Chapter 54: Drugs Acting on the Upper Respiratory Tract

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." Explanation: Measures to assist with cough control when using antitussives include cool temperatures, humidification, lozenges, and increased fluids.

The nurse is teaching a client about the potential for allergic drug reaction. What statement made by a client suggests a need for further teaching?

"If you didn't have allergies as a child, you won't develop allergies later in life." Explanation: Drug allergies can develop later in life, though many appear at a young age. All the other options contain accurate statements.

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

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

25 to 30 minutes Explanation: Dextromethorphan has an onset of action of 25 to 30 minutes.

A client, scheduled to receive one unit of packed red blood cells, has a history of an allergic reaction to a transfusion in the past. What class of medication will assist in preventing a reaction to the packed red blood cell transfusion?

Antihistamines Explanation: Premedication with an antihistamine may be used to prevent allergic reactions with the administration of a transfusion of packed red blood cells. The administration of antimicrobial or antianginal is not recommended for a transfusion reaction. An antipyretic is used to treat the symptom of fever.

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.)

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.

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

Clear the nasal passages. Explanation: Before administering the nasal spray, it would be important to clear the nasal passages to ensure that the medication reaches its intended target thereby promoting effectiveness.

Which agent acts directly on the medullary cough center?

Codeine Explanation: 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.

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 Explanation: People with diabetes, cardiovascular disorders, and glaucoma should be advised to avoid medications that contain pseudoephedrine.

The health care provider has ordered promethazine (Phenergan) for a client who is having a severe allergic reaction. The nurse is aware that this medication is also used to treat what condition?

Nausea and vomiting Explanation: Promethazine is most commonly used in the treatment of nausea and vomiting.

Which is classified as a decongestant?

Oxymetazoline (Afrin) Explanation: Afrin is a decongestant. Xyzal is a second-generation antihistamine. Delsym is a centrally acting antitussive that contains dextromethorphan. Astelin is a second-generation antihistamine.

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

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

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

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

First-generation antihistamines may be effective against what symptoms? (Select all that apply.)

Sneezing Rhinorrhea Cough Explanation: First-generation antihistamines (e.g., chlorpheniramine, diphenhydramine) have anticholinergic effects that may reduce sneezing, rhinorrhea, and cough. They do not have antipyretic effects.

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?

Take the tablet with food. Explanation: If the client has gastric irritation following ingestion of the antihistamine, the nurse should instruct the client to take the tablet with food and not before food. Taking an antacid before the tablet may reduce the absorption of the antihistamine. Drinking ample water before taking the tablet will not help to alleviate the patient's condition.

A male client presents to the health care provider'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. Explanation: There is limited or no support for the use of dietary or herbal supplements to prevent or treat symptoms of the common cold.

Expectorants elicit their effect by which mechanism?

Thinning respiratory secretions Explanation: Thinning respiratory secretions is the mechanism of action for expectorants. Breaking down thick mucus in the lower lungs is the mechanism of action of mucolytics. Depressing the cough center in the brain is the mechanism of action for centrally acting antitussives. Anesthetizing stretch receptors in the respiratory passages is the mechanism of action for peripherally acting antitussives.

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

True Explanation: Mucolytics increase or liquefy respiratory secretions to aid the clearing of the airways in high-risk respiratory patients who are coughing up thick, tenacious secretions. Patients may be suffering from conditions such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, pneumonia, or tuberculosis.

The nurse is planning care for a client who is experiencing excessive respiratory tract secretions. What intervention should the nurse include?

deep breathing and coughing exercises Explanation: With excessive respiratory tract secretions, mechanical measures (e.g., coughing, deep breathing, ambulation, chest physiotherapy, forcing fluids) are more likely to be effective than expectorant drug therapy. Research studies do not support guaifenesin's overall effectiveness, and many authorities do not recommend its use. Pseudoephedrine is not an expectorant, and supplemental oxygen will not loosen secretions.

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

ineffective airway clearance Explanation: 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.

