module 2 - upper respiratory questions

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

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

Which is classified as a decongestant?

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.

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?

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.

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

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

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

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

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

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

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?

Nasal decongestants are rapidly effective because they come into direct contact with nasal mucosa. However, if used longer than the recommended 3 days or in excessive amounts, these products may produce rebound nasal congestion that result from the irritation and swelling of the nasal mucosa. The other options would present with distinctive symptomology.

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

Pseudoephedrine is the only oral decongestant. Phenylephrine, tetrahydrozoline, and xylometazoline are topical decongestants.

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

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.

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

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.

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

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

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?

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.

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.)

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.

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

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

Guaifenesin has an onset of action of 30 minutes.

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

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

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

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 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?

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 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?

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

A client reports a hacking cough. The client asks if taking an antihistamine would be helpful. The nurse's best response is:

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

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

Meclizine is administered for relief of nausea and vomiting associated with motion sickness.

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?

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