Prep U Chapter 32
A nurse is preparing to administer an antihistamine to a client. The nurse integrates knowledge about this class of drugs, identifying which condition or disease as a possible use to alleviate symptoms? Select all that apply. • Reversal of sedation • Allergic rhinitis • Parkinsonism • Nausea • Dry mouth
Allergic rhinitis, parkinsonism, nausea Antihistamines can be used to treat a variety of conditions including allergic rhinitis, treatment of parkinsonism, and relief of nausea. Antihistamines can cause dry mouth and sedation.
A male client presents to the emergency department with symptoms of a gastrointestinal bleed. The health care provider orders a blood transfusion. The client has a history of anaphylaxis. The provider orders the administration of what drug before the blood transfusion? • Diphenhydramine • Azelastine • Desloratadine • Cetirizine
Diphenhydramine Explanation: Diphenhydramine may be given by injection, usually as a single dose, to a client who is having a blood transfusion or a diagnostic test, to prevent allergic reactions. Hydroxyzine or promethazine may be given by injection for nausea and vomiting or to provide sedation, but they are not usually the first drugs of choice for these indications.
A 76-year-old client has been prescribed an oral antihistamine. What adverse effect presents a priority safety concern for older adult clients? • Dry mouth • Drowsiness • Nasal burning • Nonproductive cough
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 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? • Hypotension • Joint pain • Central nervous system depression • Nausea and vomiting
Nausea and vomiting Promethazine is most commonly used in the treatment of nausea and vomiting.
A 41-year-old patient with an allergy to tree pollen and grasses plans to mow the lawn. When is the best time for the patient to self-administer fexofenadine? • Three hours before mowing the lawn • As soon as she notices allergic symptoms • When she begins mowing the lawn • Thirty minutes before mowing the lawn
Three hours before mowing the lawn Explanation: Antihistamine therapy is more effective if started before exposure to allergens because the drugs can occupy receptor sites before histamine is released. Since it can take approximately two hours after administration for fexofenadine to take effect, taking the drug three hours before mowing the lawn is the most effective of the four choices.
What causes the inflammation of nasal mucosa that is seen in allergic rhinitis? • Type I hypersensitivity reaction to Inhaled allergens • Type IV hypersensitivity reaction to inhaled allergens • Type III hypersensitivity reaction to inhaled allergens • Type II hypersensitivity reaction to inhaled allergens
Type I hypersensitivity reaction to Inhaled allergens Explanation: Allergic rhinitis is inflammation of nasal mucosa caused by a type I hypersensitivity reaction to inhaled allergens
A client whose daily commute includes travel on a ferry boat has been prescribed diphenhydramine. During client teaching, the nurse should instruct the client to take the medication at what time? • as soon as the ferry leaves the dock • the night before each trip • 30 to 60 minutes before the ferry trip • when the client boards the ferry
• 30 to 60 minutes before the ferry trip To prevent motion sickness, it is necessary to take diphenhydramine 30 to 60 minutes before the trip begins.
The pharmacology instructor is discussing the adverse effects of diphenhydramine. Which is not one of these effects? • Blurred vision • Dry mouth • Excessive salivation • Drowsiness
• Excessive salivation Explanation: Adverse effects of first-generation antihistamines include urinary retention, drowsiness or sedation, dry mouth, blurred vision, and gastrointestinal distress.
A client has an important presentation to make in 4 hours, and he needs relief from the congestion of seasonal rhinitis. The client calls the nurse, explains the situation, and tells the nurse that he cannot afford to be drowsy. What medication is most likely to meet this client's needs? • Diphenhydramine • Hydroxyzine • Loratadine • Dexchlorpheniramine
• Loratadine Explanation: The first-generation antihistamines, including diphenhydramine, dexchlorpheniramine, and hydroxyzine, are associated with drowsiness. Loratadine is one of the second-generation antihistamines, which have fewer anticholinergic effects and are less likely to cause drowsiness.
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 are recommended." • "Antihistamines should be taken only if you are not driving." • "Antihistamines do not relieve symptoms." • "Antihistamines should be taken only before bed."
"Antihistamines do not relieve symptoms." For treatment of the common cold, studies have demonstrated that antihistamines do not relieve symptoms and are not recommended. However, an antihistamine is often included in prescription and OTC combination products for the common cold.
