprays) are often preferred for short-term use. They are rapidly effective because they come into direct contact with nasal mucosa.

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 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." • "We should use the cup that comes with the drug to measure it out." • "We can use over-the-counter products for our 5-year-old but not for our 18-monthold."

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

The nurse is providing education to a client who has been diagnosed with a sinus infection. What would the nurse identify as a major cause of this disorder? • impaired blood supply • inflammatory processes • autoimmune processes • facial pain

inflammatory processes Explanation: As in other parts of the respiratory tract, ciliated mucous membranes in the sinuses help move fluid and microorganisms out and into the nasal cavity. This movement becomes impaired when sinus openings are blocked by nasal swelling, and the impairment is considered a major cause of sinus infections. Another contributing factor is a lower oxygen content in the sinuses, which aids the growth of microorganisms and impairs local defense mechanisms. Autoimmune processes and impaired blood supply are not major causes. Facial pain is a symptom of sinus infection.

A client reports having difficulty finding the over-the-counter (OTC) decongestant that the client used in the past. What assessment question should the nurse ask to help address the client's concern? • "How long has it been since you last needed to take a decongestant?" • "Would you like your health care provider to prescribe something for congestion?" • "Have you asked the pharmacist about a substitute medication?" • "Did the medication contain pseudoephedrine?"

• "Did the medication contain pseudoephedrine?" The use of OTC products containing pseudoephedrine to manufacture methamphetamine has increased at an alarming rate. Most states have passed laws placing these products behind pharmacy counters to restrict sales. While the other options present appropriate assessment questions, none establish if the medication was one restricted by current laws.

A 25-year-old female client presents at the clinic with bronchitis. The health care provider orders guaifenesin. Which instruction should the clinic nurse offer when teaching the client about the medication? • "Drink at least two liters of fluids each day." • "Use a second method of contraception until you've completed the drug therapy." • "Take an NSAID to relieve the joint aches that result from taking this medication." • "Restrict your fluid intake to one liter each day."

• "Drink at least two liters of fluids each day." Clients requiring expectorants, antitussives, or decongestants should drink approximately two liters of fluids each day unless contraindicated by cardiovascular or renal disease. Joint aches are not among the adverse effects of guaifenesin.

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 taking the dextromethorphan at bedtime?" • "Is the dextromethorphan making you dizzy?" • "Have you been nauseated as well since taking the dextromethorphan?" • "How much dextromethorphan have you been taking each day?"

• "How much dextromethorphan have you been taking each day?" Explanation: At normal doses, dextromethorphan is known to cause nausea, drowsiness, rash, and difficulty breathing but doses exceeding recommendations can produce hallucinations and disassociation. The question concerning dosage is the most relevant regarding the cause of hallucinations.

prescription for an antitussive medication is suggested, the client responds, "I took a tablespoon of honey before bed last night and it seemed to help. Why can't I just keep taking that a couple of times a day?" Which response should the nurse provide to best assure effective drug therapy for this client? • "It would be best to alternate between honey and doses of the antitussive medication." • "Since the honey helps, it would be wise to continue taking it but no more than 3 tablespoons a day." • "The honey's effectiveness is very likely to wear off after 2-3 days." • "That would be all right but don't use raw honey."

• "The honey's effectiveness is very likely to wear off after 2-3 days." Explanation: Research suggests that the effects of honey may be comparable to dextromethorphan when given for one day. When honey is given up to three days, there was no advantage over a placebo in decreasing cough severity. Overall, there was no strong evidence for or against using honey for the treatment of cough symptoms.

What statement by a client who is to take an antitussive with codeine indicates that the nurse's teaching has been effective? • "I will take this medication anytime I start to cough." • "I might get diarrhea, so I'll call my provider if that happens." • "This medication can cause drowsiness, so I will avoid driving after taking it." • "This medication may make me anxious and nervous."

• "This medication can cause drowsiness, so I will avoid driving after taking it." Codeine is a CNS depressant and should not be combined with driving or heavy machinery activities. Antitussives are not intended to be taken with every coughing episode because the client may overdose on the medication. The medication usually makes the client drowsy rather than nervous and anxious. Codeine may cause GI upset, although it is usually constipating; some clients may complain of nausea and stomach distress while taking this medication but diarrhea is unusual

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." • "We should use the cup that comes with the drug to measure it out." • "We need to read the label carefully to see how often and how much to give." • "We can use over-the-counter products for our 5-year-old but not for our 18-monthold."

