Pharm2-UpperResp.

Allergy testing is most likely to be useful in directing therapy for a client with which allergy​ profile? ​Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1)Multiple indoor allergens 2)Single outdoor allergen 3)Possible allergy to animal dander 4)Possible allergy to mold 5)Possible allergy to a medication

1,2,3,4. Allergy testing can help pinpoint the particular allergens responsible for the symptoms and help direct a treatment plan that includes avoiding allergens that cause the symptoms and treating the symptoms. Allergy testing is not usually performed to discover allergies to medications.

The nurse is planning care for an older adult taking fexofenadine​ (Allegra) for seasonal allergies. Which nursing diagnoses would take​ priority? Select all that apply. ​1)Injury, Risk for 2)Knowledge, Deficient 3)Falls, Risk for 4)Airway​ Clearance, Ineffective 5)Breathing​ Pattern, Ineffective

1,2,3. Although considered​ nonsedating, fexofenadine can still cause drowsiness in certain patients at high doses and if combined with CNS​ depressants, including alcohol. This places the patient at risk for injury and falls. Education is essential. Airway clearance and ease of breathing is enhanced.

A client asks the nurse why the physician has ordered an antihistamine for insomnia that is the same one a neighbor takes for seasonal allergies. The nurse explains that antihistamines are effective in treating a number of​ problems, including: Select all that apply. 1)Parkinson disease. 2)motion sickness. 3)hives. 4)bronchoconstriction. 5)hypotension.

1,2,3. Antihistamines that selectively block Upper H 1H1 receptors are widely used as OTC remedies for the relief of allergy​ symptoms, motion​ sickness, and insomnia. Drugs with significant anticholinergic actions are used to treat mild forms of Parkinson disease. They are also used to treat the tremor and extrapyramidal adverse effects from conventional antipsychotic drugs. Because diphenhydramine exerts great amounts of anticholinergic​ action, it is sometimes used to treat these conditions. They do not have a therapeutic effect on bronchoconstriction or hypotension.

The community nurse explains to a group of clients that taking combination drugs for a cold can be dangerous and cites several​ examples, such​ as: Select all that apply. 1)an older male taking a cold medication with chlorpheniramine and phenylephrine​ (Actifed Cold and​ Allergy) for congestion. 2)a client with chronic obstructive pulmonary disease​ (COPD) taking a cold medication containing triprolidine and pseudoephedrine​ (Actifed Plus) for seasonal allergies. a client with liver disease taking a medication containing diphenhydramine and acetaminophen​ (Tylenol PM). a young adult with sinusitis taking a medication containing chlorpheniramine and phenylephrine​ (Sudafed Sinus and​ Allergy). a​ middle-aged client with a cough taking a medication containing diphenhydramine and phenylephrine​ (Benadryl Allergy and Cold​ caplets).

1,2,3. Consuming combination products without appropriate symptoms can increase the risk of unnecessary adverse effects. It is usually better to take only the drugs needed to treat specific symptoms rather than a combination product. Chlorpheniramine can cause urinary retention in older males with enlarged prostate. Pseudoephedrine can cause bronchospasm in a client with COPD. Acetaminophen should be used cautiously in clients with liver disease.

It has been determined that a​ client's rhinitis is not the result of previous exposure to an allergen. The nurse explains that a nonallergic response can occur​ with: Select all that apply. ​1)x-ray dye. 2)certain drugs. 3)plasma expanders. pollens. 4)animal dander

1,2,3. Nonallergic releases of histamine can occur with cell​ damage, certain​ drugs, plasma​ expanders, or radiographic contrast media. Pollens and animal dander are sources of allergic rhinitis.

A pediatric nurse is triaging a​ 6-year-old in an urgent care facility and suspects the child is experiencing complications from allergic rhinitis. Which symptoms did the nurse​ assess? ​ 1)Loss of smell and taste 2)Hoarseness 3)Plugged ears 4)Red, swollen, itchy eyes 5)Scratchy throat

1,2,3. Sometimes called hay​ fever, the symptoms of allergic rhinitis resemble those of the common cold and include​ tearing, burning,​ red, swollen, or itching​ eyes; sneezing; nasal itching or​ congestion; postnasal​ drip; cough; and scratchy throat. In addition to the acute​ symptoms, complications of allergic rhinitis may include loss of taste or​ smell, sinusitis,​ hoarseness, and plugged ears.​ Red, swollen, and itchy eyes and a scratchy throat are symptoms of allergic​ rhinitis, not complications.

