NUR 2850 CHECKPOINT #3

Pneumonia-medications

-Bronchodilators -Anti-inflammatories -Antibiotics

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?

"You might find yourself more congested than ever as your body compensates for your use of these drugs" (frequent, long-term, or excessive use of decongestants include rebound congestion, which occurs when the nasal passages become congested as the drug effect wears off & the body compensates by vasodilating the same nasal arterioles that the drug constricted)

A nursing professor has just finished a lecture regarding histamines. Which of the following statements made by students would indicate that the teaching was effective?

-"Histamines are synthesized and stored in most body tissues" -"Histamines are located mainly in secretory granules of mast cells and basophils" -"Histamines diffuse rapidly into other tissues once released"

A nursing professor teaching junior-level students conducts a lecture regarding allergic contact dermatitis. Which of the following statements made by the students verifies the lecture was effective?

-"It is a type IV hypersensitivity reaction from direct contact with antigen" -"Poison ivy is an example" -"Skin lesions are usually blistered"

A client with osteoporosis is prescribed alendronate. Which information will the nurse include when teaching the client about this medication?

-"Take the mediation with 6-8 ounces (180-240 mL) of water" -Remain upright for 30 minutes after taking a dose of the medication" -"Take the dose first thing in the morning on an empty stomach" -"Wait at least 30 minutes after taking the medication before eating or drinking" -"Report any new onset of esophageal burning or nausea to the health care provider"

Asthma-pathophysiology

-A chronic disorder of the airways that causes episodes of airway obstruction, bronchial hyper-responsiveness, airway inflammation, & sometimes airway remodeling -Airway inflammation is mediated by the presence of inflammatory cells -exposure to causative stimuli --> IgE molecules combine with mast cells & basophils --> releases inflammatory mediators --> causes bronchoconstriction & airway inflammation

Pneumothorax-clinical manifestations

-Absent lung sounds on affected side -Asymmetrical chest -Ipsilateral chest pain -Tachypnea -Dyspnea -Hypoxemia -Tachycardia

Short-acting beta-2 agonists (Albuterol)-expected pharmacological action

-Acts by selectively activating beta-2 receptors in the bronchial smooth muscle = causes bronchodilation -Relieves bronchospasm -Inhibits histamine release -Increases ciliary motility

First generation antihistamines (Diphenhydramine)-expected pharmacological action

-Acts on central H1 receptors = results in the blocking of histamine release in small blood vessels, capillaries, & nerves during allergic reaction -Produces anticholinergic effects -Crosses blood-brain barrier = causes sedation/drowsiness -Relieves itching, sneezing, and runny nose but does not relieve nasal congestion

Second generation antihistamines (Loratadine, Certizine, Fexofedadine)-expected pharmacological action

-Acts on peripheral H1 receptors = results in blocking of histamine release in the small blood vessels, capillaries, & nerves during allergic reaction -Relieves itching, sneezing, and runny nose, but do not prevent nasal congestion

First generation antihistamines (Diphenhydramine)-administration

-Administered orally or parenterally -Take medication at night to minimize daytime sedative effect -Take with meals

Second generation antihistamines (Loratadine, Certizine, Fexofedadine)-administration

-Administered orally or parenterally -Take with meals

Nasal decongestants (Pseudophedrine)-administration

-Administered via orally, nasal drops, or topical -For oral form = can be taken with or without food -For nasal drops = be in the lateral, head-low position to increase desired effect & prevent swallowing medication

Pneumonia-risk factors

-Advanced age (>65 years old) -Being hospitalized/having surgery -Chronic disease (asthma, COPD, heart disease) -Smoking -Weakened/suppressed immune system -Prior infection -Immobility -Being on a ventilator

Antitussives (Dextromethorpan)-major interactions

-Alcohol = increases CNS depression -MAOI's, SRI's, tricyclic antidepressants, ergot alkaloids, lithium, & phenylpiperidine opioids = increases risk of serotonin syndrome

