Chapter 54- Drugs Acting on the Upper Respiratory Tract

What statement by the patient leads the nurse to believe that he needs additional instruction regarding his nasal decongestant? A) "I will blow my nose before instilling the nasal spray." B) "I will report any dizziness, drowsiness, or rapid pulse." C) "I will drink 2,000 to 3,000 mL of fluid daily." D) "I will use it only when I have nasal discharge."

Ans: D Feedback: Decongestants decrease overproduction of secretions by causing local vasoconstriction to the upper respiratory tract (See Table 54.2). This vasoconstriction leads to a shrinking of swollen mucous membranes and tends to open clogged nasal passages, providing relief from the discomfort of a blocked nose and promoting drainage of secretions and improved airflow. The patient must understand proper administration, which includes clearing the nasal passages before inhaling the medication and increasing fluid intake and reporting adverse effects. The medication must be used on a regular basis to be effective. Option B is a distracter.

The nurse advises that patient to avoid long-term use of nasal decongestants because it may lead to what condition? A) Mucosal ulcerations B) Decreased drainage C) Increased risk of infection D) Asthma

Ans: A Feedback: Adverse effects associated with topical decongestants include local stinging and burning, which may occur the first few times the drug is used. If the sensation does not resolve, the drug should be discontinued, because it may indicate lesions or erosion of the mucous membranes. Nasal decongestants do not cause asthma or increased risk of infection. These medications do not decrease drainage from the nose as they shrink the nasal mucosa.

A student nurse is doing research consisting of chart audits of 25 patients with diagnosed chronic pharyngitis; she is attempting to determine what medication has been prescribed most frequently. What type of medication would this nurse expect to find in most of the chart audits? A) Antitussives B) Nasal sprays C) Oral decongestants D) Mucolytics

Ans: A Feedback: Antitussives are drugs that suppress the cough reflex. Many disorders involving the respiratory tract, including the common cold, sinusitis, pharyngitis, and pneumonia are accompanied by an uncomfortable, nonproductive cough. Persistent coughing can be exhausting and can cause muscle strain and further irritation of the respiratory tract. Nasal sprays, oral decongestants, and mucolytics are not generally prescribed for chronic pharyngitis, however.

The nurse is caring for a patient who needs education on his medication therapy for allergic rhinitis. The patient is to take clemastine (Tavist) daily. In providing educational interventions regarding this medication, what is the most important instruction on the action of the medication? A) It blocks the effects of histamine. B) It is used to treat atrial and ventricular dysrhythmias. C) It competitively inhibits the rate-limiting enzyme in the liver. D) It leads to bronchodilation and relaxes smooth muscle in the bronchi.

Ans: A Feedback: Clemastine blocks the effects of histamine at the histamine-1 receptor sites, decreasing the allergic response. It is prescribed to treat allergic rhinitis. Antiarrhythmic medications are used to treat atrial and ventricular dysrhythmias. Beta-hydroxy-beta-methylglutaryl coenzyme A reductase inhibitors are used to lower blood cholesterol by competitively inhibiting the rate-limiting enzyme in the liver. Beta-adrenergic agents lead to bronchodilation and stimulate beta2-adrenergic receptors in the smooth muscle of the bronchi and bronchioles.

A patient presents at the clinic with signs and symptoms of seasonal allergic rhinitis. The patient is prescribed a nasal steroid to relieve symptoms. Two days later, the patient calls the clinic and tells the nurse that he is frustrated and wants a new drug. What is the most appropriate response by the nurse? A) "It may take up to 2 weeks to get the full clinical effect. Try to keep using the drug as ordered." B) "The drug must not work for you. Let's change to an oral steroid." C) "You probably are administering the drug incorrectly. Come in and we can review the process." D) "You probably need to try a different nasal steroid. This one should be effective by now."

Ans: A Feedback: Nasal steroids require about 2 weeks to reach their full clinical effect so the patient should be encouraged to use the drug for that length of time before changing drugs or giving up. The other responses could be appropriate if after 2 weeks the patient is still not getting relief.

The nurse is giving discharge instructions to the mother of a 3-month-old infant who has an upper respiratory tract infection and has been prescribed a pseudoephedrine nasal solution. What instructions are most important for the nurse to give to this mother? A) Instill the medication 20 to 30 minutes before feeding. B) Keep the baby on clear liquids until the nasal discharge has resolved. C) Start the baby on cereal, because she is having difficulty sucking right now. D) Give the medication immediately after feeding.