A​ 12-year-old with allergies has been prescribed desloratadine​ (Clarinex). The nurse instructs the client and the mother about possible adverse​ effects, including: Select all that apply. 1)insomnia. 2)nervousness. 3)dizziness. 4)confusion. 5)urinary hesitancy.

1,2. Antihistamines may cause paradoxical​ excitement, such as restlessness or​ nervousness, or insomnia especially in children. Symptoms of​ dizziness, confusion, and urinary hesitancy are more common in older adults.

A client asks the nurse why the physician prescribed an oral rather than an intranasal decongestant. The nurse​ responds: Select all that apply. ​1)"Intranasal decongestants can worsen congestion once the effects of the drug wear​ off." ​2)"You will need medication for the length of the allergy​ season, but intranasal decongestants​ shouldn't be taken for longer than 5​ days." ​3)"Oral decongestants take less time to alleviate​ symptoms." ​4)"Oral decongestants are more effective at relieving severe​ congestion." ​5)"Oral decongestants carry a lower risk of systemic adverse​ effects."

1,2. The most​ serious, limiting adverse effect of the intranasal preparations is rebound congestion. In almost all​ patients, prolonged use causes hypersecretion of mucus and worsening nasal congestion once the drug effects wear off. This leads to a cycle of increased drug use as the condition worsens to obtain the desired effect from these drugs. Because of this rebound​ congestion, intranasal sympathomimetics should be used for no longer than 3 to 5 days. When administered​ PO, sympathomimetics do not produce rebound congestion. Their onset of action by this​ route, however, is much slower than when administered​ intranasally, and they are less effective at relieving severe congestion. They carry a greater risk for systemic adverse effects.

Which outcomes would be most appropriate for a client who is receiving pharmacotherapy for cough and cold​ relief? Select all that apply. 1)The client will experience decreased congestion and drainage. 2)The client will easily expectorate excess mucus. 3)The client will report dry mouth and drowsiness to the provider. 4)The client will reduce fluid intake to assist in liquefying mucus. 5)The client will contact the health care provider if the cough becomes productive.

1,2. Treatment goals are based on symptomology.​ Typically, symptoms of cough and cold include​ congestion, drainage, and inability to easily clear the airway. Dry mouth and drowsiness are common side effects of many cold and allergy​ preparations, so there is no need to report them. Increasing fluid intake will result in more liquid mucus. Many cough preparations act to loosen​ mucus, so there is no need to report a productive cough.

A pediatric​ nurse, teaching new parents about the​ body's structural defenses against respiratory​ infections, explains that pathogens are​ "swept" away from the lungs by​ the: 1)cilia. 2)mucous membranes. 3)vestibule. 4)internal nares.

1. The mucous membranes of the URT are lined with ciliated epithelium. The cilia projecting from the epithelium are found throughout the nasal passages and help to trap smaller particles. The cilia have a wavelike motion that sweeps the pathogens and particulate matter upward toward the​ oropharynx, where they are swallowed when a person coughs or clears the throat. A sneeze clears the nasal passages. The mucous membranes secrete mucus that traps foreign​ particles, but they do not sweep them out. The nasal vestibule is the most anterior part of the nasal cavity. The internal nares are the cavity located behind the nasal cavity.

The nurse teaches the client with seasonal allergies that the most effective way to prevent allergy symptoms is​ to: 1)take allergy medication before allergy season begins. 2)take allergy medication as soon as symptoms begin. 3)take as little allergy medication as possible so the body will not become sensitized to the medication. 4)take supplemental nonpharmacologic measures.

1. Antihistamines are most effective when taken prophylactically to prevent allergic symptoms. Their effectiveness in reversing allergic symptoms that have already manifested is limited. This is because antihistamines block the effect of histamine at its receptor sites. They do not prevent the release of histamine from mast cells. Taking supplemental nonpharmacologic measures is helpful for​ decreasing, but not​ preventing, allergies.

