1301 Chapter 35: Upper Respiratory Disorders Quiz

What may be prescribes for sinusitis?

- A systemic or nasal decongestant may be indicated. - Acetaminophen, fluids, and rest may also be helpful. - For acute or severe sinusitis, an antibiotic may be prescribed.

The nurse is caring for a patient who is taking a first-generation antihistamine. What is the most important information for the nurse to teach the patient? -"Do not drive after taking this medication." -"Make sure you drink a lot of liquids while on this medication." -"Take this medication on an empty stomach." -"Do not take this medication for more than 2 days."

-"Do not drive after taking this medication." First-generation antihistamines cause drowsiness. There is no evidence to indicate that the patient should force fluids, take the medication on an empty stomach, or place the medication on hold for any period of time.

The nurse is teaching a patient about the use of an expectorant. What is the most important instruction for the nurse to include in the patient teaching? -"Increase your fiber and fluid intake to prevent constipation." -"Increase your fluid intake in order to decrease viscosity of -secretions." -"Restrict your fluids in order to decrease mucus production." -"Take the medication once a day only, at bedtime."

-"Increase your fluid intake in order to decrease viscosity of secretions." Expectorant drugs are used to decrease viscosity of secretions and allow them to be more easily expectorated. Increasing fluid intake helps this action.

A patient complains of worsening nasal congestion despite the use of oxymetazoline nasal spray every 2 hours. What is the nurse's most appropriate response? -"Oxymetazoline should be administered every hour for severe congestion." -"Overuse of nasal decongestants results in rebound congestion." -"Oxymetazoline is not an effective nasal decongestant." -"You are probably displaying an unexpected reaction to oxymetazoline."

-"Overuse of nasal decongestants results in rebound congestion." Oxymetazoline is an effective nasal decongestant, but overuse results in worsening or "rebound" congestion. It should not be used more than every 4 hours. To avoid future rebound congestion with nasal sprays, it is recommended that they be used for no more than 3-5 days.

The nurse is caring for a patient in the clinic who states that he is afraid of taking antihistamines because he is a truck driver. What is the best information for the nurse to give this patient? -"Take the medication only when you are not driving." -"You are correct; you should not take antihistamines." -"You may be able to safely take a second-generation antihistamine." -"Take a lower dose than normal when you have to drive."

-"Take a lower dose than normal when you have to drive." Second-generation antihistamines are often called non-sedating antihistamines. These may be safer for the patient to take, but the patient should still monitor for signs of excessive sedation.

A patient is prescribed an antitussive medication. What is the most important instruction for the nurse to include in the patient teaching? -"Watch for diarrhea and abdominal cramping." -"Headache and hypertension are common side effects." -"This medication may cause drowsiness and dizziness." -"This medication may cause tremors and anxiety."

-"This medication may cause drowsiness and dizziness." Antitussive medications also affect the central nervous system, thus causing drowsiness and dizziness. There is no reason to anticipate that the medication will cause diarrhea, abdominal cramping, tremors and anxiety, or headache and hypertension.

The nurse is teaching the patient on the use of beclomethasone. Which statement by the patient indicates an understanding of the teaching? -"I will need to taper off the medication to prevent acute adrenal crisis." -"I will need to monitor my blood sugar more closely because it may increase." -This medication will help prevent the inflammatory response of my allergies." -"I need to take this medication only when my symptoms get bad."

-"This medication will help prevent the inflammatory response of my allergies." Beclomethasone is a steroid spray administered nasally. It is used to prevent allergy symptoms. Its effect is localized, and therefore the patient does not have systemic side effects with normal use and does not have to worry about weaning off the medication as with oral corticosteroids. Because the medication has a localized effect, it will not produce the changes in blood sugar that would be generated by systemic steroids.