Ans: A Feedback: Oral decongestants are drugs that are taken by mouth to decrease nasal congestion related to the common cold, sinusitis, and allergic rhinitis. They are also used to relieve the pain and congestion of otitis media. Opening of the nasal passage allows better drainage of the Eustachian tube, relieving pressure in the middle ear. It should be given prior to a feeding so that infant is able to suck more effectively.

Parents who treat their children's cold and flu symptoms at home should be educated concerning the reading and understanding of over-the-counter (OTC) labels. Why is this statement true? A) Many of these preparations contain the same active ingredients so that inadvertent overdose is a common problem. B) Each product is best used for alleviating a particular symptom. C) Some of these products do not contain any drugs. D) Some of these products could interfere with breast-feeding.

Ans: A Feedback: Parents need to be educated to read the labels of any OTC preparation they give their children. Many of these preparations contain the same ingredients and inadvertent overdose is a common problem. Giving a child a drug should not interfere with the mother's milk production. All these products contain chemicals, which are drugs; many can be used to treat more than one symptom.

The family nurse practitioner is caring for a Hispanic woman who is 83 years old. The patient has been noncompliant with the care regimen the nurse practitioner has previously outlined for treatment of sinusitis. What should the nurse practitioner do that can assist the patient in being more compliant with the prescribed treatment regimen? A) Provide instructions in writing. B) Provide the instructions in large type. C) Give the treatment instructions to a member of her family. D) Give the treatment instructions to the woman's husband.

Ans: A Feedback: The nurse instructs the patient about signs and symptoms that require follow-up and provides these instructions verbally and in writing. Instructions in alternate formats (e.g., large type, patient's language) may be needed to increase the patient's understanding and adherence to the treatment plan. Option B is incorrect because the situation does not indicate that the woman cannot read regular-sized type print. Options C and D are incorrect because the situation does not indicate that any family members accompanied the patient to see the family nurse practitioner.

A 71-year-old man with a history of heart disease and diabetes has had an antihistamine prescribed. The nurse is concerned with this prescription because of the risk for what? A) Cardiac arrhythmias B) Increased salivation and choking C) Severe constipation D) Insomnia

Ans: A Feedback: The patient has history of heart disease. Antihistamines have been associated with prolongation of the QT interval, which can lead to potentially fatal cardiac arrhythmias. Antihistamines dry the mucosa and are not associated with increased salivation or choking, can cause drowsiness, and are not associated with insomnia or severe constipation.

An individual calls the nurse help line and asks what the drug diphenhydramine is used for. The nurse knows that the medication is prescribed for which conditions? (Select all that apply.) A) Urticaria B) Vasomotor rhinitis C) Productive cough D) Motion sickness E) Angioedema

Ans: A, B, D, E Feedback: Diphenhydramine is used for the symptomatic relief of perennial and seasonal rhinitis, vasomotor rhinitis, allergic conjunctivitis, urticaria, and angioedema; it is also used for treating motion sickness and parkinsonism, as a nighttime sleep aid, and to suppress cough. It would not be used to treat a productive cough, because it is not an expectorant.

A patient has been using guaifenesin for a cough that accompanied a common cold. The patient calls the nurse help line and states that she thinks she is having an adverse reaction to the medication. The nurse knows that which symptoms are adverse effects of this medication? (Select all that apply.) A) Nausea B) Rash C) Constipation D) Bleeding E) Headache

Ans: A, B, E Feedback: Adverse effects of guaifenesin are nausea, vomiting, headache, dizziness, and rash. Constipation and bleeding are not adverse effects of guaifenesin.

A patient has been prescribed an antihistamine for treatment of allergic rhinitis. What statements by the patient indicate an understanding of this medication? (Select all that apply.) A) "This medication will work best if I take it before I eat anything." B) "I need to drink less fluid while I take this medication to help reduce the amount of mucus I have." C) "I will use sugarless candies to help with the feelings of a dry mouth." D) "I will use a humidifier in the bedroom while I sleep." E) "This medication will probably cause my appetite to increase."

Ans: A, C, D Feedback: Antihistamines should be taken on an empty stomach and the patient should force fluids, not drink less fluids. The patient may use sugarless candy to help with dry mouth and should increase room humidity. The patient may experience nausea or anorexia but not increased hunger. Options B and E are not correct.