A client has been receiving a cough medicine with guaifenesin for 48 hours. Which nursing diagnosis would this medication best​ address? Airway Clearance​, Ineffective related to large amount of tenacious mucus ​Perfusion: Gastrointestinal, Risk for Ineffective related to abdominal distension from gas buildup in stomach. Gas​ Exchange, Impaired related to inability to discharge carbon dioxide ​Pain, Acute related to swollen tonsils and discomfort rated at 7 on 0dash-10 VAS

1. Expectorants reduce the thickness or viscosity of bronchial​ secretions, thus increasing mucus flow that can then be removed more easily by coughing. The only commonly used OTC expectorant is guaifenesin​ (Mucinex). It does not affect perfusion or pain and does not act at the alveolar level.

The nurse is evaluating outcomes for a client who has been using a nasal steroid consistently for several months. Which is the desired​ outcome? 1)The client reports decreased nasal congestion. 2)The​ client's upper respiratory system is free of infection. 3)The client is free of wheezing. 4)The​ client's tonsils are pink and free of swelling and exudate.

1. Nasal steroids are indicated for control of allergic rhinitis. Nasal​ congestion, drainage,​ sneezing, and watery eyes should diminish after a​ month's use. Nasal steroids do not prevent infections. Nasal steroids do not decrease wheezing because they do not penetrate the lower airway. Nasal steroids do not protect the tonsils.

A client is receiving a phenylephrine​ (Afrin) nasal spray for the symptoms of a cold. Which assessment parameter would the nurse expect to see​ improved? 1)A decrease in nasal stuffiness 2)Improved energy level 3)Less coughing 4)Fewer nasal secretions

1. Sympathomimetics​ (also called adrenergic​ agonists) with​ alpha-adrenergic activity are effective at relieving the nasal congestion associated with the common cold and allergic rhinitis when given by either the PO or intranasal route. The intranasal preparations such as oxymetazoline​ (Afrin, Others) are available OTC as sprays or drops and produce a noticeable response within minutes. Energy levels will improve as the cold​ subsides; there is no medication that assists with that symptom. The client will still have posterior pharyngeal irritation with coughing. An antihistamine decreases the quantity of secretions.

Rebound congestion is occasionally a problem after use of some drugs for allergic rhinitis. Which preparation is mostly likely to cause this​ concern? 1)Intranasal decongestants 2)Intranasal steroids 3)Oral decongestants 4)Oral antihistamines

1. The most​ serious, limiting adverse effect of the intranasal decongestants is rebound congestion. In almost all​ patients, prolonged use causes hypersecretion of mucus and worsening nasal congestion once the drug effects wear off. This leads to a cycle of increased drug use as the condition worsens to obtain the desired effect from these drugs. Because of this rebound​ congestion, intranasal sympathomimetics should be used for no longer than 3 to 5 days. Intranasal​ steroids, oral​ decongestant, and oral antihistamines do not have rebound effects.

The nurse is planning care for a client with allergies who has an order for a sympathomimetic drug. The nurse is aware that the desired effect for this client​ is: 1)relief of nasal dryness. 2)relief of nasal stuffiness. 3)alming of a wet cough. 4)increased blood flow to the nose.

2 Sympathomimetics​ (also called adrenergic​ agonists) with​ alpha-adrenergic activity are effective at relieving the nasal congestion associated with the common cold and allergic rhinitis when given by either the PO or intranasal route. Nasal dryness is not the goal of sympathomimetic drug​ use, although it can become a problem. Sympathomimetic drugs have a minimal effect on a wet cough. Arterioles shrink with less blood flow.

The nurse is assisting with the administration of an acetylcysteine​ (Mucomyst) nebulizer treatment by mask. What warning to the client is essential prior to the start of the​ treatment? ​1)"Tell us right away if your fingers start to​ tingle." 2)"This treatment does not smell very​ good." 3)"This treatment may make you feel​ dizzy." 4)"Tell us right away if you develop chest​ pain."

2. Acetylcysteine has a very unpleasant odor and can cause nausea and vomiting. Local irritation and stickiness on the face are also noted. It does not cause​ tingling, dizziness, or chest pain.

