Ch 31: Drug Therapy for Nasal Congestion and Cough

c) Breathing pattern is regular and without difficulty Pg. 623 A regular breathing pattern without difficulty would indicate that the drug is effective because oxymetazoline is a decongestant drug. Hydration of the skin, heart rate, and urine output are usually not affected by this drug.

15. A client is prescribed oxymetazoline. Which assessment data would indicate that the drug is effective? a) Skin is effectively hydrated b) Urine output is at least 30 mL/hr c) Breathing pattern is regular and without difficulty d) Heart rate is maintained at a regular rate and rhythm

c) Antidote for acetaminophen poisoning Pg. 627 Oral acetylcysteine is widely used in the treatment of acetaminophen overdosage.

3. Acetylcysteine may be used as a mucolytic agent. What is an additional indication for the drug? a) Treatment of peptic ulcer disease b) Treatment of bronchospasm c) Antidote for acetaminophen poisoning d) Conversion of cardiac arrhythmias

a) Rebound congestion Pg. 622 An adverse effect that accompanies frequent or prolonged use of these drugs is a rebound congestion, officially called rhinitis medicamentosa.

10. What is an adverse reaction commonly experienced by people taking nasal decongestants? a) Rebound congestion b) Diarrhea c) Headache d) Rash

b) Increase fluids to 2 L/d Pg. 632 Increasing fluid intake helps relieve the discomfort of congestion. The medication does not need to be taken with meals. There is no need to limit fluid intake. Caution is required if the client is pregnant, but requiring two forms of birth control is excessive.

19. A 29-year-old client has sinusitis and has been prescribed a topical nasal decongestant. What instructions should the nurse provide? a) Take the medication with meals b) Increase fluids to 2 L/d c) Temporarily avoid high-sodium foods d) Use two forms of birth control until treatment is complete

b) Misuse could result in overdose Pg. 621 Several OTC cough and cold medicines for use in infants have been recalled voluntarily due to concerns about possible misuse that could result in overdoses.

4. 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? a) The medication is not effective for croup b) Misuse could result in overdose c) The medication is contraindicated for viral infections d) The medication is contraindicated for the child's symptoms

c) Guaifenesin Pg. 620 Guaifenesin is an example of an expectorant. Acetylcysteine is a mucolytic. Dextromethorphan is an antitussive. Benzonatate is an antitussive.

8. A group of nursing students are reviewing information about expectorants. The students demonstrate understanding when they identify which medication as an example? a) Acetylcysteine b) Dextromethorphan c) Guaifenesin d) Benzonatate

c) Guaifenesin Pg. 626 Expectorants, such as guaifenesin, are agents given orally to liquefy respiratory secretions and allow for easier removal. Dextromethorphan and codeine are antitussives used to suppress coughing.

11. A client presents at the clinic with a dry, nonproductive cough. The client is diagnosed with bronchitis, and it is determined that they will need help thinning sputum so that the cough can become productive. What does the nurse expect will be prescribed for the client? a) Codeine b) Aspirin c) Guaifenesin d) Dextromethorphan

c) "How much dextromethorphan have you been taking each day?" Pg. 625 At normal doses, dextromethorphan is known to cause nausea, drowsiness, rash, and difficulty breathing but doses exceeding recommendations can produce hallucinations and disassociation. The question concerning dosage is the most relevant regarding the cause of hallucinations.

27. 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) "Is the dextromethorphan making you dizzy?" b) "Have you been nauseated as well since taking the dextromethorphan?" c) "How much dextromethorphan have you been taking each day?" d) "Have you been taking the dextromethorphan at bedtime?"

b) Antitussives suppress coughing while expectorants loosen bronchial secretions Pg. 627 Mucolytics are agents that break down the thickness of secretions for easier removal. An antitussive is used to relieve coughing for nonproductive coughs only. They are not used for non-productive coughs and do not work on the medulla.