A nurse is teaching a 55-year-old client about fexofenadine prescribed to treat allergic symptoms. Which client statement suggests an understanding of this teaching? • "Taking this medication shouldn't stop me from having my after-dinner drink." • "I should avoid driving after taking this medication." • "This medication has no serious side effects." • "It's safe to take this medication with the nighttime sinus medication that I've been using."
"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."
A professor teaching pharmacology conducts a lecture regarding allergic drug reactions. Which of the following statements made by students verifies the lecture was effective? Select all that apply. • "Allergic drug reactions are complex and diverse and may include any of the types of hypersensitivity." • "Virtually any drug may induce an immunologic response." • "Reactions to drugs and plants are identical." • "Very specific characteristics identify if a reaction is drug-related."
"Virtually any drug may induce an immunologic response." • "Allergic drug reactions are complex and diverse and may include any of the types of hypersensitivity." Explanation: Virtually any drug may induce an immunologic response in susceptible people, and any body tissues may be affected. Allergic drug reactions are complex and diverse and may include any of the types of hypersensitivity described. No specific characteristics identify drug-related reactions, although some reactions commonly attributed to drugs (e.g., skin rashes, drug fever, hematologic reactions, hepatic reactions) rarely occur with plant pollens and other naturally occurring antigens.
A female client is prescribed a first-generation antihistamine for her allergies. The nurse would expect her to experience what adverse effect? • Incontinence • Dry mouth • Diarrhea • Slurred speech
Dry mouth Explanation: First-generation antihistamines have substantial anticholinergic effects; therefore, they may cause dry mouth, urinary retention, constipation, and blurred vision.
The substances released from mast cells are responsible for what physiological response? Select all that apply. • myalgia • smooth muscle dilation • bronchoconstriction • inflammation • decreased capillary permeability
bronchoconstriction inflammation When lung tissues are exposed to causative stimuli, mast cells release substances that cause bronchoconstriction and inflammation. The mast cells substances are not associated with any of the other options
The pharmacology instructor is discussing the adverse effects of diphenhydramine. Which is not one of these effects? • Excessive salivation • Drowsiness • Blurred vision • Dry mouth
• Excessive salivation Explanation: Adverse effects of first-generation antihistamines include urinary retention, drowsiness or sedation, dry mouth, blurred vision, and gastrointestinal distress.
Some antihistamines are used for more than one purpose. What antihistamine may also be effective as an antiemetic? • Loratidine • Cyproheptadine • Cetirizine • Hydroxyzine
• Hydroxyzine Explanation: Hydroxyzine is indicated as a sedative and antiemetic and for the treatment of pruritus.
A 15-year-old patient is prescribed an antihistamine for allergic rhinitis. However, antihistamines used to treat allergic reactions may themselves cause allergy. The nurse needs to educate the patient to be aware of symptoms suggesting allergy. Which of the following is an allergic reaction to antihistamines? Skin rash and urticaria Drowsiness and sedation Dryness of mouth Disturbed coordination
• Skin rash and urticaria Explanation: The nurse should inform the patient that skin rash and urticaria could occur as allergic reactions to antihistamines. Dryness of mouth, drowsiness, sedation, and disturbed coordination may occur as dose-related side effects of the drug but are not due to any allergic reaction.
The nursing instructor is explaining the four types of allergic reaction to the nursing students. The instructor explains that allergic rhinitis is a • type III hypersensitivity reaction.. • type II hypersensitivity reaction. • type IV hypersensitivity reaction. • type I hypersensitivity reaction.
• type I hypersensitivity reaction. Explanation: Allergic rhinitis is a type I hypersensitivity reaction to inhaled allergens.
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? • "Taking this medication shouldn't stop me from having my after-dinner drink." • "I should avoid driving after taking this medication." • "It's safe to take this medication with the nighttime sinus medication that I've been using." • "This medication has no serious side effects."
"I should avoid driving after taking this medication." 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 teaching a client about the potential for allergic drug reaction. What statement made by a client suggests a need for further teaching? • "The additives that are in drugs can also cause allergic reactions." • "If you didn't have allergies as a child, you won't develop allergies later in life." • "Virtually any drug may induce an immunologic response in a susceptible person." • "All drugs have the potential to cause an allergic reaction."
"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 nurse is providing education to a client regarding the use of an over-the-counter (OTC) antihistamine. Which client statement demonstrates a need for additional teaching? • "When I know I'm going to spend time outdoors, I take an antihistamine." • "When I feel a cold coming on, I know to take an antihistamine." • "I take the medication to manage my itchy, watery eyes." • "I always need an antihistamine when I visit family members who own pets."
