Chapter 54

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 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 need to read the label carefully to see how often and how much to give." -"We can use over-the-counter products for our 5-year-old but not for our 18-monthold.

"We can use the adult brand, but we just have to decrease the amount."

A client receives diphenhydramine orally. The nurse would expect this drug to begin acting within which time frame? 45 to 60 minutes 15 to 30 minutes 60 to 75 minutes 30 to 45 minutes

15 to 30 minutes

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

Antidote for acetaminophen poisoning

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 for this issue; only antibiotics are useful. -Antihistamines are not recommended because they can dry lower respiratory secretions and worsen secretion retention and cough. -Antihistamines are recommended for extended use, as long as you monitor for adverse effects. -Antihistamines are not used for this issue.

Antihistamines are not recommended because they can dry lower respiratory secretions and worsen secretion retention and cough.

What principle should guide the nurse's response when a parent asks about the use of an antitussive to treat a 7-year-old's dry cough? -Antitussives should only be used to treat productive coughs in children not dry coughs. -Children should be administered antitussives based on weight not age. -Antitussives are not recommended for use in young children. -Children should be administered antitussives based on body surface index not age.

Antitussives are not recommended for use in young children.

A client with seasonal allergies has sought care due to a recent onset of blurred vision and urinary retention. What is the nurse's best action? -Encourage the client to ask the provider for medication to resolve the problems. -Perform a focused respiratory assessment. -Assess the client's pattern of antihistamine usage. -Determine whether the client is taking over-the-counter antitussives.

Assess the client's pattern of antihistamine usage.

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

Codeine

What are some disorders treated with antitussives

Common cold, Sinusitis, pharyngitis and pneumonia, are accompanied by an uncomfortable unproductive cough.

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 nonselectively binding to central and peripheral H1 receptors? Cetirizine Diphenhydramine Loratadine Fexofenadine

Diphenhydramine

A 76-year-old client has been prescribed an oral antihistamine. What adverse effect presents a priority safety concern for older adult clients? Drowsiness Nonproductive cough Dry mouth Nasal burning

Drowsiness

A female client presents at the clinic with a dry, nonproductive cough. The client is diagnosed with bronchitis, and it is determined that she will need help thinning sputum so that the cough can become productive. What does the nurse expect will be prescribed for the client? Codeine Aspirin Guaifenesin Dextromethophan

Guaifenesin

The nurse has been ordered to administer a preanesthetic medication that contains both anxiolytic and antiemetic properties. The nurse knows that which medication combines these two properties?

Hydroxyzine (Vistaril)

Dextromethorphan

Indications: Control of nonproductive cough. Actions: Depresses the cough center in the medulla to control cough spasms. Pharmacokinetics: Route: Oral Onset: 25-30 min peak: 2 hour duration- 3-6 hr t 1/2: 2-4 hours metabolized in the liver and excreted in the urine Adverse effects: dizziness, respiratory depression, dry mouth

Which agent would a nurse expect the health care provider to prescribe for a client experiencing motion sickness? Clemastine Cyproheptadine Meclizine Hydroxyzine

Meclizine

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

Misuse could result in overdose.

A client with cystic fibrosis may use which type of medication to reduce the viscosity of respiratory secretions? Expectorant Centrally acting antitussive Peripherally acting antitussive Mucolytic Antihistamine

Mucolytic

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? -Nausea and vomiting -Hypotension -Central nervous system depression -Joint pain

Nausea and vomiting

Which is classified as a decongestant? Dextromethorphan (Delsym) Levocetirizine (Xyzal) Azelastine (Astelin) Oxymetazoline (Afrin)

Oxymetazoline (Afrin)

Who should take Mucolytics?

Patients may be suffering from conditions such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, pneumonia, or tuberculosis. Mucolytics include acetylcysteine (generic) and dornase alfa (Pulmozyme).

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?

