Chapter 54 Drugs Acting on the Upper Respiratory Tract PrepU
A client has expressed frustration stating, "I've been taking an over-the-counter (OTC) decongestant for several days and it still hasn't really cured my cold." What teaching point should the nurse convey to the client?
"Drugs like this can often relieve some of the symptoms of a cold, but they won't cure it."
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."
The nurse is educating an older adult client diagnosed with rhinosinusitis in an outpatient clinic about the prescribed topical oxymetazoline. The client has a history of hypertension and coronary artery disease. Which statement made by the client establishes the need for further clarification?
"I can take over-the-counter pseudoephedrine, too."
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."
Which statement by the clinet would alert the nurse that more educatin is needed regarding a client receiving an antitussive?
"I should keep the room warm."
A client is instructed to take diphenhydramine after an allergic reaction. Which statement by the client indicates successful teaching concerning the safe and effective use of diphenhydramine?
"I should not drive my car after taking this medication."
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."
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."
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."
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."
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."
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."
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.
What statement made by a client suggests a need for further teaching on the risk factors associated with drug allergies?
"If you didn't have allergies as a child, you won't develop allergies later in life."
Fexofenadine (Allegra) is prescribed for a client with seasonal allergies. What should the nurse teach the client about the side effects of this medication?
"Less drowsiness occurs with this medication compared to other antihistamines."
A client is receiving dornase alfa at home. Which would the nurse instruct the client to do?
"Protect the drug from light."
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
A client has hypertension and wants to take a nasal decongestant for cold symptoms. Which statement by the nurse indicates the effect of hypertensive medications on hypertension?
"The administration of a nasal decongestant will increase blood pressure due to vasoconstriction of blood vessels."
When providing health education to a client prescribed diphenhydramine, what information should the nurse convey to the client?
"This drug is likely to make you feel drowsy."
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 client is prescribed an antitussive agent with codeine. Which statement by the client indicates that the nurse's teaching has been effective?
"This medication will cause drowsiness, and I will not drive."
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."
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."
difference between the 1st and 2an generation histamine
- 1st generation bind non-selectivity to central and peripheral H1 receptors and many result in CNS stimulation or depression -2nd generation are selective for peripheral H1 receptors and as a group are less sedating
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
What should the client be told about nasal drops? (Select all that apply.)
-Recline on a bed and hang your head over the edge. -After using the drops keep head down and rotate it from side to side. -Do not share the container with anyone. -Nasal burning or stinging may occur with the use of topical decongestants.
While using a decongestant, a client should be instructed to call the physician if which occur? (Select all that apply.)
-Symptoms do not improve in seven days. -A high fever develops.
what are the interventions of comfort measure for patient with viral condition
-antihistamines to relieve allergy symptoms -decongestants to reduce nasal edema antitussives, mucolytic, and expectorants to treat accompanying cough
what are common upper respiratory disorders?
-infections -allergic rhinitis -coughs -the common cough -congestion
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
what are three types of histamines
1) H1- contract smooth muscle and dilate capillaries 2) H2- heart rate and gastric secretions increase when activated 3) receptor located throughout the nervous system
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
When should a client prescribed diphenhydramine take the medication to prevent motion sickness during a ferry boat ride?
30 to 60 minutes before the ferry trip
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
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 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
A 71-year-old man with a history of heart disease and diabetes has had an antihistamine prescribed. The nurse is concerned with this prescription because of the risk for what? A) Cardiac arrhythmias B) Increased salivation and choking C) Severe constipation D) Insomnia
A
A patient presents at the clinic with signs and symptoms of seasonal allergic rhinitis. The patient is prescribed a nasal steroid to relieve symptoms. Two days later, the patient calls the clinic and tells the nurse that he is frustrated and wants a new drug. What is the most appropriate response by the nurse? A) It may take up to 2 weeks to get the full clinical effect. Try to keep using the drug as ordered. B) The drug must not work for you. Lets change to an oral steroid. C) You probably are administering the drug incorrectly. Come in and we can review the process. D) You probably need to try a different nasal steroid. This one should be effective by now.
A
Parents who treat their childrens cold and flu symptoms at home should be educated concerning the reading and understanding of over-the-counter (OTC) labels. Why is this statement true? A) Many of these preparations contain the same active ingredients so that inadvertent overdose is a common problem. B) Each product is best used for alleviating a particular symptom. C) Some of these products do not contain any drugs. D) Some of these products could interfere with breast-feeding.
