Chapter 54: Drugs Acting on the Upper Respiratory Tract
d
A client is admitted after overdose with acetaminophen. What medication would the nurse expect to be administered? a. Daptomycin b. Oxymetazoline hydrochloride c. Darbepoetin alfa d. Acetylcysteine
b
A group of nursing students are reviewing information about expectorants. The students demonstrate understanding when they identify which medication as an example? a. Dextromethorphan b. Guaifenesin c. Acetylcysteine d. Benzonatate
d
A male client is diagnosed with chronic bronchitis. What would the nurse expect to be one of his physical reports? a. Rhinitis b. Rhinorrhea c. Chronic nasal swelling d. Retention of secretions
b
A nurse in a three drops with respiratory problems has received orders for four patients. What medication order will the nurse question? A) Tetrahydrozoline (Tyzine) three drops in each nostril for an 8-year-old child B) Hydrocodone (Hycodan) 10 mg PO for a 5-year-old child C) Pseudoephedrine (Dorcol) 15 mg PO for a 2-year-old child D) Diphenhydramine (Benadryl) 5 mg/kg IM for a 10-year-old child
a, b, e
A patient has been using guaifenesin for a cough that accompanied a common cold. The patient calls the nurse help line and states that she thinks she is having an adverse reaction to the medication. The nurse knows that which symptoms are adverse effects of this medication? (Select all that apply.) A) Nausea B) Rash C) Constipation D) Bleeding E) Headache
a
Acetylcysteine may be used as a mucolytic agent. What is an additional indication for the drug? a. Antidote for acetaminophen poisoning b. Treatment of peptic ulcer disease c. Conversion of cardiac arrhythmias d. Treatment of bronchospasm
a, b, d, e
An individual calls the nurse help line and asks what the drug diphenhydramine is used for. The nurse knows that the medication is prescribed for which conditions? (Select all that apply.) A) Urticaria B) Vasomotor rhinitis C) Productive cough D) Motion sickness E) Angioedema
True
Mucolytics are often used for patients with cystic fibrosis, COPD, or tuberculosis. True or False
A
Parents who treat their children's cold and flu symptoms at home should be educated concerning the reading and understanding of over-the-counter (OTC) labels. Why is this statement true? A) Many of these preparations contain the same active ingredients so that inadvertent overdose is a common problem. B) Each product is best used for alleviating a particular symptom. C) Some of these products do not contain any drugs. D) Some of these products could interfere with breast-feeding.
d
The clinic nurse is caring for a patient who has been prescribed fexofenadine for hay fever. When the nurse is assessing this patient's medication history, what drug would make the nurse question the order for fexofenadine? A) Tetracycline B) Penicillin C) Gentamicin D) Ketoconazole
a
The family nurse practitioner is caring for a Hispanic woman who is 83 years old. The patient has been noncompliant with the care regimen the nurse practitioner has previously outlined for treatment of sinusitis. What should the nurse practitioner do that can assist the patient in being more compliant with the prescribed treatment regimen? A) Provide instructions in writing. B) Provide the instructions in large type. C) Give the treatment instructions to a member of her family. D) Give the treatment instructions to the woman's husband.
a
The nurse advises that patient to avoid long-term use of nasal decongestants because it may lead to what condition? A) Mucosal ulcerations B) Decreased drainage C) Increased risk of infection D) Asthma
a
The nurse is assessing a client who is taking diphenhydramine for relief of seasonal allergies. Which finding should prompt the nurse to suspect that the resident is experiencing an anticholinergic effect of the medication? a. Blurry vision b. Tinnitus c. Wheezing on expiration d. Urticaria
c
The nurse is caring for a patient who does not have a respiratory disorder but has been prescribed acetylcysteine. What is an additional indication for acetylcysteine (Mucomyst)? A) Conversion of cardiac dysrhythmias B) Treatment of peptic ulcer disease C) Antidote for acetaminophen poisoning D) Decreased bronchospasm
A
The nurse is caring for a patient who needs education on his medication therapy for allergic rhinitis. The patient is to take clemastine (Tavist) daily. In providing educational interventions regarding this medication, what is the most important instruction on the action of the medication? A) It blocks the effects of histamine. B) It is used to treat atrial and ventricular dysrhythmias. C) It competitively inhibits the rate-limiting enzyme in the liver. D) It leads to bronchodilation and relaxes smooth muscle in the bronchi.
