PrepU Pharm 1301 - Chap 54,55

Which of the following would a nurse identify as a surfactant?

Beractant Explanation: Beractant is a lung surfactant. Cromolyn is a mast cell stabilizer. Zileuton is a leukotriene receptor antagonist. Theophylline is a xanthine.

A client presents to the clinic with a dry non-specific cough. The client is diagnosed with bronchitis and it has been determined that assistance is needed in thinning the sputum so the cough can be productive. What does the nurse expect the provider will prescribe? a. Guaifenesin b. Benzonatate c. Hydrocodone d. Dextromethorphan

Guaifenesin Feedback:Because this patient 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 patient to cough them up. Benzonatate, dextromethorphan, and hydrocodone are antitussives and are given to suppress the cough reflex.

An older adult client has been prescribed an inhaled corticosteroid for the treatment of chronic obstructive pulmonary disease (COPD). Which action should the nurse perform to reduce the client's risk for developing oral candidiasis?

Have the resident rinse his or her mouth after each dose of the drug. Explanation: Rinsing may reduce a person's risk of developing oral candidiasis during treatment with inhaled corticosteroids. It would be incorrect to discourage deep inhalation of the medication. Gargling prior to administration is ineffective, and prophylactic medications are not used.

The nurse is teaching a client about the administration of a decongestant nasal spray. What information is most important to include in this discussion? a. Administer the nasal spray in the prone position. b. Overuse of nasal spray may cause rebound congestion. c. Nasal spray can be shared between family members only. d. Finish the bottle of nasal spray to clear infection effectively.

Overuse of nasal spray may cause rebound congestion.

A nurse is teaching a 55-year-old client about fexofenadine prescribed to treat allergic symptoms. Which client statement suggests an understanding of this teaching?

"I should avoid driving after taking this medication." Explanation: After taking fexofenadine or other antihistamines, clients should avoid activities that require being alert (e.g., driving). They should not combine alcohol or other sedating agents with these drugs, since doing so can result in excessive sedation. To avoid the adverse effects of combining multiple antihistamines, clients should consult the prescriber before taking any other medications, particularly cold remedies and products labelled "nighttime" or "PM."

When providing health education to a client prescribed diphenhydramine, what information should the nurse convey to the client?

"This drug is likely to make you feel drowsy." Explanation: First-generation antihistamines like diphenhydramine cause sedation. They do not cause urinary frequency, increased muscle tone, or cough.

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." 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 assesses the serum theophylline of a client. Which finding would the nurse identify as being therapeutic?

15 mcg/mL Explanation: Therapeutic theophylline levels range from 10 to 20 mcg/mL. A value of 15 mcg/mL would be considered therapeutic.

The nurse instructs a patient who is using albuterol for exercise-induced bronchospasm to use the inhaler at which time?

15 minutes prior to exercising Explanation: Albuterol for exercise induced bronchospasm should be administered 15 minutes prior to exercising.

A client has been admitted to a health care facility with asthma. The nurse is to administer theophylline to the client. To which clients can the nurse safely administer theophylline?

A 65-year-old male with asthma Explanation: The nurse can safely administer theophylline to the client who is 65 years of age. It needs to be administered cautiously in clients older 69 years of age or those with hepatic disease, cardiac disease, or hypertension.

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

Albuterol Explanation: Albuterol is the initial drug of choice for acute bronchospasm.

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

Albuterol causes relaxation of the bronchial smooth muscles. Explanation: The main result of albuterol binding to beta-2 receptors in the lungs is relaxation of bronchial smooth muscles. This relaxation of bronchial smooth muscle relieves bronchospasm, reduces airway resistance, facilitates mucous drainage, and increases vital capacity.

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

Antihistamines are not recommended because they can dry lower respiratory secretions and worsen secretion retention and cough. Explanation: Many cold remedies are over-the-counter formulations. Although antihistamines are popular over-the-counter drugs because they dry nasal secretions, they are not recommended because they can also dry lower respiratory secretions and worsen secretion retention and cough.

A client has been prescribed an antihistamine for the treatment of seasonal allergies. What dietary guideline should the nurse provide to the client? a. Increase intake of foods that are high in vitamin C. b. Avoid drinking alcohol while taking antihistamines. c. Eat several small meals instead of three larger meals in case of GI upset. d. Avoid grapefruit juice until at least 48 hours after treatment is complete.

Avoid drinking alcohol while taking antihistamines.

A 70-year-old man is being treated for chronic obstructive pulmonary disorder (COPD) with theophylline. What will be the priority assessment by the nurse? A. Weight B. Activity level C. Use of nicotine D. Intake of fatty foods

C. Use of nicotine Feedback:Nutritional status, weight, and activity level would be important for a nurse to know about a COPD patient. However, it would be most important for the nurse to know whether the patient smokes or uses tobacco in other ways or smoking cessation methods that involve nicotine. Nicotine increases the metabolism of theophyllines; the dosage may need to be increased to produce a therapeutic effect.

A client who has chronic bronchial asthma has had a mast cell stabilizer prescribed. Which of the following drugs was prescribed? a. Cromolyn b. Isoetharine c. Ipratropium d. Aminophylline

Cromolyn

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? A. Mucolytics B. Antitussives C. Expectorants D. Decongestants

Decongestants

When describing the benefits of second-generation H1 receptor antagonists to those of first-generation H1 receptor antagonists, the nurse should cite what advantage?