First generation antihistamines (Diphenhydramine)-major interactions

-Alcohol/CNS depressants = can cause additive CNS depression -MAOI's = increases duration of action & sedative and anticholinergic adverse effects -Phenothiazines = increases risk of dysrhythmias & excessive drowsiness -Pramlintide = increases risk of constipation -Tricyclic antidepressants = increases risk of anticholinergic adverse effects

Nasal decongestants (Pseudophedrine)-therapeutic use

-Allergic or non-allergic rhinitis -Common colds -Sinusitis

Atelectasis-pathophysiology

-An incomplete expansion of lung or portion of lung due to airway obstruction, lung compression, or increased recoil of the lung due to loss of pulmonary surfactant -PaCO2 = low -PaO2 = low

Allergic drug reactions should be considered when new signs and symptoms develop or when they differ from the usual manifestations of the illness being treated. Which of the following are examples of allergic drug reactions?

-Anaphylaxis -Serum sickness -Systemic lupus erythematosus (SLE) -Skin rash & urticaria

Short-acting beta-2 agonists (Albuterol)-therapeutic use

-Asthma & asthma attacks -COPD

Antitussives (Dextromethorpan)-administration

-Available in capsules, lozenges, liquids, & syrups -For liquid forms = use a measuring spoon & do not dilute -Avoid eating or drinking 30 minutes before & after medication use

Expectorants (Guifensen)-administration

-Available in tablets and capsules (that should not be crushed) -Take with a full glass of water -Take with food if GI upset occurs

Second generation antihistamines (Loratadine, Certizine, Fexofedadine)-patient education

-Avoid prolong exposure to light & use sunscreen and protective clothing -Avoid consumption of alcohol

Second-generation H1 antagonists (also called selective or nonsedating agents) were developed mainly to produce less sedation than the first-generation drugs. Which of the following are examples of these drugs?

-Azelastine (Astelin) -Cetirizine (Zyrtec) -Fexofenadine (Allergra) -Loratadine (Claritin)

Short-acting beta-2 agonists (Albuterol)-major interactions

-Beta-blockers = can counteract effect of both medications -MAOI's & tricyclic antidepressants = can increase risk of tachycardia & angina

Rhinosinusitis-diagnostic procedures

-CT -MRI -Nasal & sinus endoscopy -Allergy test

Nasal decongestants (Pseudophedrine)-major interactions

-Caffeine = enhances adverse effects -Cocaine, digoxin, general anesthetics, MAOI's, & other adrenergic drugs = increases risk of cardiac dysrhythmias -Antihistamines, epinephrine, ergot alkaloids, MAOI's, & methylphenidate = increases risk of hypertension due to vasoconstriction -Herb coleus = increases effectiveness of drug -Green or black tea, witch hazel (tannin-containing herbs) = decreases absorption & effectiveness of drug

Which represents the action of estrogen on the female body?

-Calcium and phosphorus conservation -Thinning of the cervical mucus -Stimulate contraction of the fallopian tubes (actions of estrogen on the female body also include fluid retention, growth of axillary & pubic hair, restoration of the endometrium after menstruation, and at puberty growth and development of the vagina, uterus, fallopian tubes, and breasts)

Pneumothroax-diagonstic procedures

-Chest x-ray -CT -Arterial blood gas (ABG) test (measures the amount of PaO2 & PaCO2 in blood) -Pulse oximetry

COPD-diagnostic procedures

-Chest x-ray -Sputum specimen (test used to detect & identify bacteria and fungi that infect the lungs or breathing passages) -Arterial blood gas (ABG) test (measures the amount of PaO2 & PaCO2 in blood) -CBC -Pulmonary function test (shows how well the lungs are working)

Pneumonia-diagnostic procedures

-Chest x-ray -Sputum specimen (test used to detect & identify bacteria and fungi that infect the lungs or breathing passages) -Arterial blood gas (ABG) test (measures the amount of PaO2 & PaCO2 in blood) -CBC -Pulse oximetry

COPD-chronic bronchitis-clinical manifestations

-Chronic & productive cough -Purulent (thick) sputum -Hemoptysis (coughing up blood) -Mild dyspnea -Cyanosis (due to hypoxemia) -Peripheral edema -Crackles & wheezing -Prolonged expiration

