Upper Respiratory Tract drugs (Ch. 54)

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

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

When providing health education to an adult who is taking an over-the-counter (OTC) combination cold and cough remedy, the nurse should encourage the client to implement what intervention to best assure medication safety? Start with a low dose and gradually increase it until symptoms are relieved. Withhold the medication until a prescription is obtained from a care provider. Carefully read the label and adhere to the guidelines for use. Administer the medication with an additional dose of acetaminophen to potentiate therapeutic effects.

Carefully read the label and adhere to the guidelines for use.

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

Codeine- Medulla (antitussive) benxonatate also antitussive but works directly on respiratory tract

A 76-year-old client has been prescribed an oral antihistamine. What adverse effect presents a priority safety concern for older adult clients? Drowsiness Nonproductive cough Dry mouth Nasal burning

Drowsiness

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

Guaifenesin

A female client presents at the clinic with a dry, nonproductive cough. The client is diagnosed with bronchitis, and it is determined that she will need help thinning sputum so that the cough can become productive. What does the nurse expect will be prescribed for the client? Aspirin Codeine Guaifenesin Dextromethophan

Guaifenesin Expectorants, such as guaifenesin, are agents given orally to liquefy respiratory secretions and allow for easier removal. Dextromethorphan and codeine are antitussives used to suppress coughing

What effect is associated with a first-generation H1 receptor antagonist? It raises the seizure threshold by impairing vitamin D. It depletes norepinephrine and serotonin. It catalyzes the enzymatic oxidation of uric acid. It decreases capillary permeability.

It decreases capillary permeability.

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

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? Expectorant Antihistamine Mucolytic Centrally acting antitussive Peripherally acting antitussive

Mucolytic

A client reports anxiety, restlessness, nausea, and vomiting after using a nasal decongestant. Which drug should the nurse consider as the cause for these side effects? Phenylephrine Pseudoephedrine Ephedrine Epinephrine

Pseudoephedrine

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

Retention of secretions

A gerontological nurse has encouraged a group of caregivers who work with older adults to avoid administering first-generation H1 receptor antagonists to their clients. The nurse's cautionary message is an acknowledgment of what possible nursing diagnosis? Risk for infection related to adverse effects of antihistamines Risk for deficient fluid volume related to diuresis Risk for falls related to sedation Risk for impaired skin integrity related to urticaria

Risk for falls related to sedation

What home remedies are effective for mouth dryness and cough? (Select all that apply.) Administration of over-the-counter antihistamine Sucking on hard candy or throat lozenges Humidification of the environment Swishing the mouth with astringent mouthwash. Adequate fluid intake

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

When developing the teaching plan for a client receiving an antihistamine, which would the nurse include? (Select all that apply.) Using sugarless candies or lozenges to combat dry mouth Advising the client to avoid alcohol consumption Encouraging the client to engage in usual activities such as driving Stopping the drug after 3 days if no relief is obtained

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

A client is experiencing allergy symptoms after being exposed to environmental dust. This reaction involves the action of histamine, which is released by what cells? basophils lymphocytes platelets CD4 T cells

basophils and mast cells

Which assessment finding should prompt the nurse to suspect that the resident is experiencing an anticholinergic effect of diphenhydramine? urticaria wheezing on expiration blurry vision tinnitus

blurry vision

To help liquefy cold-related secretions, the nurse should encourage the client to implement which measure? reducing salt intake deep breathing and exercises gargling with normal saline increasing fluid intake

increase fluid intake

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

Acetylcysteine (Mucomyst) is primarily administered by which route when being used to thin secretion? (Select all that apply.) Instilled into a tracheostomy Rectally Inhalation Orally Parenterally

instilled into a tracheostomy inhalation

A client asks the nurse how long to use oxymetazoline (Afrin) nasal spray for nasal congestion. What is the nurse's best response? "Consult with your primary care provider." "Use the medication until your symptoms are completely relieved." "Over-the-counter medications are safe for long-term use." "Afrin can be used as long as nasal burning and stinging do not occur."

"Consult with your primary care provider."

Which client statement suggests a need for additional education on the second-generation antihistamine prescribed for the client? "I'm really hoping that these pills will cure my allergies before summer starts." "I know these can be a bit expensive, but hopefully it will be worth it for me." "I'll check with my health care provider to make sure that the diet supplements I'm taking are okay to take at the same time as these pills." "It's handy that I don't necessarily have to take these pills at bedtime."

"I'm really hoping that these pills will cure my allergies before summer starts." not cure

What statement made by a client suggests a need for further teaching on the risk factors associated with drug allergies? "All drugs have the potential to cause an allergic reaction." "Virtually any drug may induce an immunologic response in a susceptible person." "The additives that are in drugs can also cause allergic reactions." "If you didn't have allergies as a child, you won't develop allergies later in life."

"If you didn't have allergies as a child, you won't develop allergies later in life."

