Chapter 54: Drugs Acting on the Upper Respiratory Tract

A client is currently taking pseudoephedrine to help manage the nasal congestion resulting from seasonal allergies. When the client reports being extremely restless and having difficulty getting to sleep at night, what assessment question will the nurse ask to best provide interventions to minimize those effects? "Do you tend to exercise before going to bed?" "Are you a smoker?" "Are you out in the sun much during a typical day?" "How much coffee, tea, and soda do you drink daily?"

"How much coffee, tea, and soda do you drink daily?" Explanation: Caffeine can enhance the adverse effects of pseudoephedrine. The client's coffee, tea, and soda consumption would tend to increase the client's risk for insomnia and restlessness. None of the other options are known to have this effect on those taking the decongestant.

After teaching a client who is receiving an antitussive about the drug, which statement indicates the need for additional teaching? "I'll get a humidifier for my bedroom." "I'll keep the room warm and toasty." "I can use some lozenges for comfort." "I need to increase the amount of fluids I drink."

"I'll keep the room warm and toasty." Explanation: Measures to assist with cough control when using antitussives include cool temperatures, humidification, lozenges, and increased fluids.

The nurse is caring for a client with cystic fibrosis who is receiving dornase alfa by nebulizer to help thin secretions. What statement by the client indicates a need for further instruction? "This medication will loosen up the sticky mucus that is in my lungs." "I will try to cough after I receive this medication." "I'm glad that this medication will address all of my symptoms." "I will continue to use postural drainage and take my enzymes as ordered."

"I'm glad that this medication will address all of my symptoms." Explanation: Cystic fibrosis clients who receive dornase alfa should be cautioned about the need to continue all therapies for their cystic fibrosis because dornase alfa is only a palliative therapy that improves respiratory symptoms, and other therapies, such as coughing, postural drainage, and enzymes, are still needed. This medication will not relieve all of the client's symptoms.

A client is receiving dornase alfa at home. Which would the nurse instruct the client to do? "Store the drug at room temperature." "Mix the drug with tap water." "Protect the drug from light." "Take the drug orally with meals."

"Protect the drug from light." Explanation: 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.

What home remedies are effective for mouth dryness and cough? (Select all that apply.) Administration of over-the-counter antihistamine Adequate fluid intake Humidification of the environment Sucking on hard candy or throat lozenges Swishing the mouth with astringent mouthwash.

Adequate fluid intake Humidification of the environment Sucking on hard candy or throat lozenges Explanation: An adequate fluid intake, humidification of the environment, and sucking on hard candy or throat lozenges can help relieve mouth dryness and cough. The use of astringent mouthwash will only increase mouth dryness.

Acetylcysteine may be used as a mucolytic agent. What is an additional indication for the drug? Conversion of cardiac arrhythmias Treatment of peptic ulcer disease Antidote for acetaminophen poisoning Treatment of bronchospasm

Antidote for acetaminophen poisoning Explanation: Oral acetylcysteine is widely used in the treatment of acetaminophen overdosage.

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? 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 can be helpful when they're combined with an antibiotic. 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 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? Motor coordination Blood pressure Vision Auditory tests

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.

Which agent acts directly on the medullary cough center? Benzonatate Codeine Ephedrine Tetrahydrozoline

Codeine Explanation: Codeine, a centrally acting antitussive, works directly on the medullary cough center. Benzonatate provides local anesthetic action on the respiratory passages, lungs, and pleurae. Ephedrine and tetrahydrozoline are topical nasal decongestants.

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 Vasodilation of the alveolar capillaries Stimulation of the reticular activating system (RAS) Desensitization of the cough receptors in the sinuses and trachea

Depression of the cough center in the medulla oblongata Explanation: Antitussives such as codeine suppress cough by depressing the cough center in the medulla oblongata. They do not influence blood flow or desensitize peripheral cough receptors. The RAS is not involved in the cough reflex.

A nurse is describing the action of a prescribed antihistamine to a client. The nurse is describing which medication, by explaining that the drug elicits its antihistamine effects by non-selectively binding to central and peripheral H1 receptors? Diphenhydramine Cetirizine Fexofenadine Loratadine

Diphenhydramine Explanation: Diphenhydramine is a first-generation antihistamine. First-generation antihistamines elicit their antihistamine effects by non-selectively binding to central and peripheral H1 receptors. Second-generation antihistamines, such as cetirizine, fexofenadine, and loratadine, elicit their effects by being selective for peripheral H1 receptors only.

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

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

Acetylcysteine is the antidote for aspirin toxicity. True False

False Explanation: Acetylcysteine is used to protect the liver from acetaminophen toxicity.

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 hydration of the skin Maintenance of an effective heart rate Maintenance of effective airway clearance Maintenance of an effective urine output

Maintenance of effective airway clearance Explanation: 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 would contraindicate the use of a topical nasal decongestant? Nasal ulceration Hypertension Diabetes Glaucoma

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.

