Chapter 31: Drug Therapy for Nasal Congestion and Cough

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? a. They are used to relieve a nonproductive cough. b. They are used to break down the thickness of secretions. c. They are used to relieve a productive cough. d. They are used to depress the cough center in the medulla.

b. They are used to break down the thickness of secretions. 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.

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

a. Thinning respiratory secretions Thinning respiratory secretions is the mechanism of action for expectorants. Breaking down thick mucus in the lower lungs is the mechanism of action of mucolytics. Depressing the cough center in the brain is the mechanism of action for centrally acting antitussives. Anesthetizing stretch receptors in the respiratory passages is the mechanism of action for peripherally acting antitussives.

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

a. 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 nonselectively 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.

A client who is unsure whether symptoms are attributable to a cold or to allergies is taking pseudoephedrine as well as an antihistamine. This combination of drugs creates a risk for what adverse effect? a. hypertension b. hepatotoxicity c. respiratory depression d. acute kidney injury

a. hypertension The combination of antihistamines and pseudoephedrine increase the risk of hypertension due to vasoconstriction. This combination does not result in respiratory depression or damage to the liver or kidneys.

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

a. 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.

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

b. 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.

The nurse is giving discharge instructions to a client with an upper respiratory infection who has been advised to take an over-the-counter (OTC) topical nasal decongestant. What should the nurse teach the client in order to prevent rhinitis medicamentosa? a. Avoid using nonsteroidal anti-inflammatory drugs (NSAIDs) concurrently. b. Use the medication for as short a time as possible. c. Avoid using antihistamines at the same time as the decongestant. d. Increase fluid intake for the duration of treatment.

b. Use the medication for as short a time as possible. An adverse effect that accompanies frequent or prolonged use of topical nasal decongestants is rebound congestion, technically called rhinitis medicamentosa. Avoiding the overuse of the medication is a key strategy for preventing this complication. Antihistamines do not cause it, and use of NSAIDs is not problematic. Increasing fluid intake helps with relieving congestion but does not prevent rhinitis medicamentosa.

The nursing instructor is discussing over-the-counter cold remedies. According to the instructor, these products typically combine a. an antihistamine, a stimulant, and a decongestant. b. a stimulant, a decongestant, and an antitussive. c. a decongestant, an analgesic, and an antihistamine. d. an analgesic, an antitussive, and an antiviral.

c. a decongestant, an analgesic, and an antihistamine. Many over-the-counter cold remedies are combination products that include an antihistamine, a nasal decongestant, and an analgesic. Some may also include an antitussive or an expectorant.

A client with a respiratory tract infection is prescribed expectorants. A nurse should administer expectorants cautiously in clients with: a. oral ulcers. b. psychoses. c. a persistent cough. d. sinus bradycardia.

c. a persistent cough. A nurse should administer expectorants cautiously to clients with a persistent cough as it raises secretions from the respiratory passages. Expectorants need not be used cautiously in clients with oral ulcers, psychoses, or sinus bradycardia, specifically.

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 a. supine. b. semi-Fowler's position. c. high Fowler's position. d. side-lying position.

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

The health care provider prescribes guaifenesin 200 mg PO every 4 hours as needed for a client with a respiratory ailment. The nurse understands that this medication is given for which reason? a. relief of pain b. suppression of cough c. reduction of viscosity of mucus d. soothing of the throat

c. reduction of viscosity of mucus Guaifenesin is an expectorant; this drug class liquifies respiratory secretions, which reduces their viscosity and makes them easier to cough up. Opioid antitussives are given to suppress the cough and relieve mild pain. Guaifenesin does not have any properties to soothe a sore throat.

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

a. Breathing pattern is regular and without difficulty. 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.

The nurse is providing health education to an adult client who is taking an over-the-counter combination cold and cough remedy. What guidance should the nurse include to best assure medication safety? a. Carefully read the label and adhere to the guidelines for use. b. Stop taking the medication until you get a prescription from your primary health care provider. c. Start with a low dose and gradually increase it until symptoms are relieved. d. Take the medication with an additional dose of acetaminophen to potentiate therapeutic effects.

a. Carefully read the label and adhere to the guidelines for use. In the interest of safety, it is imperative that clients follow the instructions on combination remedies carefully. A health care provider's input is not always necessary, and it is unsafe to continually increase doses. Additional acetaminophen could be dangerous because many combination drugs already contain it.