The nurse is caring for a patient who is scheduled to receive acetylcysteine because of an acetaminophen overdose. The nurse would notify the physician before administering the medication if the patient had which condition? (Select all that apply.) A) Bronchospasm B) Hypertension C) Nephrotic syndrome D) Peptic ulcer E) Esophageal varices

Ans: A, D, E Feedback: Before administration, assess for possible contraindications or cautions: any history or allergy to the prescribed drugs and the presence of bronchospasm, which are contraindications to the use of these drugs, as well as findings of peptic ulcer and esophageal varices, which would require careful monitoring and cautious use. Options B and C are not correct.

The nurse is caring for a patient who is receiving acetylcysteine (Mucomyst) by face mask. What would be an appropriate nursing diagnosis? A) Impaired swallowing B) Risk for impaired skin integrity C) Risk for falls D) Sleep deprivation

Ans: B Feedback: A patient receiving acetylcysteine by face mask should have the residue wiped off the face mask and her face with plain water to prevent skin breakdown. The appropriate nursing diagnosis would be risk for impaired skin integrity. Acetylcysteine does not cause impaired swallowing, produce any CNS effects that could increase the risk for falls, or impair the patient's ability to sleep.

The nurse is giving discharge instructions to a patient with an upper respiratory infection who has been advised to take an over-the-counter (OTC) topical nasal decongestant. The nurse advises the patient about what common adverse reaction to these medications? A) Diarrhea B) Rhinitis medicamentosa C) Rash D) Headache

Ans: B Feedback: An adverse effect that accompanies frequent or prolonged use of topical nasal decongestants is rebound congestion, technically called rhinitis medicamentosa. Other adverse reactions include disorientation, confusion, nausea, vomiting, fever, and dyspnea. Diarrhea, rash, and headache are not commonly associated with these drugs, however.

A patient has been prescribed a nasal steroid and asks the nurse what the most common reason that this medication is used to treat. What is the nurse's best response? A) Nasal steroids are only used to treat a sinus infection. B) Nasal steroids are used to treat allergic rhinitis. C) Nasal steroids are used for an infection in the adenoids. D) Nasal steroids are used for all acute upper respiratory infections.

Ans: B Feedback: 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 a sinus infection, an infection in the adenoids, or any other acute upper respiratory infection.

A patient presents at the clinic with a dry nonproductive cough. The patient is diagnosed with bronchitis and it has been determined that assistance is needed in thinning the sputum so the cough can become productive. What does the nurse expect the physician will prescribe? A) Benzonatate (Tessalon) B) Guaifenesin (Mucinex) C) Dextromethorphan (Benylin) D) Hydrocodone (Hycodan)

Ans: B Feedback: Because this patient needs to cough up respiratory secretions, he would likely be prescribed guaifenesin. This drug is an expectorant that liquefies lower respiratory secretions by reducing their viscosity and so making it easier for a patient to cough them up. Benzonatate, dextromethorphan, and hydrocodone are antitussives and are given to suppress the cough reflex.

A patient comes to the clinic with symptoms as seen in a cold. What group of upper respiratory drugs causes local vasoconstriction, which decreases blood flow and shrinks swollen membranes to improve air flow? A) Antitussives B) Decongestants C) Expectorants D) Mucolytics

Ans: B Feedback: Decongestants cause local vasoconstriction that decreases blood flow to irritated and dilated capillaries of the mucous membranes lining the nasal passages and sinus cavities. This 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 lower respiratory tract secretions, reducing the viscosity of the secretions and so 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 mucous material together.

The nurse is caring for a patient who is taking dextromethorphan for cough suppression. The nurse will assess this patient for hypotension if he also takes which other medication? A) Calcium-channel blockers B) Monoamine oxidase (MAO) inhibitors C) Beta-blockers D) Thiazide diuretics

Ans: B Feedback: Dextromethorphan should not be used in conjunction with MAO inhibitors because hypotension, fever, nausea, myoclonic jerks, and coma could occur. No known drug-drug interaction exists between dextromethorphan and calcium-channel blockers, beta-blockers, and thiazide diuretics.

A 29-year-old female patient has sinusitis, so the physician orders a topical nasal decongestant. What instructions should be given? A) Avoid becoming pregnant during decongestant therapy. B) Increase fluids to 2 L/d. C) Restrict fluids to 500 mL/d. D) Take the medication with meals.

Ans: B Feedback: Institute other measures to help relieve the discomfort of congestion (e.g., humidity, increased fluid intake, cool environment, avoidance of smoke-filled areas) as appropriate. The medication does not need to be taken with meals or to restrict fluids. It would be inappropriate to tell the patient to avoid becoming pregnant.