The nurse is teaching a client about the side effects of intranasal beclomethasone​ (Beconase), including: 1)nuchal rigidity and headache. 2)burning and nosebleed. 3)muscle aches and conjunctivitis. 4)frequent sneezing and hiccups.

2. Intranasal corticosteroids such as beclomethasone may cause transient nasal irritation along with​ burning, sneezing, and dryness. Nasal ulceration may lead to nosebleed. The remaining symptoms are not adverse effects of beclomethasone.

The nurse is advising a client who been using diphenhydramine​ (Benadryl) over-the-counter​ (OTC) to induce sleep. The client complains about a dry mouth. The nurse explains​ that: 1)Diphenhydramine causes less dryness if taken in the liquid form. 2)Drying of the mouth membranes is common after taking diphenhydramine. 3)Drowsiness caused by the diphenhydramine caused the client to reduce fluid intake. 4)Diphenhydramine has a muscle relaxant​ effect, so the client is likely sleeping with the mouth open.

2. The major adverse effect of antihistamines relates to their anticholinergic effects. Excessive drying of mucous membranes can lead to dry​ mouth, and urinary hesitancy may be troublesome for​ patients, especially those with prostatic hyperplasia. Some antihistamines produce more pronounced anticholinergic effects than others. Diphenhydramine and clemastine exhibit a significant incidence of anticholinergic adverse​ effects, whereas the​ second-generation agentslong dash—​loratadine, ​desloratadine, and fexofenadinelong dash—produce the least. Substituting the liquid form for another form will not make any difference. Diphenhydramine does not reduce fluid intake in a significant way. The client might sleep with the mouth​ open, but that is not the primary cause of the dry mouth.

A​ middle-aged male is taking pseudoephedrine​ (Sudafed) for nasal congestion. What adverse effect is most likely if he also has benign prostatic​ hypertrophy? 1)Elevated uric acid level 2)Urinary retention 3)Incontinence of urine 4)Elevated creatine level

2. Alpha-adrenergic agonists should be used with caution in patients with prostatic​ enlargement, because these drugs increase smooth muscle activity in the prostate gland and may diminish urinary outflow. Uric acid and serum creatine levels are not affected and incontinence is unlikely.

The nurse is teaching a client about beclomethasone​ (Beconase) nasal spray prior to discharge. Which side effects will the nurse prepare the client to​ manage? 1)Salt sensitivity and elevation of blood pressure 2)Nasal irritation and nosebleed 3)Bone demineralization and increased risk of fracture 4)Dyspepsia and gastric irritation

2. Transient nasal​ irritation, burning,​ sneezing, dryness are common adverse effects of this drug. Hypercorticism with symptoms of​ hypertension, bone​ demineralization, and gastric upset may occur but only if large amounts are swallowed. Nasal ulceration leading to nosebleeds may occur. Use increases risk for Candida infection.

The nurse is teaching a group of​ grade-school children about body functions. A student​ asks, "Why do I​ sneeze?" The​ nurse's best response​ is: ​1)"A sneeze is caused by a contraction of your throat and​ lungs." 2)"The back part of your brain is in charge of sneezes and​ coughs." 3)"A sneeze is your​ body's way of getting rid of something​ irritating." 4)"You sneeze because your body needs to take a really deep​ breath."

3 The URT traps particulate matter and many​ pathogens, preventing them from being carried to the bronchioles and​ alveoli, where they would have access to the capillaries of the systemic circulation. A sneeze clears the nasal passages. The diaphragm and other muscles of respiration contract. A sneeze is a reflex that does not require a deep breath.

The nurse is administering an antihistamine to a client with nasal allergies. The nurse is aware that antihistamines have which distinct​ limitation? 1)They have potent cholinergic side effects. 2)They block both​ H-1 and​ H-2 receptors. 3)They are most effective when taken prophylactically. 4)They are useful only during acute attacks.