Pseudoephedrine

A patient is advised to take a decongestant drug to relieve nasal congestion associated with hay fever. The patient is not comfortable with a nasal spray or drops and prefers an oral tablet. Which oral decongestant drugs can be administered to the patient? -Xylometazoline -Ephedrine -Pseudoephedrine -Tetrahydrozoline

Pseudoephedrine

What happens if a patient prolonged or frequent use of decongestions?

Rebound congestion (rhinitis medicamentosa)

A gerontological nurse has encouraged a group of caregivers who work with older adults to avoid administering first-generation H1 receptor antagonists to their clients. The nurse's cautionary message is an acknowledgment of what possible nursing diagnosis? -Risk for falls related to sedation -Risk for infection related to adverse effects of antihistamines -Risk for impaired skin integrity related to urticaria -Risk for deficient fluid volume related to diuresis

Risk for falls related to sedation

When the use of antihistamines result in dryness of the mouth, the nurse should recommend which to relieve the dryness? Select all that apply. -Use a dehumidifier in the home. -Administer intravenous fluid bolus. -Suck on sugarless hard candy. -Offer ice chips. -Take frequent sips of water.

Suck on sugarless hard candy. Offer ice chips. Take frequent sips of wate

A group of students demonstrate understanding of topical decongestants, identifying them as: Parasympatholytics Sympatholytics Sympathomimetics Parasympathomimetics

Sympathomimetics

A 21-year-old patient reports a mild stinging sensation on using a nasal spray containing a nasal decongestant. Which information should the nurse provide the patient? -Consult the physician immediately. -This sensation usually disappears with continued use. -Dose of the medication needs reduction. -Medication needs to be stopped immediately.

This sensation usually disappears with continued use.

Benzonatate (tessalon)

Treatment of nonproductive cough Adult and pediatric (>10y): 100- 200 mg PO t.i.d

Codeine (generic)

Treatment of nonproductive cough Adult: 10-20mg PO q4-6h Pediatric (6-12Y):5-10 mg PO q4-6h Pediatric (2-6 y): 2.5-5 mg PO q4-6h

dextromethorphan (generic)

Treatment of nonproductive cough Adult: 10-30 mg PO q4-8h; 60 mg PO b.i.d. for sustained action pediatric(6-12y): 5-10mg PO q4; 30 mg PO b.id. for sustained action pediatric(2-6y): 2.5-7.5mg PO q4; 15 mg PO b.id. for sustained action

The client states that he/she once needed medication to liquefy secretions in the respiratory tract. However, the client cannot recall the name of the medication but states that the medication is added to a nebulizer. The nurse suspects the client is taking which medication? -pseudoephedrine -guaifenesin -prednisone -acetylcysteine

acetylcysteine

MUCOLYTICS

acetylcysteine dornase alfa

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? advil eucalyptus antihistamine acetaminophen

antihistamine

A client is experiencing allergy symptoms after being exposed to environmental dust. This reaction involves the action of histamine, which is released by what cells? CD4 T cells platelets basophils lymphocytes

basophils

Topical Nasal steroid Decongestants

beclomethasone budesonide flunisolide fluticasone triamcinolone

ANTITUSSIVES

benzonatate codeine dextromethorphan hydrocodone

nasal steroids contraindications and cautions?

block the inflammatory response, their use is contraindicated in the presence of acute infections. Increased incidence of Candida albicans infection has been reported with their use related to the antiinflammatory and antiimmune activities associated with steroids.

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

cardiovascular

Pseudoephedrine contradictions and cautions

caution should be used in patients with any condition that might be exacerbated by sympathetic activity, such as glaucoma, hypertension, diabetes, thyroid disease, coronary disease, and prostate problems.