Decreased sedation Explanation: Unlike the first-generation H1 receptor antagonists, the second-generation H1 receptor antagonists do not readily enter the brain from the blood. This selectivity significantly reduces the occurrence of adverse drug reactions, such as drowsiness and sedation, while still providing effective relief of allergic conditions. Adverse effects are not wholly absent, however. Duration of action is 12 to 24 hours, and these drugs are more expensive than first-generation drugs.

The nursing instructor is teaching their lab students the best position for the administration of nasal sprays. What position would the instructor teach the students?

High Fowler's Explanation: Teach the patient to sit upright and press a finger over one nare to close it.

Acetylcysteine is primarily administered by which route when being used to thin secretion? (Select all that apply.)

Instilled into a tracheostomy Inhalation Explanation: While acetylcysteine can be administered orally in the treatment of acetaminophen overdose, it is primarily given by nebulizer or instilled into tracheostomy to thin secretions.

While reviewing a client's history, an allergy to which of the following would alert the nurse to a possible problem with the use of ipratropium?

Peanuts Explanation: The use of ipratropium is contraindicated in the presence of known allergy to the drug or to peanuts or soy products because the vehicle used to make ipratropium, an aerosol, contains a protein associated with peanut allergies.

A 62-year-old client has been prescribed an antihistamine to alleviate vasomotor rhinitis. The client reports gastric irritation after taking the tablet. Which instructions should the nurse provide to help alleviate the client's condition?

Take the tablet with food. Explanation: If the client has gastric irritation following ingestion of the antihistamine, the nurse should instruct the client to take the tablet with food and not before food. Taking an antacid before the tablet may reduce the absorption of the antihistamine. Drinking ample water before taking the tablet will not help to alleviate the patient's condition.

A nurse is caring for a 38-year-old client with asthma who has been started on albuterol. What assessment finding should the nurse most likely attribute to adverse medication effects? a. The client's oral temp is 100F. b. The client reports excessive thirst. c. The client's heart rate is 110bpm. d. The client had diarrhea this morning.

The client's heart rate is 110bpm.

Which is an additional indication of acetylcysteine? a. Decreased bronchospasm b. Treatment of peptic ulcer disease c. Conversion of cardiac arrhythmias d. Antidote for acetaminophen toxicity

Antidote for acetaminophen toxicity

A nurse caring for a client in the hospital is being discharged today with a prescription for benzonatate (Tessalon Perles) 200 mg one capsule 3 times daily. What would the nurse tell the client about this prescription during discharge counseling? (Select all that apply.)

Benzonatate can cause GI upset and sedation. The client should drink plenty fluids. Explanation: The adverse effects of benzonatate include sedation, headache, dizziness, constipation, nausea, GI upset, pruritus, and nasal congestion. It is recommended that patients with cough drink plenty of fluids (1500 to 2000 mL daily) unless fluids are contraindicate due to another disease state. Benzonatate should not be crushed or chewed due to a local anesthetic effect resulting in possible choking. Consumption of alcohol while taking benzonatate can increase CNS depression and increased sedation. The maximum daily dose of benzonatate is 600 mg daily.

A nurse is providing health education to a client recently diagnosed with asthma and prescribed albuterol and ipratropium. Which of the client's statements suggests a need for clarification by the nurse?

I'll keep taking my medications until I'm not experiencing any more symptoms." Explanation: Antiasthma medications should normally be taken on a regular schedule, not solely based on immediate symptoms. They should not be discontinued in the absence of symptoms. Increasing fluid intake, limiting caffeine, and adhering to the administration schedule are correct actions.

A client has an important presentation to make in 4 hours and needs relief from the congestion of seasonal rhinitis. The client calls the nurse, explains the situation, and tells the nurse that he can't afford to be drowsy. Which antihistamine would be a good choice for this client? a. Loratadine b. Hydroxyzine c. Diphenhydramine d. Dexchlorpheniramine

Loratadine Feedback:The first-generation antihistamines, including diphenhydramine, dexchlorpheniramine, and hydroxyzine, are associated with drowsiness. Loratadine is one of the second-generation antihistamines, which have fewer anticholinergic effects and are less likely to cause drowsiness.

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

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

A nurse is caring for a 15-year-old client with cystic fibrosis who has been prescribed dornase alfa. What should the nurse instruct the client and family to do regarding this medication? a. Use in-home nebulizer therapy up to every 4 hours. b. Store the drug in the refrigerator, protected from light. c. Expect a headache after each use, due to vasodilation. d. Avoid taking other drugs within 2 hours of dornase alfa

Store the drug in the refrigerator, protected from light. Feedback:Patients using dornase alfa should be cautioned to store the drug in the refrigerator, protected from light. Heat and light can cause the drug to break down and can decrease its therapeutic value. The drug should only be used up to two times a day and the patient should continue all other medications while using it. Dornase alfa is only a palliative therapy that improves respiratory symptoms. A severe headache is not associated with this drug.

A client informs the nurse about taking pseudoephedrine for the relief of nasal congestion due to the common cold. In which situation should the nurse suggest that the client not use this medication since it is a contraindication for this health care concern?

The client is being treated for severe hypertension. Explanation: Contraindications to pseudoephedrine use include severe hypertension or coronary artery disease because of the drug's cardiac stimulating and vasoconstricting effects. Cataracts are not a contraindication for use, but narrow-angle glaucoma is. Caution should be used in clients with hyperthyroidism, not hypothyroidism. The duration of the cold symptoms does not have any relevance to the use of pseudoephedrine.