3. Antihistamines are most effective when taken prophylactically to prevent allergic symptoms. Their effectiveness in reversing allergic symptoms that have already manifested is limited. This is because antihistamines block the effect of histamine at its receptor sites. They do not prevent the release of histamine from mast cells. Their effectiveness may diminish with​ long-term use. Antihistamines block cholinergic​ receptors; they have anticholinergic effects and adverse effects.

Which assessment is most relevant to the care of a client with a new order for an inhaled nasal​ steroid? 1)History of chronic bronchitis 2)History of emphysema 3)History of allergic rhinitis 4)History of asthma

3. Because of their effectiveness and​ safety, the intranasal corticosteroids have joined antihistamines as​ first-line drugs in the therapy of allergic rhinitis. They are now considered the most effective drug treatment for seasonal and perennial allergic rhinitis. These inhalers do not penetrate deeply enough to manage bronchitis or asthma and are not appropriate for the management of allergic rhinitis.

The nurse is administering a drug that antagonizes​ H-1 histamine receptors. Which is the most likely expected outcome of this​ therapy? 1)The client will report that headache is improved. 2)The client will cough less. 3)The client will report less sneezing and tearing. 4)The client will report less wheezing and more energy.

3. H1​-receptor ​antagonists, also called antihistamines​, are drugs that selectively block histamine from reaching its H1​ receptors, thus alleviating allergic symptoms. Antihistamines are not very effective at relieving headaches and do not relieve coughing or wheezing.

Which assessment data would provide the nurse with the best evidence of allergic​ rhinitis? 1)Copious​ thick, green nasal drainage and postnasal drip 2)Productive​ cough, sneezing, and​ low-grade fever 3)Coughing, sneezing, and watery eyes 4)Severe frontal headache and pressure along both sides of the nose

3. Sometimes called hay​ fever, the symptoms of allergic rhinitis resemble those of the common cold and include​ tearing, burning,​ red, swollen, or itching​ eyes; sneezing; nasal itching or​ congestion; postnasal​ drip; cough; and scratchy throat. In addition to the acute​ symptoms, complications of allergic rhinitis may include loss of taste or​ smell, sinusitis,​ hoarseness, and plugged ears. Some people may not obtain restful sleep and awaken very fatigued. Green nasal drainage and fever are signs of​ infection, as is a productive cough. Frontal headache and pressure along both sides of the nose suggest the sinuses are very congested and possibly infected.

The nurse is teaching a client about the use of antihistamines for allergic rhinitis. Which pointer is appropriate for increasing​ effectiveness? ​1)"Take this drug at the same time every​ day." 2)"Take this drug with the largest meal of the​ day." 3)"Take this drug when your symptoms are the​ worst." 4)"Take this drug before you are exposed to your​ allergens."

4. Antihistamines are most effective when taken prophylactically to prevent allergic symptoms. Their effectiveness in reversing allergic symptoms that have already manifested is limited. This is because antihistamines block the effect of histamine at its receptor sites. They do not prevent the release of histamine from mast cells. Their effectiveness may diminish with​ long-term use. Antihistamines work best on an empty stomach.

A client is being treated in the emergency department for an anaphylactic reaction to an antibiotic. The client will be receiving an antihistamine in addition to other preparations. Which drug would the nurse anticipate​ administering? 1)Fexofenadine​(Allegra) 2)Azelastine​ (Astelin) 3)Loratadine​ (Claritin) 4)Diphenhydramine​ (Benadryl)

4. Antihistamines are used as adjuncts to the emergency treatment of​ anaphylaxis, which is the most severe form of allergic reaction. Fexofenadine and loratadine are available only in oral​ forms, so are not appropriate for emergency use. Azelastine is available in a nasal​ mist, but this route is not useful in an emergency situation. Diphenhydramine is available in an intravenous preparation which makes emergency use possible.

A client with a severe cough has a new order for a​ hydrocodone-based antitussive. Which history assessment would result in changing the​ prescription? 1)The client has been unable to sleep for 4 nights due to coughing. 2)The client has a history of lung cancer. 3)Hydrocodone makes the client drowsy. 4)The client has a history of persistent intermittent asthma.

4. Care must be taken when using these medications in patients with asthma because bronchoconstriction may occur. Lack of sleep due to coughing is a frequently cited reason for ordering narcotic cough medication. Hydrocodone is often ordered for clients with bronchial​ cancers, because the tumor triggers the cough. Hydrocodone is a​ narcotic, so it may cause drowsiness.