The nurse is providing education for a client who has been prescribed a second-generation antihistamine. Which client statement suggests a need for additional teaching?

"I'm really hoping that these pills will cure my allergies before summer starts." Explanation: Antihistamines mitigate the signs and symptoms of allergies, but they do not cure the problem. Second-generation antihistamines are more expensive than earlier drugs. It is prudent to screen for potential interactions with herbal remedies. Because second-generation drugs do not cause sedation, they may generally be taken at any time.

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

30 minutes Explanation: Guaifenesin has an onset of action of 30 minutes.

The nurse instructs a client who is prescribed a nasal steroid that it may take up to how long before effects may be noted?

7 days Explanation: The onset of nasal steroids is not immediate, and it may take up to 7 days before any changes occur. If no effect occurs within 21 days, the drug should be discontinued.

A client asks the nurse about using dextromethorphan to relieve a cough. What type of cough would the nurse explain is best treated with the drug?

A dry, nonproductive cough Explanation: The major clinical indication for use of dextromethorphan is a dry, hacking, nonproductive cough that interferes with rest and sleep. It is not desirable to suppress a productive cough because the secretions need to be removed. The character, not cause, of the cough is relevant to its treatment with dextromethorphan.

A client exhibiting signs and symptoms of the common cold asks the nurse if taking an antihistamine would be helpful. What is the nurse's best response?

Antihistamines are not recommended for treating a cold. Explanation: Although antihistamines are popular over-the-counter drugs, studies have demonstrated that they are not successful or recommended for the treatment of the common cold. An antibiotic should not be prescribed for the treatment of the common cold, which is a viral disorder.

A 76-year-old client has been prescribed an oral antihistamine. What adverse effect presents a priority safety concern for older adult clients?

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.

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

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

A client informs the nurse about taking pseudoephedrine for the relief of nasal congestion due to the common cold. In which situation should the nurse suggest that the client not use this medication since it is a contraindication for this health care concern?

The client is being treated for severe hypertension. Explanation: Contraindications to pseudoephedrine use include severe hypertension or coronary artery disease because of the drug's cardiac stimulating and vasoconstricting effects. Cataracts are not a contraindication for use, but narrow-angle glaucoma is. Caution should be used in clients with hyperthyroidism, not hypothyroidism. The duration of the cold symptoms does not have any relevance to the use of pseudoephedrine.

A client diagnosed with the common cold asks the nurse about taking an over-the-counter (OTC) cold medications. What statement should the nurse include in client teaching?

"Follow the instructions on the label so that you don't end up making the congestion worse." Explanation: When taken according to their instructions, OTC medications can often be as safe and effective as prescribed medications and are sometimes suggested by the primary health care prescriber. However, clients should be informed that excessive or prolonged use may damage nasal mucosa and produce chronic nasal congestion. Over-the-counter (OTC) cold remedies should not be used longer than 1 week, and clients should be instructed not to use nose drops or sprays more often or longer than recommended on the label. While OTC medications may be cheaper in some cases, they will not cause more side effects. The length of the therapy is dependent on many factors, including the type and dose of the medication.

A client is taking pseudoephedrine. The nurse would assess the client for which adverse effect?

Anxiety Explanation: Adverse effects related to the sympathomimetic effects of pseudoephedrine are more likely to occur, including feelings of anxiety, restlessness, hypertension, sweating, tenseness, tremors, arrhythmias, and pallor.

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 Explanation: 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.

A client prescribed codeine for a persistent, debilitating cough tells the nurse, "I was sure that codeine was a narcotic that people take for pain." The nurse should cite what mechanism of action when describing this use of codeine?

Depression of the cough center in the medulla oblongata Explanation: Antitussives such as codeine suppress cough by depressing the cough center in the medulla oblongata. They do not influence blood flow or desensitize peripheral cough receptors. The RAS is not involved in the cough reflex.

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?

Guaifenesin Explanation: 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.

When describing the action of acetylcysteine in treating cystic fibrosis, which would the nurse need to keep in mind about the drug?