COPD-pathophysiology

-Chronic & recurrent obstruction of airflow in the pulmonary airways -Inflammation and fibrosis of bronchial wall + excess mucus secretion = obstruction of airways & mismatching of ventilation and perfusion -Emphysema = release of elastases & proteases --> leads to destruction of airway elastin --> destroys alveoli/causes alveoli to become large & flabby --> causes airway trapping (inability to blow out CO2) -Chronic bronchitis = inflammation of bronchi & bronchioles --> causes increased mucus production & thickened bronchial walls --> causes impaired airflow & gas exchange PaCO2 = high PaO2 = low SpO2 = 88-92%

COPD-clinical manifestations

-Clubbing of fingers & nails -Dyspnea -Weight loss -Difficulty lying down -Tri-pod position

Expectorants (Guifensen)-therapeutic use

-Common colds -Allergic or non-allergic rhinitis -Cough caused by lower respiratory disorders

A client is given a prescription for fluticasone/salmeterol (Advair) 250/50 to inhale one puff twice a day, before leaving the hospital after an acute asthma attack. The nurse completing the client's discharge counseling should tell the client which of the following?

-Continue to carry a rescue inhaler -Check peak flow daily -Rinse mouth after each use

When histamine binds with receptors called H1 and H2 and stimulates them, effects include which of the following?

-Contraction of smooth muscle in the bronchi and bronchioles -Stimulation of vagus nerve endings to produce reflex bronchoconstriction and cough -Dilation of capillaries in the skin, to cause flushing

Expectorants (Guifensen)-evaluation of effectiveness

-Cough becoming more productive and mucus is easier to cough/spit out -Chest congestion has decreased

Decongestants should be used cautiously in clients with which medical conditions?

-Diabetes -Thyroid disease -Glaucoma -Hypertension (decongestants are also used cautiously in clients with cardiovascular disease, prostatic hypertrophy, coronary artery disease, & peripheral vascular disease)

Short-acting beta-2 agonists (Albuterol)-patient education

-Do not exceed prescribed dose -Avoid caffeine -Take this medication first prior to taking other medications -Report changes in heart rate or chest pain -Observe for chest, jaw, or arm pain, or palpitations & notify provider if they occur

Common cold-clinical manifestations

-Dryness & stuffiness of nasopharynx -Rhinitis (excessive production of nasal secretions & tearing of eyes) -Red & swollen mucous membranes -Rhinorrhea (runny nose) -Sore throat -Hoarseness -Headache -Chills -Fever -Non-productive cough -Open mouth breathing duee to congestion

A client is prescribed sildenafil. When teaching the client about possible adverse reactions associated with this drug, which would the nurse include?

-Dyspepsia -Nasal congestion -Flushing

COPD-emphysema-clinical manifestations

-Dyspnea -Minimal cough -Increased minute ventilation -Pink skin -Pursed-lip breathing -Accessory muscle use -Cachexia (weight/muscle loss) -Barrel chest -Decreased breathing sounds -Tachypnea

An adult client with newly diagnosed asthma presents for client education regarding situations that could precipitate an asthma attack. In this teaching, which precipitants would the nurse state may trigger an attack?

-Exercise -Allergens -Mold -Cigarette smoke

Common cold-medications

-Expectorants -Nasal decongestants

Rhinosinusitis-clinical manifestations

-Facial pain -Headache -Purulent (thick) nasal discharge -Fever -Sinus pressure -Nasal congestion -decreased sense of smell -Maxillary pain

Pneumonia-clinical manifestations

-Fever -Altered mental status (restlessness, agitation, confusion) -Productive cough w/ yellow sputum -Dyspnea -Pleuritic pain (inflammation of pleura causing sharp chest pain) -Abnormal breathing sounds (coarse crackles & rhonchi) -Chills -Low pulse ox -Tachycardia -Tachypnea

The nurse is teaching a client about potential allergic drug reaction. What factors should the nurse identify as consistent with this type of reaction?

