Chap 54 PrepU

A male client asks the nurse whether antihistamines will help him cope with the symptoms of the common cold. What is the nurse's best response?

"Antihistamines do not relieve symptoms." For treatment of the common cold, studies have demonstrated that antihistamines do not relieve symptoms and are not recommended. However, an antihistamine is often included in prescription and OTC combination products for the common cold

A client asks the nurse how long he should use oxymetazoline (Afrin) nasal spray for nasal congestion. What is the nurse's best response?

"Consult with your primary care provider." Overuse of topical nasal decongestants, such as Afrin, can make the symptoms worse, causing rebound congestion. The client should consult with the primary care provider.

A patient is instructed to take diphenhydramine (Benadryl) after an allergic reaction. Which of the following statements by the patient indicates successful teaching concerning the administration of diphenhydramine (Benadryl)?

"I should not drive my car after taking this medication."

After teaching a client who is receiving an antitussive about the drug, which statement indicates the need for additional teaching?

"I'll keep the room warm and toasty."

A client is receiving dornase alfa at home. Which of the following would the nurse instruct the client to do?

"Protect the drug from light." Clients receiving dornase alfa should be cautioned to store the drug in the refrigerator, protected from light. The nurse also needs to review how to administer the drug using a nebulizer

You are teaching a 61-year-old client about the narcotic antitussive syrup that his physician has prescribed. Which of the following client statements suggests that he understands what you've taught him?

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

A patient is prescribed an antitussive agent with codeine. Which of the following statements by the patient indicates that your teaching has been effective?

"This medication will cause drowsiness, and I will not drive."

After teaching a group of parents about the use of over-the-counter cough and cold products with their children, which statement indicates the need for additional teaching?

"We can use the adult brand, but we just have to decrease the amount." Parents should use the children's, pediatric, or infant formulations of the drug. Over-the-counter cough and cold preparations should not be used in children under the age of 2 years. The parents need to read the label carefully to determine the dosage and frequency, and they need to use the device that comes with the drug to ensure a proper dosage

The health care provider suggests that a client use guaifenesin to help his cough. The nurse instructs the client to call the health care provider if he continues to have a productive cough after which amount of time?

1 week Guaifenesin should not be used for more than 1 week; if the cough persists, encourage the client to seek health care

A client receives diphenhydramine orally. The nurse would expect this drug to begin acting within which time frame?

15 to 30 minutes

A patient receives dextromethorphan. The nurse would expect this drug to begin acting within which time frame?

25 to 30 minutes

A patient receives guaifenesin. The nurse would expect the drug to begin acting within which time frame?

30 minutes

Nasal decongestants would most likely be contraindicated for which one of the following clients?

A client with a history of coronary artery disease Nasal decongestants are likely to be contraindicated in patients with severe hypertension or coronary artery disease because of their cardiac stimulating and vasoconstricting effects.

A patient is admitted to the emergency room after consuming 50 acetaminophen tablets in a suicide attempt. What medication will be administered to counteract the effect of the acetaminophen?

Acetylcysteine (Mucomyst)

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

Antidote for acetaminophen poisoning Oral acetylcysteine is widely used in the treatment of acetaminophen overdosage.

Which agent would the nurse identify as providing local anesthesia to the respiratory passages?

Benzonatate Benzonatate provides local anesthetic action on the respiratory passages, lungs, and pleurae. Ephedrine provides topical nasal decongestant action. Hydrocodone is a centrally acting antitussive that works directly on the medullary cough center. Dextromethorphan acts directly on the medullary cough center

When instructing a patient in how to use a topical nasal spray, which of the following would the nurse emphasize to do first?

Clear the nasal passages

Which agent acts directly on the medullary cough center?

Codeine Codeine, a centrally acting antitussive, works directly on the medullary cough center. Benzonatate provides local anesthetic action on the respiratory passages, lungs, and pleurae. Ephedrine and tetrahydrozoline are topical nasal decongestants

A female client administers diphenhydramine to her child, who experiences seasonal allergies, before his first baseball game. What may the child experience if he has a paradoxical effect to the medication?

