Chapter 31 Drug Therapy Nasal Congestion and cough

A patient has expressed frustration at the fact that he has been taking Sudafed for several days and "it still hasn't really cured my cold." What teaching point should the nurse convey to the patient? Drug like this can often relieve some of the symptoms of a cols, but the won't cure it. Most people find that cold medicine are essentially ineffective. It usually takes between 6 and 8 days for sudafed to cure your cold. Sudafed can sometimes mask the effects of your cold, essentially prolonging it.

"Drugs like this can often relieve some of the symptoms of a cold, but they won't cure it."

A patient has hypertension and wants to take a nasal decongestant for cold symptoms. Which of the following statements by the nurse best describes the effect of decongestants on blood pressure? This administration of a nasal decongestant will increase blood pressure due to vasoconstriction of blood vessels. This administration of a nasal decongestant will cause bradycardia and increase peripheral blood pressure. This administration of a nasal decongestant Will decrease the thyroid production and increase blood pressure. This administration of a nasal decongestant will act on the central nervous system to cause vasodilation of blood vessels.

"The administration of a nasal decongestant will increase blood pressure due to vasoconstriction of blood vessels."

A patient is prescribed an antitussive agent with codeine. Which of the following statements by the patient indicates that the nurse's teaching has been effective? I will take this medication whenever I am coughing This medication may make me anxious and nervous I will call mu physician if I develop diarrhea when I take it. This medication will cause drowsiness, and I will not drive.

"This medication will cause drowsiness, and I will not drive."

The FDA pediatric safety labeling changes, warning against the use of prescription opioid cough and cold medicines in children younger than 18 years, are based on available data and expert opinion that supports which of the following statements? SELECT ALL THAT APPLY.A) A cough should not be suppressed unless it is causing clinical consequences, such as consecutive nights of poor sleep and/or vomiting, rib fractures, or hypoxia. B) The safety labeling changes should protect children from unnecessary exposure to opioids. C) The risks for prescription opioid cough products typically outweigh the potential benefits in children of all ages. D) Addiction or abuse potential is a concern regarding the use of hydrocodone or codeine in children.

A cough should not be suppressed unless it is causing clinical consequences, such as consecutive nights of poor sleep and/or vomiting, rib fractures, or hypoxia. B) The safety labeling changes should protect children from unnecessary exposure to opioids. C) The risks for prescription opioid cough products typically outweigh the potential benefits in children of all ages. D) Addiction or abuse potential is a concern regarding the use of hydrocodone or codeine in children.

A patient has asked the nurse if it would be appropriate to use dextromethorphan to treat her cough. What type of cough is best suited to treatment with dextromethorphan? An occasional, productive cough. A cough that is nearly continuous and that is accompanied by a copious irritants. A dry, nonproductive cough.

A dry, nonproductive cough

A community health nurse is cautious when recommending the use of OTC cold remedies to patients. The use of pseudoephedrine would most likely be contraindicated in which of the following patients? A woman who is breast-feeding A man which a history of angina and hypertension. A man who has diagnoses of chronic obstructive pulmonary disease and diabetes. A woman who has myasthenia gravis

A man with a history of angina and hypertension

A patient has purchased an OTC cold remedy that advertises a "nondrowsy" formulation. The nurse should recognize that this produce likely contains which of the following? A nasal decongestant but not an antihistamine An expectorant, a mucolytic, and a benzodiazepine. An expectorant but not a decongestant. A narcotic analgesic and a decongestant.

A nasal decongestant but not an antihistamine

A nurse is teaching a client who has a new prescription for diphenhydramine for allergic rhinitis. The nurse should instruct the client to monitor for which of the following manifestations as an adverse effect of this medication? SELECT ALL THAT APPLY. A) Dry mouth B) Nonproductive cough C) Skin rash D) Drowsiness E) Urinary hesitation

A) Dry mouth D) Drowsiness E) Urinary hesitation

A client has purchased an over-the-counter (OTC) cold remedy that advertises a "nondrowsy" formulation. The nurse explains to the client that such a medication is likely what classification of drug? A) a nasal decongestant B) a benzodiazepine C) an antihistamine D) a narcotic analgesic

A) a nasal decongestant

A common mucolytic used to liquefy mucus in the respiratory tract is A) acetylcysteine B) ipratropium C) dextromethorphan D) pseudoephedrine

