PrepU ch 31

A client reports having difficulty finding the over-the-counter (OTC) decongestant that the client used in the past. What assessment question should the nurse ask to help address the client's concern?

"Did the medication contain pseudoephedrine?" The use of OTC products containing pseudoephedrine to manufacture methamphetamine has increased at an alarming rate. Most states have passed laws placing these products behind pharmacy counters to restrict sales.

What statement by a 61-year-old client who is to take an antitussive with codeine indicates that the teaching has been effective?

"This medication can cause drowsiness, so I will avoid driving while I use it."

What home remedies are effective for mouth dryness and cough? (Select all that apply.)

Adequate fluid intake Humidification of the environment Sucking on hard candy or throat lozenges

When developing the teaching plan for a patient receiving an antihistamine, which would the nurse include? (Select all that apply.) Advising the patient to avoid alcohol consumption Using sugarless candies or lozenges to combat dry mouth Stopping the drug after 3 days if no relief is obtained Encouraging the patient to engage in usual activities such as driving

Advising the patient to avoid alcohol consumption Using sugarless candies or lozenges to combat dry mouth

A client reports a hacking cough. The client asks if taking an antihistamine would be helpful. The nurse's best response is: Antihistamines are not used for this issue. Antihistamines are recommended for extended use, as long as you monitor for adverse effects. Antihistamines are not recommended for this issue; only antibiotics are useful. Antihistamines are not recommended because they can dry lower respiratory secretions and worsen secretion retention and cough.

Antihistamines are not recommended because they can dry lower respiratory secretions and worsen secretion retention and cough

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.

A client has been prescribed an antihistamine for the treatment of seasonal allergies. What dietary guidelines should the nurse provide to the client? Eat several small meals instead of three larger meals in case of GI upset Avoid drinking alcohol while taking antihistamines Avoid grapefruit juice until at least 48 hours after treatment is complete Increase intake of foods that are high in vitamin C

Avoid drinking alcohol while taking antihistamines

Which agent would the nurse identify as providing local anesthesia to the respiratory passages? Benzonatate Ephedrine Hydrocodone Dextromethorphan

Benzonatate

Which agent acts directly on the medullary cough center?

Codeine

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?

Dextromethorphan works in the medulla to suppress the cough reflex.

Second generation antihistamines are associated with a higher risk of sedation than first generation antihistamines. True False

False

A female client presents at the clinic with a dry, nonproductive cough. The client is diagnosed with bronchitis, and it is determined that she will need help thinning sputum so that the cough can become productive. What does the nurse expect will be prescribed for the client?

Guaifenesin

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

Guaifenesin

What non pharmacological recommendation should be made to the client to prevent pooling of secretions in the lungs during the administration of an antitussive? (Select all that apply) Increase fluid intake Change positions frequently Decrease fluid intake Remain in one position Refrain from trying to cough

Increase fluid intake Change positions frequently

A 29-year-old female client has sinusitis, so the health care provider orders a topical nasal decongestant. What instructions should be given?

Increase fluids to 2 L per day

A patient with vasomotor rhinitis has been prescribed an antihistamine. The patient is eager to know whether the prescribed antihistamine may cause excessive sedation. Which of the following antihistamines has very little sedative effect? Brompheniramine Clemastine Chlorpheniramine Loratadine

Loratadine

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?

Misuse could result in overdose.

A client with cystic fibrosis may use which type of medication to reduce the viscosity of respiratory secretions?

Mucolytic

A client has been prescribed a nasal steroid. The client asks the nurse about the infection that the nasal steroid has been prescribed for. What would be an appropriate response by the nurse? Nasal steroids are used only for a sinus infection. Nasal steroids are contraindicated in the presence of an acute infection. Nasal steroids are used for an infection in the adenoids. Nasal steroids are used for all acute upper respiratory infections.

Nasal steroids are contraindicated in the presence of an acute infection.

Pseudoephedrine (Sudafed) is prescribed for a client suffering from nasal and sinus congestion. What is the most important assessment the nurse should complete before the client leaves the clinic to purchase the medication? Ask about history of hay fever. Observe for swelling in nasal passages. Ask about nausea and vomiting. Obtain the client's blood pressure.

Obtain the client's blood pressure.

Which is classified as a decongestant?

Oxymetazoline (Afrin)

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?

Pseudoephedrine

An instructor is describing topical decongestants as belonging to which class?