A
A patient has been using guaifenesin for a cough that accompanied a common cold. The patient calls the nurse help line and states that she thinks she is having an adverse reaction to the medication. The nurse knows that which symptoms are adverse effects of this medication? (Select all that apply.) A) Nausea B) Rash C) Constipation D) Bleeding E) Headache
A B E
A patient has been prescribed an antihistamine for treatment of allergic rhinitis. What statements by the patient indicate an understanding of this medication? (Select all that apply.) A) This medication will work best if I take it before I eat anything. B) I need to drink less fluid while I take this medication to help reduce the amount of mucus I have. C) I will use sugarless candies to help with the feelings of a dry mouth. D) I will use a humidifier in the bedroom while I sleep. E) This medication will probably cause my appetite to increase.
A C D
Nasal decongestants would most likely be contraindicated for which client?
A client with a history of coronary artery disease
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 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
A nurse administers an antitussive agent cautiously to a client with asthma for which reason?
A loss of respiratory reserve can occur.
A client is admitted after overdose with acetaminophen. What medication would the nurse expect to be administered?
Acetylcysteine
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)
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
Mr. Johnson is prescribed pseudoephedrine to relieve his nasal congestion. What should the nurse include in patient and family education? Select all that apply.
Advise him to avoid excessive and frequent use of the drug. Advise him not to take other OTC drugs.
Acetylcysteine may be used as a mucolytic agent. What is an additional indication for the drug?
Antidote for acetaminophen poisoning
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
A client reports a hacking cough. The client asks if taking an antihistamine would be helpful. The nurse's best response is:
Antihistamines are not recommended because they can dry lower respiratory secretions and worsen secretion retention and cough.
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 client is taking pseudoephedrine. The nurse would assess the client for which adverse effect?
Anxiety
An adult client has asked the nurse to recommend an OTC cold remedy. Before making a recommendation, the nurse should implement which intervention?
Assess the client for health problems that may contraindicate the use of a particular remedy.
A male client presents to the physician's office with allergy-related symptoms that interfere with his job as a car salesman. What nasal spray does the nurse expect the physician to order?
Azelastine (Astelin)
A 29-year-old female patient has sinusitis, so the physician orders a topical nasal decongestant. What instructions should be given? A) Avoid becoming pregnant during decongestant therapy. B) Increase fluids to 2 L/d. C) Restrict fluids to 500 mL/d. D) Take the medication with meals.
B
A patient has been prescribed a nasal steroid and asks the nurse what the most common reason that this medication is used to treat. What is the nurses best response? A) Nasal steroids are only used to treat a sinus infection. B) Nasal steroids are used to treat allergic rhinitis. C) Nasal steroids are used for an infection in the adenoids. D) Nasal steroids are used for all acute upper respiratory infections.
B
A patient presents at the clinic with a dry nonproductive cough. The patient is diagnosed with bronchitis and it has been determined that assistance is needed in thinning the sputum so the cough can become productive. What does the nurse expect the physician will prescribe? A) Benzonatate (Tessalon) B) Guaifenesin (Mucinex) C) Dextromethorphan (Benylin) D) Hydrocodone (Hycodan)
B
The nurse is caring for a patient who is receiving acetylcysteine (Mucomyst) by face mask. What would be an appropriate nursing diagnosis? A) Impaired swallowing B) Risk for impaired skin integrity C) Risk for falls D) Sleep deprivation
B
The nurse is giving discharge instructions to a patient with an upper respiratory infection who has been advised to take an over-the-counter (OTC) topical nasal decongestant. The nurse advises the patient about what common adverse reaction to these medications? A) Diarrhea B) Rhinitis medicamentosa C) Rash D) Headache
B
What would be the nurses best response if a patient calls the clinic and reports that he has had a persistent cough for 2 weeks and asks the nurse for a recommendation for a cough medicine? A) Antitussives B) Decongestants C) Expectorants D) Mucolytics
B
A client is experiencing allergy symptoms after being exposed to environmental dust. This reaction involves the action of histamine, which is released by what cells?
Basophils
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.
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
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
The nurse is assessing a client who is taking diphenhydramine for relief of seasonal allergies. Which finding should prompt the nurse to suspect that the resident is experiencing an anticholinergic effect of the medication?
Blurry vision
A critically ill client with a diagnosis of ventilator-associated pneumonia has been administered acetylcysteine. The inhalation of acetylcysteine helps to liquefy secretions in the respiratory tract by what mechanism?
Breaking the protein bonds that exist in mucus
A client is prescribed oxymetazoline. Which assessment data would indicate that the drug is effective?
Breathing pattern is regular and without difficulty.
A nurse is caring for a 15-year-old patient with cystic fibrosis who has been prescribed dornase alfa (Pulmozyme) to relieve the buildup of secretions and keep airways open and functioning longer. What will the nurse instruct the patient to do concerning the use of this drug? A) Use in home nebulizer up to four times a day if needed. B) Stop all other medications while using the drug. C) Store the drug in the refrigerator, protected from light. D) Expect a severe headache after each use.