A client, having an allergic reaction to mold, describes chest tightness and difficulty breathing. Which body effect is occurring? -suppression of the vagus nerve endings producing tachycardia -decreased secretion of the mucous glands -decreased permeability of the veins and capillaries -contraction of smooth muscle in the bronchi

contraction of smooth muscle in the bronchi

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 clemastine cetirizine epinephrine

diphenhydramine

first-generation antihistamines have greater anticholinergic effects with resultant?

drowsiness

antihistamines

drugs that block the release or action of histamine, a chemical released during inflammation that increases secretions and narrows airways

decongestants

drugs that decrease the blood flow to the upper respiratory tract and decrease the overproduction of secretions

mucolytics

drugs that increase or liquefy respiratory secretions to aid the clearing of the airways

Acetylcysteine is the antidote for aspirin toxicity.

false

Topical Nasal Decongestants

oxymetazoline phenylephrine tetrahydrozoline xylometazoline

Topical nasal steroid decongestants are?

popular for the treatment of allergic rhinitis and to relieve inflammation after the removal of nasal polyps. They have been found to be effective in patients who are no longer getting a response with other decongestants

Oral Decongestants

pseudoephedrine

A client reports experiencing severe nasal congestion since starting to use an over-the-counter (OTC) nasal decongestant spray a week ago. This symptomology most supports what possible medical condition? -rebound congestion -a drug allergy -bronchitis -sinusitis

rebound congestion

rhinitis medicamentosa

reflex reaction to vasoconstriction caused by decongestants; a rebound vasodilation that often leads to prolonged overuse of decongestants; also called rebound congestion

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." -"Use the medication until your symptoms are completely relieved." -"Consult with your primary care provider." -"Afrin can be used as long as nasal burning and stinging do not occur."

"Consult with your primary care provider."

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?

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

After teaching a client who is receiving an antitussive about the drug, which statement indicates the need for additional teaching?

"I'll keep the room warm and toasty."

A client is receiving dornase alfa at home. Which would the nurse instruct the client to do?

"Protect the drug from light."

An older client diagnosed with hypertension is requesting an oral nasal decongestant for cold symptoms. Which statement by the nurse best describes the effect of decongestants on blood pressure? -"The administration of nasal decongestant will act on the central nervous system to cause vasodilation of blood vessels." -"The administration of a nasal decongestant will cause bradycardia and increase peripheral blood pressuregastric reflux." -"The administration of a nasal decongestant will decrease the thyroid production and increase rebound congestion." -"The administration of a nasal decongestant will increase blood pressure due to vasoconstriction of blood vessels."

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

The health care provider suggests that a client use guaifenesin to help his cough. The nurse instructs the client to call the health care provider if he continues to have a productive cough after which amount of time?

1 week

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 capsules should be sucked on like a lozenge. -The client should drink plenty fluids. -Benzonatate can be taken more frequently than prescribed if needed. -Benzonatate can cause GI upset and sedation. -Consumption of alcohol is okay while taking benzonatate.

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

An elderly client is prescribed diphenhydramine for allergic response to mold. What should be the focus of the nursing assessment for the client? -dysrhythmias -anticholinergic effects -increased muscle tone -respiratory depression

anticholinergic effects

Which assessment finding should prompt the nurse to suspect that the resident is experiencing an anticholinergic effect of diphenhydramine?

blurry vision

ANTIHISTAMINES First Generation

brompheniramine carbinoxamine chlorpheniramine clemastine cyproheptadine dexchlorpheniramine dimenhydrinate diphenhydramine hydroxyzine meclizine promethazine triprolidine

When describing the benefits of second-generation H1 receptor antagonists to those of first-generation H1 receptor antagonists, the nurse should cite what advantage? -lower cost -absence of adverse effects -once-weekly dosing -decreased sedation

decreased sedation

Oral decongestants are?

drugs that are taken orally 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.

antitussives

drugs that block the cough reflex

expectorants

drugs that increase productive cough to clear the airways

pharmacokinetics of pseudoephedrine?

generally well absorbed and reaches peak levels quickly in 20-45 minutes

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? -"I should avoid driving after taking this medication." -"Taking this medication shouldn't stop me from having my after-dinner drink." -"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."