A client is being treated with dornase alfa​ (Pulmozyme). The nurse anticipates that the client is most likely to experience which cluster of adverse​ effects? ​1)Headache, nasal​ stuffiness, and earaches 2)Nausea, vomiting, and diarrhea. 3)Epigastric​ pain, belching, and flatulence 4)Sore​ throat, conjunctivitis, and hoarseness

4. Dornase alfa​ (Pulmozyme), is an enzyme that was approved in 1993 for the management of thick bronchial secretions in patients with cystic fibrosis. Dornase alfa breaks down deoxyribonucleic acid​ (DNA) molecules in the​ mucus, causing it to become less viscous. It is administered by the oral inhalation route. Adverse effects include chest​ pain, conjunctivitis,​ hoarseness, and pharyngitis. The remaining adverse effects are not assocated with Pulmozyme.

A student needs to take an antihistamine for chronic rhinitis. Which preparation is least likely to make the student sleepy in​ class? 1)Hydroxyzine​ (Atarax) 2)Cetirizine​ (Zyrtec) 3)Diphenhydramine​(Benadryl) 4)Fexofenadine​(Allegra)

4. First generation antihistamines like hydroxyzine and diphenhydramine have sedation as a significant adverse effect. This effect is lessened in the second generation antihistamines such as cetirizine and fexofenadine. Cetirizine appears to be somewhat more sedating than other​ second-generation agents.

Which point should the nurse include when instructing a client in the use of a budesonide​ (Rhinocort) nasal​ preparation? ​1)"Use this preparation before your nasal​ decongestant." 2)"Avoid the use of ultrasonic humidifiers with this​ preparation." 3)"You should see improvement in your symptoms in about a​ week." 4)"You could experience​ nosebleeds."

4. In order to achieve maximum​ effect, decongestant nasal sprays should be used​ first, before a nasal steroid. Transient nasal​ irritation, burning,​ sneezing, dryness are common adverse effects of nasal steroids. Nasal ulceration leading to nosebleeds may occur. Moisture in the air can help prevent excess​ drying; a humidifier is a good idea. Improvement is not apparent for several weeks in most clients.

An older male client with several chronic conditions is using pseudoephedrine​ (Sudafed) for cold symptoms. Which adverse effect does the nurse teach the client to report to the​ physician? 1)Increased coughing 2)Irritated, crusty nares 3)Thickening and color change of nasal drainage 4)Decreased urinary stream

4. Pseudoephedrine should not be used by patients with severe​ HTN, severe coronary artery​ disease, or hypersensitivity to this​ drug, or by those who take monoamine oxidase inhibitor​ (MAOI) drugs.​ Alpha-adrenergic agonists should be used with caution in patients with prostatic​ enlargement, because these drugs increase smooth muscle activity in the prostate gland and may diminish urinary outflow. Decongestants do not affect coughing. Earlier irritation often makes the outer opening to the nares red and sore after several days of a cold. The problem will gradually improve. Nasal drainage often evolves from clear to colored in the common cold.

A mother is asking the nurse about relief of cold symptoms in her​ 4-year-old. Which preparation should the nurse advise the mother to​ avoid? 1)Loratadine​ (Claritin) 2)Acetaminophen​ (Tylenol) 3)Ibuprofen​ (Advil) 4)Dextromethorphan​ (Robitussin)

4. The FDA has issued advisories that nonprescription cough and cold products​ (including those containing​ dextromethorphan) not be used in children under 6 years of age and that they be used with extreme caution in all children. Loratadine​ (Claritin) may be given to children ages 2 and older. Acetaminophen and ibuprofen are safe for the relief of aches in​ children, provided dose guidelines are followed.