"When I feel a cold coming on, I know to take an antihistamine." Rhinitis is a very common disorder characterized by nasal congestion, itching, sneezing, and watery drainage. Itching of the throat, eyes, and ears often occurs as well. These symptoms may occur when coming in contact with certain seasonal plant pollens or animal dander. Studies have demonstrated that although antihistamines relieve symptoms of allergic rhinitis, antihistamine are not successful or recommended for treatment of the common cold.
The nurse is providing education to a client regarding the use of an over-the-counter (OTC) antihistamine. Which client statement demonstrates a need for additional teaching? • "When I feel a cold coming on, I know to take an antihistamine." • "I take the medication to manage my itchy, watery eyes." • "When I know I'm going to spend time outdoors, I take an antihistamine." • "I always need an antihistamine when I visit family members who own pets."
"When I feel a cold coming on, I know to take an antihistamine." Explanation: Rhinitis is a very common disorder characterized by nasal congestion, itching, sneezing, and watery drainage. Itching of the throat, eyes, and ears often occurs as well. These symptoms may occur when coming in contact with certain seasonal plant pollens or animal dander. Studies have demonstrated that although antihistamines relieve symptoms of allergic rhinitis, antihistamine are not successful or recommended for treatment of the common cold.
You are caring for a client who takes a monoamine oxidase inhibitor (MAOI) for treatment of depression. The client occasionally self-administers an over-the-counter antihistamine to control allergy symptoms. What effect could this client experience as a result of combining these two medications? • The antidepressant will interfere with the therapeutic effect of the antihistamine. • Adverse effects of the antihistamine will be more severe. • The antihistamine will interfere with the therapeutic effect of the antidepressant. • The client will experience no adverse effects as a result of this combination.
Adverse effects of the antihistamine will be more severe. Concomitant use of MAOIs and antihistamines may increase the incidence and severity of the antihistamine's sedative and anticholinergic effects. The antihistamine will not affect therapeutic effect of the antidepressant. The MAOI will not interfere with the therapeutic effect of the antihistamine to inhibit, but will increase its effects to severity.
When considering possible side effects, which client should be considered for a prescription of cetirizine rather than diphenhydramine? • A 36-year-old diagnosed with acute gastritis • A 42-year-old client diagnosed with an acid reflux disorder • A child younger than 10-years-of age • Any adult older than 56-years-of age.
Any adult older than 56-years-of age. Unlike the first-generation H1 receptor antagonists like diphenhydramine, the second-generation H1 receptor antagonists like cetirizine do not readily enter the brain from the blood but bind preferentially to peripheral rather than central H1 receptors. This selectivity significantly reduces the occurrence of adverse drug reactions of the central nervous system, but drowsiness and CNS depression may occur but likely to a lessening degree. In general, second-generation antihistamines are much safer than first-generation agents for older adults because they are less likely to impair consciousness, thinking, or ability to perform activities of daily living (e.g., driving a car or operating various machines). Young children may experience paradoxical excitement after receiving therapeutic dosages of diphenhydramine and other first-generation H1 receptor antagonists. For safe use in children, close supervision and appropriate dosages are necessary. Cetirizine may be used in children six-months of age and older. Neither acid reflux nor acute gastritis precludes the use of diphenhydramine
A client is in the clinic for seasonal allergic rhinitis. Loratadine (Claritin) is prescribed. Which statement will the nurse include when providing education concerning this drug? • "You should take the medication twice a day." • "Be sure to take this medication on a full stomach." • "This drug has to be taken every 4 to 6 hours." • "Determine if the drug is going to make you drowsy before you drive."
Determine if the drug is going to make you drowsy before you drive." Loratadine (Claritin) is a second-generation antihistamine and does not usually cause drowsiness like the first-generation medications; however, the client should take it for at least a day to determine the drug's effect before driving. Loratadine should be taken on an empty stomach to increase absorption. The drug is taken only once a day. Brompheniramine, a nonselective H1 blocker (first-generation antihistamine) is taken every 4 to 6 hours. Fexofenadine can be taken twice daily.
