316- Chap 54: Upper Respiratory Drugs PREPU

Nasal decongestants would most likely be contraindicated for which client?

- A client with a history of coronary artery disease Explanation: Nasal decongestants are likely to be contraindicated in patients with severe hypertension or coronary artery disease because of their cardiac stimulating and vasoconstricting effects. They must be used with caution in the presence of cardiac dysrhythmias, hyperthyroidism, diabetes mellitus, glaucoma, and prostatic hypertrophy. In clients with diabetes and hypertension that are controlled, they can be used with caution. A client with a pulse rate of 58 bpm, otherwise symptom free, can be given this medication under observation.

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

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

A group of students demonstrate understanding of topical decongestants, identifying them as:

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

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

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

Pseudoephedrine (Sudafed) is prescribed for a client suffering from nasal and sinus congestion. What is the most important assessment the nurse should complete before the client leaves the clinic to purchase the medication?

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

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. Explanation: 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.

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

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

A patient in the renal unit has allergic rhinitis. The physician has ordered fexofenadine 60 mg twice daily, which is the typical adult dose, to control the patient's allergic symptoms. What is the priority nursing action in this situation?

Contact the physician. Explanation: The nurse should question the prescribing physician about the order. Fexofenadine and other antihistamines must be used with caution in patients with impaired renal function. Serum levels and half-life of these drugs are increased in patients with renal impairment, so such patients may require dosage reductions.

The use of centrally acting antitussives, such as codeine, increase the risk for injury related to which conditions? (Select all that apply.)

Drowsiness Dizziness Explanation: The use of centrally acting antitussives increase risk of injury related to the drowsiness, dizziness, and sedation. Recognition of these side effects is important to decreasing patient risk of injury during therapy.

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

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

Expectorants are indicated for patients who have a dry, nonproductive cough.

True Explanation: Expectorants increase productive cough to clear the airways.

There are two types of antitussives, centrally acting and peripherally acting. Which are centrally acting antitussives? (Select all that apply.)

- Codeine -Dextromethorphan -hyrocodone does as well Explanation: Centrally acting antitussives include codeine and dextromethorphan. Benzonatate is a peripherally acting antitussive. Guaifenesin is an expectorant. Eucalyptus is classified as a decongestant and expectorant.

What elicits its antihistamine effects by nonselectively binding to central and peripheral H1 receptors?

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

A 79-year-old client calls the clinic requesting advice for something that will relieve nasal congestion. The nurse is aware that oral decongestants may cause which adverse effects in older adults? (Select all that apply.)

- Hypertension - Heart rhythm abnormalities - Nervousness Explanation: Older adults may experience hypertension, heart rhythm abnormalities, nervousness, and insomnia when they use oral nasal decongestants.

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

Codeine containing antitussives should be used cautiously in clients with which conditions? (Select all that apply.)

- Pregnancy - Convulsive disorders - Prostatic hypertrophy Explanation: Codeine-containing antitussives should be used cautiously during pregnancy, labor, COPD, acute asthma attack, preexisting respiratory disorders, acute abdominal conditions, head injury, increased intracranial pressure, convulsive disorders, hepatic or renal impairment, and prostatic hypertrophy.

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. Explanation: Offering the client frequent sips of water or ice chips, and suggesting use of sugarless gum or candy are appropriate suggestions to relieve dry mouth. An intravenous fluid bolus is invasive and not a first-line suggestion to relieve dryness. The client should run a humidifier, not a dehumidifier, to add moisture to the air at home and help relieve dryness.

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 Explanation: OTC cough and cold preparations should not be used in children under the age of 4 years. Accurate dosing is essential. Following the directions is essential to prevent inadvertent overdosage. Measuring devices that come with the medication should be used to ensure accurate dosages. Parents should look for the formula for children, infants, or pediatrics.

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

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

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

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

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

A nurse administers an antitussive agent cautiously to a client with asthma for which reason?

A loss of respiratory reserve can occur. Explanation: Antitussives are used cautiously in clients with asthma because cough suppression can lead to accumulation of secretion and a loss of respiratory reserve. Airway maintenance is important for clients who have had surgery and need a cough to maintain the airway. Antitussives such as codeine and hydrocodone must be used cautiously in clients with a history of addiction. Increased sedation can be problematic for clients who need to drive or be alert.

A patient has been prescribed a decongestant drug for congestion associated with rhinitis. Which possible side effect of the drug should the nurse caution the patient about?

Blurred vision Explanation: The nurse should inform the patient that blurred vision is a possible side effect of decongestant drugs. Additionally, an increased and not decreased pulse rate may also be seen. Drowsiness is not seen with decongestant usage. Dryness of the nasal mucosa and not the throat may be seen with decongestant drugs, which are used mostly as topical sprays and drops.

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 Explanation: Co-administration of dextromethorphan and a monoamine oxidase inhibitor may result in hypotension, fever, nausea, leg jerking, and coma.

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. Explanation: With nasal decongestants, topical preparations (i.e., nasal solutions or sprays) are often preferred for short-term use. They are rapidly effective because they come into direct contact with nasal mucosa.

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

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

A 62-year-old client has been prescribed an antihistamine to alleviate vasomotor rhinitis. The client reports gastric irritation after taking the tablet. Which instructions should the nurse provide to help alleviate the client's condition?

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

Expectorants elicit their effect by which mechanism

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