The health care provider indicates that the patient will be ordered an opioid antitussive. Which medication does the nurse anticipate the provider will order? -Codeine -Promethazine with dextromethorphan -Benzonatate -Levocetirizine

-Codeine Codeine is classified as an opioid antitussive. Promethazine with dextromethorphan and benzonatate are both non-opioid antitussives. Levocetirizine is an antihistamine.

The health care provider indicates that the patient will be ordered an expectorant. Which medication does the nurse anticipate the provider will order? -Brompheniramine maleate -Dexchlorpheniramine maleate -Guaifenesin -Chlorpheniramine maleate

-Guaifenesin Guaifenesin is classified as an expectorant. The other drugs listed are classified as first-generation antihistamines.

What is the most important thing for the nurse to teach a patient who is switching allergy medications from diphenhydramine to loratadine? -Loratadine has fewer sedative effects. -Loratadine has increased bronchodilating effects. -Loratadine causes less gastrointestinal upset. -Loratadine can potentially cause dysrhythmias.

-Loratadine has fewer sedative effects. Loratadine does not affect the central nervous system and therefore is non-sedating. There is insufficient evidence to indicate that loratadine can cause dysrhythmias, can act as a bronchodilator, or cause gastrointestinal upset than other comparable medications.

What are some interventions for viral pharyngitis?

-Saline gargles, lozenges, and increased fluid intake are usually indicated. -Acetaminophen may be taken to decrease an elevated temperature. -Antibiotics are not effective for viral pharyngitis.

Is the common cold contagious?

A cold is most contagious 1 to 4 days before the onset of symptoms and during the first 3 days of the cold. Transmission occurs more frequently from touching contaminated surfaces and then touching the nose or mouth than it does from viral droplets released by sneezing.

What do we do for strep?

A throat culture should be obtained to rule out beta-hemolytic streptococcal infection. If the culture is positive for beta-hemolytic streptococci, a 10-day course of antibiotics is often prescribed.

What causes acute pharyngitis?

Acute pharyngitis can be caused by a virus, beta-hemolytic streptococci, or other bacteria. It can occur alone or with the common cold and rhinitis or acute sinusitis.

What is accompanies for the cold?

Acute rhinitis usually accompanies the common cold.

The patient tells the nurse that she has a cold, is coughing, and feels like she has fluid in her lungs. What action will the nurse anticipate performing first? -Encourage the patient to drink fluids hourly. -Administer guaifenesin. -Administer dextromethorphan. -Administer fluticasone (Flonase).

Administer guaifenesin. The patient needs an expectorant. This medication will help the patient cough the fluid out of her lungs. Dextromethorphan and fluticasone will not help the patient expectorate. There is no information about the patient's fluid intake, so hourly fluids may be too much.

How do antihistamines work?

Antihistamines compete with histamine for receptor sites, preventing a histamine response. When the H1 receptor is stimulated, the extravascular smooth muscles, including those lining the nasal cavity, are constricted.

How do antitussives work?

Antitussives act on the cough-control center in the medulla to suppress the cough reflex. The three types of antitussives are nonopioid, opioid, or combination preparations.

G.H., a 35-year-old patient, has allergic rhinitis. Her prescriptions include loratadine 5 mg/day and fluticasone, two nasal inhalations per day. Previously, she had taken OTC drugs and asked if she should continue to take the OTC drug with her prescriptions. She has never used a nasal inhaler before. What are the similarities and differences between loratadine and diphenhydramine? Could one of these antihistamines be more effective than the other? Explain your answer.

Both loratadine and diphenhydramine are antihistamines. Diphenhydramine, a first-generation antihistamine, has been available for years and is frequently found as an ingredient in common cold remedies. Loratadine, a second-generation drug, is used as a single agent for rhinitis. It has fewer anticholinergic effects than diphenhydramine.

When would decongestants cause adverse effects on the heart?

Decongestants can make a patient nervous or restless. Taken together with monoamine oxidase inhibitors (MAOIs), decongestants may increase the possibility of hypertension or cardiac dysrhythmias.