Decreased mental alertness First-generation antihistamines (e.g., diphenhydramine) may cause drowsiness and decreased mental alertness in children as in adults.

Which of the following elicits its antihistamine effects by selectively binding to peripheral H1 receptors? (Choose one)

Desloratadine Desloratadine is a second generation antihistamine. Second-generation antihistamines elicit their effects by selectively binding to peripheral H1 receptors. The other answers listed are first-generation antihistamines

Which of the following elicits its antihistamine effects by nonselectively binding to central and peripheral H1 receptors? (Choose one)

Diphenhydramine Diphenhydramine is a first-generation antihistamine. First-generation antihistamines elicit their antihistamine effects be nonselectively binding to central and peripheral H1 receptors. The other answers listed are second-generation antihistamines

What adverse effect of most oral antihistamines presents a priority safety concern for older adult clients?

Drowsiness 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 us

A female client is prescribed a first-generation antihistamine for her allergies. The nurse would expect her to experience what adverse effect?

Dry mouth First-generation antihistamines have substantial anticholinergic effects; therefore, they may cause dry mouth, urinary retention, constipation, and blurred vision.

Which drug is classified as an expectorant?

Guaifenesin (Robitussin) Robitussin is an expectorant that contains guaifenesin. Mucomyst is a mucolytic that contains acetylcysteine. Delsym is a centrally acting antitussive that contains dextromethorphan. Tessalon Perles are a peripherally acting antitussive that contain benzonatate

A patient is using oxymetazoline (Afrin). Which of the following conditions will contraindicate the use of this adrenergic drug?

Hypertension Oxymetazoline is contraindicated in patients with severe hypertension or coronary artery disease because of its cardiac stimulating and vasoconstricting effects. Oxymetazoline is prescribed for nasal congestion. Oxymetazoline is not contraindicated in cough or skin rash

Which of the following instructions would the nurse least likely include in the teaching plan for a patient receiving an antitussive?

Limiting fluids

A group of students are reviewing information about antihistamines. The students demonstrate understanding of the information when they identify which agent as a second generation antihistamine?

Loratadine

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

Maintenance of effective airway clearance Evaluation of the maintenance of effective airway clearance helps in assessing the efficacy of oxymetazoline, which is a decongestant drug. The hydration of the skin, the heart rate and the urine output are usually not changed in decongestant therapy

Which agent would a nurse expect the health care provider to prescribe for a client experiencing motion sickness

Meclizine Meclizine is used to relieve the nausea and vomiting associated with motion sickness. Clemastine, cyproheptadine, and hydroxyzine are used to provide relief of seasonal and perennial allergic rhinitis

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

Mucolytic Dornase alfa (Pulmozyme) is a mucolytic use in the treatment of cystic fibrosis.

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?

Obtain the client's blood pressure.

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

Oxymetazoline

Which of the following is classified as a decongestant? (Choose one)

Oxymetazoline (Afrin)

Which agent would the nurse instruct a client to use orally?

Pseudoephedrine

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 of the following oral decongestant drugs can be administered to the patient?

Pseudoephedrine The patient can take an oral preparation of pseudoephedrine. Xylometazoline, ephedrine, and tetrahydrozoline are usually available only in the form of nasal sprays or drops for topical use

A patient complains of anxiety, restlessness, nausea and vomiting after using a nasal decongestant. Which of the following drugs should the nurse consider as the cause for these side effects?

Pseudoephedrine The side effects of pseudoephedrine include anxiety, restlessness, nausea and vomiting. The drugs ephedrine, epinephrine and phenylephrine do not cause these side effects. Their side effects include nasal burning, stinging, dryness and a rebound nasal congestion

A male client presents to the physician's office with complaints of inability to breathe freely. When the nurse reviews his use of over-the-counter medications, it is discovered that the client routinely uses nasal spray three times a day for 1 year. The nurse knows that what may be causing this client's continuous nasal congestion?

Rebound nasal swelling

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

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

When describing the effects of second-generation antihistamines, which of the following would the nurse address as being decreased?