• "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. 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

What would be the nurse's best response if a client calls the clinic and reports that he has had a persistent cough for 2 weeks and asks the nurse for a recommendation for a cough medicine? • "Look for dextromethorphan as an ingredient in any OTC cough preparation." • "Drink a lot of fluids and take aspirin, which should reduce the irritation in your throat." • "The doctor could order an antihistamine, which might dry up your secretions and stop the cough." • "You should come to the clinic to be evaluated. A cough that lasts that long might indicate a medical problem."

• "You should come to the clinic to be evaluated. A cough that lasts that long might indicate a medical problem." A cough that has persisted for 2 weeks could be indicative of an underlying medical condition that should be addressed before treating the cough. The client should be asked to come in for an evaluation. Dextromethorphan could help stop the cough, but suppressing the cough might not be in the client's best interest. Drying the mucosa with an antihistamine could aggravate the cough. Aspirin would not be indicated for relieving throat irritation

What would be the nurse's best response if a client calls the clinic and reports that he has had a persistent cough for 2 weeks and asks the nurse for a recommendation for a cough medicine? • "Look for dextromethorphan as an ingredient in any OTC cough preparation." • "You should come to the clinic to be evaluated. A cough that lasts that long might indicate a medical problem." • "Drink a lot of fluids and take aspirin, which should reduce the irritation in your throat." • "The doctor could order an antihistamine, which might dry up your secretions and stop the cough."

• "You should come to the clinic to be evaluated. A cough that lasts that long might indicate a medical problem." Explanation: A cough that has persisted for 2 weeks could be indicative of an underlying medical condition that should be addressed before treating the cough. The client should be asked to come in for an evaluation. Dextromethorphan could help stop the cough, but suppressing the cough might not be in the client's best interest. Drying the mucosa with an antihistamine could aggravate the cough. Aspirin would not be indicated for relieving throat irritation.

Acetylcysteine may be used as a mucolytic agent. What is an additional indication for the drug? • Treatment of bronchospasm • Antidote for acetaminophen poisoning • Conversion of cardiac arrhythmias • Treatment of peptic ulcer disease

• Antidote for acetaminophen poisoning Explanation: Oral acetylcysteine is widely used in the treatment of acetaminophen overdosage

Which agent acts directly on the medullary cough center? • Ephedrine • Codeine • Benzonatate • Tetrahydrozoline

• Codeine Codeine, a centrally acting antitussive, works directly on the medullary cough center. Benzonatate provides local anesthetic action on the respiratory passages, lungs, and pleurae. Ephedrine and tetrahydrozoline are topical nasal decongestants.

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? • Expectorants • Mucolytics • Decongestants • Antitussives

• Decongestants Decongestants cause local vasoconstriction that decrease blood flow to irritated and dilated capillaries of the mucous membranes lining the nasal passages and sinus cavities. The vasoconstriction leads to a shrinking of swollen membranes and opens clogged nasal passages promoting drainage of secretions and improved air flow. Antitussives either work directly on the medullary cough center of the brain or act as a local anesthetic on the respiratory passages blocking the effectiveness of the stretch receptors that stimulate a cough reflex. Expectorants liquefy the lower respiratory tract secretions, reducing the viscosity of the secretions and making it easier to cough them up. Mucolytics break down mucus to aid a person in coughing up thick tenacious secretions by separating cells that hold mucus material together.

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 • Antitussives • Mucolytics • Expectorants

• Decongestants Explanation: Decongestants cause local vasoconstriction that decrease blood flow to irritated and dilated capillaries of the mucous membranes lining the nasal passages and sinus cavities. The vasoconstriction leads to a shrinking of swollen membranes and opens clogged nasal passages promoting drainage of secretions and improved air flow. Antitussives either work directly on the medullary cough center of the brain or act as a local anesthetic on the respiratory passages blocking the effectiveness of the stretch receptors that stimulate a cough reflex. Expectorants liquefy the lower respiratory tract secretions, reducing the viscosity of the secretions and making it easier to cough them up. Mucolytics break down mucus to aid a person in coughing up thick tenacious secretions by separating cells that hold mucus material together.

