Chapter 54: Drugs Acting on the Upper Respiratory Tract

The nurse is teaching a patient how to self-administer a medication that is contained in a nasal aerosol. The nurse knows the patient needs further instruction if she tells the nurse what information? (Select all that apply.) a. "I will press the canister and sniff twice and then blow out through my nose." b. "I will shake the medication well before using it." c. "I will blow my nose right before and right after I use the nasal aerosol." d. "I will lie down on the couch when I use this medication." e. "Just the tip of the applicator should be place inside my nostril."

a. "I will press the canister and sniff twice and then blow out through my nose." c. "I will blow my nose right before and right after I use the nasal aerosol." d. "I will lie down on the couch when I use this medication." (Rationale: The patient should place the medication cartridge into the plastic nasal adapter and shake it well. The tip of the applicator should be placed inside the nostril. The patient should sit upright and tilt the head back, then firmly press on the canister once to deliver the drug; the patient inhales, holds his breath for a few seconds, then exhales. The patient should keep the head tilted back for a few minutes and should not blow the nose for at least 2 minutes after the medication delivery.)

The nurse is caring for a patient who will be going home with a prescription for an antitussive. What discharge instructions are most important for the nurse to share with this patient? (Select all that apply.) a. "Use sugarless candy if this medication causes you to experience a dry mouth." b. "This drug may cause you to have diarrhea." c. "If this cough continues for a week, please contact your physician." d. "Don't drive or use heavy machinery because this medication may cause sedation." e. "While you are taking this medication, limit the amount of fluids that you drink."

a. "Use sugarless candy if this medication causes you to experience a dry mouth." c. "If this cough continues for a week, please contact your physician." d. "Don't drive or use heavy machinery because this medication may cause sedation." (Rationale: Traditional antitussives can cause patients to experience CNS effects such as drowsiness and sedation, so the patient shouldn't drive or use heavy machinery until the effect on the patient is known. These medications can lead to nausea, constipation, and complaints of dry mouth. Patients should increase fluid intake and suck on sugarless candies.)

The nurse is conducting a class for parents of newborns about the use of over-the-counter cough and cold medications. The nurse encourages the parents to follow which important safety information? (Select all that apply.) a. Do not give over-the-counter (OTC) medications to your child until he is older than 2 years. b. Do not give your child more than one cough and cold preparation at the same time. c. Carefully follow the directions in the "Drug Facts" section of the label. d. Cough and cold products can also be used to help your child go to sleep. e. Give your child half the adults dose if pediatric dosage instructions are not available.

a. Do not give over-the-counter (OTC) medications to your child until he is older than 2 years. b. Do not give your child more than one cough and cold preparation at the same time. c. Carefully follow the directions in the "Drug Facts" section of the label. (Rationale: Information that is important for parents includes: OTC medications for cough and cold should not be given to children under the age of 2, and extreme caution should be used if the child is age 2 to 6; do not give a child OTC cough and cold preparations unless they are labeled for pediatric use; always check the "Active Ingredients" on the drug label; do not give a child more than one cough and cold medication at the same time; follow the "Drug Facts" section of the label and follow the directions for how often the drug can be given; use the measuring spoons that come with the medication; always use child-proof caps; use the medication to treat only those symptoms that are affecting the child, and consult a doctor if the child's condition doesn't improve; do not use these products to help your child sleep; and tell the physician the names of any OTC products that the child is using.)

When teaching a patient who is receiving pseudoephedrine about possible adverse effects, what would the nurse include? (Select all that apply.) a. Hypertension b. Anxiety c. Sweating d. Dizziness e. Flushing f. Sedation

a. Hypertension b. Anxiety c. Sweating (Rationale: Possible adverse effects associated with pseudoephedrine are related to the sympathomimetic effects and include anxiety, tenseness, restlessness, hypertension, pallor, and sweating. Sedation, dizziness, and flushing are not associated with pseudoephedrine.)

The nursing instructor is teaching a group of nursing students about oral nasal decongestants. The nursing students correctly identify what adverse effects as being sympathomimetic reactions? (Select all that apply.) a. Increased pulse b. Pallor c. Cold, moist skin d. Feelings of sadness e. Arrhythmias

a. Increased pulse b. Pallor e. Arrhythmias (Rationale: Sympathomimetic reactions include increased pulse and blood pressure, pallor, sweating, arrhythmias, feelings of anxiety, tension, and dry skin. These reactions do not include cold, moist skin or feelings of sadness.)

When describing the action of dornase alfa in treating cystic fibrosis, the nurse understands that this drug does what? a. Separates extracellular DNA from protein in mucus b. Binds with a metabolite that is toxic to the liver c. Splits the disulfide bonds that hold mucous material together d. Liquefies secretions to decrease viscosity

a. Separates extracellular DNA from protein in mucus (Rationale: Dornase alfa selectively breaks down respiratory tract mucus by separating extracellular DNA from proteins. Expectorants liquefy secretions. Acetylcysteine, in treating CF, splits apart the disulfide bonds that are responsible for holding the mucous material together. Acetylcysteine protects liver cells from damage because it normalizes hepatic glutathione levels and binds with a reactive hepatotoxic metabolite of acetaminophen.)