-Follows a previous exposure to the same or similar drug -Ingestion of a drug known to produce allergic reactions -Occurs approximately 7-10 days after initial exposure to suspected drug

Adverse effects of inhaled corticosteroids include which of the following?

-Fungal infection -Pharyngeal irritation (adverse effects of inhaled corticosteroids also include oral & laryngeal irritation and suppression of HPA function)

Second generation antihistamines (Loratadine, Certizine, Fexofedadine)-complications

-GI discomfort (nausea, vomiting, constipation) -Drowsiness -Headache -Dizziness -Fatigue

Expectorants (Guifensen)-complication

-GI upset (nausea, vomiting) -Drowsiness -Dizziness -Rash -Headache

First generation antihistamines (Diphenhydramine)-evaluation of effectiveness

-Improvement of allergic reaction (absence of rhinitis & urticaria) -Relief of motion sickness (decreased nausea & vomiting)

Second generation antihistamines (Loratadine, Certizine, Fexofedadine)-evaluation of effectiveness

-Improvement of allergic reaction (absence of rhinitis & urticaria) -Relief of motion sickness (decreased nausea & vomiting)

The nurse is discussing the use of estrogen with a female client who smokes cigarettes. The nurse informs the client that clients who take estrogen and continue to smoke are at a greater risk for thromboembolic disorder because of what reasons?

-Increased platelet aggregation -Increased liver production of blood clotting factors

Rhinosinusitis-pathophysiology

-Inflammation of nasal sinuses -Develops when a viral upper respiratory infection or allergic rhinitis obstruct the ostia (pairs of lateral openings) --> impairs muco-cillary clearance mechanism -Acute = may be viral, bacterial or mixed viral-bacterial origin & may last up to 4 weeks -Chronic = duration of greater than 12 weeks & is associated with bacterial or fungal infections and allergies

Pneumonia-pathophysiology

-Inflammation of parenchymal structures of the lungs in the lower respiratory tract -Alveoli become inflamed & fill with pus and/or fluid --> leads to impaired gas exchange -Germs enter the lungs via inspiration, aspiration (inhalation of fluid, food, or secretions into airway) or blood --> attack alveoli PaO2 = low PaCO2 = high

The nurse provides care for numerous pediatric clients diagnosed with asthma. The nurse should expect to administer which drug to these clients?

-Long-acting inhaled steroids -Leukotriene-receptor antagonists -Short-acting beta-2 agonists

Short-acting beta-2 agonists (Albuterol)-evaluation of effectiveness

-Long-term control of asthma -Prevention of exercise-induced asthma -Resolution of asthma exacerbations (absence of dyspnea, clear breath sounds, absence of wheezing, & return of respiratory rate to baseline)

First generation antihistamines (Diphenhydramine)-patient education

-Maintain 2-3L of water intake each day -Avoid prolong exposure to light & use sunscreen and protective clothing -Take sips of water or suck on sugarless candy to prevent dry mouth -Avoid consumption of alcohol

Atelectasis-treatment

-Mobility -Pain management -Incentive spirometer (helps maintain lung strength & helps lungs get stronger after illness or injury)

Nasal decongestants (Pseudophedrine)-nursing interventions

-Monitor cardiac symptoms -Monitor for anaphylaxis, chest tightness, or throat swelling - stop medication if they occur -Taper use and discontinue medication using one nostril at a time -Stop medication if manifestations of CNS stimulation occur

Which manifestations are most common in clients with COPD that is predominantly chronic bronchitis?