A client presents at the clinic with a dry nonproductive cough. The client is diagnosed with bronchitis, and it has been determined that assistance is needed in thinning the sputum so the cough can become productive. What does the nurse expect the provider will prescribe? • Guaifenesin • Dextromethorphan • Hydrocodone • Benzonatate

• Guaifenesin Explanation: Because this client needs to cough up respiratory secretions, he would likely be prescribed guaifenesin. This drug is an expectorant that liquefies lower respiratory secretions by reducing their viscosity and so making it easier for a client to cough them up. Benzonatate, dextromethorphan, and hydrocodone are antitussives and are given to suppress the cough reflex.

a client taking metoprolol (Lopressor) 50 mg one tablet twice daily begins taking pseudoephedrine (Sudafed) over the counter, which of the following might occur? Select all that apply: • Bradycardic episode • Hypoglycemic episode • Rebound congestion • Hypertensive episode • Hyperglycemic episode

• Hypertensive episode • Bradycardic episode A client taking a beta-adrenergic blocker, such as metoprolol, and a decongestant, such as pseudoephedrine, may develop an initial hypertensive episode followed by bradycardia.

A client is encouraged to take guaifenesin to loosen the secretions due to a viral respiratory infection. What should the nurse suggest to the client to make the medication work more effectively? • Increase fluid intake • Take the medication with food • Take the medication with other over-the-counter medications to enhance the effect • Dilute the liquid medication with water prior to administration

• Increase fluid intake Explanation: Guaifenesin reduces the viscosity of tenacious secretions by irritating the gastric vagal receptors stimulating respiratory tract fluid. Thus, it increases the volume and decreases the viscosity of respiratory tract secretions. By increasing the amount of fluid ingested, the secretions will become thinner and allow an easier passage for removal. The medication should be taken undiluted to increase effectiveness and taken without food for at least 30 minutes. The nurse should educate the client about reading labels on over-the-counter medications that may interact with guaifenesin to prevent complications.

A client is encouraged to take guaifenesin to loosen the secretions due to a viral respiratory infection. What should the nurse suggest to the client to make the medication work more effectively? • Take the medication with other over-the-counter medications to enhance the effect • Dilute the liquid medication with water prior to administration • Increase fluid intake • Take the medication with food

• Increase fluid intake Explanation: Guaifenesin reduces the viscosity of tenacious secretions by irritating the gastric vagal receptors stimulating respiratory tract fluid. Thus, it increases the volume and decreases the viscosity of respiratory tract secretions. By increasing the amount of fluid ingested, the secretions will become thinner and allow an easier passage for removal. The medication should be taken undiluted to increase effectiveness and taken without food for at least 30 minutes. The nurse should educate the client about reading labels on over-the-counter medications that may interact with guaifenesin to prevent complications.

A 29-year-old client has sinusitis and has been prescribed a topical nasal decongestant. What instructions should the nurse provide? • Increase fluids to 2 L/d. • Take the medication with meals. • Temporarily avoid high-sodium foods. • Use two forms of birth control until treatment is complete.

• Increase fluids to 2 L/d. Increasing fluid intake helps relieve the discomfort of congestion. The medication does not need to be taken with meals. There is no need to limit fluid intake. Caution is required if the client is pregnant, but requiring two forms of birth control is excessive.

A 29-year-old client has sinusitis and has been prescribed a topical nasal decongestant. What instructions should the nurse provide? • Take the medication with meals. • Temporarily avoid high-sodium foods. • Increase fluids to 2 L/d. • Use two forms of birth control until treatment is complete.

• Increase fluids to 2 L/d. Explanation: Increasing fluid intake helps relieve the discomfort of congestion. The medication does not need to be taken with meals. There is no need to limit fluid intake. Caution is required if the client is pregnant, but requiring two forms of birth control is excessive.

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? • The medication is not effective for croup. • Misuse could result in overdose. • The medication is contraindicated for the child's symptoms. • The medication is contraindicated for viral infections.

• 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

A client with cystic fibrosis may use which type of medication to reduce the viscosity of respiratory secretions? • Antihistamine • Peripherally acting antitussive • Mucolytic • Expectorant • Centrally acting antitussive

• Mucolytic Mucolytic drugs may be used by patients suffering from conditions such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, pneumonia, or tuberculosis to reduce the viscosity of respiratory secretions by direct action on the mucus. Mucolytic drugs increase or liquefy respiratory secretions to aid the clearing of the airways in high-risk respiratory patients who are coughing up thick, tenacious secretions.

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 • Chronic nasal polyps • Burning of the nares secondary to chronic use of nasal sprays

• Rebound nasal swelling Explanation: Rebound nasal swelling can occur with excessive or extended use of nasal sprays.

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 • Chronic nasal polyps • Damage of the nasal concha • Burning of the nares secondary to chronic use of nasal sprays

• Rebound nasal swelling Explanation: Rebound nasal swelling can occur with excessive or extended use of nasal sprays.