The nurse is caring for a patient who is receiving acetylcysteine by aerosol. The nurse is aware that this patient is at risk for what adverse effects? (Select all that apply.) a. Stomatitis b. Mucus plug c. Nasal congestion d. Nausea e. Bronchospasm

a. Stomatitis d. Nausea e. Bronchospasm (Rationale: Acetylcysteine is a mucolytic that is delivered by aerosol to help thin secretions. Adverse effects include nausea, stomatitis, urticaria, bronchospasm, and rhinorrhea. The patient would not be at risk for nasal congestion or mucus plug because the action of the medication is to thin secretions.)

When developing the teaching plan for a patient receiving an antihistamine, what would the nurse include? (Select all that apply.) a. Taking the drug on an empty stomach b. Encouraging the patient to engage in usual activities such as driving c. Reading the labels of OTC medications because they may contain the same ingredient d. Advising the patient to avoid alcohol consumption e. Using sugarless candies or lozenges to combat dry mouth f. Stopping the drug after 3 days if no relief is obtained

a. Taking the drug on an empty stomach c. Reading the labels of OTC medications because they may contain the same ingredient d. Advising the patient to avoid alcohol consumption e. Using sugarless candies or lozenges to combat dry mouth (Rationale: When taking an antihistamine, the nurse needs to inform the patient to take the drug on an empty stomach, 1 hour before or 2 hours after meals, use sugarless candies to combat dry mouth, to read the labels of OTC medications because they may contain the same ingredient or alcohol, which could increase the risk of adverse effects or toxicity, and to avoid alcohol intake to prevent excess CNS effects. The patient should not drive because of the sedation that occurs with antihistamines. The patient should not stop the medication without the physician's approval.)

Which agent would the nurse identify as providing local anesthesia to the respiratory passages? a. Hydrocodone b. Benzonatate c. Ephedrine d. Dextromethorphan

b. Benzonatate (Rationale: Benzonatate provides local anesthetic action on the respiratory passages, lungs, and pleurae. Ephedrine provides topical nasal decongestant action. Hydrocodone is a centrally acting antitussive that works directly on the medullary cough center. Dextromethorphan acts directly on the medullary cough center.)

What would a nurse identify as a first-generation antihistamine? (Select all that apply.) a. Fexofenadine b. Clemastine c. Meclizine d. Azelastine e. Loratadine f. Dimenhydrinate

b. Clemastine c. Meclizine f. Dimenhydrinate (Rationale: First-generation antihistamines include clemastine, dimenhydrinate, and meclizine. Fexofenadine, azelastine, and loratadine are all second-generation antihistamines.)

A patient calls the nurse help line and asks if he may take an over-the-counter (OTC) expectorant. The nurse is aware that an expectorant would be contraindicated or used very cautiously if the patient has what conditions? (Select all that apply.) a. Urinary tract infection b. Emphysema c. Hypothyroidism d. Very productive cough e. Asthma

b. Emphysema d. Very productive cough e. Asthma (Rationale: Possible contraindications or cautions include any history of allergy to the drug, persistent cough due to smoking, asthma or emphysema, or a very productive cough that would indicate an underlying problem that should be evaluated. Hypothyroidism and a urinary tract infection would not be contraindications for use of an expectorant.)

A nurse is preparing a presentation for a local elementary school parent group about over-the-counter cold medications and their use in children. What information would be most appropriate to include? (Select all that apply.) a. Using adult formulation with smaller doses b. Importance of reading the label for ingredients and dosage c. Using household measuring devices for dosage measurements d. Need to follow the directions for how often to give the drug e. Avoidance of use in children under age 2

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

Which instruction would the nurse least likely include in the teaching plan for a patient receiving an antitussive? a. Using a humidifier b. Limiting fluids c. Using lozenges d. Keeping the room cool

b. Limiting fluids (Rationale: Increased fluids are important to maintain hydration, thin secretions, and keep the mucous membranes moist. Humidification, cool temperatures, and lozenges are helpful in relieving cough.)

The pharmacology instructor is quizzing students about the reasons decongestants are prescribed for patients. The students who respond correctly are those that name what reasons? (Select all that apply.) a. Glaucoma b. Middle ear infections c. Common cold d. Benign prostatic hyperplasia e. Hay fever

b. Middle ear infections c. Common cold e. Hay fever (Rationale: Decongestants are used for the symptomatic relief of nasal and nasopharyngeal mucosal congestion due to the common cold, hay fever, or other respiratory allergies; and as adjunctive therapy of middle ear infections to decrease congestion around the eustachian ostia. Its use is contraindicated in patients with glaucoma or prostate disorders.)

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

b. Oxymetazoline (Rationale: Oxymetazoline is administered by nasal spray. The others are administered orally.)