-Peripheral edema -Increased mucus secretions -Cyanosis

Pneumonia-complications

-Pleural effusion -Septic shock -Hypoxia (absence of enough O2 in tissue to sustain bodily function) -Bacteremia (bacteria in bloodstream) -Lung abscess (pus-filled cavity in lung)

First generation antihistamines (Diphenhydramine)-contradictions

-Pregnancy risk category B -During third trimester of pregnancy, breastfeeding, & in newborns -Hypersensitivity to drug, narrow-angle glaucoma, stenosing peptic ulcer, bladder neck obstruction -Use with caution in clients who have asthma, seizure disorders, cardiac disease, renal disease, urinary retention, open-angle glaucoma, hypertension, & prostate hypertrophy -Use with caution in children & older adults (have increased risk for experiencing adverse effects)

Expectorants (Guifensen)-contradictions

-Pregnancy risk category C -Children -Clients with hypersensitivity to drug -Use with caution in clients with asthma (can cause bronchospasm)

Antitussives (Dextromethorpan)-contradictions

-Pregnancy risk category C -Clients with productive cough -Use with caution in children with atopic syndrome caused by histamine release

Nasal decongestants (Pseudophedrine)-contradictions

-Pregnancy risk category C -Closed-angle glaucoma -Use with caution in clients who have hypertension, cerebrovascular disease, dysrhythmias, coronary artery disease, hyperthyroidism, diabetes mellitus, & prostatic hypertrophy

Short-acting beta-2 agonists (Albuterol)-contradictions

-Pregnancy risk category C -Hypersensitivity to drug, tachydysrhytmias, & severe coronary artery disease -Use with caution in clients who have diabetes mellitus, hyperthyroidism, heart disease, hypertension & angina

Asthma-diagnostic procedures

-Pulmonary function test (shows how well lungs are working) -Spirometry -Peak flow test (a meter device that measures how hard you can breathe out)

Nasal decongestants (Pseudophedrine)-complications

-Rebound congestion (constant nasal stuffiness that develop from overuse of nasal decongestant) -CNS stimulation (agitation, nervousness, uneasiness) -Hypotension -Dysrhythmias -Dizziness -Headache -Dysuria -Insomnia

Nasal decongestants (Pseudophedrine)-evaluation of effectiveness

-Relief of congestion -Increased ease of breathing

First generation antihistamines (Diphenhydramine)-therapeutic use

-Seasonal allergic rhinitis -Urticaria (rash) -Mild transfusion reactions -Anaphylaxis (hypotension, acute laryngeal edema, bronchospasm) -Respiratory depression

Second generation antihistamines (Loratadine, Certizine, Fexofedadine)-therapeutic use

-Seasonal allergic rhinitis -Urticaria (rash) -Mild transfusion reactions -Anaphylaxis (hypotension, acute laryngeal edema, bronchospasm) -Respiratory depression

Rhinosinusitis-risk factors

-Seasonal allergies -Common cold -Deviated nasal septum -Nasal polyps (benign growth in lining of nose or sinuses) -Cystic fibrosis -Weakened immune system -Smoking or second-hand smoking

An older adult client is prescribed an antihistamine for the relief of allergic rhinitis. Which findings would the nurse likely assess in this client?

-Sedation -Dry throat -Confusion

Antitussives (Dextromethorpan)-complications

-Sedation -Mild nausea -Dizziness -Rash -Difficulty breathing -Potential abuse --> can cause euphoria

First generation antihistamines (Diphenhydramine)-complications

-Sedation -Dry mouth -Constipation -Photosensitivity -Blurred vision -Urinary retention -GI discomfort (nausea, vomiting) -Acute toxicity (flushing, high fever, tachycardia) -Hallucinations -Incoordination -Seizures in children

COPD-medications

-Short-acting beta-2 agonists -Long-acting beta-2 agonists -Anticholinergics -Inhaled corticosteroids

Asthma-medications

-Short-acting beta-2 agonists -Long-acting beta-2 agonists -Anticholinergics -Inhaled corticosteroids -Leukotriene modifiers

Common cold-complications

-Sinusitis (swelling and pain of sinuses) -Pneumonia -Bronchitis (inflammation of bronchial tubes) -Asthma -Otitis media (middle ear infection-inflammation & build-up of fluid behind eardrum)

COPD-risk factors

-Smoking -Frequent respiratory infections -Frequent exposure to chemicals/pollutions -Asthma