What combined drugs work for oral cold remdies?

Ephedrine and pseudoephedrine are frequently combined with an antihistamine, analgesic, or antitussive in oral cold remedies.

What do expectorants do?

Expectorants loosen bronchial secretions so they can be eliminated by coughing.

What happens with the overuse of decongestants?

Frequent use of decongestants, especially nasal spray or drops, can result in tolerance and rebound nasal congestion. Rebound nasal congestion is caused by irritation of the nasal mucosa.

What is a natural expectorant?

Hydration is the best natural expectorant. When taking an expectorant, one should increase fluid intake to at least eight glasses per day to help loosen mucus.

What happens if you get a bacterial infection while having a cold?

If a bacterial infection secondary to the cold occurs, infectious rhinitis may result, and nasal discharge becomes tenacious, mucoid, and yellow or yellow-green.

G.H., a 35-year-old patient, has allergic rhinitis. Her prescriptions include loratadine 5 mg/day and fluticasone, two nasal inhalations per day. Previously, she had taken OTC drugs and asked if she should continue to take the OTC drug with her prescriptions. She has never used a nasal inhaler before. What could you suggest to decrease allergens such as dust mites in the home?

Instruct the patient to use protective mattress and pillow covers designed to prevent dust mites and an allergen filtration vacuum cleaner. Instruct G.H., her partner, or a family member in proper dusting techniques.

What treats allergic rhinitis?

Intranasal glucocorticoids and steroids are effective for treating allergic rhinitis. These have an antiinflammatory action, thus decreasing the allergic rhinitis symptoms of rhinorrhea, sneezing, and congestion.

Why should you not operate heavy machinery when taking OTC allergy meds?

Many OTC cold remedies contain a first-generation antihistamine, which can cause drowsiness; therefore, patients should be alerted not to drive or operate dangerous machinery when taking such medications.

What is nasal congestion?

Nasal congestion results from dilation of nasal blood vessels caused by infection, inflammation, or allergy. With this dilation, there is a transudation of fluid into the tissue spaces, resulting in swelling of the nasal cavity.

How do nasal decongestions work?

Nasal decongestants stimulate the alpha-adrenergic receptors, producing vascular constriction of the capillaries within the nasal mucosa. The result is shrinking of the nasal mucous membranes and a reduction in fluid secretion.

What is the limit to buying pseudoephedrine drugs?

National regulatory measures control pseudoephedrine drug sales with individual limits of 3.6 g/day and 9 g within 30 days. Identifications are scanned with each purchase.

G.H., a 35-year-old patient, has allergic rhinitis. Her prescriptions include loratadine 5 mg/day and fluticasone, two nasal inhalations per day. Previously, she had taken OTC drugs and asked if she should continue to take the OTC drug with her prescriptions. She has never used a nasal inhaler before. What is your response to G.H. concerning the use of OTC drugs with her prescription drugs?

Over-the-counter drugs taken with prescribed medications should be approved by the health care provider. Adverse reactions and drug-drug interactions might result.

What is sinustis?

Sinusitis is an inflammation of the mucous membranes of one or more of the maxillary, frontal, ethmoid, or sphenoid sinuses.

How are antihistamines grouped?

The antihistamine group can be divided into first and second generations. Most first-generation antihistamines cause drowsiness, dry mouth, and other anticholinergic symptoms, whereas second-generation antihistamines have fewer anticholinergic effects and a lower incidence of drowsiness.

What causes a cold?

The common cold is caused by the rhinovirus and primarily affects the nasopharyngeal tract.

What is a cold?

The common cold is the most prevalent type of upper respiratory infection. A cold is not considered a life-threatening illness, but it causes physical and mental discomfort and loss of time at work and school.

What class of drugs manage a cold?

The groups of drugs used to manage cold symptoms include antihistamines, decongestants, antitussives, and expectorants.