13. A client asks, "What is the difference between antitussive medications and expectorants?" What information should the nurse's response be based upon? a) Antitussives liquefy bronchial secretions while expectorants assist in the expectoration of those secretions b) Antitussives suppress coughing while expectorants loosen bronchial secretions c) Both drug types loosen bronchial secretions for ease of removal d) Antitussives kill cold viruses while expectorants liquefy bronchial secretions

b) Consistency of sputum c) Lung sounds e) Amount of dyspnea Pg. 627 Heart rate and temperature are not required documentation prior to the administration of a mucolytic although they may be helpful in diagnosing an infection. Baseline description of the sputum, lung sounds, and amount of dyspnea are necessary for comparison post treatment to determine efficacy.

14. Prior to administering a mucolytic to a client what must the nurse document. (Select all that apply) a) Temperature b) Consistency of sputum c) Lung sounds d) Heart rate e) Amount of dyspnea

c) Ineffective airway clearance Pg. 628 Acetylcysteine reduces the viscosity of mucous secretions with the ultimate goal of allowing the client to establish and maintain a clear airway. This drug does not directly influence the pattern of breathing. Impaired tissue perfusion can have multiple causes, many of which are unrelated to the presence of mucus secretions.

16. Which nursing diagnosis would provide the clearest indication for the administration of inhaled acetylcysteine? a) Ineffective breathing pattern b) Impaired tissue perfusion c) Ineffective airway clearance d) Risk for infection

b) Stop taking the medication and come to the clinic as ordered by the health care provider Pg. 624 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. The nurse would not instruct the client to change the dosage of any drug, and having the client lie down after each dose will not limit or alleviate sympathomimetic effects of the drug. Continuation of the drug would worsen the adverse effects and could cause serious complications.

17. 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: a) Decrease the dosage by one half b) Stop taking the medication and come to the clinic as ordered by the health care provider c) Continue taking the drug because the sensations will resolve with time d) Lie down after each dose

a) Need to follow the directions for how often to give the drug c) Avoidance of use in children under age 2 e) Importance of reading the label for ingredients and dosage Pg. 630 OTC cough and cold preparations should not be used in children under the age of 4 years. Accurate dosing is essential. Following the directions is essential to prevent inadvertent overdosage. Measuring devices that come with the medication should be used to ensure accurate dosages. Parents should look for the formula for children, infants, or pediatrics.

18. 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.) a) Need to follow the directions for how often to give the drug b) Using adult formulation with smaller doses c) Avoidance of use in children under age 2 d) Using household measuring devices for dosage measurements e) Importance of reading the label for ingredients and dosage

a) Decongestant Pg. 620 Nasal decongestants relieve nasal congestion and swelling by constricting arterioles and reducing blood flow to nasal mucosa. Antihistamines refer to a type of medication that treats allergy symptoms. The goal of antitussive therapy is to suppress nonpurposeful coughing. Expectorants are agents given orally to liquefy respiratory secretions and allow for their easier removal.

2. A client reports to the nurse, "My head is stuffed up and I can't breathe through my nose." Nasal discharge is noted upon examination. The client is diagnosed with a common cold. The nurse should prepare to provide medication instructions related to what classification of medication directed at the client's nasal mucosa? a) Decongestant b) Antitussant c) Antihistamine d) Expectorant

c) Mucolytic Pg. 627 Mucolytic drugs may be used by patients suffering from conditions such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, pneumonia, or tuberculosis to reduce the viscosity of respiratory secretions by direct action on the mucus. Mucolytic drugs increase or liquefy respiratory secretions to aid the clearing of the airways in high-risk respiratory patients who are coughing up thick, tenacious secretions. Expectorants increase the production of respiratory secretions, which in turn appear to decrease the viscosity of the mucus. This helps to raise secretions from the respiratory passages. Antitussives are cough suppressants. Antihistamines are used to treat allergic reactions.

