Upper Respiratory PREPU

A patient is using oxymetazoline (Afrin). Which of the following conditions will contraindicate the use of this adrenergic drug?

Hypertension Rationale: Oxymetazoline is contraindicated in patients with severe hypertension or coronary artery disease because of its cardiac stimulating and vasoconstricting effects. Oxymetazoline is prescribed for nasal congestion. Oxymetazoline is not contraindicated in cough or skin rash.

A patient is prescribed oxymetazoline, a decongestant, for the treatment of hay fever. Which of the following should the nurse evaluate to assess the efficacy of therapy?

Maintenance of effective airway clearance Rationale: Evaluation of the maintenance of effective airway clearance helps in assessing the efficacy of oxymetazoline, which is a decongestant drug. The hydration of the skin, the heart rate and the urine output are usually not changed in decongestant therapy.

Decongestants are available in which of the following dosage forms? (Select all that apply)

Nasal sprays Oral tablets Nasal drops Rationale: Decongestants are available as oral tablets, nasal sprays, and nasal drops.

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

Pseudoephedrine Rationale: Pseudoephedrine is the only oral decongestant. Phenylephrine, tetrahydrozoline, and xylometazoline are topical decongestants.

A nurse is caring for a patient who has been prescribed a nasal decongestant. Which of the following factors should the nurse assess before administering the drug?

Blood pressure Rationale: As a pre-administration assessment before giving a nasal decongestant, the nurse should assess the patient's blood pressure, pulse, and respiratory rates. Assessments for disturbed coordination, blurred vision, or auditory tests may be done as an ongoing assessment to check for signs of adverse effects.

A patient has been prescribed a decongestant drug for congestion associated with rhinitis. Which of the following possible side effects of the drug should the nurse caution the patient about?

Blurred vision Rationale: The nurse should inform the patient that blurred vision is a possible side effect of decongestant drugs. Additionally, an increased and not decreased pulse rate may also be seen. Drowsiness is not seen with decongestant usage. Dryness of the nasal mucosa and not the throat may be seen with decongestant drugs, which are used mostly as topical sprays and drops.

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

"Consult with your primary care provider." Rationale: Overuse of topical nasal decongestants, such as Afrin, can make the symptoms worse, causing rebound congestion. The client should consult with the primary care provider. Not all over-the-counter medications are safe for long-term use. Afrin should not be used long term without nasal burning or stinging, or until symptoms are relieved. The primary care provider should be notified to provide medication use information.

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

"I'll keep the room warm and toasty." Rationale: Measures to assist with cough control when using antitussives include cool temperatures, humidification, lozenges, and increased fluids.

A patient is admitted to the emergency room after consuming 50 acetaminophen tablets in a suicide attempt. What medication will be administered to counteract the effect of the acetaminophen?

Acetylcysteine (Mucomyst) Rationale: Acetylcysteine is effective in the treatment of acetaminophen overdose. Oxymetazoline hydrochloride is used for nasal congestion, not acetaminophen overdose. Daptomycin and darbepoetin alfa are not used for acetaminophen overdose.

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

Antidote for acetaminophen poisoning Rationale: Oral acetylcysteine is widely used in the treatment of acetaminophen overdosage.

Your client is complaining of a hacking cough. She asks if taking an antihistamine would be helpful. Your best response is:

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

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

Therapeutic effect Frequency of cough Lung sounds Pain assessment Rationale: Vital signs, lung sounds, therapeutic effect, and assessment of pain induced by cough should be part of the ongoing client assessment. Auscultation of heart sounds are not part of the ongoing client assessment.

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?

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

Meclizine is used to relieve the nausea and vomiting that occurs with motion sickness.

True Rationale:

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

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

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?

antihistamine Rationale: Antitussives that contain an antihistamine may cause drowsiness. The others are not found in antitussives and therefore do not cause the adverse reaction of drowsiness.

You are teaching a 61-year-old client about the narcotic antitussive syrup that his physician has prescribed. Which of the following client statements suggests that he understands what you've taught him?

"This medication might cause drowsiness, so I will avoid driving while I use it." Rationale: Although narcotic antitussives include only small doses of narcotics, some of the adverse effects of that drug category (e.g., drowsiness, dizziness) are still possible. To decrease the risk of adverse effects, clients should take antitussives at the prescribed schedule and dosage. They should not dilute the medications with fluids or take them with food because doing so may clear the medications from the pharynx, reducing their benefit. Antitussives are intended to suppress only non-purposeful cough; suppression of all coughing can prevent the clearance of secretions.

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." Rationale: 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.

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

Antitussives suppress coughing, and expectorants loosen bronchial secretions. Rationale: 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 is taking pseudoephedrine. The nurse would assess the client for which of the following adverse effects?