An instructor is describing topical decongestants as belonging to which class? • Anticholinergics • Sympathomimetics • Adrenergic antagonists • Antihistamines

• Sympathomimetics Explanation: Topical decongestants are sympathomimetic, imitating the effects of the sympathetic nervous system to cause vasoconstriction. Pseudoephedrine has adrenergic properties. Topical decongestants are not anticholinergics or antihistamines or adrenergic antagonists.

What statement best describes how the common cold is effected by and managed using medication therapy? • The tendencies to overmedicate and use antibiotics inappropriately with the common cold are widespread and pose significant risk for complications and drug resistance. • Herbal remedies containing zinc have not demonstrated any ability to reduce the symptoms generally associated with a cold. • Because of the way cold viruses are spread, antibiotics are the most important protective and curative measure. • Colds may be difficult to manage because they often result from drug-resistant microorganisms and occur in people whose immunity is impaired.

• The tendencies to overmedicate and use antibiotics inappropriately with the common cold are widespread and pose significant risk for complications and drug resistance. Common colds are caused by viruses, not bacteria. The tendencies to overmedicate and use antibiotics inappropriately with the common cold are widespread and pose significant risk for complications and drug resistance making treatment more challenging. Herbal preparations containing oral zinc have demonstrated ability to reduce the duration and severity of cold symptoms in adults. While immunity issues increase the risk of developing a cold, it is not the sole factor related to the risk for developing a cold.

What statement best describes how the common cold is effected by and managed using medication therapy? • The tendencies to overmedicate and use antibiotics inappropriately with the common cold are widespread and pose significant risk for complications and drug resistance. • Colds may be difficult to manage because they often result from drug-resistant microorganisms and occur in people whose immunity is impaired. • Herbal remedies containing zinc have not demonstrated any ability to reduce the symptoms generally associated with a cold. • Because of the way cold viruses are spread, antibiotics are the most important protective and curative measure.

• The tendencies to overmedicate and use antibiotics inappropriately with the common cold are widespread and pose significant risk for complications and drug resistance. Explanation: Common colds are caused by viruses, not bacteria. The tendencies to overmedicate and use antibiotics inappropriately with the common cold are widespread and pose significant risk for complications and drug resistance making treatment more challenging. Herbal preparations containing oral zinc have demonstrated ability to reduce the duration and severity of cold symptoms in adults. While immunity issues increase the risk of developing a cold, it is not the sole factor related to the risk for developing a cold.

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. • Echinacea is the OTC drug of choice for prevention of viral infections. • To be effective, echinacea must be taken daily regardless of symptoms. • He is healthier because he uses the echinacea.

• There is limited or no support for the use of echinacea to prevent or treat symptoms of the common cold. There is limited or no support for the use of dietary or herbal supplements to prevent or treat symptoms of the common cold.

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? • To be effective, echinacea must be taken daily regardless of symptoms. • He is healthier because he uses the echinacea. • Echinacea is the OTC drug of choice for prevention of viral infections. • There is limited or no support for the use of echinacea to prevent or treat symptoms of the common cold.

• There is limited or no support for the use of echinacea to prevent or treat symptoms of the common cold. Explanation: There is limited or no support for the use of dietary or herbal supplements to prevent or treat symptoms of the common cold.

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? • Echinacea is the OTC drug of choice for prevention of viral infections. • There is limited or no support for the use of echinacea to prevent or treat symptoms of the common cold. • To be effective, echinacea must be taken daily regardless of symptoms. • He is healthier because he uses the echinacea.

• There is limited or no support for the use of echinacea to prevent or treat symptoms of the common cold. Explanation: There is limited or no support for the use of dietary or herbal supplements to prevent or treat symptoms of the common cold.

The instructor is teaching about the use of mucolytics. The nursing student demonstrates an understanding of the action of the mucolytic drugs when stating which? • They are used to relieve a productive cough. • They are used to relieve a nonproductive cough. • They are used to break down the thickness of secretions. • They are used to depress the cough center in the medulla.

• They are used to break down the thickness of secretions. Explanation: Mucolytics are agents that break down the thickness of secretions for easier removal. An antitussive is used to relieve coughing for nonproductive coughs only. They are not used for non-productive coughs and do not work on the medulla.

When describing the action of decongestants, a nurse integrates knowledge of this class of drugs, identifying which mechanism? • 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

• Vasoconstriction of small blood vessels of the nasal membranes Vasoconstriction of small blood vessels of the nasal membranes is the mechanism of action for decongestants. First-generation antihistamines act to non-selectively bind to peripheral H1 receptors; the mechanism of action for second-generation antihistamines is to selectively bind to peripheral H1 receptors only; and peripherally acting antitussives anesthetize stretch receptors in the respiratory passages.