The nurse is writing a care plan for a patient who has been prescribed a nasal steroid. What would be an appropriate nursing diagnosis for this patient? A) Disturbed sensory perception (kinesthetic) related to CNS effects B) Risk for injury related to suppression of inflammatory reaction C) Ineffective airway clearance related to bronchospasm D) Ineffective airway related to nasal obstruction

Ans: B Feedback: Nursing diagnoses related to drug therapy might include acute pain related to local effects of the drug, risk for injury related to suppression of inflammatory reaction, and deficient knowledge regarding drug therapy. Nursing diagnosis for this patient does not include disturbed sensory perception, ineffective airway clearance, or ineffective airway.

A nurse in a three drops with respiratory problems has received orders for four patients. What medication order will the nurse question? A) Tetrahydrozoline (Tyzine) three drops in each nostril for an 8-year-old child B) Hydrocodone (Hycodan) 10 mg PO for a 5-year-old child C) Pseudoephedrine (Dorcol) 15 mg PO for a 2-year-old child D) Diphenhydramine (Benadryl) 5 mg/kg IM for a 10-year-old child

Ans: B Feedback: The nurse should question the order for hydrocodone. The ordered dose, 10 mg, is an adult dose and should not be given to a 5-year-old. Patients from 2 to 12 years of age should be given between 1.25 and 5 mg/dose. The other medications are all correct dosages for the age of the child for whom they were prescribed.

What would be the nurse's best response if a patient calls the clinic and reports that he has had a persistent cough for 2 weeks and asks the nurse for a recommendation for a cough medicine? A) "Look for dextromethorphan as an ingredient in any OTC cough preparation." B) "The doctor could order an antihistamine, which might dry up your secretions and stop the cough." C) "You should come to the clinic to be evaluated. A cough that lasts that long might be an indication of an underlying medical problem." D) "Drink a lot of fluids and take aspirin, which should reduce the irritation in your throat."

Ans: C Feedback: A cough that has persisted for 2 weeks could be indicative of an underlying medical condition that should be addressed before treating the cough. The patient should be asked to come in for an evaluation. Dextromethorphan could help stop the cough, but suppressing the cough might not be in the patient's best interest. Drying the mucosa with an antihistamine could aggravate the cough. Aspirin would not be indicated for relieving throat irritation.

The nurse is caring for a patient who does not have a respiratory disorder but has been prescribed acetylcysteine. What is an additional indication for acetylcysteine (Mucomyst)? A) Conversion of cardiac dysrhythmias B) Treatment of peptic ulcer disease C) Antidote for acetaminophen poisoning D) Decreased bronchospasm

Ans: C Feedback: Acetylcysteine is used orally to protect liver cells from being damaged during episodes of acetaminophen toxicity because it normalizes hepatic glutathione levels and binds with a reactive hepatotoxic metabolite of acetaminophen. Acetylcysteine is not used for the conversion of cardiac dysrhythmias, for treatment of peptic ulcer disease, or for decreasing bronchospasm.

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

Ans: C Feedback: Cystic fibrosis patients 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.

The pharmacology instructor questions the students as to which classification of drugs is commonly found in over-the-counter (OTC) combination cold medications? A) Stimulants B) Opioids C) Oral decongestants D) Antitussives

Ans: C Feedback: Oral decongestants are found in many OTC cold and flu preparations so that care must be taken to avoid inadvertent overdose when more than one such drug is used. Opioids are only available by prescription; stimulants and antitussives are not generally found in OTC combination cold medications.

A nurse is caring for a 15-year-old patient with cystic fibrosis who has been prescribed dornase alfa (Pulmozyme) to relieve the buildup of secretions and keep airways open and functioning longer. What will the nurse instruct the patient to do concerning the use of this drug? A) Use in home nebulizer up to four times a day if needed. B) Stop all other medications while using the drug. C) Store the drug in the refrigerator, protected from light. D) Expect a severe headache after each use.

Ans: C Feedback: Patients using dornase alfa should be cautioned to store the drug in the refrigerator, protected from light. Heat and light can cause the drug to break down and can decrease its therapeutic value. The drug should only be used up to two times a day and the patient should continue all other medications while using it. Dornase alfa is only a palliative therapy that improves respiratory symptoms. A severe headache is not associated with this drug.

The nurse is teaching a group of patients with allergic rhinitis about the use of their medications. What would be the most essential information to give these patients about preventing possible drug interactions? A) Over-the-counter (OTC) medications are safe to use. B) Use only one pharmacy so the pharmacist can check drug interactions. C) Read drug labels before taking OTC medications. D) Ask the pharmacy tech for assistance in selecting an OTC medication.