Decongestants are available in which dosage forms? (Select all that apply.) Oral tablets Nasal sprays Nasal drops Suppositories Inhalers

Oral tablets Nasal sprays Nasal drops Explanation: Decongestants are available as oral tablets, nasal sprays, and nasal drops.

Which agent would the nurse instruct a client to use orally? Pseudoephedrine Phenylephrine Tetrahydrozoline Xylometazoline

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

A client reports anxiety, restlessness, nausea, and vomiting after using a nasal decongestant. Which drug should the nurse consider as the cause for these side effects? Ephedrine Pseudoephedrine Epinephrine Phenylephrine

Pseudoephedrine Explanation: 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? Diarrhea Rebound congestion Rash Headache

Rebound congestion Explanation: An adverse effect that accompanies frequent or prolonged use of these drugs is a rebound congestion, officially called rhinitis medicamentosa.

When describing the action of dornase alfa in treating cystic fibrosis, the nurse understands that this drug: Separates extracellular DNA from protein in mucus Liquifies secretions to decrease viscosity Splits the disulfide bonds that hold mucus material together Binds with a metabolite that is toxic to the liver

Separates extracellular DNA from protein in mucus Explanation: 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 mucus material together. Acetylcysteine protects liver cells from damage because it normalizes hepatic glutathione levels and binds with a reactive hepatotoxic metabolite of acetaminophen.

The nursing instructor is discussing the use of nasal decongestants and shares what reason for their effectiveness? They are absorbed systemically. They treat multiple symptoms in a cost-effective manner. They come into direct contact with nasal mucosa. Their effects last for 48 to 72 hours.

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.

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 Selectively binding to peripheral H1 receptors Non-selectively binding to central and peripheral H1 receptors Anesthetizing stretch receptors in the respiratory passages

Vasoconstriction of small blood vessels of the nasal membranes Explanation: Vasoconstriction of small blood vessels of the nasal membranes is the mechanism of action for decongestants. First-generation antihistamines act to non-selectively 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.

Which client has an increased risk for developing an adverse reaction if prescribed pseudoephedrine nasally? a 50-year-old female diagnosed with hypothyroidism a 70-year-old male being treated for bilateral cataracts a 30-year-old female being treated for hyperlipidemia a 20-year-old male who has a 1-pack-a-day cigarette habit

a 30-year-old female being treated for hyperlipidemia Explanation: Contraindications to pseudoephedrine use include severe hypertension or coronary artery disease because of the drug's cardiac stimulating and vasoconstricting effects. None of the other options present clients with conditions that are contraindicated for pseudoephedrine use.

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? eucalyptus antihistamine acetaminophen Advil

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 client has just been admitted for an overdose of pseudoephedrine. The nurse's assessment of the client should prioritize what system? cardiovascular neurological gastrointestinal renal

cardiovascular Explanation: Because pseudoephedrine is a stimulant, cardiac symptoms are a notable adverse effect, especially in the acute stage of the overdose. All the other systems should be monitored, but the cardiac-related adverse reactions have priority.

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 Using household measuring devices for dosage measurements Using adult formulation with smaller doses

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.

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? The medication is not effective for croup. Misuse could result in overdose. The medication is contraindicated for the child's symptoms. The medication is contraindicated for viral infections.

Misuse could result in overdose. Explanation: 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.

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? Central nervous system depression Hypotension Nausea and vomiting Joint pain

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

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 epinephrine clemastine cetirizine

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 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.

Which condition would contraindicate the use of oxymetazoline? nasal congestion cough hypertension skin rash

hypertension Explanation: Oxymetazoline is contraindicated in clients 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 cases that involve cough or skin rash.

Which nursing diagnosis would provide the clearest indication for the administration of inhaled acetylcysteine? ineffective airway clearance impaired tissue perfusion ineffective breathing pattern risk for infection

ineffective airway clearance Explanation: Acetylcysteine reduces the viscosity of mucous secretions with the ultimate goal of allowing the client to establish and maintain a clear airway. This drug does not directly influence the pattern of breathing. Impaired tissue perfusion can have multiple causes, many of which are unrelated to the presence of mucus secretions.

A client asks the nurse how long to use oxymetazoline (Afrin) nasal spray for nasal congestion. What is the nurse's best response? "Over-the-counter medications are safe for long-term use." "Consult with your primary care provider." "Afrin can be used as long as nasal burning and stinging do not occur." "Use the medication until your symptoms are completely relieved."

"Consult with your primary care provider." Explanation: 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 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." "Most people find that cold medications are essentially ineffective." "It usually takes between 8 and 10 days for a decongestant to cure affect cold symptoms." "Sometimes a decongestant 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." Explanation: Most people experience some relief, but clients should be made aware that cold medications do not cure the common cold; they only relieve some symptoms. Over-the-counter (OTC) cold remedies should not be used longer than 1 week. Such medications do not inhibit healing by masking symptoms.

