ch 31 prepU

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.

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.

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."

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

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

Breathing pattern is regular and without difficulty.

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 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

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.

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

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

Guaifenesin

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)

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

Mucolytic

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

Oxymetazoline

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

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

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

Soothing irritated pharyngeal mucosa

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

Sympathomimetics

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.

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

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

deep breathing and coughing exercises

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.

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.

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."

Which agent acts directly on the medullary cough center?

Codeine

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.

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.

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

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."

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 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.

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 is a major cause of sinus infections?

inflammatory processes

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