Sympathomimetics

A 62-year-old client has been prescribed an antihistamine to alleviate vasomotor rhinitis. The client reports gastric irritation after taking the tablet. Which instructions should the nurse provide to help alleviate the client's condition? Drink ample water before taking the tablet. Take an antacid before the tablet. Take the tablet with food. Take the tablet one hour before food.

Take the tablet with food.

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.

Expectorants elicit their effect by which mechanism?

Thinning respiratory secretions

A patient visits the clinic and is diagnosed with acute sinusitis. To promote sinus drainage what medication might be ordered?

Topical decongestants

A client is diagnosed with a viral upper respiratory tract infection. Which of the following is appropriate treatment for the client? Select all that apply:

Use of comfort measures. Increase of fluid intake. Use of antitussive for nonproductive cough.

A client is diagnosed with a viral upper respiratory tract infection. Which of the following is appropriate treatment for the client? Select all that apply: Administration of an antibiotic. Use of comfort measures. Decrease of fluid intake. Increase of fluid intake. Use of antitussive for nonproductive cough.

Use of comfort measures. Increase of fluid intake. Use of antitussive for nonproductive cough.

The nursing instructor is discussing over-the-counter cold remedies. According to the instructor, these products typically combine

a decongestant, an analgesic, and an antihistamine.

The client with bilateral pneumonia has been prescribed a mucolytic. The nurse correctly identifies a mucolytic as having which action?

a drug that breaks down thick, tenacious mucus in the lower portions of the lungs

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

ineffective airway clearance

The nurse is listening to the respiratory therapist teaching a client about the proper use of respiratory equipment for administration of drugs such as expectorants and mucolytics when they are discharged home. The nurse knows the therapist will inform the client that the best position to do this is which?

sitting or in high Fowler's position

The pharmacology instructor is discussing the adverse effects of diphenhydramine. Which is not one of these effects? Dry mouth Drowsiness Excessive salivation Blurred vision

Correct response: Excessive salivation Explanation: Adverse effects of first-generation antihistamines include urinary retention or frequency, sedation, dry mouth, blurred vision, and gastrointestinal distress.

Which statement by the client leads the nurse to believe that the client needs additional instruction regarding the nasal decongestant? "I will blow my nose before instilling the nasal spray." "I will report any dizziness, drowsiness, or rapid pulse." "I will drink 2,000 to 3,000 mL of fluid daily." "I will use it only when I have nasal discharge."

"I will use it only when I have nasal discharge."

Cough syrups serve as vehicles for antitussive drugs and also may exert antitussive effects of their own by doing what?

Soothing irritated pharyngeal mucosa

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."

Which statement by the client leads the nurse to believe that the client needs additional instruction regarding the nasal decongestant?

"I will use it only when I have nasal discharge." Decongestants decrease the overproduction of secretions by causing local vasoconstriction to the upper respiratory tract. This vasoconstriction leads to a shrinking of swollen mucus membranes and tends to open clogged nasal passages, providing relief from the discomfort of a blocked nose and promoting drainage of secretions and improved air flow.

The nurse has taught a client to self-administer a topical decongestant. What statement made by the client should the nurse follow up with further education?

"I'll squeeze the bottle to get the medication up into my sinuses."

The nurse is caring for a client with cystic fibrosis who is receiving dornase alfa by nebulizer to help thin secretions. What statement by the client indicates a need for further instruction?

"I'm glad that this medication will address all of my symptoms." Cystic fibrosis clients who receive dornase alfa should be cautioned about the need to continue all therapies for their cystic fibrosis because dornase alfa is only a palliative therapy that improves respiratory symptoms, and other therapies, such as coughing, postural drainage and enzymes, are still needed. This medication will not relieve all of the client's symptoms.

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?

"You might find yourself more congested than ever as your body compensates for your use of these drugs."

What would be the nurse's best response if a client calls the clinic and reports a persistent cough for 2 weeks and then asks the nurse for a recommendation for a cough medicine?

"You should come to the clinic to be evaluated. A cough that lasts that long might be an indication of an underlying medical problem."

When antihistamines result in dryness of the mouth, the nurse should recommend which actions to relieve the dryness? Select all that apply. Suck on sugarless hard candy. Administer intravenous fluid bolus. Offer ice chips. Take frequent sips of water. Use a dehumidifier in the home.

Suck on sugarless hard candy. Offer ice chips. Take frequent sips of water.

Acetylcysteine may be used as a mucolytic agent. What is an additional indication for the drug?

Antidote for acetaminophen poisoning

A student nurse is researching the charts of 25 patients with a diagnosis of chronic pharyngitis and what medication is most commonly prescribed. What type of medication would the nurse expect to find in the majority of the chart audits?