Sedation The adverse effects most often seen with antihistamine use are drowsiness and sedation. However, second-generation antihistamines are less sedating in many people. The anticholinergic effects associated with both generations include drying of the respiratory and gastrointestinal mucous membranes, gastrointestinal upset and nausea, arrhythmias, dysuria, urinary hesitancy, and skin eruption and itching associated with dryness

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

Sympathomimetics Topical decongestants are sympathomimetic, imitating the effects of the sympathetic nervous system to cause vasoconstriction.

A group of students demonstrate understanding of topical decongestants, identifying them as which of the following?

Sympathomimetics Topical decongestants are sympathomimetics, imitating the effects of the sympathetic nervous system to cause vasoconstriction.

A 62-year-old patient has been prescribed an antihistamine to alleviate vasomotor rhinitis. He complains that he has gastric irritation on taking the tablet. Which of the following instructions should the nurse provide to help alleviate the patient's condition?

Take the tablet with food.

A male client presents to the physician's office for his annual visit. When questioned about over-the-counter medication use, he states that he uses Echinacea to prevent colds. What statement is true about Echinacea?

There is limited or no support for the use of Echinacea to prevent or treat symptoms of the common cold.

A 21-year-old patient complains of a mild stinging sensation on using a nasal spray containing a nasal decongestant. Which of the following information should the nurse provide the patient?

This sensation usually disappears with continued use. The nurse needs to assure the patient that the mild stinging sensation usually disappears with continued use. The drug needs to be stopped only if the stinging sensation is severe. The dose of the medication need not be altered. The physician need not be consulted immediately in the presence of a mild stinging sensation

Parents who treat their children's cold and flu symptoms at home should be reminded to read the labels of any over-the-counter medications they use. What is the most important reason for doing so?

To understand proper use, precautions, and contraindications Anyone using an over-the-counter medication should read the label to understand ingredients, instructions for use, precautions, contraindications, and drug interactions. Because these labels are frequently confusing, users of these products should contact a health care provider if they're unsure whether using a product is safe

Meclizine is used to relieve the nausea and vomiting that occurs with motion sickness.

True

Decongestants elicit their effect by which of the following mechanisms? (Choose one)

Vasoconstriction of small blood vessels of the nasal membranes Vasoconstriction of small blood vessels of the nasal membrane is the mechanism of action for decongestants. First-generation antihistamines act to nonselectively bind to peripheral H1 receptors; the mechanism of action for second-generation antihistamines is to selectively bind to peripheral H1 receptors; and peripherally acting antitussives anesthetize stretch receptors in the respiratory passages

The nursing instructor is teaching the students about antitussives and their side effects. What ingredient found in some antitussives does the instructor tell students sometimes can cause drowsiness?

antihistamine Antitussives that contain an antihistamine may cause drowsiness. The others are not found in antitussives and therefore do not cause the adverse reaction of drowsiness.

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

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

• Cardiovascular disorders • Glaucoma • Diabetes

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 of the following would be most appropriate to include? Select all that apply.

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

Acetylcysteine (Mucomyst) can be used to treat which of the following conditions? (Select all that apply)

• Tracheostomy care • Atelectasis due to mucus obstruction • Pulmonary complications of cystic fibrosis • Post-traumatic chest conditions

A nurse is caring for a patient who has been prescribed a nasal decongestant. Which of the following factors should the nurse assess before administering the drug?

Blood pressure As a pre-administration assessment before giving a nasal decongestant, the nurse should assess the patient's blood pressure, pulse, and respiratory rates. Assessments for disturbed coordination, blurred vision, or auditory tests may be done as an ongoing assessment to check for signs of adverse effects

Acetylcysteine is the antidote for aspirin toxicity.

False Acetylcysteine is used to protect the liver from acetaminophen toxicity.

Which of the following would contraindicate the use of a topical nasal decongestant?

Nasal ulceration Any lesion or erosion in the mucous membranes is a contraindication because of the increased risk for systemic drug absorption.

Your client complains that he has had severe nasal congestion for the last 8 days. He has been using an OTC nasal decongestant spray. You know that this is indicative of:

Rebound nasal congestion. With nasal decongestants, topical preparations are often preferred for short-term use. They 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. Oral drugs are preferred for long-term use.