Ms. James contacts her physician's office and asks if it is safe to use diphenhydramine while breast-feeding. The nurse's answer is based on the fact that diphenhydramine is a pregnancy category B drug and on which characteristic? It may cause gray baby syndrome in the neonate. It may inhibit lactation. It may induce seizures in neonates. It may induce paradoxical CNS stimulation in premature infants.

It may inhibit lactation. Explanation: First-generation H1 antagonists are not used during breast-feeding, because they may inhibit lactation. In addition, they may induce paradoxical CNS stimulation in neonates or seizures in premature infants. They do not cause gray baby syndrome in neonates.

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? "You should really consider prescription medications rather than OTC medications." "While OTC medications may be cheaper, they generally result in more side effects." "Follow the instructions on the label so that you don't end up making the congestion worse." "No OTC medication, especially sprays or nose drops, should be taken for more than 3-4 days."

"Follow the instructions on the label so that you don't end up making the congestion worse." Explanation: When taken according to their instructions, OTC medications can often be as safe and effective as prescribed medications and are sometimes suggested by the primary health care prescriber. However, clients should be informed that excessive or prolonged use may damage nasal mucosa and produce chronic nasal congestion. Over-the-counter (OTC) cold remedies should not be used longer than 1 week, and clients should be instructed not to use nose drops or sprays more often or longer than recommended on the label. While OTC medications may be cheaper in some cases, they will not cause more side effects. The length of the therapy is dependent on many factors, including the type and dose of the medication.

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 over-the-counter products for our 5-year-old but not for our 18-monthold." "We need to read the label carefully to see how often and how much to give." "We can use the adult brand, but we just have to decrease the amount." "We should use the cup that comes with the drug to measure it out."

"We can use the adult brand, but we just have to decrease the amount." Explanation: Parents should use the children's, pediatric, or infant formulations of the drug. Over-the-counter cough and cold preparations should not be used in children under the age of 2 years. The parents need to read the label carefully to determine the dosage and frequency, and they need to use the device that comes with the drug to ensure a proper dosage.

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? "It's best to take small doses of decongestants several times daily rather than two larger doses each day." "You can probably expect to get relief within the next few days or a week at the longest." "Over-the-counter decongestants don't normally work; you'll likely need to get a prescription for something more effective." "You might find yourself more congested than ever as your body compensates for your use of these drugs."

"You might find yourself more congested than ever as your body compensates for your use of these drugs." Explanation: Frequent, long-term, or excessive use of decongestants induces rebound congestion. Rebound congestion occurs when the nasal passages become congested as the drug effect wears off and the body compensates by vasodilating the same nasal arterioles that the drug constricted. This does not occur because of the ineffectiveness of decongestants, however. Dosing should be based on the instructions provided.

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. Both drug types loosen bronchial secretions for ease of removal. Antitussives liquefy bronchial secretions while expectorants assist in the expectoration of those secretions. Antitussives kill cold viruses while expectorants liquefy bronchial secretions.

Antitussives suppress coughing while expectorants loosen bronchial secretions. Explanation: Antitussive agents suppress cough by depressing the cough center in the medulla oblongata or the cough receptors in the throat, trachea, or lungs. Expectorants are agents given orally to liquefy respiratory secretions and allow for their easier removal.

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. Benzonatate capsules should be sucked on like a lozenge. Consumption of alcohol is okay while taking benzonatate. Benzonatate can be taken more frequently than prescribed if needed.

Benzonatate can cause GI upset and sedation. The client should drink plenty fluids. Explanation: 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.

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? Antitussives Decongestants Expectorants Mucolytics

Decongestants Explanation: Decongestants cause local vasoconstriction that decrease blood flow to irritated and dilated capillaries of the mucous membranes lining the nasal passages and sinus cavities. The vasoconstriction leads to a shrinking of swollen membranes and opens clogged nasal passages promoting drainage of secretions and improved air flow. Antitussives either work directly on the medullary cough center of the brain or act as a local anesthetic on the respiratory passages blocking the effectiveness of the stretch receptors that stimulate a cough reflex. Expectorants liquefy the lower respiratory tract secretions, reducing the viscosity of the secretions and making it easier to cough them up. Mucolytics break down mucus to aid a person in coughing up thick tenacious secretions by separating cells that hold mucus material together.

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 has a history of cataracts. The client has had a cold for 3 days. The client is being treated for severe hypertension. The client has hypothyroidism.

The client is being treated for severe hypertension. Explanation: Contraindications to pseudoephedrine use include severe hypertension or coronary artery disease because of the drug's cardiac stimulating and vasoconstricting effects. Cataracts are not a contraindication for use, but narrow-angle glaucoma is. Caution should be used in clients with hyperthyroidism, not hypothyroidism. The duration of the cold symptoms does not have any relevance to the use of pseudoephedrine.