A female client is prescribed a first-generation antihistamine for her allergies. The nurse would expect her to experience what adverse effect? • Diarrhea • Dry mouth • Slurred speech • Incontinence
Dry mouth First-generation antihistamines have substantial anticholinergic effects; therefore, they may cause dry mouth, urinary retention, constipation, and blurred vision
The pharmacology instructor is discussing the adverse effects of diphenhydramine. Which is not one of these effects? • Excessive salivation • Dry mouth • Blurred vision • Drowsiness
Excessive salivation Adverse effects of first-generation antihistamines include urinary retention, drowsiness or sedation, dry mouth, blurred vision, and gastrointestinal distress.
The pharmacology instructor is discussing the adverse effects of diphenhydramine. Which is not one of these effects? • Excessive salivation • Blurred vision • Dry mouth • Drowsiness
Excessive salivation Explanation: Adverse effects of first-generation antihistamines include urinary retention, drowsiness or sedation, dry mouth, blurred vision, and gastrointestinal distress.
Which statement accurately describes an aspect of serum sickness? • Sensitization to the antigen will diminish the reaction. • Is a delayed hypersensitivity reaction. • It can develop in 1 to 2 days. • Symptoms include sensitivity to light resulting in optic pain.
Is a delayed hypersensitivity reaction. Serum sickness is a delayed hypersensitivity reaction most often caused by drugs, such as antimicrobials. In addition, many drugs that produce anaphylaxis also produce serum sickness. With initial exposure to the antigen, symptoms usually develop within 7 to 10 days and include urticaria, lymphadenopathy, myalgia, arthralgia, and fever. The reaction usually resolves within a few days but may be severe or even fatal. With repeated exposure to the antigen, after prior sensitization of the host, accelerated serum sickness may develop within 2 to 4 days, with similar but often more severe signs and symptoms.
The nurse is providing education regarding food allergies to the parent of a preschool-age child. What statement made by the parent would indicate a need for further education on the subject? • "Foods have an equal risk of causing an allergic response." • "Food allergies are often an immune response to the ingestion of a protein." • "Certain fruits and vegetables have been identified as allergens." • "Children allergic to milk or soy will often outgrow their allergy."
• "Foods have an equal risk of causing an allergic response." Typically, food allergies are an immune response to the ingestion of a protein. Some food allergens such as shellfish, fish, corn, seeds, bananas, egg, milk, soy, peanut, and tree nuts have a higher inherent risk for triggering anaphylaxis than do others. However, many other foods have been identified as allergens, including certain fruits and vegetables. It is common for children with allergies to milk, eggs, wheat, or soy to outgrow their allergies.
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." • "Virtually any drug may induce an immunologic response in a susceptible person." • "The additives that are in drugs can also cause allergic reactions." • "All drugs have the potential to cause an allergic reaction."
• "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 nurse is providing education to a client regarding the use of an over-the-counter (OTC) antihistamine. Which client statement demonstrates a need for additional teaching? • "I always need an antihistamine when I visit family members who own pets." • "I take the medication to manage my itchy, watery eyes." • "When I know I'm going to spend time outdoors, I take an antihistamine." • "When I feel a cold coming on, I know to take an antihistamine."
• "When I feel a cold coming on, I know to take an antihistamine." Explanation: Rhinitis is a very common disorder characterized by nasal congestion, itching, sneezing, and watery drainage. Itching of the throat, eyes, and ears often occurs as well. These symptoms may occur when coming in contact with certain seasonal plant pollens or animal dander. Studies have demonstrated that although antihistamines relieve symptoms of allergic rhinitis, antihistamine are not successful or recommended for treatment of the common cold.
A client whose daily commute includes travel on a ferry boat has been prescribed diphenhydramine. During client teaching, the nurse should instruct the client to take the medication at what time? • the night before each trip • as soon as the ferry leaves the dock • 30 to 60 minutes before the ferry trip • when the client boards the ferry
• 30 to 60 minutes before the ferry trip Explanation: To prevent motion sickness, it is necessary to take diphenhydramine 30 to 60 minutes before the trip begins
Which client is most likely to benefit from the administration of a nasal steroid? • A client who has a deviated nasal septum • A client who has chronic allergic rhinitis • A client with an acute sinus infection • A client who is recovering from a tonsillectomy
• A client who has chronic allergic rhinitis Because nasal steroids block the inflammatory response, their use is contraindicated in the presence of acute infections. The most common reason they are prescribed is for the treatment of allergic rhinitis or to relieve inflammation after the removal of nasal polyps. Nasal steroids are not used for treatment after a tonsillectomy or for clients with a deviated nasal septum
Which client is most likely to benefit from the administration of a nasal steroid? • A client who is recovering from a tonsillectomy • A client who has chronic allergic rhinitis • A client who has a deviated nasal septum • A client with an acute sinus infection
• A client who has chronic allergic rhinitis Explanation: Because nasal steroids block the inflammatory response, their use is contraindicated in the presence of acute infections. The most common reason they are prescribed is for the treatment of allergic rhinitis or to relieve inflammation after the removal of nasal polyps. Nasal steroids are not used for treatment after a tonsillectomy or for clients with a deviated nasal septum.