C
A patient has an important presentation to make in 4 hours and he needs relief from the congestion of seasonal rhinitis. The patient calls the nurse, explains the situation, and tells the nurse that he cannot afford to be drowsy. Which antihistamine would be a good choice for this patient? A) Diphenhydramine (Benadryl) B) Dexchlorpheniramine (Polaramine) C) Loratadine (Claritin) D)
C
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.
A female client is diagnosed with type 2 diabetes mellitus, hyperlipidemia, and mild hepatic impairment. She presents to the emergency department after taking promethazine, obtained from a friend, for motion sickness. The nurse would expect what adverse effect?
Cholestatic jaundice
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
When instructing a client in how to use a topical nasal spray, what would the nurse emphasize to do first?
Clear the nasal passages.
Which of the following would a nurse identify as a first generation antihistamine? Select all that apply.
Clemastine Dimenhydrinate
Which agent acts directly on the medullary cough center?
Codeine
A client in the renal unit has developed allergic rhinitis. The health care provider has ordered fexofenadine 60 mg twice daily. What is the priority nursing action in this situation?
Contact the provider.
A client having an allergic reaction to mold, describes chest tightness and difficulty breathing. Which process is occurring?
Contraction of smooth muscle in the bronchi
22. A patient visits the clinic and is diagnosed with acute sinusitis. To promote sinus drainage, what medication might be ordered? A) Topical nasal steroid decongestants B) First-generation antihistamines C) Second-generation antihistamines D) Topical decongestants
D
The nursing instructor is discussing the administration of nasal spray with the nursing students. What information is most important to include in this discussion? A) Finish the bottle of nasal spray to clear the infection effectively. B) Nasal spray can be shared between family members only. C) Administer the nasal spray in a prone position. D) Overuse of nasal spray may cause rebound congestion.
D
What disorders would the pharmacology instructor tell the nursing students may be exacerbated by the use of nasal decongestants? A) Pneumonia B) Rheumatoid arthritis C) Acid reflux D) Hypothyroidism
D
What statement by a 61-year-old patient who is to take an antitussive with codeine indicates that the nurses teaching has been effective? A) I will take this medication anytime I start to cough. B) This medication may make me anxious and nervous. C) I should call the physician if I develop nausea, diarrhea, or stomach cramps while taking this medication. D) This medication can cause drowsiness, so I will avoid driving or using power equipment while I take it.
D
What statement by the patient leads the nurse to believe that he needs additional instruction regarding his nasal decongestant? A) I will blow my nose before instilling the nasal spray. B) I will report any dizziness, drowsiness, or rapid pulse. C) I will drink 2,000 to 3,000 mL of fluid daily. D) I will use it only when I have nasal discharge.
D
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 female client administers diphenhydramine to her 9-year-old male 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
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.
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
Before administering a mucolytic drug to a client with an upper respiratory infection, which would the nurse need to assess?
Degree of dyspnea
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
A nursing student is researching which antihistamine drug that elicits its antihistamine effects by selectively binding to peripheral H1 receptors?
Desloratadine
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
A 45-year-old female client is being seen in the physician's office for 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.
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
Decongestants should be used cautiously in clients with which conditions? (Select all that apply.)
Diabetes Glaucoma
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
An adult client has reported experiencing a dry mouth and urinary retention after several nights of taking an over-the-counter (OTC) sleep aid. The nurse should suspect that this medication contains what antihistamine?
Diphenhydramine
What elicits its antihistamine effects by nonselectively binding to central and peripheral H1 receptors?
Diphenhydramine
A 76-year-old client has been prescribed an oral antihistamine. What adverse effect presents a priority safety concern for older adult clients?
Drowsiness
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
The pharmacology instructor is discussing the adverse effects of diphenhydramine. Which is not one of these effects?
Excessive salivation
Second generation antihistamines are associated with a higher risk of sedation than first generation antihistamines
False
Acetylcysteine is the antidote for aspirin toxicity.
False Acetylcysteine is used to protect the liver from acetaminophen toxicity.
A client is taking phenelzine (Nardil), a monoamine oxidase inhibitor, for depression. The client started taking dextromethorphan (Robitussin) over the counter without consulting his physician. The use of these two medications is contraindicated. Which symptoms might the patient exhibit? (Select all that apply.)
Fever Coma
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 group of nursing students are reviewing information about expectorants. The students demonstrate understanding when they identify which medication as an example?
Guaifenesin
Which drug is classified as an expectorant?
Guaifenesin (Robitussin)
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
The nursing instructor is teaching their lab students the best position for the administration of nasal sprays. What position would the instructor teach the students?
High Fowler's
What is the chemical mediator released in immune and inflammatory response to allergic reactions?
Histamine
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
When teaching a patient who is receiving pseudoephedrine about possible adverse effects, what would the nurse include? (Select all that apply.)