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

"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

A patient receives guaifenesin. The nurse would expect the drug to begin acting within which time frame? 60 minutes 45 minutes 15 minutes 30 minutes

30 minutes

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? Vision Auditory tests Blood pressure Motor coordination

Blood pressure 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 nurse is describing the action of a prescribed antihistamine to a client. The nurse is describing which medication, by explaining that the drug elicits its antihistamine effects by nonselectively binding to central and peripheral H1 receptors? Loratadine Diphenhydramine Fexofenadine Cetirizine

Diphenhydramine all other are 2nd generation antihistamines

A group of students demonstrate understanding of topical decongestants, identifying them as: Parasympathomimetics Sympathomimetics Parasympatholytics Sympatholytics

Sympathomimetic

The nursing instructor is discussing the use of nasal decongestants and shares what reason for their effectiveness? They treat multiple symptoms in a cost-effective manner. They come into direct contact with nasal mucosa. They are absorbed systemically. Their effects last for 48 to 72 hours.

They come into direct contact with nasal mucosa.

A 21-year-old patient reports a mild stinging sensation on using a nasal spray containing a nasal decongestant. Which information should the nurse provide the patient? Consult the physician immediately. Dose of the medication needs reduction. Medication needs to be stopped immediately. This sensation usually disappears with continued use.

This sensation usually disappears with continued use.

Nasal decongestants would be contraindicated for which client? a client with a history of coronary artery disease a client with a history of diet-controlled diabetes mellitus a client with a pulse rate of 58 beats per minute a client with a history of controlled hypertension

a client with a history of coronary artery disease

What type of cough is best treated with dextromethorphan? a dry, nonproductive cough a cough that is associated with an allergy to ragweed a cough that occurs when the client is exposed to airborne irritants an occasional, productive cough

a dry, nonproductive cough

A client, scheduled to receive one unit of packed red blood cells, has a history of an allergic reaction to a transfusion in the past. What class of medication will assist in preventing a reaction to the packed red blood cell transfusion? antianginals antipyretics antihistamines antimicrobials

antihistamine

The nurse's assessment should prioritize what system when caring for a client who has just been admitted for an overdose of pseudoephedrine? renal cardiovascular gastrointestinal neurological

cardiovascular

An adult client has reported experiencing a dry mouth and urinary retention after several nights of taking an over-the-counter (OTC) sleep aid. The nurse should suspect that this medication contains what antihistamine? promethazine diphenhydramine loratadine olopatadine

diphenhydramine

The pharmacology instructor is discussing the adverse effects of diphenhydramine. Which is not one of these effects? Dry mouth Excessive salivation Blurred vision Drowsiness

excessive salivation

What is the chemical mediator released in immune and inflammatory response to allergic reactions? mast cells norepinephrine histamine epinephrine

histamine

The nurse is educating an older adult client diagnosed with rhinosinusitis in an outpatient clinic about the prescribed topical oxymetazoline. The client has a history of hypertension and coronary artery disease. Which statement made by the client establishes the need for further clarification? "I will rinse the spray tip off after each use." "I will blow my nose before using the nasal spray." "I can take over-the-counter pseudoephedrine, too." "The drug is used no longer than 3 days."

"I can take over-the-counter pseudoephedrine, too."

The nurse is educating an adult client diagnosed with a nonproductive cough about the prescribed dextromethorphan. Which statement made by the client establishes the need for further clarification? "If I raise mucous, I will stop taking the drug and call my prescriber." "I will not eat or drink for 30 minutes after taking a dose." "I will dilute the drug syrup with an equal amount of water." "The drug should only be taken as directed on the package."

"I will dilute the drug syrup with an equal amount of water."

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." "I can use some lozenges for comfort." "I need to increase the amount of fluids I drink." "I'll get a humidifier for my bedroom."

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

The health care provider suggests that a client use guaifenesin to help his cough. The nurse instructs the client to call the health care provider if he continues to have a productive cough after which amount of time? 1 week 2 weeks 3 weeks 5 days

1 week

A patient receives dextromethorphan. The nurse would expect this drug to begin acting within which time frame? 25 to 30 minutes 10 to 15 minutes 20 to 25 minutes 15 to 20 minutes

25 to 30 minutes

A client has expressed frustration stating, "I've been taking an over-the-counter (OTC) decongestant for several days and it still hasn't really cured my cold." What teaching point should the nurse convey to the client? "Sometimes a decongestant can sometimes mask the effects of your cold, essentially prolonging it." "It usually takes between 8 and 10 days for a decongestant to cure affect cold symptoms." "Most people find that cold medications are essentially ineffective." "Drugs like this can often relieve some of the symptoms of a cold, but they won't cure it."

"Drugs like this can often relieve some of the symptoms of a cold, but they won't cure it."

A male college student has presented to the campus medical clinic reporting cold symptoms that he has been experiencing for the past 2 weeks. He tells the nurse that he has been taking OTC decongestants twice daily since the onset of the cold. What teaching point should the nurse provide to this student? "Over-the-counter decongestants don't normally work; you'll likely need to get a prescription for something more effective." "You can probably expect to get relief within the next few days or a week at the longest." "You might find yourself more congested than ever as your body compensates for your use of these drugs." "It's best to take small doses of decongestants several times daily rather than two larger doses each day."