Ans: C Feedback: Teach patients to read the OTC labels to avoid inadvertent overdose. It would be inappropriate to teach the patient 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 patients.

The nursing instructor is teaching the lab students the best position for the administration of nasal sprays. What position would the instructor teach the students? A) Supine B) Semi-Fowler's C) High Fowler's D) Side-lying

Ans: C Feedback: Teach the patient to sit upright and press a finger over one nostril to close it. This body position is important to prevent excessive amounts of the medication running down the back of the throat. It needs to be in direct contact with the greatest amount of nasal mucosa and the high Fowler's position provides that.

A patient has an important presentation to make in 4 hours and he needs relief from the congestion of seasonal rhinitis. The patient calls the nurse, explains the situation, and tells the nurse that he cannot afford to be drowsy. Which antihistamine would be a good choice for this patient? A) Diphenhydramine (Benadryl) B) Dexchlorpheniramine (Polaramine) C) Loratadine (Claritin) D) Hydroxyzine (Atarax)

Ans: C Feedback: 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.

The nursing instructor is discussing the administration of nasal spray with the nursing students. What information is most important to include in this discussion? A) Finish the bottle of nasal spray to clear the infection effectively. B) Nasal spray can be shared between family members only. C) Administer the nasal spray in a prone position. D) Overuse of nasal spray may cause rebound congestion.

Ans: D Feedback: An adverse effect that accompanies frequent or prolonged use of decongestants is rebound vasodilation, clinically called rhinitis medicamentosa. The reflex reaction to vasoconstriction is a rebound vasodilation, which often leads to prolonged overuse of decongestants. The patient should hold his or her head back for maximum distribution of the spray. Only an individual patient should use the bottle of medication.

What disorders would the pharmacology instructor tell the nursing students may be exacerbated by the use of nasal decongestants? A) Pneumonia B) Rheumatoid arthritis C) Acid reflux D) Hypothyroidism

Ans: D Feedback: Assess for possible contraindications or cautions; any history of allergy to the drug or a component of the drug vehicle; glaucoma, hypertension, diabetes, thyroid disease, coronary disease, and prostate problems, all of which could be exacerbated by the sympathomimetic effects. Nasal decongestants do not appear to exacerbate pneumonia, rheumatoid arthritis, or acid reflux.

What statement by a 61-year-old patient who is to take an antitussive with codeine indicates that the nurse's teaching has been effective? A) "I will take this medication anytime I start to cough." B) "This medication may make me anxious and nervous." C) "I should call the physician if I develop nausea, diarrhea, or stomach cramps while taking this medication." D) "This medication can cause drowsiness, so I will avoid driving or using power equipment while I take it."

Ans: D Feedback: Codeine is a CNS depressant and should not be combined with driving or heavy machinery activities. Antitussives are not intended to be taken with every coughing episode because the patient may overdose on the medication. The medication usually makes the patient drowsy rather than nervous and anxious. Codeine may cause GI upset, although it is usually constipating; some patients may complain of nausea and stomach distress while taking this medication.

The clinic nurse is caring for a patient who has been prescribed fexofenadine for hay fever. When the nurse is assessing this patient's medication history, what drug would make the nurse question the order for fexofenadine? A) Tetracycline B) Penicillin C) Gentamicin D) Ketoconazole

Ans: D Feedback: Drug-drug interactions vary among antihistamines. For example, anticholinergic effects may be prolonged if diphenhydramine is taken with a monoamine inhibitor and the interaction of fexofenadine with ketoconazole or erythromycin may raise fexofenadine concentrations to toxic levels. This is not a concern with tetracycline, penicillin, or gentamicin.

A patient visits the clinic and is diagnosed with acute sinusitis. To promote sinus drainage, what medication might be ordered? A) Topical nasal steroid decongestants B) First-generation antihistamines C) Second-generation antihistamines D) Topical decongestants

Ans: D Feedback: Topical decongestants are sympathomimetics, meaning that they imitate the effects of the sympathetic nervous system to cause vasoconstriction, leading to decreased edema and reduced inflammation of the nasal membranes. They are available as nasal sprays that are used to relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis, and allergic rhinitis. Topical nasal steroid decongestants are used for the treatment of allergic rhinitis and to relieve inflammation after the removal of nasal polyps. First- and second-generation antihistamines are not ordered for sinusitis.