A) acetylcysteine

In caring for a patient with nasal congestion, the nurse knows that adrenergic drugs are used as nasal decongestants to relieve symptoms by A) constricting arterioles and reducing blood flow to nasal mucosa B) stimulating air movement in the lungs C) stabilizing mast cells D) initiating the cough reflex

A) constricting arterioles and reducing blood flow to nasal mucosa

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? Oxymetazoline hydrochloride (afrin) Acetylcysteine (mucomyst) Daptomycin (cubicin) Dabepoetin alfa (aranesp)

Acetylcysteine (Mucomyst)

An adult patient has asked the nurse to recommend an OTC cold remedy because she is unsure which of the many options available is most appropriate. Before making a recommendation, the nurse should do which of the following? Consult with pharmacist or pharmacy technician. Assess the patient's understanding of the epidemiology of the common cold and upper respiratory infection. Assess the patient of health problems that may contraindicate the use of a particular remedy. Ensure that the patient has tried some of the more common herbal and natural remedies.

Assess the patient for health problems that may contraindicate the use of a particular remedy.

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? A) "I will not eat or drink for 30 minutes after taking a dose." B) "I will dilute the drug syrup with an equal amount of water." C) "If I raise mucous, I will stop taking the drug and call my prescriber." D) "The drug should only be taken as directed on the package."

B) "I will dilute the drug syrup with an equal amount of water."

The nurse prepares to administer acetylcysteine by nebulization to an adult client diagnosed with chronic bronchitis. Which measures would the nurse provide for safe and effective drug administration? SELECT ALL THAT APPLY. A) Instruct client that the drug irritates gastric vagal receptors to stimulate respiratory tract fluid. B) Administer prescribed bronchodilator aerosolized treatment 10 to 15 minutes before the acetylcysteine treatment. C) Provide drug after meals and before bedtime to remove mucous, which causes difficulties in breathing. D) Assess for improvement in coughing up increased amounts of mucous, respirations less than 26, and SaO2 greater than 90% .E) Report dyspnea, chest tightness, bronchospasms, and inability to expel secretions to the prescriber.

B) Administer prescribed bronchodilator aerosolized treatment 10 to 15 minutes before the acetylcysteine treatment. D) Assess for improvement in coughing up increased amounts of mucous, respirations less than 26, and SaO2 greater than 90% .E) Report dyspnea, chest tightness, bronchospasms, and inability to expel secretions to the prescriber.

A nurse is teaching the family of a child who has cystic fibrosis and a new prescription for acetylcysteine. Which of the following information should the nurse include in the instructions? A) Expect this medication to suppress your child's cough. B) Expect this medication to smell like rotten eggs. C) Expect this medication to cause euphoria. D) Expect this medication to turn your child's urine orange.

B) Expect this medication to smell like rotten eggs.

A nurse is caring for a client who has been taking phenylephrine nasal drops for the past 10 days for sinusitis. The nurse should assess the client for which of the following manifestations as an adverse effect of this medication? A) Sedation B) Nasal congestion C) Productive cough D) Constipation

B) Nasal congestion

Cold remedies listed as "nondrowsy" or labeled as "daytime" formulas do not contain A) a nasal decongestant B) a first-generation antihistamine C) a pain reliever D) any of the above

B) a first-generation antihistamine

Which of the following herbal preparations appears to play a role in the defense mechanisms of the respiratory system in adults? A) echinacea B) vitamin C C) zinc gluconate D) valerian

B) vitamin C

A critically ill patient with a diagnosis of ventilator-associated pneumonia has been administered acetylcysteine by inhalation. The critical care nurse knows that this medication helps to liquefy secretions in the respiratory tract by? Increasing the osmolality of mucus. Decreasing the osmolality of mucus. Breaking the protein bonds that exist in mucus. Drawing increased amounts of water from interstitial spaces into mucus.

Breaking the protein bonds that exist in mucus.

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? A) "I will blow my nose before using the nasal spray." B) "I will rinse the spray tip off after each use." C) "I can take over-the-counter pseudoephedrine, too." D) "The drug is used no longer than 3 days."

C) "I can take over-the-counter pseudoephedrine, too."

The nurse is educating an adult client diagnosed with rhinosinusitis with viscous clear mucous about the prescribed guaifenesin 400 mg PO every 4 hours. Which statement made by the client establishes the need for further clarification? A) "I will ask my pharmacist before taking any over-the-counters." B) "I will drink at least 8 ounces of water with each dose." C) "The drug will suppress my cough so I can sleep easier." D) "The drug is not affected by taking it with or without meals."