It splits the disulfide bonds that hold mucus together. Explanation: In treating cystic fibrosis, acetylcysteine splits apart the disulfide bonds that are responsible for holding the mucus material together. When used to treat acetaminophen toxicity, the drug protects liver cells from damage because it normalizes hepatic glutathione levels and binds with a reactive hepatotoxic metabolite of acetaminophen. Dornase alfa selectively breaks down respiratory tract mucus by separating extracellular DNA from proteins. Expectorants liquefy secretions.

A nurse is assigned to care for a client who is prescribed dextromethorphan. The client's history reveals that the client is also taking a monoamine oxidase inhibitor for depression. The nurse would assess the client for which effect?

Jerking leg motions Explanation: The nurse should monitor for hypotension, fever, nausea, jerking motions of the le.g., and, in severe cases, coma in a client who has been taking monoamine oxidase inhibitors and is receiving dextromethorphan. Additive antidepressant effect occurs with the interaction of central nervous system (CNS) depressants and antitussives containing codeine. When potassium-containing medications and potassium-sparing diuretics are administered with iodine products, the client may experience hypokalemia, cardiac arrhythmias, or cardiac arrest.

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 Explanation: Loratadine is a second-generation antihistamine. Brompheniramine, promethazine, and meclizine are considered first-generation antihistamines.

What elicits their pharmacological effect by reducing swelling in the nasal passages by vasoconstriction? (Select all that apply.)

Phenylephrine Oxymetazoline Explanation: Answers D and E are decongestants which reduce swelling in the nasal passages by vasoconstriction. A is an antihistamine, B is an expectorant, and C is a centrally acting antitussive.

An older adult client is administered dimenhydrinate. Which is the priority nursing intervention for this client?

Protect from injury. Explanation: Dimenhydrinate causes drowsiness and sedation, which can increase the risk for falls. Since older adults may already be at higher risk, the nurse should institute precautions to protect the client from injury. There is no indication that fluids should be forced. The client will not require IV access unless fluid replacement is prescribed.

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

Which should be observed during ongoing assessment of a client taking a decongestant? (Select all that apply.)

Blood pressure Level of congestion Therapeutic effect Explanation: The ongoing assessment for a client taking a decongestant should include blood pressure, pulse, and asking about level of congestion, therapeutic effect, and adverse reactions.

A client is being evaluated for possible rhinosinusitis. Which assessment question(s) asked by the nurse is most relevant to confirm this diagnosis? Select all that apply.

"Are you experiencing any facial pain?" "Are you feeling any sensation of pressure above your eyes?" "Are you able to breathe through your nose?" "Can you describe what your nasal drainage looks like?" Explanation: In acute rhinosinusitis, the classic symptom triad is purulent nasal drainage, nasal obstruction, and facial pressure and/or pain. While the client may sneeze, this reaction is more associated with a general reaction to seasonal allergies.

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

"Consult with your primary care provider." Explanation: 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. Not all over-the-counter medications are safe for long-term use. Afrin should not be used long term without nasal burning or stinging, or until symptoms are relieved. The primary care provider should be notified to provide medication use information.

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?

"How much dextromethorphan have you been taking each day?" Explanation: 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.

A nurse is teaching a 55-year-old client about fexofenadine prescribed to treat allergic symptoms. Which client statement suggests an understanding of this teaching?

"I should avoid driving after taking this medication." Explanation: After taking fexofenadine or other antihistamines, clients should avoid activities that require being alert (e.g., driving). They should not combine alcohol or other sedating agents with these drugs, since doing so can result in excessive sedation. To avoid the adverse effects of combining multiple antihistamines, clients should consult the prescriber before taking any other medications, particularly cold remedies and products labelled "nighttime" or "PM."

The nurse is educating an adult client diagnosed with rhinosinusitis with viscous clear mucous about the prescribed guaifenesin 400 mg PO every 4 hours. Which statement made by the client establishes the need for further clarification?