When describing the action of decongestants, a nurse integrates knowledge of this class of drugs, identifying which mechanism? • Non-selectively binding to central and peripheral H1 receptors • Vasoconstriction of small blood vessels of the nasal membranes • Selectively binding to peripheral H1 receptors • Anesthetizing stretch receptors in the respiratory passages

• Vasoconstriction of small blood vessels of the nasal membranes Explanation: Vasoconstriction of small blood vessels of the nasal membranes is the mechanism of action for decongestants. First-generation antihistamines act to non-selectively bind to peripheral H1 receptors; the mechanism of action for second-generation antihistamines is to selectively bind to peripheral H1 receptors only; and peripherally acting antitussives anesthetize stretch receptors in the respiratory passages.

The client with bilateral pneumonia has been prescribed a mucolytic. The nurse correctly identifies a mucolytic as having which action? • a drug that depresses the cough reflex • a drug that breaks down thick, tenacious mucus in the lower portions of the lungs • a drug that relieves the discomfort produced by coughing • a drug that thins the upper respiratory secretions to make them easier to remove

• a drug that breaks down thick, tenacious mucus in the lower portions of the lungs Explanation: A mucolytic breaks down thick, tenacious mucus in the lower portions of the lungs. An expectorant thins respiratory secretions to make them easier to remove from the respiratory system. An antitussive relieves coughing. An opioid antitussive relieves mild to moderate discomfort associated with coughing.

A client asks, "What is the difference between antitussive medications and expectorants?" What information should the nurse's response be based upon? • Antitussives kill cold viruses while expectorants liquefy bronchial secretions. • Antitussives suppress coughing while expectorants loosen bronchial secretions. • Both drug types loosen bronchial secretions for ease of removal. • Antitussives liquefy bronchial secretions while expectorants assist in the expectoration of those secretions.

• antitussives suppress coughing while expectorants loosen bronchial secretions. Explanation: Antitussive agents suppress cough by depressing the cough center in the medulla oblongata or the cough receptors in the throat, trachea, or lungs. Expectorants are agents given orally to liquefy respiratory secretions and allow for their easier removal.

A client has just been admitted for an overdose of pseudoephedrine. The nurse's assessment of the client should prioritize what system? • renal • neurological • gastrointestinal • cardiovascular

• cardiovascular . Explanation: Because pseudoephedrine is a stimulant, cardiac symptoms are a notable adverse effect, especially in the acute stage of the overdose. All the other systems should be monitored, but the cardiac-related adverse reactions have priority.

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 • expectorant • antihistamine • antitussant

• decongestant Explanation: Nasal decongestants relieve nasal congestion and swelling by constricting arterioles and reducing blood flow to nasal mucosa. Antihistamines refer to a type of medication that treats allergy symptoms. The goal of antitussive therapy is to suppress nonpurposeful coughing. Expectorants are agents given orally to liquefy respiratory secretions and allow for their easier removal

The nurse is providing education to a client who has been diagnosed with a sinus infection. What would the nurse identify as a major cause of this disorder? • facial pain • impaired blood supply • autoimmune processes • inflammatory processes

• inflammatory processes Explanation: As in other parts of the respiratory tract, ciliated mucous membranes in the sinuses help move fluid and microorganisms out and into the nasal cavity. This movement becomes impaired when sinus openings are blocked by nasal swelling, and the impairment is considered a major cause of sinus infections. Another contributing factor is a lower oxygen content in the sinuses, which aids the growth of microorganisms and impairs local defense mechanisms. Autoimmune processes and impaired blood supply are not major causes. Facial pain is a symptom of sinus infection.

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? • a drug allergy • bronchitis • sinusitis • rebound congestion

• rebound congestion Explanation: Nasal decongestants are rapidly effective because they come into direct contact with nasal mucosa. However, if used longer than the recommended 3 days or in excessive amounts, these products may produce rebound nasal congestion that result from the irritation and swelling of the nasal mucosa. The other options would present with distinctive symptomology.

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 on the receptors in the throat to prevent a cough. • Dextromethorphan works by inhibiting allergen response. • 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. Dextromethorphan is related chemically to the opiate agonists and can suppress coughing as effectively as narcotics. Cough suppression occurs by several mechanisms, but mainly the drug directly affects the cough center in the medulla. Therapeutic doses do not affect ciliary activity.