Hypertension Anxiety Restlessness
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 nurse is assigned to care for a patient who has to be administered dextromethorphan. From the patient's medical history, the nurse knows that the patient has been taking monoamine oxidase inhibitors. Which of the following effects of interaction of the two drugs should the nurse monitor for in this patient?
Hypotension, fever, nausea
The nurse is providing education to a client diagnosed with the common cold. What measure should the nurse recommend implementing to help liquefy cold-related secretions?
Increasing fluid intake
Acetylcysteine (Mucomyst) is primarily administered by which route when being used to thin secretion? (Select all that apply.)
Instilled into a tracheostomy Inhalation
The physician has order promethazine (Phenergan) for a client who is nauseated and vomiting. Which would be an appropriate route of administering promethazine to the client? (Select all that apply.)
Intramuscularly Intravenously
A client has been suffering from repeated sinus infections. The client is diagnosed with allergic rhinitis. The client is prescribed a daily antihistamine. What is the mechanism of action in the antihistamine medications?
It prevents histamine from acting on target tissues.
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.
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 client reports increased sedation after the initiation of chlorpeniramine to treat her allergies. Which antihistamines could the nurse recommend to the client to treat her allergy symptoms that would result in less sedation? (Select all that apply.)
Loratadine (Claritin) Cetirizine (Zyrtec)
What should be observed during ongoing assessment of a client taking an antitussive? (Select all that apply.)
Lung sounds Frequency of cough Therapeutic effect Pain assessment
A client is prescribed oxymetazoline, a decongestant, for the treatment of hay fever. What should the nurse evaluate to assess the efficacy of therapy?
Maintenance of effective airway clearance
A patient is prescribed oxymetazoline, a decongestant, for the treatment of hay fever. What should the nurse evaluate to assess the efficacy of therapy?
Maintenance of effective airway clearance
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
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.
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.
A client with cystic fibrosis may use which type of medication to reduce the viscosity of respiratory secretions?
Mucolytic
A male 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. The nurse suspects he is taking:
Mucomyst
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
Which would contraindicate the use of a topical nasal decongestant?
Nasal ulceration
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.
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
The physician 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
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.
Decongestants are available in which dosage forms? (Select all that apply.)
Oral tablets Nasal sprays Nasal drops
Which of the following would the nurse expect to administer as a nasal spray?
Oxymetazoline
Which would the nurse expect to administer as a nasal spray?
Oxymetazoline
Which is classified as a decongestant?
Oxymetazoline (Afrin)
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
Codeine containing antitussives should be used cautiously in clients with which conditions? (Select all that apply.)
Pregnancy Convulsive disorders Prostatic hypertrophy
Some antihistamines can produce significant sedation. Which drug is most likely to cause this adverse effect?
Promethazine
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
A patient reports anxiety, restlessness, nausea, and vomiting after using a nasal decongestant. Which drug should the nurse consider as the cause for these side effects?
Pseudoephedrine
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
What is an adverse reaction commonly experienced by people taking nasal decongestants?
Rebound congestion
The instructor is discussing adverse effects associated with nasal decongestants. What is an effect of excessive use of these products when admnistered correctly?
Rebound nasal congestion
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 male client presents to the health care provider's office with reports 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 reports?
Retention of secretions
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.
A gerontological nurse has encouraged a group of caregivers who work with older adults to avoid administering first-generation H1 receptor antagonists to their clients. The nurse's cautionary message is an acknowledgment of what possible nursing diagnosis?
Risk for falls related to sedation
When describing the effects of second-generation antihistamines, which would the nurse address as being decreased?
Sedation
A patient, aged 82 years, is prescribed an antihistamine for the relief of allergic rhinitis. An older age predisposes the patient to a higher risk of adverse effects. Which adverse effects is a nurse more likely to observe in the patient? (Select all that apply.)
Sedation Dryness of throat Confusion
When describing the action of dornase alfa in treating cystic fibrosis, the nurse understands that this drug:
Separates extracellular DNA from protein in mucus
First-generation antihistamines may be effective against what symptoms? (Select all that apply.)
Sneezing Rhinorrhea Cough
When antihistamines result in dryness of the mouth, the nurse should recommend which actions to relieve the dryness? Select all that apply.
Suck on sugarless hard candy. Offer ice chips. Take frequent sips of water.
When the use of antihistamines result in dryness of the mouth, the nurse should recommend which to relieve the dryness? Select all that apply.
Suck on sugarless hard candy. Offer ice chips. Take frequent sips of water.
A group of students demonstrate understanding of topical decongestants, identifying them as:
Sympathomimetics
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 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.
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 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.
The parent of a toddler asks about giving an over-the-counter (OTC) cough and cold product containing pseudoephedrine to the child. What information regarding safety and efficacy should the nurse offer?