c
The nursing instructor is teaching the 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
The pharmacology instructor is discussing the adverse effects of diphenhydramine. Which is not one of these effects? a. Dry mouth b. Blurred vision c. Excessive salivation d. Drowsiness
c
The pharmacology instructor questions the students as to which classification of drugs is commonly found in over-the-counter (OTC) combination cold medications? A) Stimulants B) Opioids C) Oral decongestants D) Antitussives
d
What disorders would the pharmacology instructor tell the nursing students may be exacerbated by the use of nasal decongestants? A) Pneumonia B) Rheumatoid arthritis C) Acid reflux D) Hypothyroidism
c
What is an adverse reaction commonly experienced by people taking nasal decongestants? a. Diarrhea b. Headache c. Rebound congestion d. Rash
D
What statement by a 61-year-old patient who is to take an antitussive with codeine indicates that the nurse's teaching has been effective? A) I will take this medication anytime I start to cough. B) This medication may make me anxious and nervous. C) I should call the physician if I develop nausea, diarrhea, or stomach cramps while taking this medication. D) This medication can cause drowsiness, so I will avoid driving or using power equipment while I take it.
D
What statement by the patient leads the nurse to believe that he needs additional instruction regarding his nasal decongestant? A) I will blow my nose before instilling the nasal spray. B) I will report any dizziness, drowsiness, or rapid pulse. C) I will drink 2,000 to 3,000 mL of fluid daily. D) I will use it only when I have nasal discharge.
C
What would be the nurse's best response if a patient calls the clinic and reports that he has had a persistent cough for 2 weeks and asks the nurse for a recommendation for a cough medicine? A) Look for dextromethorphan as an ingredient in any OTC cough preparation. B) The doctor could order an antihistamine, which might dry up your secretions and stop the cough. C) You should come to the clinic to be evaluated. A cough that lasts that long might be an indication of an underlying medical problem. D) Drink a lot of fluids and take aspirin, which should reduce the irritation in your throat.
c
Which condition would contraindicate the use of oxymetazoline? a. skin rash b. cough c. hypertension d. nasal congestion
b
The nurse is caring for a patient who is receiving acetylcysteine (Mucomyst) by face mask. What would be an appropriate nursing diagnosis? A) Impaired swallowing B) Risk for impaired skin integrity C) Risk for falls D) Sleep deprivation
a, d, e
The nurse is caring for a patient who is scheduled to receive acetylcysteine because of an acetaminophen overdose. The nurse would notify the physician before administering the medication if the patient had which condition? (Select all that apply.) A) Bronchospasm B) Hypertension C) Nephrotic syndrome D) Peptic ulcer E) Esophageal varices
B
The nurse is caring for a patient who is taking dextromethorphan for cough suppression. The nurse will assess this patient for hypotension if he also takes which other medication? A) Calcium-channel blockers B) Monoamine oxidase (MAO) inhibitors C) Beta-blockers D) Thiazide diuretics
c
The nurse is caring for a patient with cystic fibrosis who is receiving dornase alfa by nebulizer to help thin secretions. What statement by the patient indicates a need for further instruction? A) This medication will loosen up the sticky mucus that is in my lungs. B) I will try to cough after I receive this medication.' C) I'm glad that this medication will solve all of my problems. D) I will continue to use postural drainage and take my enzymes as ordered.
B
The nurse is giving discharge instructions to a patient with an upper respiratory infection who has been advised to take an over-the-counter (OTC) topical nasal decongestant. The nurse advises the patient about what common adverse reaction to these medications? A) Diarrhea B) Rhinitis medicamentosa C) Rash D) Headache
a
The nurse is giving discharge instructions to the mother of a 3-month-old infant who has an upper respiratory tract infection and has been prescribed a pseudoephedrine nasal solution. What instructions are most important for the nurse to give to this mother? A) Instill the medication 20 to 30 minutes before feeding. B) Keep the baby on clear liquids until the nasal discharge has resolved. C) Start the baby on cereal, because she is having difficulty sucking right now. D) Give the medication immediately after feeding.
c
The nurse is teaching a group of patients with allergic rhinitis about the use of their medications. What would be the most essential information to give these patients about preventing possible drug interactions? A) Over-the-counter (OTC) medications are safe to use. B) Use only one pharmacy so the pharmacist can check drug interactions. C) Read drug labels before taking OTC medications. D) Ask the pharmacy tech for assistance in selecting an OTC medication.
b
The nurse is writing a care plan for a patient who has been prescribed a nasal steroid. What would be an appropriate nursing diagnosis for this patient? A) Disturbed sensory perception (kinesthetic) related to CNS effects B) Risk for injury related to suppression of inflammatory reaction C) Ineffective airway clearance related to bronchospasm D) Ineffective airway related to nasal obstruction
D
The nursing instructor is discussing the administration of nasal spray with the nursing students. What information is most important to include in this discussion? A) Finish the bottle of nasal spray to clear the infection effectively. B) Nasal spray can be shared between family members only. C) Administer the nasal spray in a prone position. D) Overuse of nasal spray may cause rebound congestion.
b
patient comes to the clinic with symptoms as seen in a cold. What group of upper respiratory drugs causes local vasoconstriction, which decreases blood flow and shrinks swollen membranes to improve air flow? A) Antitussives B) Decongestants C) Expectorants D) Mucolytics
B
A 29-year-old female patient has sinusitis, so the physician orders a topical nasal decongestant. What instructions should be given? A) Avoid becoming pregnant during decongestant therapy. B) Increase fluids to 2 L/d. C) Restrict fluids to 500 mL/d. D) Take the medication with meals.