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. • Yes, but it's important to monitor for adverse effects. • Yes, but be sure to use a brand that mentions 'cold remedy' on the packaging. • Antihistamines can be helpful when they're combined with an antibiotic.
• Antihistamines are not recommended for treating a cold. 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 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 can be helpful when they're combined with an antibiotic. • Yes, but be sure to use a brand that mentions 'cold remedy' on the packaging. • Yes, but it's important to monitor for adverse effects. • Antihistamines are not recommended for treating a cold.
• 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 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. • Yes, but it's important to monitor for adverse effects. • Antihistamines can be helpful when they're combined with an antibiotic. • Yes, but be sure to use a brand that mentions 'cold remedy' on the packaging.
• 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 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 can be helpful when they're combined with an antibiotic. • Antihistamines are not recommended for treating a cold. • Yes, but it's important to monitor for adverse effects. • Yes, but be sure to use a brand that mentions 'cold remedy' on the packaging.
• 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 client has begun taking an antihistamine for the treatment of seasonal allergies. What dietary guidelines should the nurse provide to the client? • Eat several small meals instead of three larger meals in case of GI upset • Avoid grapefruit juice until at least 48 hours after treatment is complete • Avoid drinking alcohol while taking antihistamines • Increase intake of foods that are high in vitamin C
• Avoid drinking alcohol while taking antihistamines Alcohol is contraindicated during treatment with antihistamines due to their sedative effects that can be compounded by alcohol. There is no need to change the client's eating schedule or to avoid grapefruit juice. Vitamin C intake does not need to be increased
A client has begun taking an antihistamine for the treatment of seasonal allergies. What dietary guidelines should the nurse provide to the client? • Avoid grapefruit juice until at least 48 hours after treatment is complete • Increase intake of foods that are high in vitamin C • Eat several small meals instead of three larger meals in case of GI upset • Avoid drinking alcohol while taking antihistamines
• Avoid drinking alcohol while taking antihistamines Explanation: Alcohol is contraindicated during treatment with antihistamines due to their sedative effects that can be compounded by alcohol. There is no need to change the client's eating schedule or to avoid grapefruit juice. Vitamin C intake does not need to be increased.
The health care provider has prescribed medication to prevent posttransfusion reaction in a client with a history of the disorder. Which medication would the nurse anticipate being administered? • Ibuprofen • Diphenhydramine • Epinephrine • Furosemide
• Diphenhydramine Explanation: A client who is having a blood transfusion or a diagnostic test may receive diphenhydramine, often by injection and usually as a single dose, to prevent allergic reactions. Epinephrine would be given for an acute reaction. Furosemide is a diuretic. Ibuprofen is given for pain or fever.
The health care provider has prescribed medication to prevent posttransfusion reaction in a client with a history of the disorder. Which medication would the nurse anticipate being administered? • Ibuprofen • Furosemide • Diphenhydramine • Epinephrine
• Diphenhydramine Explanation: A client who is having a blood transfusion or a diagnostic test may receive diphenhydramine, often by injection and usually as a single dose, to prevent allergic reactions. Epinephrine would be given for an acute reaction. Furosemide is a diuretic. Ibuprofen is given for pain or fever.
A 76-year-old client has been prescribed an oral antihistamine. What adverse effect presents a priority safety concern for older adult clients? • Nasal burning • Dry mouth • Drowsiness • Nonproductive cough
• 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 use.
A 76-year-old client has been prescribed an oral antihistamine. What adverse effect presents a priority safety concern for older adult clients? • Nasal burning • Dry mouth • Drowsiness • Nonproductive cough
• 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.