21. A client with cystic fibrosis may use which type of medication to reduce the viscosity of respiratory secretions? a) Antihistamine b) Centrally acting antitussive c) Mucolytic d) Expectorant e) Peripherally acting antitussive

a) Decongestants Pg. 621 Decongestants cause local vasoconstriction that decrease blood flow to irritated and dilated capillaries of the mucous membranes lining the nasal passages and sinus cavities. The vasoconstriction leads to a shrinking of swollen membranes and opens clogged nasal passages promoting drainage of secretions and improved air flow. Antitussives either work directly on the medullary cough center of the brain or act as a local anesthetic on the respiratory passages blocking the effectiveness of the stretch receptors that stimulate a cough reflex. Expectorants liquefy the lower respiratory tract secretions, reducing the viscosity of the secretions and making it easier to cough them up. Mucolytics break down mucus to aid a person in coughing up thick tenacious secretions by separating cells that hold mucus material together.

23. 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? a) Decongestants b) Antitussives c) Mucolytics d) Expectorants

a) "I'll squeeze the bottle to get the medication up into my sinuses" Pg. 623 The client should not squeeze too forcefully, which could send the drug up into the sinuses; the goal is to keep the drug in the nares. Each of the client's other three statements reflect safe and effective medication delivery.

25. The nurse has taught a client to self-administer a topical decongestant. What statement should the nurse follow up with further education? a) "I'll squeeze the bottle to get the medication up into my sinuses" b) "I'll sit upright when I give myself the drug" c) "I won't take the drug if I've got a sore inside my nose" d) "I'll put the tip of the bottle about half an inch into my nostril"

b) Humidification of the environment d) Adequate fluid intake e) Sucking on hard candy or throat lozenges Pg. 632 An adequate fluid intake, humidification of the environment, and sucking on hard candy or throat lozenges can help relieve mouth dryness and cough. The use of astringent mouthwash will only increase mouth dryness.

26. What home remedies are effective for mouth dryness and cough? (Select all that apply.) a) Swishing the mouth with astringent mouthwash b) Humidification of the environment c) Administration of over-the-counter antihistamine d) Adequate fluid intake e) Sucking on hard candy or throat lozenges

d) Misuse could result in overdose Pg. 621 Several OTC cough and cold medicines for use in infants have been recalled voluntarily due to concerns about possible misuse that could result in overdoses.

28. 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? a) The medication is contraindicated for viral infections b) The medication is not effective for croup c) The medication is contraindicated for the child's symptoms d) Misuse could result in overdose

a) A client currently being treated for depression Pg. 622 Clients who take tricyclic or monoamine oxidase inhibitor antidepressants should not receive pseudoephedrine. None of the other options presents a known contraindication to pseudoephedrine.

29. Which client, acknowledging the regular use of pseudoephedrine, should be assessed further for the possible risk of contraindications to the use of this medication? a) A client currently being treated for depression b) A client currently recovering from hip replacement surgery c) A client with an allergy to dairy products d) A client with a history of breast cancer

d) Retention of secretions Pg. 620 Retention of secretions commonly occurs with influenza, pneumonia, upper respiratory infections, acute and chronic bronchitis, emphysema, and acute attacks of asthma.

30. A male client is diagnosed with chronic bronchitis. What would the nurse expect to be one of his physical reports? a) Chronic nasal swelling b) Rhinitis c) Rhinorrhea d) Retention of secretions

c) "There's no evidence that echinacea is effective in treating the cold" Pg. 628 Randomized trials and a meta-analysis have shown no evidence that echinacea is effective in treating the common cold. There is no consensus that vitamin C is helpful. Although oral zinc preparations have demonstrated some reduction of symptoms among adults, no similar benefit has been established among children. Nasal zinc gluconate preparations have been linked to loss of smell.