"You might find yourself more congested than ever as your body compensates for your use of these drugs."

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 would be most appropriate to include? (Select all that apply.) Using household measuring devices for dosage measurements Avoidance of use in children under age 2 Importance of reading the label for ingredients and dosage Need to follow the directions for how often to give the drug Using adult formulation with smaller doses

-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

A nurse administers an antitussive agent cautiously to a client with asthma for which reason? The client may experience increased sedation. A loss of respiratory reserve can occur. The drug can lead to addiction. The airway needs to be maintained.

A loss of respiratory reserve can occur.

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

A. Antitussives suppress coughing, and expectorants loosen bronchial secretions.

The client states that he/she once needed medication to liquefy secretions in the respiratory tract. However, the client cannot recall the name of the medication but states that the medication is added to a nebulizer. The nurse suspects the client is taking which medication? prednisone acetylcysteine guaifenesin pseudoephedrine

Acetylcysteine 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

A client reports a hacking cough. The client asks if taking an antihistamine would be helpful. The nurse's best response is: Antihistamines are recommended for extended use, as long as you monitor for adverse effects. Antihistamines are not recommended for this issue; only antibiotics are useful. Antihistamines are not recommended because they can dry lower respiratory secretions and worsen secretion retention and cough. Antihistamines are not used for this issue.

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

An adult client has asked the nurse to recommend an OTC cold remedy. Before making a recommendation, the nurse should implement which intervention? Consult with a pharmacist or pharmacy technician. Ensure that the client has tried some of the more common herbal and natural remedies. Assess the client's understanding of the epidemiology of the common cold and upper respiratory infections. Assess the client for health problems that may contraindicate the use of a particular remedy.

Assess the client for health problems that may contraindicate the use of a particular remedy.

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 on the receptors in the throat to prevent a cough. Dextromethorphan works in the medulla to suppress the cough reflex. Dextromethorphan works by relaxing the smooth muscles in the bronchioles. Dextromethorphan works by inhibiting allergen response.

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

A client calls the clinic and reports 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? Phenergan Diphenhydramine Epinephrine Antihistamine

Diphenhydramine

Which would contraindicate the use of a topical nasal decongestant? Glaucoma Hypertension Diabetes Nasal ulceration

Nasal ulceration all others are cautionary

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. Take an antacid before the tablet. Take the tablet one hour before food. Drink ample water before taking the tablet.

Take the tablet with food

After teaching a group of students about topical nasal steroid decongestants, the instructor determines the need for additional teaching when the students identify which as an example? Fluticasone Triamcinolone Tetrahydrozoline Flunisolide

Tetrahydrozoline- topical nasal decongestant

True/False: Mucolytics are often used for patients with cystic fibrosis, COPD, or tuberculosis.

True; add pneumonia

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

A client, having an allergic reaction to mold, describes chest tightness and difficulty breathing. Which body effect is occurring? contraction of smooth muscle in the bronchi suppression of the vagus nerve endings producing tachycardia decreased permeability of the veins and capillaries decreased secretion of the mucous glands

contraction of smooth muscle in the bronchi

A female client administers diphenhydramine to her 9-year-old male child, who experiences seasonal allergies, before his first baseball game. What may the child experience if he has a paradoxical effect to the medication? Poor reflexes Exacerbation of allergic symptoms Decreased mental alertness Hyperactivity

decreased mental alertness

What intervention should be included in the care plan of a client experiencing excessive respiratory tract secretions? deep breathing and coughing exercises administration of guaifenesin supplemental oxygen by nasal prongs administration of pseudoephedrine

deep breathing and coughing exercises With excessive respiratory tract secretions, mechanical measures (e.g., coughing, deep breathing, ambulation, chest physiotherapy, forcing fluids) are more likely to be effective than expectorant drug therapy. Research studies do not support guaifenesin's overall effectiveness, and many authorities do not recommend its use. Pseudoephedrine is not an expectorant, and supplemental oxygen will not loosen secretions.

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

degree of dyspnea

A client prescribed codeine for a persistent, debilitating cough tells the nurse, "I was sure that codeine was a narcotic that people take for pain." The nurse should cite what mechanism of action when describing this use of codeine? vasodilation of the alveolar capillaries stimulation of the reticular activating system (RAS) desensitization of the cough receptors in the sinuses and trachea depression of the cough center in the medulla oblongata

depression of the cough center in the medulla oblongata

What medication should be prescribed to minimize the risk associated with a blood transfusion for a client with a history of a previous transfusion reaction? diphenhydramine cetirizine epinephrine clemastine

diphenhydramine

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

rebound nasal swelling

Expectorants elicit their effect by which mechanism? Breaking down thick mucus in the lower lungs Thinning respiratory secretions Depressing the cough center in the brain Anesthetizing stretch receptors in the respiratory passages

thin respiratory secretions

When the use of antihistamines result in dryness of the mouth, the nurse should recommend which to relieve the dryness? Select all that apply. Suck on sugarless hard candy. Offer ice chips. Take frequent sips of water. Administer intravenous fluid bolus. Use a dehumidifier in the home.

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