Ch 31 Upper Respiratory System

31. A 21-year-old client complains of a mild stinging sensation on using a nasal spray decongestant. Which response by the nurse would be most appropriate? A) "You need to stop the medication immediately." B) "The dose is probably too strong and needs to be reduced." C) "This sensation is common and usually disappears with continued use." D) "We better contact your primary health care provider right away."

Ans: C Feedback: The nurse needs to assure the client that the mild stinging sensation usually disappears with continued use. The drug needs to be stopped only if the stinging sensation is severe. The dose of the medication does not need to be altered. The primary health care provider does not need to be consulted immediately in the presence of a mild stinging sensation.

14. The nurse understands that an expectorant is administered cautiously to a client with which condition? A) Renal impairment B) Persistent headache C) Persistent cough D) Seizure disorder

Ans: C Feedback: The nurse should use the expectorant drugs with caution in clients with persistent cough. The nurse should use antitussives with caution in clients with persistent headache. The nurse needs to use opioid antitussives cautiously in clients with renal impairment and seizure disorders.

16. The nurse is preparing to administer a drug that acts by reducing the swelling in the nasal passages by vasoconstriction. Which of the following might the nurse be administering? Select all that apply. A) Loratadine B) Guaifenesin C) Dextromethorphan D) Phenylephrine E) Oxymetazoline

Ans: D, E Feedback: Phenylephrine and oxymetazoline are decongestants that reduce swelling in the nasal passages by vasoconstriction. Loratadine is an antihistamine, guaifenesin is an expectorant, and dextromethorphan is a centrally acting antitussive.

11. A nurse is assigned to care for a client with bronchial irritation. The client is prescribed diphenhydramine. Before administering the drug, which of the following would the nurse do? A) Document color and amount of any sputum present. B) Record the previous prescriptions. C) Take vital signs every 4 hours. D) Assess the client's cardiovascular status.

Ans: A Feedback: Before drug administration, the nurse should document the color and amount of any sputum present. The nurse need not record the previous prescriptions; however, the nurse should determine if any drugs the client uses would potentially interact with diphenhydramine. The nurse needs to take the client's vital signs, but not every 4 hours. The nurse needs to assess the respiratory status of the client before administering mucolytics and expectorants, but not before administering diphenhydramine HCl. Assessing the client's cardiovascular status is not necessary.

23. Based on the nurse's understanding of decongestants, the nurse would expect to administer this drug cautiously to a client with which of the following? Select all that apply. A) Diabetes B) Glaucoma C) Hypotension D) Hypothyroidism E) Arthritis

Ans: A, B Feedback: The nurse should administer decongestants cautiously to clients with diabetes, heart disease, hypertension, hyperthyroidism, benign prostatic hypertrophy, and glaucoma. These clients should contact their primary health care provider before taking over-the-counter decongestants.

24. After teaching a group of nursing students about antihistamines, the instructor determines that the teaching was successful when the students identify which of the following as less sedating? Select all that apply. A) Loratadine (Claritin) B) Fexofenadine (Allegra) C) Cetirizine (Zyrtec) D) Brompheniramine (Lodrane) E) Clemastine (Tavist)

Ans: A, B, C Feedback: Loratadine, fexofenadine, and cetirizine are considered second-generation antihistamines that are less sedating than first-generation antihistamines (brompheniramine and clemastine).

8. A client has a nursing diagnosis of Ineffective Airway Clearance. Which of the following would the nurse include in the client's plan of care? Select all that apply. A) Encouraging increased fluid intake B) Assisting the client in taking deep, diaphragmatic breaths C) Discouraging client movement D) Instructing the client to avoid coughing E) Encouraging the client to change positions

Ans: A, B, E Feedback: Clients should be encouraged to change positions frequently, breathe deeply, and increase fluid intake to aid in effectively clearing the airway of sputum. Coughing helps to move mucus.

22. When assessing an older client who is receiving an antihistamine, the nurse integrates knowledge of which of the following as contributing to the client's higher risk of injury? Select all that apply. A) Hearing loss B) Steady gait C) Visual impairment D) Hypertension E) Diabetes

Ans: A, C Feedback: Older adult clients are more likely to experience injury from dizziness because with age comes an increased risk for falls due to sensorimotor deficits (hearing loss, visual impairment) or unsteady gait.