Antitussives

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.)

Avoidance of use in children under age 2 Importance of reading the label for ingredients and dosage Need to follow the directions for how often to give the drug

A 29-year-old female client has sinusitis, so the physician orders a topical nasal decongestant. What instructions should be given? Avoid becoming pregnant during decongestant therapy Increase fluids to 2 L per day Restrict fluids to 500 mL per day Take the medication with meals

Increase fluids to 2 L per day

Your client has a history of post-transfusion reactions. Her medical provider has ordered medication to prevent this. Which of the following medications would you anticipate being ordered for this client? Epinephrine Lasix Benadryl Tylenol

Benadryl

A nurse caring for a client in the hospital is being discharged today with a prescription for benzonatate (Tessalon Perles) 200 mg one capsule 3 times daily. What would the nurse tell the client about this prescription during discharge counseling? (Select all that apply.) The client should drink plenty fluids. Consumption of alcohol is okay while taking benzonatate. Benzonatate capsules should be sucked on like a lozenge. Benzonatate can be taken more frequently than prescribed if needed. Benzonatate can cause GI upset and sedation.

Benzonatate can cause GI upset and sedation. The client should drink plenty fluids. Explanation: The adverse effects of benzonatate include sedation, headache, dizziness, constipation, nausea, GI upset, pruritus, and nasal congestion. It is recommended that patients with cough drink plenty of fluids (1500 to 2000 mL daily) unless fluids are contraindicate due to another disease state. Benzonatate should not be crushed or chewed due to a local anesthetic effect resulting in possible choking. Consumption of alcohol while taking benzonatate can increase CNS depression and increased sedation. The maximum daily dose of benzonatate is 600 mg daily.

A client is prescribed oxymetazoline. Which assessment data would indicate that the drug is effective?

Breathing pattern is regular and without difficulty.

A patient is having an allergic reaction to mold. The patient describes chest tightness and difficulty breathing. Which of the following body effects are occurring? Contraction of smooth muscle in the bronchi Suppression of the vagus nerve endings producing tachycardia Decreased permeability of the veins and capillaries Decreased secretion of the mucous glands

Contraction of smooth muscle in the bronchi

A 76-year-old client has been prescribed an oral antihistamine. What adverse effect presents a priority safety concern for older adult clients? Drowsiness Dry mouth Nonproductive cough Nasal burning

Correct response: Drowsiness Explanation: Older adults are more likely to experience anticholinergic effects (dryness of mouth, nose, throat), dizziness, sedation, hypotension, and confusion from the use of antihistamines. Drowsiness and sedation present the greatest safety concerns compared to other effects such as dry mouth and nonproductive cough. Nasal burning may occur due to nasal spray use.

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: Severe constipation Increased salivation and choking Insomnia Cardiac arrhythmias

Cardiac arrhythmias

When providing health education to an adult who is taking an over-the-counter (OTC) combination cold and cough remedy, the nurse should encourage the client to implement what intervention to best assure medication safety?

Carefully read the label and adhere to the guidelines for use.

When instructing a client in how to use a topical nasal spray, what would the nurse emphasize to do first?

Clear the nasal passages.

A client has been suffering from repeated sinus infections. The client is diagnosed with allergic rhinitis. The client is prescribed a daily antihistamine. What is the mechanism of action in the antihistamine medications? It raises the seizure threshold by impairing vitamin D. It catalyzes the enzymatic oxidation of uric acid. It prevents histamine from acting on target tissues. It depletes norepinephrine and serotonin.

Correct response: It prevents histamine from acting on target tissues. Explanation: Antihistamines prevent histamine from acting on target tissues. Antihypertensive agents deplete norepinephrine and serotonin. Antigout medications catalyze the enzymatic oxidation of uric acid. Antiseizure medications, such as primidone, impair vitamin D metabolism.

Which assessment finding should prompt the nurse to suspect that the resident is experiencing an anticholinergic effect of diphenhydramine? urticaria tinnitus blurry vision wheezing on expiration

Correct response: blurry vision Explanation: Anticholinergic effects are produced by the inhibition of cholinergic neurotransmission at muscarinic receptor sites. First-generation H1 receptor antagonists are associated with anticholinergic effects such as dry mouth, urinary retention, constipation, and blurred vision. Wheezing, urticaria, and tinnitus are not anticholinergic effects since they are not related to the cholinergic neurotransmission at muscarinic receptor sites.