Hypersensitivity reactions are grouped into four types according to the mechanisms by which they are produced. Type I hypersensitivity reaction for allergic rhinitis follows a specific pattern. Please place the following in order as they would occur. • First exposure to inhaled antigens • Formation of immunoglobulin E (IgE) antibody molecules • IgE binds to and sensitizes the surface membranes of mast cells • Re-exposure to inhaled pollens or other antigens • Release of histamine and other chemical mediators • Nasal mucosa produces characteristic symptoms of allergic rhinitis
• First exposure to inhaled antigens • Formation of immunoglobulin E (IgE) antibody molecules • IgE binds to and sensitizes the surface membranes of mast cells • Re-exposure to inhaled pollens or other antigens • Release of histamine and other chemical mediators • Nasal mucosa produces characteristic symptoms of allergic rhinitis The first exposure of mast cells in nasal mucosa to inhaled antigens (e.g., pollens from weeds, grasses, trees) leads to the formation of IgE antibody molecules. These molecules then bind to the surface membranes of mast cells. This process sensitizes mast cells to the effects of inhaled antigens (allergens). When sensitized mast cells are re-exposed to inhaled pollens or other antigens, they release histamine and other chemical mediators, which then act on nasal mucosa to produce characteristic symptoms of allergic rhinitis.
Antihistamines are used frequently in the home care setting for the treatment of allergies. Which of the following is most likely to be a responsibility of the nurse caring for a patient who is taking antihistamines for this indication? • Ensuring that the patient uses a second-generation antihistamine • Administering the antihistamine • Helping the patient identify environmental allergens • Removing environmental allergens
• Helping the patient identify environmental allergens Explanation: In any care setting, the nurse assists the patient in identifying and avoiding factors that precipitate hypersensitivity reactions. Patients are likely able to administer their own medications. Although second-generation antihistamines are preferred for older patients, first-generation drugs are still used widely and safely.
Some antihistamines are used for more than one purpose. What antihistamine may also be effective as an antiemetic? • Loratidine • Cetirizine • Cyproheptadine • Hydroxyzine
• Hydroxyzine Explanation: Hydroxyzine is indicated as a sedative and antiemetic and for the treatment of pruritus.
A patient with vasomotor rhinitis has been prescribed an antihistamine. The patient is eager to know whether the prescribed antihistamine may cause excessive sedation. Which of the following antihistamines has very little sedative effect? • Loratadine • Chlorpheniramine • Brompheniramine • Clemastine
• Loratadine The nurse should assure the patient that loratadine has very little sedative effect. Loratadine is a second-generation antihistamine with little effect on central nervous system (CNS) depression. Brompheniramine, clemastine, and chlorpheniramine are first-generation antihistamines. Sedation is seen more often with first-generation antihistamines.
A client has an important presentation to make in 4 hours, and he needs relief from the congestion of seasonal rhinitis. The client calls the nurse, explains the situation, and tells the nurse that he cannot afford to be drowsy. What medication is most likely to meet this client's needs? • Diphenhydramine • Hydroxyzine • Dexchlorpheniramine • Loratadine
• Loratadine Explanation: The first-generation antihistamines, including diphenhydramine, dexchlorpheniramine, and hydroxyzine, are associated with drowsiness. Loratadine is one of the second-generation antihistamines, which have fewer anticholinergic effects and are less likely to cause drowsiness.
A patient with vasomotor rhinitis has been prescribed an antihistamine. The patient is eager to know whether the prescribed antihistamine may cause excessive sedation. Which of the following antihistamines has very little sedative effect? • Clemastine • Brompheniramine • Chlorpheniramine • Loratadine
• Loratadine Explanation: The nurse should assure the patient that loratadine has very little sedative effect. Loratadine is a second-generation antihistamine with little effect on central nervous system (CNS) depression. Brompheniramine, clemastine, and chlorpheniramine are first-generation antihistamines. Sedation is seen more often with first-generation antihistamines.
The nurse is aware that clients who use OTC fexofenadine would use which class of antibacterial that would cause an increased plasma concentration of the fexofenadine? • Macrolides • Penicillins • Tetracyclines • Cephalosporins
• Macrolides Explanation: Macrolides increase the plasma concentration of fexofenadine.
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? • Hypotension • Joint pain • Nausea and vomiting • Central nervous system depression
• Nausea and vomiting Explanation: Promethazine is most commonly used in the treatment of 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. • Ask about nausea and vomiting. • Observe for swelling in nasal passages. • Ask about history of hay fever.
• Obtain the client's blood pressure. 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.