5. A client diagnosed with the common cold expresses interest in taking echinacea. What information is most appropriate for the nurse to provide? a) "Formulations that include vitamin C are the most effective" b) "Be sure to use the brand recommended by your pharmacist" c) "There's no evidence that echinacea is effective in treating the cold" d) "Echinacea use has been associated with loss of smell"

b) Increase fluid intake Pg. 626 Guaifenesin reduces the viscosity of tenacious secretions by irritating the gastric vagal receptors stimulating respiratory tract fluid. Thus, it increases the volume and decreases the viscosity of respiratory tract secretions. By increasing the amount of fluid ingested, the secretions will become thinner and allow an easier passage for removal. The medication should be taken undiluted to increase effectiveness and taken without food for at least 30 minutes. The nurse should educate the client about reading labels on over-the-counter medications that may interact with guaifenesin to prevent complications.

6. A client is encouraged to take guaifenesin to loosen the secretions due to a viral respiratory infection. What should the nurse suggest to the client to make the medication work more effectively? a) Dilute the liquid medication with water prior to administration b) Increase fluid intake c) Take the medication with other over-the-counter medications to enhance the effect d) Take the medication with food

a) Rebound congestion Pg. 623 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. The other options would present with distinctive symptomology.

7. 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? a) Rebound congestion b) Sinusitis c) A drug allergy d) Bronchitis

d) They are used to break down the thickness of secretions Pg. 627 Mucolytics are agents that break down the thickness of secretions for easier removal. An antitussive is used to relieve coughing for nonproductive coughs only. They are not used for non-productive coughs and do not work on the medulla.

9. The instructor is teaching about the use of mucolytics. The nursing student demonstrates an understanding of the action of the mucolytic drugs when stating which? a) They are used to relieve a nonproductive cough b) They are used to relieve a productive cough c) They are used to depress the cough center in the medulla d) They are used to break down the thickness of secretions

c) "Did the medication contain pseudoephedrine?" Pg. 629 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. While the other options present appropriate assessment questions, none establish if the medication was one restricted by current laws.

1. 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? a) "Have you asked the pharmacist about a substitute medication?" b) "Would you like your health care provider to prescribe something for congestion?" c) "Did the medication contain pseudoephedrine?" d) "How long has it been since you last needed to take a decongestant?"

b) Antidote for acetaminophen poisoning Pg. 627 Oral acetylcysteine is widely used in the treatment of acetaminophen overdosage.

12. Acetylcysteine may be used as a mucolytic agent. What is an additional indication for the drug? a) Treatment of bronchospasm b) Antidote for acetaminophen poisoning c) Treatment of peptic ulcer disease d) Conversion of cardiac arrhythmias

c) A decongestant, an analgesic, and an antihistamine Pg. 628-629 Many over-the-counter cold remedies are combination products that include an antihistamine, a nasal decongestant, and an analgesic. Some may also include an antitussive or an expectorant.

20. The nursing instructor is discussing over-the-counter cold remedies. According to the instructor, these products typically combine a) A stimulant, a decongestant, and an antitussive b) An antihistamine, a stimulant, and a decongestant c) A decongestant, an analgesic, and an antihistamine d) An analgesic, an antitussive, and an antiviral

b) Carefully read the label and adhere to the guidelines for use Pg. 623 In the interest of safety, it is imperative that clients follow the instructions on combination remedies carefully. A health care provider's input is not always necessary, and it is unsafe to continually increase doses. Additional acetaminophen could be dangerous because many combination drugs already contain it.

22. The nurse is providing health education to an adult client who is taking an over-the-counter combination cold and cough remedy. What guidance should the nurse include to best assure medication safety? a) Take the medication with an additional dose of acetaminophen to potentiate therapeutic effects b) Carefully read the label and adhere to the guidelines for use c) Stop taking the medication until you get a prescription from your primary health care provider d) Start with a low dose and gradually increase it until symptoms are relieved

c) High fowler's position Pg. 624 The patient should be standing or sitting during administration of nasal sprays. This is closest to high Fowler's position.

24. 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 a) Side-lying position b) Supine c) High fowler's position d) Semi-fowler's position