The nurse recognizes that respiratory depression is a risk with some cough suppressants. Which preparation has the least risk of causing respiratory​ depression? ​1)Codeine-based 2)Codeine with bromodiphenhydramine​ (Ambenyl) 3)Hydrocodone with homatropine​ (Hycodan) 4)Dextromethorphan​ (Delsym)

4. There are almost no adverse effects at therapeutic doses of dextromethorphan. Sedation and dizziness have occurred at moderate doses. In abuse situations the drug can cause CNS toxicity with a wide variety of​ symptoms, including slurred​ speech, ataxia,​ hyperexcitability, stupor, respiratory​ depression, seizures,​ coma, and toxic psychosis. The remaining products are all​ narcotic-based with risk for respiratory depression.

The nurse is teaching a group of teens with asthma how the structures of the upper respiratory tract protect against infections. Which statement by a teen demonstrates that teaching has been​ successful? Select all that apply. ​1)"The passages of the nose and throat​ filter, warm, and humidify air when I​ inhale." 2)"The structures of the upper respiratory tract trap particulate matter and​ pathogens, preventing them from going down into my​ lungs." 3)"The upper respiratory tract is lined with tiny hairs that move back and​ forth, pushing foreign matter away from the​ lungs." 4)"Mucous membranes inside the nose produce allergens that neutralize​ pathogens." 5)"The saliva in my mouth contains cells that can eat​ bacteria."

1,2,3 The upper respiratory tract​ (URT) consists of the​ nose, nasal​ cavity, pharynx, and paranasal sinuses. These passageways​ filter, warm, and humidify air during inhalation. The URT traps particulate matter and many​ pathogens, preventing them from being carried to the bronchioles and​ alveoli, where they would have access to the capillaries of the systemic circulation. The mucous membranes of the URT are lined with ciliated epithelium. The cilia projecting from the epithelium are found throughout the nasal passages and help to trap smaller particles. The cilia have a wavelike motion that sweeps the pathogens and particulate matter upward toward the​ oropharynx, where they are swallowed when a person coughs or clears the throat. A sneeze clears the nasal passages. Saliva contains immunoglobulins​ (IgA) and​ lysozyme, which break down bacterial cell walls. Swallowed saliva or nasal mucus exposes microorganisms to the hostile environment of the stomach where they contact high gastric acidity and enzymes that kill them. The nasal mucosa is also part of the first line of body​ defense, secreting up to a quart of mucus daily. This fluid is rich in immunoglobulins that are able to neutralize airborne pathogens.

The nurse is teaching a client about the actions of an intranasal inhaler containing ipratropium​ (Atrovent). Which statement by the nurse is most​ accurate? ​1)"You will notice a decrease in nasal​ secretions." 2)"You will notice you are not sneezing as​ much." 3)"You will not have as much postnasal​ drip." 4)"Your throat​ won't feel so​ scratchy."

1. Ipratropium​ (Atrovent) nasal spray is an anticholinergic drug indicated for the symptomatic relief of runny nose​ (rhinorrhea) associated with seasonal allergic rhinitis or the common cold. Its actions are limited to decreasing nasal​ secretions; it does not stop the​ sneezing, postnasal​ drip, or itchy throat or eyes characteristic of allergic rhinitis or the common cold.

The nurse is assessing a client who regularly takes an oral​ first-generation antihistamine for nasal allergies. Which medication order would trigger concerns about drug interaction with the​ antihistamine? ​1)Hydrochlorothiazide, a diuretic 2)Tylenol with​ codeine, an opiate analgesic 3)Enoxaparin​ (Lovenox), an anticoagulant 4)Atenolol, an antihypertensive

2. ​First-generation antihistamines can cause significant drowsiness as can narcotics such as codeine. The additive effect may suppress respirations. The remaining drugs do not interact adversely with antihistamines.

The nurse is teaching a group about the use of cough medications. Which preparation should be used for nonproductive​ coughs? 1)Guaifenesin​ (Robitussin GF) 2)Acetylcysteine​ (Mucomyst) 3)Dextromethorphan​ (Delsym) 4)Guaifenesin​ (Mucinex)

3. Although used for over​ 50 years to treat​ cough, controlled studies examining the effectiveness of dextromethorphan have given mixed results. Its present status is that the FDA considers it a safe and effective cough suppressant when used at recommended doses. It appears to be more effective at reducing nonproductive cough due to chronic throat irritation from tobacco use or emphysema rather than acute cough due to colds. Guaifenesin is an expectorant and acetlycysteine is a mucolytic.