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? • Ask about history of hay fever. • Obtain the client's blood pressure. • Observe for swelling in nasal passages. • Ask about nausea and vomiting. •
• 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 drug is commonly implicated in anaphylactic reactions? Select all that apply. • cisplatin • penicillin • aspirin • tetanus vaccine • acetaminophen
• Penicillin • Cisplatin • aspirin Virtually all drugs have been implicated in anaphylactic reactions. Penicillins and other antimicrobials, radiocontrast media, aspirin and other nonsteroidal anti-inflammatory drugs, and antineoplastics such as L-asparaginase and cisplatin are more common offenders. Drugs less commonly associated with such reactions include anesthetics (local and general), opioid analgesics, skeletal muscle relaxants used with general anesthetics, and vaccines.
The nurse is teaching a group of clients with allergic rhinitis about the use of their medications. What would be the most essential information to give these clients about preventing possible drug interactions? • Use only one pharmacy so the pharmacist can check drug interactions. • Read drug labels before taking OTC medications. • Ask the pharmacy technician for assistance in selecting an OTC medication. • Over-the-counter (OTC) medications are safe to use.
• Read drug labels before taking OTC medications. Teach clients to read the OTC labels to avoid inadvertent overdose. It would be inappropriate to teach the client to use only one pharmacy for OTC medications. OTC medications are generally safe to use if used correctly. Asking the pharmacy tech for help in selecting an OTC medication is appropriate but not the most essential information to give the clients.
What type of antihistamine is typically preferred for older adults? • First-generation • Second-generation • Antihistamines are contraindicated in older adults. • Neither type is preferred over the other.
• Second-generation Second-generation antihistamines are typically preferred for older adults because they lack some of the adverse effects associated with the first-generation versions. First-generation antihistamines have several adverse effects (e.g., sedation and confusion) that can be mistaken for senility or depression in older adults. Such effects may be more severe in patients who take anticholinergic drugs, such as some antiparkinson medications. Additionally, patients with prostatic hypertrophy may have difficulty voiding when taking first-generation antihistamines.
What type of antihistamine is typically preferred for older adults? • First-generation • Second-generation • Neither type is preferred over the other. • Antihistamines are contraindicated in older adults.
• Second-generation Explanation: Second-generation antihistamines are typically preferred for older adults because they lack some of the adverse effects associated with the first-generation versions. First-generation antihistamines have several adverse effects (e.g., sedation and confusion) that can be mistaken for senility or depression in older adults. Such effects may be more severe in patients who take anticholinergic drugs, such as some antiparkinson medications. Additionally, patients with prostatic hypertrophy may have difficulty voiding when taking first-generation antihistamines.
A 15-year-old patient is prescribed an antihistamine for allergic rhinitis. However, antihistamines used to treat allergic reactions may themselves cause allergy. The nurse needs to educate the patient to be aware of symptoms suggesting allergy. Which of the following is an allergic reaction to antihistamines? • Skin rash and urticaria • Dryness of mouth • Drowsiness and sedation • Disturbed coordination
• Skin rash and urticaria Explanation: The nurse should inform the patient that skin rash and urticaria could occur as allergic reactions to antihistamines. Dryness of mouth, drowsiness, sedation, and disturbed coordination may occur as dose-related side effects of the drug but are not due to any allergic reaction.
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 one hour before food. • Drink ample water before taking the tablet. • Take the tablet with food. • Take an antacid before the tablet
• 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.
Second-generation H1 antagonists cause less CNS depression because they are selective for peripheral H1 receptors and because of which other property? • They cross the blood-brain barrier. • They are excreted by the renal system. • They are metabolized by the liver. • They do not cross the blood-brain barrier.
• They do not cross the blood-brain barrier. Second-generation H1 antagonists cause less CNS depression because they are selective for peripheral H1 receptors and do not cross the blood-brain barrier.
Second-generation H1 antagonists cause less CNS depression because they are selective for peripheral H1 receptors and because of which other property? • They do not cross the blood-brain barrier. • They are metabolized by the liver. • They are excreted by the renal system. • They cross the blood-brain barrier.
• They do not cross the blood-brain barrier. Explanation: Second-generation H1 antagonists cause less CNS depression because they are selective for peripheral H1 receptors and do not cross the blood-brain barrier.
