Chapter 31: Drug Therapy for Nasal Congestion and Cough - ML5

The client reports a mild stinging sensation after using a nasal spray decongestant. Which response by the nurse would be most appropriate?

"This sensation is common and usually disappears with continued use." 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.

A client asks, "What is the difference between antitussive medications and expectorants?" What information should the nurse's response be based upon?

Antitussives suppress coughing while expectorants loosen bronchial secretions. Explanation: 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 prescribed oxymetazoline. Which assessment data would indicate that the drug is effective?

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.

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?

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

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

A client has been prescribed an antitussive. The nurse prepares to assess which factors on the ongoing assessment? Select all that apply.

Lung sounds Frequency of cough Therapeutic effect Pain assessment ~ Explanation: 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 as there are no recognized cardiac adverse reactions.

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 W Explanation: Rebound nasal swelling can occur with excessive or extended use of nasal sprays.

What statement best describes how the common cold is effected by and managed using medication therapy?

The tendencies to overmedicate and use antibiotics inappropriately with the common cold are widespread and pose significant risk for complications and drug resistance. Explanation: 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.

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?

They are used to break down the thickness of secretions. ~ Explanation: 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 nonproductive coughs and do not work on the medulla.

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

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

A client is questioning the use of eucalyptus as a decongestant. The nurse should point out that eucalyptus is contraindicated for which clients? Select all that apply. Pregnant females Children younger than 2 years Lactating females Postmenopausal females Men

Pregnant females Children younger than 2 years Lactating females • Explanation: 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. Eucalyptus is generally considered safe for postmenopausal females and men.

The nurse is preparing a teaching session for a client prescribed dextromethorphan orally. Which instruction should the nurse prioritize?

Swallow the whole tablet and do not chew it. Explanation: 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.

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?

"Drink at least two liters of fluids each day." ~ Explanation: 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.

A client is currently taking pseudoephedrine to help manage the nasal congestion resulting from seasonal allergies. When the client reports being extremely restless and having difficulty getting to sleep at night, what assessment question will the nurse ask to best provide interventions to minimize those effects?

"How much coffee, tea, and soda do you drink daily?" Explanation: Caffeine can enhance the adverse effects of pseudoephedrine. The client's coffee, tea, and soda consumption would tend to increase the client's risk for insomnia and restlessness. None of the other options are known to have this effect on those taking the decongestant.

An older adult client has reported "seeing things that aren't there" after starting to take over-the-counter dextromethorphan for a nonproductive cough associated with a cold. What assessment question will provide the most relevant information regarding the possible cause of this adverse effect?

"How much dextromethorphan have you been taking each day?" Explanation: At normal doses, dextromethorphan is known to cause nausea, drowsiness, rash, and difficulty breathing but doses exceeding recommendations can produce hallucinations and disassociation. The question concerning dosage is the most relevant regarding the cause of hallucinations.

A client calls the clinic and states, "I have had a persistent cough for 2 weeks. What should I do?" What would be the nurse's best response?

"You should come to the clinic to be evaluated. A cough that lasts that long might indicate a medical problem." W Explanation: A cough that has persisted for 2 weeks could be indicative of an underlying medical condition that should be addressed before treating the cough. The client should be asked to come in for an evaluation. Dextromethorphan could help stop the cough, but suppressing the cough might not be in the client's best interest. Drying the mucosa with an antihistamine could aggravate the cough. Aspirin would not be indicated for relieving throat irritation.

A client is hospitalized with acute bronchitis, a dry, nonproductive cough, elevated temperature, and complaints of being unable to sleep well at night due to coughing. The nurse notes diminished breath sounds in both lower lung lobes. Which medication will the nurse most anticipate the health care provider to prescribe for this client?

expectorant Explanation: An acute respiratory infection with a continued elevated temperature would indicate the treatment is possibly not effective. The dry, nonproductive cough and diminished breath sounds could indicate an accumulation of secretions which are not being actively removed from the body. The use of the expectorant will assist with liquifying the secretions and helping to get the exudate out of the body. The antitussive is used to suppress nonproductive coughs which may or may not be related to an infection. In this case, the priority will be to get the infected exudate out of the body as quickly as possible. A mucolytic is used to reduce the viscosity of mucus. Nasal decongestants are for the relief of nasal obstruction and discharge. While these three may be used later, they are not the current priority.

Which nursing diagnosis would provide the clearest indication for the administration of inhaled acetylcysteine?

ineffective airway clearance Explanation: 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 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:T-Mobile

stop taking the medication and come to the clinic as ordered by the health care provider. * Explanation 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.