There are concerns among health professionals about how safe and effective these medications are.
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.
The nursing instructor is discussing the use of nasal decongestants and shares what reason for their effectiveness?
They come into direct contact with nasal mucosa.
Expectorants elicit their effect by which mechanism?
Thinning respiratory secretions
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.
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
After teaching a group of nursing students about the uses of acetylcysteine, the instructor determines that the teaching was successful when the students identify which of the following? Select all that apply.
Tracheostomy care Atelectasis due to mucus obstruction Pulmonary complications of cystic fibrosis Posttraumatic chest conditions
Meclizine is used to relieve the nausea and vomiting that occurs with motion sickness.
True
Mucolytics are often used for patients with cystic fibrosis, COPD, or tuberculosis.
True
A client is prescribed epinephrine for the treatment of anaphylaxis. This client is experiencing what type of hypersensitivity reaction?
Type I
The nurse is giving discharge instructions to a client with an upper respiratory infection. The client has been advised to take an over-the-counter (OTC) topical nasal decongestant. What should the nurse teach the client in order to prevent rhinitis medicamentosa?
Use the medication for as short a time as possible
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
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
Nasal decongestants would be contraindicated for which client?
a client with a history of coronary artery disease
Rebound congestion
a process that occurs when the nasal passages become congested as the effect of a decongestant drug wears off; patients tend to use more drug to decrease the congestion, and a vicious circle of congestion, drug, and congestion develops, leading to abuse of the decongestant; also called rhinitis medicamentosa
The nurse is teaching a patient how to self-administer a medication that is contained in a nasal aerosol. The nurse knows the patient needs further instruction if she tells the nurse what information? (Select all that apply.) a. "I will press the canister and sniff twice and then blow out through my nose." b. "I will shake the medication well before using it." c. "I will blow my nose right before and right after I use the nasal aerosol." d. "I will lie down on the couch when I use this medication." e. "Just the tip of the applicator should be place inside my nostril."
a. "I will press the canister and sniff twice and then blow out through my nose." c. "I will blow my nose right before and right after I use the nasal aerosol." d. "I will lie down on the couch when I use this medication." (Rationale: The patient should place the medication cartridge into the plastic nasal adapter and shake it well. The tip of the applicator should be placed inside the nostril. The patient should sit upright and tilt the head back, then firmly press on the canister once to deliver the drug; the patient inhales, holds his breath for a few seconds, then exhales. The patient should keep the head tilted back for a few minutes and should not blow the nose for at least 2 minutes after the medication delivery.)
The nurse is caring for a patient who will be going home with a prescription for an antitussive. What discharge instructions are most important for the nurse to share with this patient? (Select all that apply.) a. "Use sugarless candy if this medication causes you to experience a dry mouth." b. "This drug may cause you to have diarrhea." c. "If this cough continues for a week, please contact your physician." d. "Don't drive or use heavy machinery because this medication may cause sedation." e. "While you are taking this medication, limit the amount of fluids that you drink."
a. "Use sugarless candy if this medication causes you to experience a dry mouth." c. "If this cough continues for a week, please contact your physician." d. "Don't drive or use heavy machinery because this medication may cause sedation." (Rationale: Traditional antitussives can cause patients to experience CNS effects such as drowsiness and sedation, so the patient shouldn't drive or use heavy machinery until the effect on the patient is known. These medications can lead to nausea, constipation, and complaints of dry mouth. Patients should increase fluid intake and suck on sugarless candies.)
The nurse is conducting a class for parents of newborns about the use of over-the-counter cough and cold medications. The nurse encourages the parents to follow which important safety information? (Select all that apply.) a. Do not give over-the-counter (OTC) medications to your child until he is older than 2 years. b. Do not give your child more than one cough and cold preparation at the same time. c. Carefully follow the directions in the "Drug Facts" section of the label. d. Cough and cold products can also be used to help your child go to sleep. e. Give your child half the adults dose if pediatric dosage instructions are not available.
a. Do not give over-the-counter (OTC) medications to your child until he is older than 2 years. b. Do not give your child more than one cough and cold preparation at the same time. c. Carefully follow the directions in the "Drug Facts" section of the label. (Rationale: Information that is important for parents includes: OTC medications for cough and cold should not be given to children under the age of 2, and extreme caution should be used if the child is age 2 to 6; do not give a child OTC cough and cold preparations unless they are labeled for pediatric use; always check the "Active Ingredients" on the drug label; do not give a child more than one cough and cold medication at the same time; follow the "Drug Facts" section of the label and follow the directions for how often the drug can be given; use the measuring spoons that come with the medication; always use child-proof caps; use the medication to treat only those symptoms that are affecting the child, and consult a doctor if the child's condition doesn't improve; do not use these products to help your child sleep; and tell the physician the names of any OTC products that the child is using.)