A college student has presented the campus medical clinic complaining of 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."

The use of centrally acting antitussives, such as codeine, increase the risk for injury related to which of the following? Select all that apply:

• Drowsiness • Dizziness

When antihistamines result in dryness of the mouth, the nurse should recommend which actions to relieve the dryness? Select all that apply.

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

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 you tell the patient about this prescription during discharge counseling? (Select all that apply)

• The patient should drink plenty fluids. • Benzonatate can cause GI upset and sedation.

Ms. Thompson, age 45, is being seen in the physician's office today for complaints of a dry, hacking cough that is keeping her up at night. The physician prescribes dextromethorphan for the cough. Which statement is true about dextromethorphan?

Dextromethorphan works in the medulla to suppress the cough reflex. Dextromethorphan is related chemically to the opiate agonists and can suppress coughing as effectively as narcotics. Cough suppression occurs by several mechanisms, but mainly the drug directly affects the cough center in the medulla. Therapeutic doses do not affect ciliary activity

A patient with a respiratory tract infection is prescribed expectorants by a physician. In which of the following types of patients should a nurse administer expectorants cautiously?

Patients with a persistent cough

Mucolytics are often used for patients with cystic fibrosis, COPD, or tuberculosis.

True

When developing the teaching plan for a patient receiving an antihistamine, which of the following would the nurse include? Select all that apply.

• Advising the patient to avoid alcohol consumption • Using sugarless candies or lozenges to combat dry mouth When taking an antihistamine, the nurse needs to inform the patient to take the drug on an empty stomach, 1 hour before or 2 hours after meals, use sugarless candies to combat dry mouth, to read the labels of OTC medications because they may contain the same ingredient or alcohol, which could increase the risk of adverse effects or toxicity, and to avoid alcohol intake to prevent excess CNS effects

A 75-year-old client is self-administering an oral nasal decongestant. The nurse is concerned that the client is at risk for what conditions? (Select all that apply.)

• Hypertension • Nervousness A major consideration is that older adults are at high risk of adverse effects from oral nasal decongestants (e.g., hypertension, cardiac dysrhythmias, nervousness, insomnia)

A patient with a cough has been prescribed 400 mg of benzonatate daily by a physician. The on-hand availability of benzonatate is a 100 mg softgel capsule. How many capsules will the nurse have to administer to the patient daily?

4 capsules

Your client is complaining of a hacking cough. She asks if taking an antihistamine would be helpful. Your best response is:

Antihistamines are not recommended because they can dry lower respiratory secretions and worsen secretion retention and cough. Many cold remedies are over-the-counter formulations. Although antihistamines are popular over-the-counter drugs because they dry nasal secretions, they are not recommended because they can also dry lower respiratory secretions and worsen secretion retention and cough

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

False

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 physician advises against the medication, for what reason?

Misuse could result in overdose. 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.

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 physician advises against the medication, for what reason?

Misuse could result in overdose. 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.

Your client states that he is taking medication to liquefy secretions in his respiratory tract. However, he cannot recall the name of the medication. He states that the medication is added to a nebulizer. You suspect he is taking which of the following medications?

Mucomyst Mucolytics are administered by inhalation to liquefy mucus in the respiratory tract. Solutions of mucolytic drugs may be nebulized into a face mask or mouthpiece or instilled directly into the respiratory tract through a tracheostomy. Sodium chloride solution and acetylcysteine (Mucomyst) are the only agents recommended for use as mucolytics

A patient is receiving a topical nasal decongestant. The nurse instructs the patient to stop using the drug after which length of time?

5 days A topical nasal decongestant should not be used for longer than 5 days to prevent rebound congestion. Also, if the condition persists longer than 5 days, medical care should be sought

The pharmacology instructor is discussing the adverse effects of diphenhydramine. Which of the following is not one of these effects?

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

A patient presents at the clinic with a dry, nonproductive cough. The patient 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 the physician will prescribe?

Guaifenesin 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