"The drug will suppress my cough so I can sleep easier." Explanation: The nurse needs to clarify the statement that the client made regarding that the drug suppresses a cough. The drug liquefies respiratory secretions, so it is easier for the client to expectorate or cough the mucous out of the respiratory tract. The other statements are correct. The client needs to ask a pharmacist before using any over-the-counter preparation to prevent drug interactions, or overdosing drug ingredients that are the same or similar. Drinking adequate amounts of water will help loosen the mucous making it easier to expectorate. The drug absorption is not affected by food intake, so it may be taken with or without meals.

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." Explanation: 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.

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 Explanation: 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.

When describing the benefits of second-generation H1 receptor antagonists to those of first-generation H1 receptor antagonists, the nurse should cite what advantage?

Decreased sedation Explanation: Unlike the first-generation H1 receptor antagonists, the second-generation H1 receptor antagonists do not readily enter the brain from the blood. This selectivity significantly reduces the occurrence of adverse drug reactions, such as drowsiness and sedation, while still providing effective relief of allergic conditions. Adverse effects are not wholly absent, however. Duration of action is 12 to 24 hours, and these drugs are more expensive than first-generation drugs.

A client calls the clinic and reports symptoms of a cold. The client is most concerned because the cold symptoms are preventing him from sleeping. The nurse would inform the client that what medication relieves cold symptoms and aids sleep?

Diphenhydramine Explanation: Antihistamines are clearly useful in allergic conditions, but their use to relieve cold symptoms is controversial. First-generation antihistamines (e.g., chlorpheniramine, diphenhydramine) have anticholinergic effects that may reduce sneezing, rhinorrhea, and cough. Also, their sedative effects may aid sleep. Many multi-ingredient cold remedies contain an antihistamine.

Mr. Zee is prescribed an inhaled nasal steroid to relieve his symptoms associated with seasonal allergies. What is true about inhaled nasal steroids?

Inhaled nasal steroids are more effective than oral medications in treating the global symptoms associated with allergies. Explanation: Inhaled nasal steroidal preparations are used to treat seasonal or perennial allergic rhinitis. In fact, studies indicate that they are superior to oral antihistamines for alleviating nasal, eye, and global allergy symptoms. Common adverse effects of inhaled nasal steroids include a burning or itching sensation and a drying effect on the nasal mucosa. By delivering steroids directly to the nasal passage, inhaled nasal steroids maximize the beneficial therapeutic effects of corticosteroids while minimizing their potential systemic adverse effects, although systemic adverse effects may still occur during long-term or high-dose therapy.

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

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

Mucolytic Explanation: 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.

Which would contraindicate the use of a topical nasal decongestant?

Nasal ulceration Explanation: Any lesion or erosion in the mucous membranes is a contraindication because of the increased risk for systemic drug absorption. Topical nasal decongestants should be used cautiously in patients with hypertension. Topical nasal decongestants should be used cautiously in patients with diabetes. Topical nasal decongestants should be used cautiously in patients with glaucoma.

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. Explanation: Sudafed is a decongestant. Decongestants are used cautiously in clients with a history of hypertension because of the vasoconstrictive effects of the drug. Swelling of nasal passages is a symptom of congestion. A history of hay fever is not a contraindication to taking decongestants. Nausea and vomiting are potential adverse effects but are not as important as assessing blood pressure.

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

Oxymetazoline Explanation: Oxymetazoline is administered by nasal spray. Hydrocodone is administered orally. Dextromethorphan is administered orally. Benzonatate is administered orally.

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

Sedation Explanation: 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 82-year-old client is prescribed an antihistamine for the relief of allergic rhinitis. Which findings would the nurse most likely assess in this client? Select all that apply.

Sedation Dry throat Confusion Explanation: A nurse is more likely to observe sedation, dry throat, and confusion in an older adult client receiving an antihistamine. Hypotension, and not hypertension, is seen in such cases. Bradycardia is not an adverse reaction with the use of antihistamines.

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

This sensation usually disappears with continued use. Explanation: 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.