C) "The drug will suppress my cough so I can sleep easier."

As the nurse caring for a patient with nasal congestion who is using the OTC decongestant oxymetazoline, the nurse counsels the patient that this medication should be used only for the time recommended on the package and no longer because excessive use may produce A) copious lower respiratory tract secretions B) ringing in the ears C) rebound nasal congestion D) a suppressed cough reflex

C) rebound nasal congestion

An elderly patient has presented to the clinic for a scheduled visit and states that he has been taking a combination antitussive/decongestant/expectorant for several weeks in order to prevent the common cold. The nurse should cite which of the following effects of long-term use of OTC cold remedies? Select all that apply. Chronic epistaxis Anticholinergic affects chronic congestion Damage to the nasal mucosa Hepatotoxicity

Chronic congestion Damage to the nasal mucosa

A patient with a persistent and debilitating cough is confused that his physician has prescribed codeine. He 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. Vasodilation of the alveolar capillaries. Stimulation of the reticular activating system (RAS). Desensitization of the cough receptors in the sinus and trachea.

Depression of the cough center in the medulla oblongata

A 3-year-old child is seen in the pediatric office for a dry, hacking cough. The mother is requesting a prescription for dextromethorphan. In providing patient education, which of the following provides the most effective teaching regarding the use of dextromethorphan in children? Dextromethorphan suppresses cough in children Dextromethorphan is ineffective in children Dextromethorphan must be combined with codeine. Dextromethorphan raises blood pressure in children

Dextromethorphan is ineffective in children.

You are the school nurse educating a group of parents on the prevention of the common cold among their children. Which of the following preventive measures is most important to teach the parents? Frequent handwashing Maintaining vaccinated Taking 1200 mg of vitamin c Taking echinacea daily

Frequent handwashing

A 17-year-old boy has been brought to the emergency department by his mother who is distraught by the fact that she caught him and his friend "guzzling cough syrup." What assessment finding is suggestive of an overdose of dextromethorphan? Hallucinations Dysrhythmias Kussmaul's respirations Profound diaphoresis

Hallucinations

A patient is using oxymetazoline (Afrin) to relieve nasal congestion. Which of the following conditions would contraindicate the use of this drug? Nasal congestion cough hypertension skin rash

Hypertension

A nurse has taught an adult patient about the fact that guaifenesin is not necessarily an effective way of liquefying secretions. To help liquefy the patient's secretions, the nurse should encourage which of the following measures? Reducing salt Deep breathing and exercises. Gargling with normal saline. Increasing fluid intake.

Increasing fluid intake

A nurse is caring for a client who has been taking phenylephrine nasal drops for the past 10 days for sinusitis. The nurse should assess the client for which of the following manifestations as an adverse effect of this medication? Sedation Nasal congestion Productive cough Constipation

Nasal congestion

A 55-year-old male patient has been living with type 1 diabetes for many years and has begun to experience diabetic nephropathy over the past year. How will this patient's current health status influence the possible use of pseudoephedrine in the treatment of cold symptoms? The patient should monitor his blood glucose levels more frequently when taking pseudoephedrine. The use of pseudoephedrine is absolutely contraindicated by the fact that the patient has diabetes and takes insulin. The patient may require a higher-than- average dose of pseudoephedrine because of excess fluid volume secondary to renal failure. The patient should use caution and will likely require a lower dose of pseudoephedrine because of his impaired renal function.

The patient should use caution and will likely require a lower dose of pseudoephedrine because of his impaired renal function.

A 30-year-old woman with two preschoolers has sought the nurse's advice because she has heard conflicting reports about the safety and efficacy of cough and cold products in young children. The nurse should inform the woman that? Cough and cold remedies are generally safe and effective for children over the age 13. There are concerns among health professionals about how safe and effective these medications are. Media reports about the risk of cough and cold medications in children have greatly exaggerated the risks. It is imperative to use age-specific preparations of cough and cold remedies.

There are concerns among health professionals about how safe and effective these medications are.

A patient is taking a nasal decongestant. Which of the following medications may dangerously increase the effects of nasal decongestants? anti-inflammatory agents anti-infective agents Proton-pump inhibitors Thyroid preparations

Thyroid preparations

A patient presents at the clinic with sneezing and coughing. He is diagnosed with the common cold. Which type of microorganism causes the common cold? Gram-positive bacteria Gram-negative bacteria virus Fungus

Virus