17. Before administering an antihistamine to a client, which of the following would the nurse include in the preadministration assessment? Select all that apply. A) Asking about symptoms B) Checking visual acuity C) Asking about prescription medications D) Auscultating bowel sounds E) Auscultating heart sounds

Ans: A, C Feedback: The preadministration assessment for clients receiving antihistamines depends on the reason for use but should at the least include asking about symptoms of the involved areas and asking about prescription medications the client is taking.

1. 1. When describing the actions of upper respiratory system drugs, a nursing instructor explains that which of the following exerts its effect by increasing the production of secretions, thereby decreasing the viscosity? Select all that apply. A) Benzonatate B) Guaifenesin C) Codeine D) Potassium iodide E) Dextromethorphan

Ans: A, D Feedback: Benzonatate and potassium iodide are expectorants, which increase the production of secretions, thus making the secretions less viscous. Guaifenesin, codeine, and dextromethorphan are antitussives, which suppress cough.

18. After administering a decongestant, which of the following would the nurse include in the ongoing assessment? Select all that apply. A) Heart sounds B) Blood pressure C) Level of congestion D) Therapeutic effect E) Pain assessment

Ans: B, C, D Feedback: The ongoing assessment for a client taking a decongestant should include assessment of blood pressure and pulse and asking about level of congestion, therapeutic effect, and adverse reactions.

3. After administering an antitussive, the nurse would continue to assess which of the following? Select all that apply. A) Heart sounds B) Lung sounds C) Frequency of cough D) Therapeutic effect E) Pain assessment

Ans: B, C, D, E Feedback: Vital signs, lung sounds, therapeutic effect including frequency of cough, and assessment of pain should be part of the ongoing client assessment. Auscultation of heart sounds is not part of the ongoing client assessment.

25. A client taking metoprolol (Lopressor) 50 mg one tablet twice daily begins taking over-the-counter pseudoephedrine. The nurse would assess for which of the following? Select all that apply. A) Hyperglycemic episode B) Hypertensive episode C) Rebound congestion D) Hypoglycemic episode E) Bradycardic episode

Ans: B, E Feedback: A client taking a beta-adrenergic blocker, such as metoprolol, and a decongestant, such as pseudoephedrine, may develop an initial hypertensive episode followed by a bradycardic episode.

12. A nurse is caring for a client with thick sputum who is having difficulty bringing up mucus. Which nursing diagnosis would the nurse most likely identify? A) Ineffective Airway Clearance B) Acute Pain C) Risk for Injury D) Impaired Oral Mucous Membranes

Ans: A Feedback: Thick sputum interferes with moving air effectively in and out of the respiratory tract. Therefore, the most likely nursing diagnosis would be Ineffective Airway Clearance. There is no evidence of pain. Risk for Injury would be appropriate if the client was experiencing sedation or drowsiness from the prescribed medication. Impaired Oral Mucous Membranes would be appropriate if the client was experiencing dry mouth from the medication.

15. A client suffers from motion sickness. Which of the following would the nurse anticipate the primary health care provider to prescribe? Select all that apply. A) Promethazine (Phenergan) B) Diphenhydramine (Benadryl) C) Levocetirizine (Xyzal) D) Azelastine (Astelin) E) Pseudoephedrine (Sudafed)

Ans: A, B Feedback: Both promethazine and diphenhydramine can be used in the treatment of motion sickness. None of the other drugs listed would be appropriate.

21. A nursing instructor is describing the advantages of using a second-generation antihistamine over a first-generation antihistamine. Which of the following would the instructor most likely include? Select all that apply. A) Less sedation B) Fewer anticholinergic effects C) Less nausea D) Can be used during pregnancy E) Can be used during lactation

Ans: A, B Feedback: Second-generation antihistamines cause less sedation and fewer anticholinergic effects because they selectively bind to peripheral rather than central H1 receptors. Some first-generation antihistamines can be used as antiemetics. Use of any antihistamine is contraindicated during pregnancy and lactation.