pseudoephedrine

-Indications: Temporary relief of nasal congestions caused by the common cold, hay fever, sinusitis; promotion of nasal and sinus drainage; relief of eustachian tube congestion. -Actions: Sympathomimetic effects, causes vasoconstriction in mucous membranes of nasal passages resulting in their shrinkage, which promotes drainage and improvement in ventilation. -Pharmacokinetics: -route: oral -onset: 30 min -duration: 4-6 h t1/2:7 hours metabolized in the liver and excicreted in the urine Adverse effects: anxiety, restlessness, headache, dizziness, drowsiness, vision changes, seizures

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.

A male client presents to the health care provider's office with reports of inability to breathe freely. When the nurse reviews his use of over-the-counter medications, it is discovered that the client routinely uses nasal spray three times a day for 1 year. The nurse knows that what may be causing this client's continuous nasal congestion?

Rebound nasal swelling

Hydrocodone (genertic)

Treatment of nonproductive cough Adult:5-10mg PO q4-6h Pediatric (2-12y): 1.25-5mg PO q4-6h

rebound congestion

a process that occurs when the nasal passages become congested as the effect of a decongestant drug wears off; patients tend to use more drug to decrease the congestion, and a vicious circle of congestion, drug, and congestion develops, leading to abuse of the decongestant; also called rhinitis medicamentosa

Antihistamines Second Generation (Nonsedation)

azelastine cetirizine desloratadine fexofenadine levocetirizine loratadine

true or false: first generation antihistamines do not make you drowsy?

false

The substances released from mast cells are responsible for what physiological response? Select all that apply. -myalgia -inflammation -smooth muscle dilation -decreased capillary -permeability -bronchoconstriction

inflammation bronchoconstriction

cautions of using nasal topical decongestions

should be used when there is any lesion or erosion in the mucous membranes that could lead to systemic absorption. Caution should also be used in patients with any condition that might be exacerbated by sympathetic activity, such as glaucoma, hypertension, diabetes, thyroid disease, coronary disease, or prostate problems, because these agents have adrenergic properties.

What can does vasoconstriction lead to

shrinking of swollen mucous membranes

dornase alfa (pulmozyme)

to relieve buildup of secretion in high- risk respiratory patients who have difficulty moving secretion including postoperative patient. treatment of atelectasis from thick mucus secretions in cystic fibrosis

When providing health education to a client prescribed diphenhydramine, what information should the nurse convey to the client? "You might have a dry cough for a few hours after taking this drug." "Some people find that this drug makes their muscles weak." "This drug will likely make you urinate more than usual." "This drug is likely to make you feel drowsy."

"This drug is likely to make you feel drowsy."

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.) -Importance of reading the label for ingredients and dosage -Using adult formulation with smaller doses -Need to follow the directions for how often to give the drug -Using household measuring devices for dosage measurements -Avoidance of use in children under age 2

-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

acetycysteine (generic)

-Indications: Mucolytic adjunctive therapy for abnormal, viscid, or inspissated mucous secretions in acute and chronic bronchopulmonary disorders; to lessen hepatic injury in cases of acetaminophen toxicity. -Actions: Splits links in the mucoproteins contained in the respiratory mucus secretions, decreasing the viscosity of the secretions; protects liver cells from acetaminophen effects. -Pharmacokinetics: route: inhalation, instilation; onset: 1 min; peak: 5-10 min; Duration: 2-3 h Route: oral; onset: 30-60 min; peak 1-2 h; duration: unknown T1/2: 6.25 hours; metabolized in the lever and excreted in the urine A/E: nausea, stomatitis, urthicaria, bronchospasm, rhinorrhea