What is the most common guaifenesin?

The most common expectorant is guaifenesin.

Which way should nasal spray be turned when using?

The spray should be directed away from the nasal septum, and the patient should sniff gently.

What are upper respiratory infections?

Upper respiratory infections include the common cold, acute rhinitis, sinusitis, and acute pharyngitis.

Why do we not overuse nasal decongestants?

Usage of nasal decongestants for as little as 3 days could result in rebound nasal congestion. The nurse should emphasize the importance of limiting the use of nasal sprays and drops.

G.H., a 35-year-old patient, has allergic rhinitis. Her prescriptions include loratadine 5 mg/day and fluticasone, two nasal inhalations per day. Previously, she had taken OTC drugs and asked if she should continue to take the OTC drug with her prescriptions. She has never used a nasal inhaler before. What additional information is needed from G.H. concerning her health problem?

When is the occurrence of rhinitis more prevalent? Has G.H.'s allergic rhinitis affected her breathing, such as causing asthma? Is her nasal discharge clear or yellow?

What is a common side effect with continuous use of nasal sprays?

With continuous use, dryness of the nasal mucosa may occur.

The nurse is teaching a patient about diphenhydramine. Which instructions should the nurse include in the patient's teaching plan? (Select all that apply.) a. Take medication on an empty stomach to facilitate absorption. b. Avoid alcohol and other central nervous system depressants. c. Notify a health care provider if confusion or hypotension occurs. d. Use sugarless candy, gum, or ice chips for temporary relief of dry mouth. e. Avoid handling dangerous equipment or performing dangerous activities until stabilized on the medication.

b. Avoid alcohol and other central nervous system depressants. c. Notify a health care provider if confusion or hypotension occurs. d. Use sugarless candy, gum, or ice chips for temporary relief of dry mouth. e. Avoid handling dangerous equipment or performing dangerous activities until stabilized on the medication.

A patient tells the nurse that he has started to take an over-the-counter antihistamine, diphenhydramine. In teaching about side effects, what is most important for the nurse to tell the patient? a. To avoid insomnia, do not to take this drug at bedtime. b. Avoid driving a motor vehicle until stabilized on the drug. c. Nightmares and nervousness are more likely in an adult. d. Medication may cause excessive secretions.

b. Avoid driving a motor vehicle until stabilized on the drug.

A patient has been prescribed guaifenesin. The nurse understands that the purpose of the drug is to accomplish what? a. Treat allergic rhinitis and prevent motion sickness b. Loosen bronchial secretions so coughing can eliminate them c. Compete with histamine for receptor sites, thus preventing a histamine response d. Stimulate alpha-adrenergic receptors, thus producing vascular constriction of capillaries in nasal mucosa

b. Loosen bronchial secretions so coughing can eliminate them

A patient complains of a sore throat and has been told it is due to beta-hemolytic streptococcal infection. The nurse anticipates that the patient has which acute condition? a. Rhinitis b. Sinusitis c. Pharyngitis d. Rhinorrhea

c. Pharyngitis

A patient is prescribed a decongestant nasal spray that contains oxymetazoline. What will the nurse teach the patient? a. Take this drug at bedtime because it may cause drowsiness. b. Directly spray the medication away from the nasal septum and gently sniff. c. This drug may be used in maintenance treatment for asthma. d. Limit use of the drug to 5 to 7 days to prevent rebound nasal congestion.

d. Limit use of the drug to 5 to 7 days to prevent rebound nasal congestion.

Beclomethasone has been prescribed for a patient with allergic rhinitis. What should the nurse teach the patient regarding this medication? a. This may be used for an acute attack. b. An oral form is available if the patient prefers to use it. c. Avoid large amounts of caffeine intake because an increased heart rate may occur. d. With continuous use, dryness of the nasal mucosa/lining may occur.

d. With continuous use, dryness of the nasal mucosa/lining may occur.