6. The nurse understands that codeine-containing antitussives should be used cautiously in clients with which of the following conditions? Select all that apply. A) Pregnancy B) Convulsive disorders C) Prostatic hypertrophy D) Hyperlipidemia E) Type 2 diabetes

Ans: A, B, C Feedback: Codeine-containing antitussives should be used cautiously during pregnancy and labor and in clients with COPD, acute asthma attacks, pre-existing respiratory disorders, acute abdominal conditions, head injury, increased intracranial pressure, convulsive disorders, hepatic or renal impairment, and prostatic hypertrophy.

7. Eucalyptus is an herbal product that can be used as a decongestant and expectorant. In which of the following client populations would the nurse identify a contraindication for its use? Select all that apply. A) Pregnant females B) Children younger than 2 years of age C) Lactating females D) Postmenopausal females E) Men

Ans: A, B, C Feedback: The use of eucalyptus is contraindicated during pregnancy and lactation, as well as in people who are hypersensitive to eucalyptus and in children younger than 2 years of age.

2. 2. Before administering an antitussive to a client, which of the following would the nurse assess? Select all that apply. A) Temperature B) Sputum presence C) Type of cough D) Bowel sounds E) Heart sounds

Ans: A, B, C Feedback: Vital signs, type of cough, presence of sputum, color and amount of sputum, home remedies used, and actions taken should be assessed prior to initiation of an antitussive. Bowel and heart sounds are not part of the preadministration assessment.

20. The nurse would be especially alert for the development of which of the following when administering an antihistamine to an older adult? Select all that apply. A) Hypotension B) Hypertension C) Dry mouth D) Insomnia E) Sedation

Ans: A, C, E Feedback: Older adult clients are more likely to experience anticholinergic effects (dry mouth), dizziness, sedation, hypotension, and confusion while taking an antihistamine.

26. A client is suffering from rebound congestion. Which of the following would the nurse expect to do to help the client experience relief from rebound congestion? Select all that apply. A) Suggest the client switch from a topical decongestant to an oral product. B) Recommend the client switch from an oral decongestant to a topical product. C) Tell the client to abruptly discontinue the decongestant product. D) Advise the client to gradually discontinue the decongestant product. E) Suggest a saline irrigation of the nasal passages in place of the decongestant.

Ans: A, D, E Feedback: Rebound congestion can be treated by a switch from a topical to an oral decongestant, gradual discontinuation of the topical decongestant, or replacement of the topical decongestant with saline irrigation of the nasal passages.

9. After teaching a client about his upper respiratory drug therapy, the nurse determines that additional teaching is needed when the client identifies which of the following as a reason to notify his primary health care provider? A) Cough changes from nonproductive to productive. B) Sputum appears clear. C) Sputum increases. D) Shortness of breath occurs.

Ans: B Feedback: The client should notify his primary health care provider if the type of cough changes, sputum changes color or increases, and shortness of breath occurs. Clear sputum is normal.

29. A client has been prescribed a decongestant drug for congestion associated with rhinitis. When teaching the client about this drug, which of the following would the nurse include as a possible adverse reaction? A) Decreased pulse rate B) Blurred vision C) Drowsiness D) Dryness of throat

Ans: B Feedback: The nurse should inform the client that blurred vision is a possible adverse reaction 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.

13. A client with a nonproductive cough has been prescribed dextromethorphan HBr LiquiCaps. What instructions should the nurse provide the client to promote an optimal response to therapy? A) Take the drug with a glass of milk. B) Swallow the whole tablet and do not chew it. C) Dissolve the tablet in water and take the drug. D) Take the drug on an empty stomach.

Ans: B Feedback: The nurse should instruct the client to swallow the whole tablet and not to chew it to ensure that the drug is absorbed properly. The nurse need not instruct the client to take the drug with a glass of milk, dissolve the tablet in water and take the drug, or take the drug on an empty stomach.

32. A client has been prescribed a nasal decongestant for nasal stuffiness due to a common cold. The client is also taking an antidepressant that is a monoamine oxidase inhibitor. The nurse would warn the client about which of the following? A) Hypotension B) Severe headache C) Sedation D) Bradycardia

Ans: B Feedback: The nurse should warn the client of the possibility of severe headache due to an interaction between the two drugs. Such an interaction may also result in hypertensive crisis instead of hypotension. Sedation and bradycardia do not occur when an MAOI and decongestant are used together.