The nurse is instructing a client on the proper use of an intranasal decongestant. The​ nurse's caution about rebound effect will center primarily​ on: 1)concerns about chest pain with repeated use. 2)the need to minimize the​ drug's systemic effects. 3)the need to count the number of sprays of medication at each application. 4)the need to stop the medication after three to five days of use.

4. Intranasal sympathomimetics produce few systemic effects because only minimal amounts of these drugs are absorbed in the circulation. The most​ serious, limiting adverse effect of the intranasal preparations is rebound congestion. In almost all​ patients, prolonged use causes hypersecretion of mucus and worsening nasal congestion once the drug effects wear off. This leads to a cycle of increased drug use as the condition worsens to obtain the desired effect from these drugs. Because of this rebound​ congestion, intranasal sympathomimetics should be used for no longer than 3 to 5 days. If chest pain​ occurs, it is unrelated to the topical preparation the client is using. Another concern is greater than the need to count the number of sprays per application.

What is an expected outcome of antihistamine therapy for allergic​ rhinitis? 1)The nasal airway opens wider. 2)The sinuses drain more effectively. 3)Coughing becomes productive. 4)Sneezing and tearing decrease.

5. The most frequent therapeutic use of antihistamines is for the treatment of allergies. These medications provide symptomatic relief from the​ sneezing, runny​ nose, and itching of the​ eyes, nose, and throat of allergic rhinitis. Decongestants open the nares and improve sinus drainage. Mucolytics make a cough more productive.

The nurse instructing a client with allergic rhinitis would recommend which actions to decrease exposure to​ allergens? Select all that apply. Remove pets from the home or limit exposure. Routinely clean moldy surfaces. Clean frequently to remove dust mites from​ bedding, carpets, and furniture. Remove all carpeting and replace with wood floors. Buy new mattresses every 2 years.

1,2,3. Nurses should help patients identify the sources of the allergy and recommend appropriate actions. These may include removing pets from the home environment or limiting their exposure​ (such as not allowing the pet on​ furniture); cleaning moldy​ surfaces; using and routinely cleaning or replacing microfilters on​ air-conditioning units; and frequent cleaning to remove dust mites from​ bedding, carpet, or furniture. Although dust mites can never be totally removed from​ mattresses, regularly decreasing their numbers can help lessen symptoms of allergic rhinitis. Removal of carpet may not be a reasonable solution for many families.

The nurse would expect to see an order for a drug that blocks H2 receptors in a client​ with: Select all that apply. 1)production. 2)peptic ulcer disease. )gastroesophageal reflux disease. 4)allergic rhinitis. 5)seasonal allergies.

1,2,3. Drugs that block Upper H 2H2 receptors such as ranitidine​ (Zantac) reduce gastric acid secretion and are used to treat peptic ulcer disease and gastroesophageal reflux disease. This histamine receptor activity is not related to allergic responses.

The nurse is caring for a client who is taking benzonatate​ (Tessalon) for a cough. The client accidentally bites into one of the gelcaps prior to swallowing it. What should the nurse do​ next? 1)Call the physician and complete a variance report. 2)Explain that the client might experience numbness of the tongue. 3)Assess blood pressure frequently for the next hour. 4)Explain that the client is likely to become very nauseated.

2. Chemically related to the local anesthetic tetracaine​ (Pontocaine), benzonatate suppresses the cough reflex by anesthetizing stretch receptors in the lungs. If​ chewed, this drug can cause numbing of the mouth and pharynx. Variance report is not​ indicated, tessalon does not affect blood​ pressure, and nausea is unlikely.

The nurse keeps which therapeutic goals in mind when teaching a client with allergic rhinitis about prescribed​ medications? Select all that apply. 1)Prevent its occurrence. 2)Relieve symptoms. 3)Decrease the risk of infection. 4)Treat evidence of infection. 5)Avoid the use of medications that cause drowsiness.

1,2. The therapeutic goals of treating allergic rhinitis are to prevent its occurrence and to relieve symptoms. Decreasing infection​ risk, treating current​ infection, and avoiding medications that cause drowsiness are not therapeutic goals of this therapy.