A group of students demonstrate understanding of topical decongestants, identifying them as being part of which drug classification? a. Parasympathomimetics b. Sympathomimetics c. Parasympatholytics d. Sympatholytics

b. Sympathomimetics (Rationale: Topical decongestants are sympathomimetics, imitating the effects of the sympathetic nervous system to cause vasoconstriction. Sympatholytic drugs are used for the treatment of hypertension, not as a topical decongestant. Parasympathomimetics are drugs that mimic the action of the parasympathetic nervous system and are also known as cholinesterase inhibitors. They are not used as topical decongestants. These are medications that block the effects of the parasympathetic nervous system. Parasympatholytics are anticholinergic medications but they are not used as topical decongestants.)

The home health nurse is caring for an 83-year-old patient who has an upper respiratory infection and is taking an over-the-counter (OTC) cough and cold preparation. What issues must be discussed with this patient related to the OTC medication? (Select all that apply.) a. The patient may need an increased dose because of hepatic or renal impairment. b. The patient is at an increased risk for falls because of dizziness. c. The patient should expect to take the cough and cold medication for at least 2 to 3 weeks. d. The patient may become confused and disoriented. e. This patient should call the physician before taking this medication because it may be contraindicated due to other conditions the patient has.

b. The patient is at an increased risk for falls because of dizziness. d. The patient may become confused and disoriented. e. This patient should call the physician before taking this medication because it may be contraindicated due to other conditions the patient has. (Rationale: Older adults are more likely to develop adverse effects associated with the use of these drugs, including sedation, confusion, and dizziness. Older adults are also more likely to have renal and/or hepatic impairment related to underlying medical conditions. The does for older adults should be started at a lower level than recommended for younger adults and should be monitored very closely, with dose adjustment based on the patient's response.)

A patient is receiving a topical nasal decongestant. The nurse instructs the patient to stop using the drug after which length of time? a. 3 days b. 4 days c. 5 days d. 6 days

c. 5 days (Rationale: A topical nasal decongestant should not be used for longer than 5 days to prevent rebound congestion. Also, if the condition persists longer than 5 days, medical care should be sought.)

When instructing a patient in how to use a topical nasal spray, what would the nurse emphasize to do first? a. Lie down to tilt the head back. b. Spray the medication with the bottle upright. c. Clear the nasal passages. d. Close the opposite nares.

c. Clear the nasal passages. (Rationale: Before administering the nasal spray, it would be important to clear the nasal passages to ensure that the medication reaches its intended target, thereby promoting effectiveness. The bottle should be held upright but it is most important for the patient to clear the nasal passages before spraying the medication. It would be important for the patient to sit upright, not lie down. The patient should sit upright and press a finger over one nare to close it. After squeezing the medication, the procedure should be repeated with the opposite nare.)

What would contraindicate the use of a topical nasal decongestant? a. Diabetes b. Hypertension c. Nasal ulceration d. Glaucoma

c. Nasal ulceration (Rationale: Any lesion or erosion in the mucous membranes is a contraindication because of the increased risk for systemic drug absorption. Topical nasal decongestants should be used cautiously in patients with hypertension, diabetes, and glaucoma.)

A patient who has been using a nasal decongestant for the last two weeks calls the clinic and asks for an antibiotic because the nasal congestion is getting worse instead of better. The nurse is aware that the patient has developed what condition? a. Vasoconstriction of the nasal capillaries b. Pneumonia c. Rhinitis medicamentosa d. Common cold

c. Rhinitis medicamentosa (Rationale: Rhinitis medicamentosa is rebound vasodilation caused by frequent or prolonged use of decongestants. The patient is experiencing vasodilation, not vasoconstriction of the nasal capillaries. The nasal congestion that the patient is experiencing is due to the rebound nasal congestion caused by the prolonged use of a topical nasal decongestant and does not have a cold. Patients with pneumonia have fever and cough and productive sputum. This patient is complaining of persistent nasal congestion caused by prolonged use of a topical nasal decongestant.)

The physician ordered flunisolide for a patient who was previously prescribed ephedrine for seasonal rhinitis. What is the nurse's best response to the patient's question as to why his medication has been changed? a. "Patients who use flunisolide don't experience any adverse effects." b. "You aren't at any risk for infection with this medication." c. "Ephedrine is an old drug and flunisolide is a new drug." d. "Your physician has ordered your new medication because your previous medication wasn't giving you enough relief from your symptoms."

d. "Your physician has ordered your new medication because your previous medication wasn't giving you enough relief from your symptoms." (Rationale: Flunisolide is used as treatment for seasonal allergic rhinitis for patients who are not getting any response from other decongestant preparations. Ephedrine is an older product than flunisolide but flunisolide is prescribed because the ephedrine wasn't effective in treating the seasonal rhinitis. Patients who use flunisolide are at an increased risk for infection. Adverse effects with flunisolide include local burning, irritation, stinging, dryness of the mucosa, headache, and increased risk of infection.)

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

d. 25 to 30 minutes (Rationale: Dextromethorphan has an onset of action of 25 to 30 minutes.)

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

d. 30 minutes (Rationale: Guaifenesin has an onset of action of 30 minutes.)

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

d. Tetrahydrozoline (Rationale: Tetrahydrozoline is a topical nasal decongestant, not a topical nasal steroid decongestant. Flunisolide, fluticasone, and triamcinolone are topical nasal steroid decongestants.)