The nursing instructor is teaching a group of nursing students about oral nasal decongestants. The nursing students correctly identify what adverse effects as being sympathomimetic reactions? (Select all that apply.) a. Increased pulse b. Pallor c. Cold, moist skin d. Feelings of sadness e. Arrhythmias
a. Increased pulse b. Pallor e. Arrhythmias (Rationale: Sympathomimetic reactions include increased pulse and blood pressure, pallor, sweating, arrhythmias, feelings of anxiety, tension, and dry skin. These reactions do not include cold, moist skin or feelings of sadness.)
An antihistamine would be the drug of choice for treating which conditions? a. Itchy eyes b. Irritating cough c. Nasal congestion d. Runny nose e. Idiopathic urticaria f. Thick, tenacious secretions
a. Itchy eyes c. Nasal congestion d. Runny nose e. Idiopathic urticaria
Common adverse effects associated with the use of topical nasal steroids would include which conditions? a. Local burning and stinging b. Dryness of the mucosa c. Headache d. Constipation and urinary retention e. Fungal infections f. Osteonecrosis
a. Local burning and stinging b. Dryness of the mucosa c. Headache e. Fungal infections
When describing the action of dornase alfa in treating cystic fibrosis, the nurse understands that this drug does what? a. Separates extracellular DNA from protein in mucus b. Binds with a metabolite that is toxic to the liver c. Splits the disulfide bonds that hold mucous material together d. Liquefies secretions to decrease viscosity
a. Separates extracellular DNA from protein in mucus (Rationale: Dornase alfa selectively breaks down respiratory tract mucus by separating extracellular DNA from proteins. Expectorants liquefy secretions. Acetylcysteine, in treating CF, splits apart the disulfide bonds that are responsible for holding the mucous material together. Acetylcysteine protects liver cells from damage because it normalizes hepatic glutathione levels and binds with a reactive hepatotoxic metabolite of acetaminophen.)
The nurse is caring for a patient who is receiving acetylcysteine by aerosol. The nurse is aware that this patient is at risk for what adverse effects? (Select all that apply.) a. Stomatitis b. Mucus plug c. Nasal congestion d. Nausea e. Bronchospasm
a. Stomatitis d. Nausea e. Bronchospasm (Rationale: Acetylcysteine is a mucolytic that is delivered by aerosol to help thin secretions. Adverse effects include nausea, stomatitis, urticaria, bronchospasm, and rhinorrhea. The patient would not be at risk for nasal congestion or mucus plug because the action of the medication is to thin secretions.)
When developing the teaching plan for a patient receiving an antihistamine, what would the nurse include? (Select all that apply.) a. Taking the drug on an empty stomach b. Encouraging the patient to engage in usual activities such as driving c. Reading the labels of OTC medications because they may contain the same ingredient d. Advising the patient to avoid alcohol consumption e. Using sugarless candies or lozenges to combat dry mouth f. Stopping the drug after 3 days if no relief is obtained
a. Taking the drug on an empty stomach c. Reading the labels of OTC medications because they may contain the same ingredient d. Advising the patient to avoid alcohol consumption e. Using sugarless candies or lozenges to combat dry mouth (Rationale: 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. The patient should not drive because of the sedation that occurs with antihistamines. The patient should not stop the medication without the physician's approval.)
Additional nursing interventions for clients receiving antihistamines would probably include which recommendations? a. Using a humidifier b. Advising the client to suck sugarless lozenges to help relieve the dry mouth c. Limiting fluid intake to decrease swelling d. Providing safety measures to prevent falls or injury e. Encouraging pushing fluids, if allowed f. Leaving bowls of water around the house to increase humidity
a. Using a humidifier b. Advising the client to suck sugarless lozenges to help relieve the dry mouth d. Providing safety measures to prevent falls or injury e. Encouraging pushing fluids, if allowed f. Leaving bowls of water around the house to increase humidity
Antihistamines should be used cautiously in patients with a. histories of arrhythmias or prolonged QT intervals. b. COPD or bronchitis. c. asthma or seasonal rhinitis. d. angioedema or low blood pressure.
a. histories of arrhythmias or prolonged QT intervals
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
The nursing instructor is teaching about antitussives and their side effects. What ingredient found in some antitussives does the instructor tell students can cause drowsiness?
antihistamine
What would a nurse identify as a first-generation antihistamine? (Select all that apply.) a. Fexofenadine b. Clemastine c. Meclizine d. Azelastine e. Loratadine f. Dimenhydrinate
b. Clemastine c. Meclizine f. Dimenhydrinate (Rationale: First-generation antihistamines include clemastine, dimenhydrinate, and meclizine. Fexofenadine, azelastine, and loratadine are all second-generation antihistamines.)