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

The nurse would caution clients with which disorders to avoid the use of over-the-counter pseudoephedrine? (Select all that apply.)

Diabetes Cardiovascular disorders Glaucoma

The use of centrally acting antitussives, such as codeine, increase the risk for injury related to which conditions? (Select all that apply.)

Drowsiness Dizziness

Second-generation antihistamines were developed to remove the sedation of first generation drugs. Which of the following antihistamines is a second-generation drug? Dexchlorpheniramine Chlorpheniramine Fexofenadine Diphenhydramine

Fexofenadine

A client presents at the clinic with a dry, non-productive cough. The client is diagnosed with bronchitis, and it is determined that the client needs help thinning the sputum so the cough can become productive. What does the nurse expect the health care provider will prescribe?

Guaifenesin (Mucinex)

What factors contribute to elderly clients being at higher risk of injury while taking antihistamines? Select all that apply: Hearing loss Steady gait Diabetes Hypertension Visual impairment

Hearing loss Visual impairment

Which of the following medications, if administered with pseudoephedrine, could increase risk of cardiac dysrhythmia? MAO inhibitors Beta blockers Calcium-channel blockers Thiazide diuretics

MAO inhibitors

A client is prescribed oxymetazoline, a decongestant, for the treatment of hay fever. What should the nurse evaluate to assess the efficacy of therapy?

Maintenance of effective airway clearance

Which would the nurse expect to administer as a nasal spray?

Oxymetazoline

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? Xylometazoline Pseudoephedrine Ephedrine Tetrahydrozoline

Pseudoephedrine

A female client self-administers pseudoephedrine for relief of her symptoms associated with seasonal allergies. She phones the office reporting restlessness and insomnia. The nurse explains to the client that these are expected side effects of the medication. What is the reason for these side effects? Pseudoephedrine is a stimulant and causes stimulation of the central nervous system. Pseudoephedrine produces a sympathomimetic effect. Pseudoephedrine causes an adverse response in the CNS. Pseudoephedrine causes an anticholinergic response.

Pseudoephedrine produces a sympathomimetic effect.

A female client self-administers pseudoephedrine for relief of her symptoms associated with seasonal allergies. She phones the office reporting restlessness and insomnia. The nurse explains to the client that these are expected side effects of the medication. What is the reason for these side effects? Pseudoephedrine is a stimulant and causes stimulation of the central nervous system. Pseudoephedrine causes an anticholinergic response. Pseudoephedrine causes an adverse response in the CNS. Pseudoephedrine produces a sympathomimetic effect.

Pseudoephedrine produces a sympathomimetic effect.

What is an adverse reaction commonly experienced by people taking nasal decongestants?

Rebound congestion

A male client is diagnosed with chronic bronchitis. What would the nurse expect to be one of his physical reports?

Retention of secretions

A 15-year-old patient is prescribed an antihistamine for allergic rhinitis. However, antihistamines used to treat allergic reactions may themselves cause allergy. The nurse needs to educate the patient to be aware of symptoms suggesting allergy. Which of the following is an allergic reaction to antihistamines? Dryness of mouth Drowsiness and sedation Skin rash and urticaria Disturbed coordination

Skin rash and urticaria

A client reports experiencing severe nasal congestion since starting to use an over-the-counter (OTC) nasal decongestant spray a week ago. This symptomology most supports what possible medical condition?

rebound congestion, Nasal decongestants are rapidly effective because they come into direct contact with nasal mucosa. However, if used longer than the recommended 3 days or in excessive amounts, these products may produce rebound nasal congestion that result from the irritation and swelling of the nasal mucosa.

When describing the action of decongestants, a nurse integrates knowledge of this class of drugs, identifying which mechanism?

Vasoconstriction of small blood vessels of the nasal membranes

A 76-year-old man with a history of heart disease has been prescribed an oral decongestant. The nurse is concerned with this prescription because of the risk for serious cardiovascular effects. increased salivation and choking. severe constipation. insomnia.

serious cardiovascular effects.

The client states that he/she once needed medication to liquefy secretions in the respiratory tract. However, the client cannot recall the name of the medication but states that the medication is added to a nebulizer. The nurse suspects the client is taking which medication?

acetylcysteine

What intervention should be included in the care plan of a client experiencing excessive respiratory tract secretions?

deep breathing and coughing exercises

What adverse effect of most oral antihistamines presents a priority safety concern for older adult clients? Drowsiness Dry mouth Nasal burning Nonproductive cough

drowsiness

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.

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:

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.