Anxiety Rationale: Adverse effects related to the sympathomimetic effects of pseudoephedrine are more likely to occur, including feelings of anxiety, restlessness, hypertension, sweating, tenseness, tremors, arrhythmias, and pallor.

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 you tell the patient about this prescription during discharge counseling? (Select all that apply)

Benzonatate can cause GI upset and sedation. The patient should drink plenty fluids. Rationale: 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.

Which of the following would a nurse identify as a first generation antihistamine? Select all that apply.

Clemastine Dimenhydrinate Rationale: First generation antihistamines include clemastine and dimenhydrinate.

Ms. Thompson, age 45, is being seen in the physician's office today for complaints of a dry, hacking cough that is keeping her up at night. The physician prescribes dextromethorphan for the cough. Which statement is true about dextromethorphan?

Dextromethorphan works in the medulla to suppress the cough reflex. Rationale: 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.

A client calls the clinic and complains of symptoms of a cold. The client is most concerned because the cold symptoms are preventing him from sleeping. The nurse would inform the client that what medication relieves cold symptoms and aids sleep?

Diphenhydramine Rationale: Antihistamines are clearly useful in allergic conditions, but their use to relieve cold symptoms is controversial. First-generation antihistamines (e.g., chlorpheniramine, diphenhydramine) have anticholinergic effects that may reduce sneezing, rhinorrhea, and cough. Also, their sedative effects may aid sleep. Many multi-ingredient cold remedies contain an antihistamine.

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

Drowsiness Rationale: Older adults are more likely to experience anticholinergic effects (dryness of mouth, nose, throat), dizziness, sedation, hypotension, and confusion from the use of antihistamines. Drowsiness and sedation present the greatest safety concerns compared to other effects such as dry mouth and nonproductive cough. Nasal burning may occur due to nasal spray use.

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

Dry mouth Rationale: First-generation antihistamines have substantial anticholinergic effects; therefore, they may cause dry mouth, urinary retention, constipation, and blurred vision.

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

False Rationale: The risk for sedation is higher with first generation antihistamines than with second generation antihistamines.

Decongestants should be used cautiously in clients with which of the following? Select all that apply:

Glaucoma Diabetes Rationale: Clients with diabetes, heart disease, hypertension, hyperthyroidism, benign prostatic hypertrophy, and glaucoma should contact their physician before taking over the counter decongestants.

Which drug is classified as an expectorant?

Guaifenesin (Robitussin) Rationale: Robitussin is an expectorant that contains guaifenesin. Mucomyst is a mucolytic that contains acetylcysteine. Delsym is a centrally acting antitussive that contains dextromethorphan. Tessalon Perles are a peripherally acting antitussive that contain benzonatate.

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?

Mucomyst Rationale: Mucolytics are administered by inhalation to liquefy mucus in the respiratory tract. Solutions of mucolytic drugs may be nebulized into a face mask or mouthpiece or instilled directly into the respiratory tract through a tracheostomy. Sodium chloride solution and acetylcysteine (Mucomyst) are the only agents recommended for use as mucolytics.

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?

Nausea and vomiting Rationale: Promethazine is most commonly used in the treatment of nausea and vomiting.

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.

Need to follow the directions for how often to give the drug Avoidance of use in children under age 2 Importance of reading the label for ingredients and dosage Rationale: OTC cough and cold preparations should not be used in children under the age of 2 years. Accurate dosing is essential. Following the directions is essential to prevent inadvertent overdosage. Measuring devices that come with the medication should be used to ensure accurate dosages. Parents should look for the formula for children, infants, or pediatrics.

Your client complains that he has had severe nasal congestion for the last 8 days. He has been using an OTC nasal decongestant spray. You know that this is indicative of:

Rebound nasal congestion. Rationale: With nasal decongestants, topical preparations are often preferred for short-term use. They 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. Oral drugs are preferred for long-term use.

A male client presents to the physician's office with complaints 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 Rationale: Rebound nasal swelling can occur with excessive or extended use of nasal sprays.

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

Suck on sugarless hard candy. Take frequent sips of water. Offer ice chips. Rationale: Offering the client frequent sips of water or ice chips, and suggesting use of sugarless gum or candy are appropriate suggestions to relieve dry mouth. An intravenous fluid bolus is invasive and not a first-line suggestion to relieve dryness. The client should run a humidifier, not a dehumidifier, to add moisture to the air at home and help relieve dryness.

A 62-year-old patient has been prescribed an antihistamine to alleviate vasomotor rhinitis. He complains that he has gastric irritation on taking the tablet. Which of the following instructions should the nurse provide to help alleviate the patient's condition?

Take the tablet with food. Rationale: If the patient has gastric irritation following ingestion of the antihistamine, the nurse should instruct the patient 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.