A patient calls the nurse help line and asks if he may take an over-the-counter (OTC) expectorant. The nurse is aware that an expectorant would be contraindicated or used very cautiously if the patient has what conditions? (Select all that apply.) a. Urinary tract infection b. Emphysema c. Hypothyroidism d. Very productive cough e. Asthma
b. Emphysema d. Very productive cough e. Asthma (Rationale: Possible contraindications or cautions include any history of allergy to the drug, persistent cough due to smoking, asthma or emphysema, or a very productive cough that would indicate an underlying problem that should be evaluated. Hypothyroidism and a urinary tract infection would not be contraindications for use of an expectorant.)
Which instruction would the nurse least likely include in the teaching plan for a patient receiving an antitussive? a. Using a humidifier b. Limiting fluids c. Using lozenges d. Keeping the room cool
b. Limiting fluids (Rationale: Increased fluids are important to maintain hydration, thin secretions, and keep the mucous membranes moist. Humidification, cool temperatures, and lozenges are helpful in relieving cough.)
The pharmacology instructor is quizzing students about the reasons decongestants are prescribed for patients. The students who respond correctly are those that name what reasons? (Select all that apply.) a. Glaucoma b. Middle ear infections c. Common cold d. Benign prostatic hyperplasia e. Hay fever
b. Middle ear infections c. Common cold e. Hay fever (Rationale: Decongestants are used for the symptomatic relief of nasal and nasopharyngeal mucosal congestion due to the common cold, hay fever, or other respiratory allergies; and as adjunctive therapy of middle ear infections to decrease congestion around the eustachian ostia. Its use is contraindicated in patients with glaucoma or prostate disorders.)
What drug would the nurse expect to administer as a nasal spray? a. Dextromethorphan b. Oxymetazoline c. Benzonatate d. Hydrocodone
b. Oxymetazoline (Rationale: Oxymetazoline is administered by nasal spray. The others are administered orally.)
The home health nurse is caring for an 83-year-old patient who has an upper respiratory infection and is taking an over-the-counter (OTC) cough and cold preparation. What issues must be discussed with this patient related to the OTC medication? (Select all that apply.) a. The patient may need an increased dose because of hepatic or renal impairment. b. The patient is at an increased risk for falls because of dizziness. c. The patient should expect to take the cough and cold medication for at least 2 to 3 weeks. d. The patient may become confused and disoriented. e. This patient should call the physician before taking this medication because it may be contraindicated due to other conditions the patient has.
b. The patient is at an increased risk for falls because of dizziness. d. The patient may become confused and disoriented. e. This patient should call the physician before taking this medication because it may be contraindicated due to other conditions the patient has. (Rationale: Older adults are more likely to develop adverse effects associated with the use of these drugs, including sedation, confusion, and dizziness. Older adults are also more likely to have renal and/or hepatic impairment related to underlying medical conditions. The does for older adults should be started at a lower level than recommended for younger adults and should be monitored very closely, with dose adjustment based on the patient's response.)
A patient taking a behind-the-counter cold medication and a behind-the-counter allergy medicine is found to be taking double doses of pseudoephedrine. As a result, the patient might exhibit a. ear pain and eye redness. b. restlessness and palpitations. c. sinus pressure and ear pain. d. an irritating cough and nasal drainage.
b. restlessness and palpitations
A patient is receiving a topical nasal decongestant. The nurse instructs the patient to stop using the drug after which length of time? a. 3 days b. 4 days c. 5 days d. 6 days
c. 5 days (Rationale: 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.)
When instructing a patient in how to use a topical nasal spray, what would the nurse emphasize to do first? a. Lie down to tilt the head back. b. Spray the medication with the bottle upright. c. Clear the nasal passages. d. Close the opposite nares.
c. Clear the nasal passages. (Rationale: 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. The bottle should be held upright but it is most important for the patient to clear the nasal passages before spraying the medication. It would be important for the patient to sit upright, not lie down. The patient should sit upright and press a finger over one nare to close it. After squeezing the medication, the procedure should be repeated with the opposite nare.)
What would contraindicate the use of a topical nasal decongestant? a. Diabetes b. Hypertension c. Nasal ulceration d. Glaucoma
c. Nasal ulceration (Rationale: 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, diabetes, and glaucoma.)
A patient who has been using a nasal decongestant for the last two weeks calls the clinic and asks for an antibiotic because the nasal congestion is getting worse instead of better. The nurse is aware that the patient has developed what condition? a. Vasoconstriction of the nasal capillaries b. Pneumonia c. Rhinitis medicamentosa d. Common cold
c. Rhinitis medicamentosa (Rationale: Rhinitis medicamentosa is rebound vasodilation caused by frequent or prolonged use of decongestants. The patient is experiencing vasodilation, not vasoconstriction of the nasal capillaries. The nasal congestion that the patient is experiencing is due to the rebound nasal congestion caused by the prolonged use of a topical nasal decongestant and does not have a cold. Patients with pneumonia have fever and cough and productive sputum. This patient is complaining of persistent nasal congestion caused by prolonged use of a topical nasal decongestant.)