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

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

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

The nurse is providing education to a client who is receiving pseudoephedrine. When discussing possible adverse effects, what would the nurse include? Select all that apply. a. Hypertension b. Anxiety c. Restlessness d. Sedation e. Anhidrosis

a. Hypertension b. Anxiety c. Restlessness Possible adverse effects associated with pseudoephedrine are related to the sympathomimetic effects and include anxiety, tenseness, restlessness, dizziness, hypertension, pallor, and sweating.

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

a. cardiovascular 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.

The nurse is planning care for a client who is experiencing excessive respiratory tract secretions. What intervention should the nurse include? a. deep breathing and coughing exercises b. administration of pseudoephedrine c. supplemental oxygen d. administration of guaifenesin

a. 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.

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

b. Adequate fluid intake c. Humidification of the environment d. Sucking on hard candy or throat lozenges An adequate fluid intake, humidification of the environment, and sucking on hard candy or throat lozenges can help relieve mouth dryness and cough. The use of astringent mouthwash will only increase mouth dryness.

Which agent acts directly on the medullary cough center? a. Benzonatate b. Codeine c. Ephedrine d. Tetrahydrozoline

b. 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? a. Antitussives b. Decongestants c. Expectorants d. Mucolytics

b. 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 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? a. Dilute the liquid medication with water prior to administration b. Increase fluid intake c. Take the medication with food d. Take the medication with other over-the-counter medications to enhance the effect

b. 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.

A nurse is assigned to care for a client who is prescribed dextromethorphan. The client's history reveals that the client is also taking a monoamine oxidase inhibitor for depression. The nurse would assess the client for which effect? a. Additive antidepressant effects b. Jerking leg motions c. Hypokalemia d. Cardiac arrhythmias

b. Jerking leg motions The nurse should monitor for hypotension, fever, nausea, jerking motions of the leg, and, in severe cases, coma in a client who has been taking monoamine oxidase inhibitors and is receiving dextromethorphan. Additive antidepressant effect occurs with the interaction of central nervous system (CNS) depressants and antitussives containing codeine. When potassium-containing medications and potassium-sparing diuretics are administered with iodine products, the client may experience hypokalemia, cardiac arrhythmias, or cardiac arrest.

An older adult client diagnosed with hypertension and cardiac disease is experiencing a cold. The client asks the nurse what medications the client can take. Which groups of medications should the nurse suggest? Select all that apply. a. Oral nasal decongestants such as pseudoephedrine. b. Oral expectorants such as guaifenesin. c. Locally acting antitussives such as cough drops. d. An antacid such as calcium carbonate. e. Vitamins such as vitamin B12.

b. Oral expectorants such as guaifenesin. c. Locally acting antitussives such as cough drops. Oral expectorants and locally active antitussives are encouraged for the older client. Oral expectorants suppress nonpurposeful coughing. Locally acting agents suppress cough by increasing the flow of saliva. Older clients with significant cardiovascular disease should avoid pseudoephedrine with is an oral nasal decongestant. Antacids are not used in treating colds. Vitamins such as vitamin C are used to reduce the incidence and severity of colds and influenza, not B12.

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

b. a drug that breaks down thick, tenacious mucus in the lower portions of the lungs 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 reports taking pseudoephedrine to relieve nasal congestion. The nurse would instruct the client to stop using the medication if what disorder is documented in the client history? a. pulse rate of 58 beats/min b. history of controlled hypertension c. history of coronary artery disease d. history of diet-controlled diabetes mellitus

c. history of coronary artery disease Nasal decongestants are contraindicated in clients with severe hypertension or coronary artery disease because of their cardiac-stimulating and vasoconstricting effects. They must be used with caution in the presence of cardiac dysrhythmias, hyperthyroidism, diabetes mellitus, glaucoma, and prostatic hypertrophy. In clients with diabetes and hypertension that are controlled, they can be used with caution. A client with a pulse rate of 58 beats/min, otherwise symptom free, can be given this medication under observation.

A 43-year-old man is taking pseudoephedrine (Sudafed) for sinusitis. He calls the clinic to report that it feels like his heart is racing and that he can "feel his heart beating fast." The nurse will instruct him to: a. continue taking the drug because the sensations will resolve with time. b. decrease the dosage by one half. c. stop taking the medication and come to the clinic as ordered by the health care provider. d. lie down after each dose.

c. stop taking the medication and come to the clinic as ordered by the health care provider. Cardiovascular adverse effects such as palpitations, tachycardia, hypertension, and arrhythmias are possible with the administration of pseudoephedrine (Sudafed). If the client reports palpitations and tachycardia, the nurse should instruct him to stop the medication and come in to see his provider. This drug produces sympathomimetic effects and could aggravate any existing cardiovascular issues. The nurse would not instruct the client to change the dosage of any drug, and having the client lie down after each dose will not limit or alleviate sympathomimetic effects of the drug. Continuation of the drug would worsen the adverse effects and could cause serious complications.