Tetrahydrozoline

-Indications: Symptomatic relief of nasal and nasopharyngeal mucosal congestion due to the common cold, hay fever, or other respiratory allergies. -Actions: Sympathomimetic effects, partly due to release of norepinephrine from nerve terminals; vasoconstriction leads to decreased edema and inflammation of the nasal membranes. -Pharmacokinetics: -route: topical nasal spray -peak: 5-10 min -Duration: 6-10 h -T1/2: unknown metabolized in the liver and excreted in the urine -Adverse effects: disorientation ,confusion, light-headedness, nausea, vomiting, fever ,dyspnea

diphenhydamine

-Indications: Symptomatic relief of perennial and seasonal rhinitis, vasomotor rhinitis, allergic conjunctivitis, urticaria, and angioedema; also used for treating motion sickness and parkinsonism and as a nighttime sleep aid and to suppress coughs. -Actions: Competitively blocks the effects of histamine at histamine-1 receptor sites; has atropine-like antipruritic and sedative effects. -Pharmacokinetics: -route: oral 15-30 min; peak: 1-4 h; duration 4-7h -route IM onset 20-30 min peak 1-4 h duration 4-8 h -route IV onset rapid, peak: 30-60min duration 4-8 h -T1/2 2.5-7 hours

guaifenesin (mucinex, others)

-Indications: Symptomatic relief of respiratory conditions characterized by dry, nonproductive cough and in the presence of mucus in the respiratory tract. -Actions: Enhances the output of respiratory tract fluid by reducing the adhesiveness and surface tension of the fluid, facilitating the removal of viscous mucus. -Pharmacokinetics: -route: oral -onset: 30 min -peak: unknown -duration: 4- 6 h -T1/2: unknown: metabolism and excretion are also unknown

flunisolide

-Indications: Treatment of seasonal allergic rhinitis for patients who are not getting any response from other decongestant preparations; relief of inflammation after the removal of nasal polyps. -Actions: Antiinflammatory action, which results from the ability to produce a direct local effect that blocks many of the complex reactions responsible for the inflammatory response. -Pharmacokinetics: -route: topical (nasal spray) -onset: fast<30 min -peak: 10-30 min duration: 4-6 h -T1/2 not generally absorbed Adverse effects: local burning, irritation, stinging, dryness of the mucosae, headache

A patient receives guaifenesin. The nurse would expect the drug to begin acting within which time frame? 60 minutes 15 minutes 30 minutes 45 minutes

30 minutes

A male client is diagnosed with chronic bronchitis. What would the nurse expect to be one of his physical reports? Rhinorrhea Chronic nasal swelling Rhinitis Retention of secretions

Retention of secretions

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. Drink ample water before taking the tablet. Take the tablet one hour before food. Take an antacid before the tablet.

Take the tablet with food.

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

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

A client, scheduled to receive one unit of packed red blood cells, has a history of an allergic reaction to a transfusion in the past. What class of medication will assist in preventing a reaction to the packed red blood cell transfusion? antihistamines antianginals antimicrobials antipyretics

antihistamines

EXPECTORANT

guaifenesin

The nurse is caring for a client who has been taking an OTC cold remedy containing pseudoephedrine for the past two days. What assessment finding should the nurse most likely attribute to this medication? -nasal congestion and rhinorrhea -drowsiness and reports of sleeping for 10 hours the previous day -heart rate 98 beats/min and blood pressure 142/93 mm Hg -diaphoresis and oral temperature of 37.9°C (100.2°F)

heart rate 98 beats/min and blood pressure 142/93 mm Hg

Topical decongestants are ?

sympathomimetics, meaning they imitate the effects of the sympathetic nervous system to cause vasoconstriction, leading to decreased edema and inflammation of the nasal membranes.

person who needs to be alert should be given one of?

the second-generation, less-sedating antihistamines. In some people, the second-generation antihistamines are also sedating, so care must be taken until the patient knows what response will occur.

what are the theraputic actions and indications of antitussives

which act directly on the medullary cough center of the brain to depress the cough reflex. Because they are centrally acting, they are not the drugs of choice for anyone who has a head injury or who could be impaired by central nervous system (CNS) depression. Other antitussives have a direct effect on the respiratory tract.