What causes the inflammation of nasal mucosa that is seen in allergic rhinitis? • Type II hypersensitivity reaction to inhaled allergens • Type I hypersensitivity reaction to Inhaled allergens • Type IV hypersensitivity reaction to inhaled allergens • Type III hypersensitivity reaction to inhaled allergens
• Type I hypersensitivity reaction to Inhaled allergens Allergic rhinitis is inflammation of nasal mucosa caused by a type I hypersensitivity reaction to inhaled allergens
What causes the inflammation of nasal mucosa that is seen in allergic rhinitis? • Type I hypersensitivity reaction to Inhaled allergens • Type III hypersensitivity reaction to inhaled allergens • Type II hypersensitivity reaction to inhaled allergens • Type IV hypersensitivity reaction to inhaled allergens
• Type I hypersensitivity reaction to Inhaled allergens Explanation: Allergic rhinitis is inflammation of nasal mucosa caused by a type I hypersensitivity reaction to inhaled allergens
A client reports nasal congestion, sneezing, watery drainage from the nose, and itching of the throat, eyes, and ears. The nurse recognizes that these are consistent with what disorder? • anaphylaxis • a histamine reaction • sinus infection • allergic rhinitis
• allergic rhinitis Allergic rhinitis is inflammation of nasal mucosa caused by a type I hypersensitivity reaction to inhaled allergens. It is a very common disorder characterized by nasal congestion, itching, sneezing, and watery drainage. Itching of the throat, eyes, and ears often occurs as well. The other conditions would present with a different set of signs and symptoms.
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 • cetirizine • epinephrine • clemastine
• diphenhydramine A client who is having a blood transfusion or a diagnostic test may receive diphenhydramine, often by injection and usually as a single dose, to prevent allergic reactions. Epinephrine is the drug of choice for treating severe anaphylaxis once it has occurred. Clemastine is prescribed for allergic rhinitis and urticaria. Cetirizine is prescribed for the management of seasonal allergies
A 20-year-old woman calls the clinic at 5 PM and reports to the nurse that she forgot to take her morning dose of fexofenadine (Allegra). She usually takes her evening dose at 8 PM. She wants to know what she should do. The nurse will instruct her to • double her evening dose. • skip the evening dose and start back in the morning. • take the morning dose now and the evening dose at the regular time. • forget about the morning dose and take the evening dose.
• forget about the morning dose and take the evening dose. Explanation: Since it is only 3 hours until her evening dose, the nurse will instruct her to forget about the morning dose and take the evening dose as scheduled. It is not advisable to take two doses at the same time, and there is no need to skip the evening dose as well.
A 20-year-old woman calls the clinic at 5 PM and reports to the nurse that she forgot to take her morning dose of fexofenadine (Allegra). She usually takes her evening dose at 8 PM. She wants to know what she should do. The nurse will instruct her to • forget about the morning dose and take the evening dose. • skip the evening dose and start back in the morning. • double her evening dose. • take the morning dose now and the evening dose at the regular time.
• forget about the morning dose and take the evening dose. Explanation: Since it is only 3 hours until her evening dose, the nurse will instruct her to forget about the morning dose and take the evening dose as scheduled. It is not advisable to take two doses at the same time, and there is no need to skip the evening dose as well.
The nurse regularly assesses clients for risk of anaphylactic reaction to prescribed medications. The nurse is aware that such reactions most commonly occur with what type of medication? • opioid analgesics • penicillins • vaccines • local anesthestics
• penicillins Virtually all drugs have been implicated in anaphylactic reactions but penicillins are a common offender. Less common causes include anesthetics (local and general), opioid analgesics, skeletal muscle relaxants used with general anesthetics, and vaccines.
The nurse regularly assesses clients for risk of anaphylactic reaction to prescribed medications. The nurse is aware that such reactions most commonly occur with what type of medication? • local anesthestics • vaccines • opioid analgesics • penicillins
• penicillins Explanation: Virtually all drugs have been implicated in anaphylactic reactions but penicillins are a common offender. Less common causes include anesthetics (local and general), opioid analgesics, skeletal muscle relaxants used with general anesthetics, and vaccines.
The nursing instructor is explaining the four types of allergic reaction to the nursing students. The instructor explains that allergic rhinitis is a • type III hypersensitivity reaction.. • type IV hypersensitivity reaction. • type I hypersensitivity reaction. • type II hypersensitivity reaction.
• type I hypersensitivity reaction. Allergic rhinitis is a type I hypersensitivity reaction to inhaled allergens.