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? a. "It's best to take small doses of decongestants several times daily rather than two larger doses each day." b. "You can probably expect to get relief within the next few days or a week at the longest." c. "Over-the-counter decongestants don't normally work; you'll likely need to get a prescription for something more effective." d. "You might find yourself more congested than ever as your body compensates for your use of these drugs."

d. "You might find yourself more congested than ever as your body compensates for your use of these drugs." Frequent, long-term, or excessive use of decongestants induces rebound congestion. Rebound congestion occurs when the nasal passages become congested as the drug effect wears off and the body compensates by vasodilating the same nasal arterioles that the drug constricted. This does not occur because of the ineffectiveness of decongestants, however. Dosing should be based on the instructions provided.

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

d. 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 client visits the clinic and is diagnosed with acute sinusitis. To promote sinus drainage, what medication might be ordered? a. Topical nasal steroid decongestants b. First-generation antihistamines c. Second-generation antihistamines d. Topical decongestants

d. Topical decongestants Topical decongestants are sympathomimetics, meaning that they imitate the effects of the sympathetic nervous system to cause vasoconstriction, leading to decreased edema and reduced inflammation of the nasal membranes. They are available as nasal sprays that are used to relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis, and allergic rhinitis. Topical nasal steroid decongestants are used for the treatment of allergic rhinitis and to relieve inflammation after the removal of nasal polyps. First- and second-generation antihistamines are not ordered for sinusitis.

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? a. autoimmune processes b. facial pain c. impaired blood supply d. inflammatory processes

d. inflammatory processes 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 parent asks the nurse about the use of an antitussive to treat a 7-year-old's dry cough. What principle should guide the nurse's response? a. Antitussives are not recommended for use in young children. b. Children should be administered antitussives based on weight not age. c. Antitussives should only be used to treat productive coughs in children, not dry coughs. d. Children should be administered antitussives based on body surface index, not age.

a. Antitussives are not recommended for use in young children. Studies have not demonstrated that antitussives, particularly dextromethorphan, are effective in children and adolescents. The American Academy of Pediatrics and several other groups advise against the use of antitussives in young people.

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.) a. Avoidance of use in children under age 2 b. Importance of reading the label for ingredients and dosage c. Need to follow the directions for how often to give the drug d. Using household measuring devices for dosage measurements e. Using adult formulation with smaller doses

a. Avoidance of use in children under age 2 b. Importance of reading the label for ingredients and dosage c. Need to follow the directions for how often to give the drug OTC cough and cold preparations should not be used in children under the age of 4 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.

A client with cystic fibrosis may use which type of medication to reduce the viscosity of respiratory secretions? a. Mucolytic b. Centrally acting antitussive c. Expectorant d. Peripherally acting antitussive e. Antihistamine

a. 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. Expectorants increase the production of respiratory secretions, which in turn appear to decrease the viscosity of the mucus. This helps to raise secretions from the respiratory passages. Antitussives are cough suppressants. Antihistamines are used to treat allergic reactions.

A client has been using guaifenesin for a cough that accompanied a common cold. The client calls the nurse help line and states that he thinks he is having an adverse reaction to the medication. Which symptoms are adverse effects of this medication? Select all that apply. a. Nausea b. Rash c. Constipation d. Bleeding e. Headache

a. Nausea b. Rash e. Headache Adverse effects of guaifenesin are nausea, vomiting, headache, dizziness, and rash. Constipation and bleeding are not adverse effects of guaifenesin.

Which would the nurse expect to administer as a nasal spray? a. Oxymetazoline b. Hydrocodone c. Dextromethorphan d. Benzonatate

a. Oxymetazoline Oxymetazoline is administered by nasal spray. Hydrocodone is administered orally. Dextromethorphan is administered orally. Benzonatate is administered orally.

Which is classified as a decongestant? a. Oxymetazoline (Afrin) b. Levocetirizine (Xyzal) c. Dextromethorphan (Delsym) d. Azelastine (Astelin)

a. Oxymetazoline (Afrin) Afrin is a decongestant. Xyzal is a second-generation antihistamine. Delsym is a centrally acting antitussive that contains dextromethorphan. Astelin is a second-generation antihistamine.