5. Assessment of a client reveals that he is taking phenelzine (Nardil), a monoamine oxidase inhibitor, for depression. The client reports that he just started using dextromethorphan over the counter without consulting his primary health care provider. The nurse would be alert for which of the following? Select all that apply. A) Hypertension B) Fever C) Coma D) Constipation E) Shortness of breath

Ans: B, C Feedback: Coadministration of dextromethorphan and a monoamine oxidase inhibitor may result in hypotension, fever, nausea, leg jerking, and coma.

19. When teaching a client about using a decongestant in a nasal spray form, which instruction would the nurse include? Select all that apply. A) "Recline on a bed and hang your head over the edge." B) "Sniff hard for a few minutes after administration." C) "Make sure the tip of the container is touching the nasal mucosa." D) "Do not share the container with anyone except family members." E) "Know that nasal burning or stinging may occur."

Ans: B, E Feedback: A client should be instructed to administer a nasal spray while sitting upright, not allow the tip of the container to touch the nasal mucosa, and to sniff hard for a few minutes after administration. The client may experience some burning or stinging after the administration of the nasal spray. The container should not be shared with anyone.

10. A nurse is assigned to care for a client with a nonproductive cough. The client has been prescribed codeine sulfate. The nurse understands that this drug is contraindicated in which client? A) Client with head injury B) Client with COPD C) Premature infant D) Clients with asthma

Ans: C Feedback: Codeine sulfate is contraindicated in premature infants. Codeine sulfate should be used cautiously in clients with head injury, COPD, and asthma.

27. A client complains of increased sedation after the initiation of chlorpheniramine to treat her allergies. Which of the following would the nurse suggest to the client to treat her allergy symptoms that would result in less sedation? Select all that apply. A) Diphenhydramine (Benadryl) B) Clemastine (Tavist) C) Loratadine (Claritin) D) Cetirizine (Zyrtec) E) Phenylephrine (Neo-Synephrine)

Ans: C, D Feedback: Loratadine and cetirizine are second-generation antihistamines, which can be less sedating than first-generation antihistamines, like chlorpheniramine, diphenhydramine, and clemastine. Phenylephrine is a decongestant used to treat nasal congestion.

28. A client with vasomotor rhinitis has been prescribed an antihistamine. The client is eager to know whether the prescribed antihistamine may cause excessive sedation. Which antihistamine would the nurse identify as having very little sedative effect? A) Brompheniramine B) Clemastine C) Chlorpheniramine D) Azelastine

Ans: D Feedback: The nurse should assure the client that azelastine has very little sedative effect; it is a second-generation antihistamine with little effect on central nervous system (CNS) depression. Brompheniramine, clemastine, and chlorpheniramine are first-generation antihistamines. Sedation is seen more often with first-generation antihistamines.

30. A client with allergic rhinitis is prescribed an antihistamine. The nurse instructs the client to suck on sugarless hard candy to address which of the following? A) Drowsiness and sedation B) Thickening of the bronchial secretions C) Altered sensation of taste D) Dryness of the oral mucosa and the throat

Ans: D Feedback: The nurse should instruct the client to suck on a sugarless hard candy to prevent dryness of the oral mucosa and the throat, which is a side effect of antihistamine therapy. Sucking on candy does not relieve drowsiness, sedation, and thickening of the bronchial mucosa seen with antihistamine therapy. Altered sense of taste does not occur with most antihistamines.

4. A client is prescribed an antitussive for home use. Which of the following should a nurse include in the client's teaching plan? Select all that apply. A) Decreasing fluid intake during treatment with an antitussive B) Encouraging the use of sedatives during treatment C) Drinking fluids at least 30 minutes after taking a lozenge form D) Swallowing oral antitussive capsules whole E) Avoiding respiratory irritants during antitussive treatment

Ans: D, E Feedback: A client's antitussive teaching plan should include the following instructions: do not exceed recommended dose; avoid respiratory irritants; drink plenty of fluids if not contraindicated; swallow oral capsules whole; avoid drinking fluids for 30 minutes after taking a lozenge; do not use alcohol or other CNS depressants while being treated with antitussives; and contact the physician if cough is not relieved or becomes worse or is accompanied by chills, fever, chest pain, or sputum production.