A
A 71-year-old man with a history of heart disease and diabetes has had an antihistamine prescribed. The nurse is concerned with this prescription because of the risk for what? A) Cardiac arrhythmias B) Increased salivation and choking C) Severe constipation D) Insomnia
a
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. Urine output is at least 30 mL/hr. d. Heart rate is maintained at a regular rate and rhythm.
C
A nurse is caring for a 15-year-old patient with cystic fibrosis who has been prescribed dornase alfa (Pulmozyme) to relieve the buildup of secretions and keep airways open and functioning longer. What will the nurse instruct the patient to do concerning the use of this drug? A) Use in home nebulizer up to four times a day if needed. B) Stop all other medications while using the drug. C) Store the drug in the refrigerator, protected from light. D) Expect a severe headache after each use
c
A patient has an important presentation to make in 4 hours and he needs relief from the congestion of seasonal rhinitis. The patient calls the nurse, explains the situation, and tells the nurse that he cannot afford to be drowsy. Which antihistamine would be a good choice for this patient? A) Diphenhydramine (Benadryl) B) Dexchlorpheniramine (Polaramine) C) Loratadine (Claritin) D) Hydroxyzine (Atarax)
b
A patient has been prescribed a nasal steroid and asks the nurse what the most common reason that this medication is used to treat. What is the nurse's best response? A) Nasal steroids are only used to treat a sinus infection. B) Nasal steroids are used to treat allergic rhinitis. C) Nasal steroids are used for an infection in the adenoids. D) Nasal steroids are used for all acute upper respiratory infections.
a, c, d
A patient has been prescribed an antihistamine for treatment of allergic rhinitis. What statements by the patient indicate an understanding of this medication? (Select all that apply.) A) This medication will work best if I take it before I eat anything. B) I need to drink less fluid while I take this medication to help reduce the amount of mucus I have. C) I will use sugarless candies to help with the feelings of a dry mouth. D) I will use a humidifier in the bedroom while I sleep. E) This medication will probably cause my appetite to increase.
b
A patient is advised to take a decongestant drug to relieve nasal congestion associated with hay fever. The patient is not comfortable with a nasal spray or drops and prefers an oral tablet. Which oral decongestant drugs can be administered to the patient? a. Xylometazoline b. Pseudoephedrine c. Tetrahydrozoline d. Ephedrine
B
A patient presents at the clinic with a dry nonproductive cough. The patient is diagnosed with bronchitis and it has been determined that assistance is needed in thinning the sputum so the cough can become productive. What does the nurse expect the physician will prescribe? A) Benzonatate (Tessalon) B) Guaifenesin (Mucinex) C) Dextromethorphan (Benylin) D) Hydrocodone (Hycodan)
A
A patient presents at the clinic with signs and symptoms of seasonal allergic rhinitis. The patient is prescribed a nasal steroid to relieve symptoms. Two days later, the patient calls the clinic and tells the nurse that he is frustrated and wants a new drug. What is the most appropriate response by the nurse? A) It may take up to 2 weeks to get the full clinical effect. Try to keep using the drug as ordered. B) The drug must not work for you. Let's change to an oral steroid. C) You probably are administering the drug incorrectly. Come in and we can review the process. D) You probably need to try a different nasal steroid. This one should be effective by now.
a
A patient receives guaifenesin. The nurse would expect the drug to begin acting within which time frame? a. 30 minutes b. 45 minutes c. 60 minutes d. 15 minutes
D
A patient 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
a
A student nurse is doing research consisting of chart audits of 25 patients with diagnosed chronic pharyngitis; she is attempting to determine what medication has been prescribed most frequently. What type of medication would this nurse expect to find in most of the chart audits? A) Antitussives B) Nasal sprays C) Oral decongestants D) Mucolytics
a
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 the adult brand, but we just have to decrease the amount." b. "We need to read the label carefully to see how often and how much to give." c. "We can use over-the-counter products for our 5-year-old but not for our 18-monthold." d. "We should use the cup that comes with the drug to measure it out."
b
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? a. "Have you been nauseated as well since taking the dextromethorphan?" b. "How much dextromethorphan have you been taking each day?" c. "Is the dextromethorphan making you dizzy?" d. "Have you been taking the dextromethorphan at bedtime?"