Antitussives are useful in blocking the cough reflex and preserving the energy associated with prolonged, nonproductive coughing. Antitussives are best used with a. postoperative patients. b. asthma patients. c. patients with a dry, irritating cough. d. COPD patients who tire easily.
c. patients with a dry, irritating cough
A patient is not getting a response to the antihistamine that was prescribed. Appropriate action might include a. switching to a decongestant. b. stopping the drug and increasing fluids. c. trying a different antihistamine. d. switching to a corticosteroid.
c. trying a different antihistamine
The nurse's assessment should prioritize what system when caring for a client who has just been admitted for an overdose of pseudoephedrine?
cardiovascular
The physician ordered flunisolide for a patient who was previously prescribed ephedrine for seasonal rhinitis. What is the nurse's best response to the patient's question as to why his medication has been changed? a. "Patients who use flunisolide don't experience any adverse effects." b. "You aren't at any risk for infection with this medication." c. "Ephedrine is an old drug and flunisolide is a new drug." d. "Your physician has ordered your new medication because your previous medication wasn't giving you enough relief from your symptoms."
d. "Your physician has ordered your new medication because your previous medication wasn't giving you enough relief from your symptoms." (Rationale: Flunisolide is used as treatment for seasonal allergic rhinitis for patients who are not getting any response from other decongestant preparations. Ephedrine is an older product than flunisolide but flunisolide is prescribed because the ephedrine wasn't effective in treating the seasonal rhinitis. Patients who use flunisolide are at an increased risk for infection. Adverse effects with flunisolide include local burning, irritation, stinging, dryness of the mucosa, headache, and increased risk of infection.)
After teaching a group of students about topical nasal steroid decongestants, the instructor determines the need for additional teaching when the students identify what as an example? a. Fluticasone b. Triamcinolone c. Flunisolide d. Tetrahydrozoline
d. Tetrahydrozoline (Rationale: Tetrahydrozoline is a topical nasal decongestant, not a topical nasal steroid decongestant. Flunisolide, fluticasone, and triamcinolone are topical nasal steroid decongestants.)
A patient with sinus pressure and pain related to seasonal rhinitis would benefit from taking a. an antitussive. b. an expectorant. c. a mucolytic. d. a decongestant.
d. a decongestant
Dornase alfa (Pulmozyme), because of its mechanism of action, is reserved for use in a. clearing secretions before diagnostic tests. b. facilitating the removal of secretions postoperatively. c. protecting the liver from acetaminophen toxicity. d. relieving the buildup of secretions in cystic fibrosis.
d. relieving the buildup of secretions in cystic fibrosis
Patients with seasonal rhinitis experience irritation and inflammation of the nasal passages and passages of the upper airways. Treatment for these patients might include a. systemic corticosteroids. b. mucolytic agents. c. an expectorant. d. topical nasal steroids.
d. topical nasal steroids
What intervention should be included in the care plan of a client experiencing excessive respiratory tract secretions?
deep breathing and coughing exercises
What medication should be prescribed to minimize the risk associated with a blood transfusion for a client with a history of a previous transfusion reaction?
diphenhydramine
Antitussives
drugs that block the cough reflex
Antihistamines
drugs that block the release or action of histamine, a chemical released during inflammation that increases secretions and narrows airways
Decongestants
drugs that decrease the blood flow to the upper respiratory tract and decrease the overproduction of secretions
Mucolytics
drugs that increase or liquefy respiratory secretions to aid the clearing of the airways
Expectorants
drugs that increase productive cough to clear the airways
A 59-year-old client is unsure whether his or her symptoms are attributable to a cold or to allergies, so he/she is taking pseudoephedrine as well as an antihistamine. This combination of drugs creates a risk for what adverse effect?
hypertension
Which condition would contraindicate the use of or oxymetazoline?
hypertension
Which nursing diagnosis would provide the clearest indication for the administration of inhaled acetylcysteine?
ineffective airway clearance
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
Rhinitis medicamentosa
reflex reaction to vasoconstriction caused by decongestants; a rebound vasodilation that often leads to prolonged overuse of decongestants; also called rebound congestion
what is the purpose/ mechanism of the respiratory system?
to exchange oxygen and carbon dioxide in the lungs
First-generation antihistamines frequently cause what adverse effect? Select all that apply.
urinary retention blurred vision dry mouth
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
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
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
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)
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.
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