A nurse in a healthcare facility is preparing a teaching plan for a patient receiving an antitussive drug. What instructions should the nurse include in the teaching plan? Select all that apply. a. Take frequent sips of water b. Include a high protein diet c. Swallow capsules whole d. Suck on sugarless hard candy e. Take medication with milk

a. Take frequent sips of water c. Swallow capsules whole d. Suck on sugarless hard candy Taking frequent sips of water, swallowing capsules whole, and sucking on sugarless hard candy are the instructions that the nurse should include in the teaching plan for a patient receiving antitussive drugs. The nurse need not include points such as taking high protein diets and taking medication with milk in the teaching plan of the patient receiving antitussive drugs.

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? a. "Use a second method of contraception until you've completed the drug therapy." b. "Drink at least two liters of fluids each day." c. "Restrict your fluid intake to one liter each day." d. "Take an NSAID to relieve the joint aches that result from taking this medication."

b. "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.

The nurse is educating a client with a cough about the use of taking dextromethorphan for relief. What statement made by the client indicates teaching has been effective? a. "I can dilute the medication with water to make it more palatable." b. "I will take my medication and not eat or drink for 30 minutes." c. "If my cough doesn't get better in 2 days, I should call my provider." d. "Since the medication is over-the-counter, I can use as much as I want."

b. "I will take my medication and not eat or drink for 30 minutes." After a dose of cough medication, the client should abstain from eating or drinking for at least 30 minutes. Food and fluid removes the medication from the throat therefore, minimizing the effects. The client should follow up with the health care provider if the cough is not resolved after 7 days. Cough medication should be taken undiluted to maximize the benefit. Diluting the medication decrease its effectiveness.

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

b. 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.

A 79-year-old client calls the clinic requesting advice for something that will relieve nasal congestion. The nurse is aware that oral decongestants may cause which adverse effects in older adults? (Select all that apply.) a. Excessive sleepiness b. Hypertension c. Heart rhythm abnormalities d. Bradycardia e. Nervousness

b. Hypertension c. Heart rhythm abnormalities e. Nervousness Older adults may experience hypertension, heart rhythm abnormalities, nervousness, and insomnia when they use oral nasal decongestants.

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

b. 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.

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

b. 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.

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? a. "You should really consider prescription medications rather than OTC medications." b. "While OTC medications may be cheaper, they generally result in more side effects." c. "Follow the instructions on the label so that you don't end up making the congestion worse." d. "No OTC medication, especially sprays or nose drops, should be taken for more than 3-4 days."

c. "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.

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? a. "We can use over-the-counter products for our 5-year-old but not for our 18-month old." b. "We need to read the label carefully to see how often and how much to give." c. "We can use the adult brand, but we just have to decrease the amount." d. "We should use the cup that comes with the drug to measure it out."

c. "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 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? a. Chronic nasal polyps b. Burning of the nares secondary to chronic use of nasal sprays c. Rebound nasal swelling d. Damage of the nasal concha

c. Rebound nasal swelling Rebound nasal swelling can occur with excessive or extended use of nasal sprays.

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

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

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? a. Supine b. Semi-Fowler's c. High Fowler's d. Side-lying

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

Cough syrups serve as vehicles for antitussive drugs and also may exert antitussive effects of their own by doing what? a. Precipitating an anticholinergic reaction b. Reducing the bacterial load in the respiratory tract c. Soothing irritated pharyngeal mucosa d. Thinning pharyngeal mucus

c. Soothing irritated pharyngeal mucosa Cough syrups serve as vehicles for antitussive drugs and may exert antitussive effects of their own by soothing irritated pharyngeal mucosa.

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? a. The client has a history of cataracts. b. The client has had a cold for 3 days. c. The client is being treated for severe hypertension. d. The client has hypothyroidism.

c. The client is being treated for severe hypertension. 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.

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

c. 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.

Katie, 14 years old, is seen by the health care provider due to increased nasal congestion and a sore throat lasting 2 days. Katie reports to the provider that every fall at this time she has increased nasal congestion and pressure. Upon examination, the provider notes enlarged turbinates with excessive mucus in the nose and at the back of the throat and a reddened throat. The provider prescribes pseudoephedrine. Why is Katie being prescribed this medication? a. To decrease the size of the turbinates by vasoconstriction b. To decrease mucus production from the sinus cavities c. To provide relief of the nasal congestion d. To relieve the throat pain and nasal pressure

c. To provide relief of the nasal congestion Pseudoephedrine can reduce the volume of nasal mucus and is recommended for the temporary relief of nasal congestion related to the common cold, allergic rhinitis, and sinusitis. It also is used to relieve the pressure of otitis media by promoting drainage of the Eustachian tubes.