What hospital procedure has the greatest potential to cause an anaphylactoid reaction?

administration of contrast media for diagnostic tests Explanation: Contrast media for radiologic diagnostic tests are often implicated in anaphylactoid reactions. The other options present a lesser risk for the development of an anaphylactoid reaction.

A client has just been admitted for an overdose of pseudoephedrine. The nurse's assessment of the client should prioritize what system?

cardiovascular Explanation: Because pseudoephedrine is a stimulant, cardiac symptoms are a notable adverse effect, especially in the acute stage of the overdose. All the other systems should be monitored, but the cardiac-related adverse reactions have priority.

The nurse is educating an adult client diagnosed with a nonproductive cough about the prescribed dextromethorphan. Which statement made by the client establishes the need for further clarification?

"I will dilute the drug syrup with an equal amount of water." Explanation: The nurse needs to clarify the statement that the client made regarding diluting the drug with equal amount of water because this would decrease the soothing effect on pharyngeal mucosa. The other statements are correct. Eating or drinking decreases effectiveness of drug to soothe mucosa of the pharynx. The drug is only to be taken for nonproductive dry, hacking cough. If the cough becomes productive, the client should stop the drug and notify the prescriber. The drug should be taken only as directed on the package or by prescriber because exceeding the dosage can result in hallucinations.

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." Explanation: Frequent, long-term, or excessive use of decongestants induces rebound congestion. Rebound congestion occurs when the nasal passages become congested as the drug effect wears off and the body compensates by vasodilating the same nasal arterioles that the drug constricted. This does not occur because of the ineffectiveness of decongestants, however. Dosing should be based on the instructions provided.

The nurse prepares to administer acetylcysteine by nebulization to an adult client diagnosed with chronic bronchitis. Which measures would the nurse provide for safe and effective drug administration? Select all that apply.

Administer prescribed bronchodilator aerosolized treatment 10 to 15 minutes before the acetylcysteine treatment. Assess for improvement in coughing up increased amounts of mucous, respirations less than 26, and SaO2 greater than 90%. Report dyspnea, chest tightness, bronchospasms, and inability to expel secretions to the prescriber. Explanation: The nurse should instruct the client that the mucolytic drug attacks protein bonds in mucous and liquefies it, so it is easier to expel the mucous. Guaifenesin, an expectorant, irritates gastric vagal receptors stimulating respiratory tract fluid to increase and liquifies the mucous. The bronchodilator is administered first to dilate the bronchi so that the mucolytic will be more effective. The optimal times to administer the drug are upon rising, before meals, and at bedtime to effectively remove mucous that causes problems with breathing. Providing the drug after meals will increase nausea and vomiting, potential adverse effects. Therapeutic effects the nurse assesses includes increase in mucous raised from the lungs, a decrease of respirations to a normal range, and stabilization of SaO2 at 90% or greater. The nurse would report adverse effects to the prescriber that reflect the drug is not therapeutic, including chest tightness, bronchospasm, and inability to expel mucous.

A nursing student is researching which antihistamine drug that elicits its antihistamine effects by selectively binding to peripheral H1 receptors?

Desloratadine Explanation: Desloratadine is a second-generation antihistamine. Second-generation antihistamines elicit their effects by selectively binding to peripheral H1 receptors only. First-generation antihistamines, such as diphenhydramine, brompheniramine, and clemastine, elicit their antihistamine effects by nonselectively binding to central and peripheral H1 receptors.

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 Explanation: Vasoconstriction of small blood vessels of the nasal membranes 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 only; and peripherally acting antitussives anesthetize stretch receptors in the respiratory passages.

A nurse is describing the action of a prescribed antihistamine to a client. The nurse is describing which medication, by explaining that the drug elicits its antihistamine effects by nonselectively binding to central and peripheral H1 receptors?

Diphenhydramine Explanation: Diphenhydramine is a first-generation antihistamine. First-generation antihistamines elicit their antihistamine effects by nonselectively binding to central and peripheral H1 receptors. Second-generation antihistamines, such as cetirizine, fexofenadine, and loratadine, elicit their effects by being selective for peripheral H1 receptors only.