Pneumothorax-risk factors

-Smoking -Genetics -Previous pneumothorax

Nasal decongestants (Pseudophedrine)-expected pharmacological action

-Sympathomimetic decongestant that stimulates alpha-1 adrenergic receptors = causes vasoconstriction of respiratory tract = reduces inflammation of nasal membranes -Act indirectly by releasing norepinephrine from its storage sites -Relieves nasal congestion and swelling via constricting arterioles & reducing blood flow to nasal mucosa

Atelectasis-clinical manifestations

-Tachypnea -Tachycardia -Dyspnea -Cyanosis -Diminished chest expansion -Hypoxemia -Decreased breathing sounds -Intercostal retractions

Pneumothorax-pathophysiology

-The presence of air in the pleural space due to trauma--> causes partial or complete collapse of affected lung -PaCO2 = low -PaO2 = low

Why are second-generation H1 receptor antagonists less likely to cause less central nervous system (CNS) depression?

-They do not cross the blood-brain barrier -They are selective for peripheral H1 receptors

Which health concerns in the client's history increase the client's risk for erectile dysfunction (ED)?

-Tobacco smoker -Depression -High blood pressure -Diabetes (causes of ED may include drugs, lifestyle factors, disease, and spinal cord injuries)

Short-acting beta-2 agonists (Albuterol)-complications

-Tremors -Tachycardia -Angina -Palpitations -CNS stimulation (agitation, anxiety, insomnia, seizures)

A nurse suspects a client might be abusing anabolic steroids. Which signs might a client exhibit that would indicate abuse of anabolic steroids?

-Uncontrolled rage -Jaundice -Inability to concentrate -Acne -Severe depression (abuse of anabolic steroids can also exhibit suicidal tendencies, malignant or benign tumors, aggressive behavior, personality changes, anorexia, male pattern baldness, fluid and electrolyte imbalances, & muscle cramps)

The nurse is caring for a client who is taking diphenhydramine. What potential indications may this drug be used for?

-Urticaria -Vasomotor rhinitis -Motion sickness -Angioedema

Expectorants (Guifensen)-patient education

-Use for short-term therapy, no more than 3-5 days -May relieve symptoms but do not cure disorder causing the symptoms -Do not exceed recommended dose -Report a cough last longer than 1 week to provider -Maintain optimal fluid intake -Read OTC label carefully -Stop medication and obtain medical care if rash or other manifestations of allergy occur

Nasal decongestants (Pseudophedrine)-patient education

-Use for short-term therapy, no more than 3-5 days -May relieve symptoms but do not cure disorder causing the symptoms -Do not exceed recommended dose -Observe and report manifestations of CNS stimulation

Antitussives (Dextromethorpan)-patient education

-Use for short-term therapy, no more than 3-5 days -May relieve symptoms but do not cure disorder than causes the symptoms -Do not exceed recommended dose -If cough has not improved after 1 week, notify provider

Asthma-clinical manifestations

-Wheezing -Chest tightness -Dyspnea -Retraction -Cough (productive or non-productive, at night) -Anxiety -Excessive use of accessory muscles -Tachypnea -Tachycardia -Inability to speak -Decreased LOC -Cyanosis

Asthma-risk factors

-Genetics -Eczema -Seasonal allergies -Smoking or second-hand smoking -Frequent exposure to chemicals/pollution -Obesity

The nurse is providing medication information to a parent whose 9-year-old child has been prescribed dextromethorphan in liquid form. Which statement by the parent demonstrates the information has been received correctly?

"Eating and drinking within 30 minutes of taking the medication would minimize the effect of the medication"

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?

"I will dilute the drug syrup with an equal amount of water" (diluting the drug with equal amounts of water would decrease the soothing effect on the pharyngeal mucosa)

The nurse is providing education for a client who has been prescribed a second-generation antihistamine. Which client statement suggests a need for additional teaching?

"I'm really hoping that these pills will cure my allergies before summer starts" (antihistamines mitigate the signs and symptoms of allergies, but they do not cure the problem)

After teaching a group of nursing students about drugs used to treat genitourinary problems in the older adult, the instructor determines that the teaching was successful when the students correctly choose which drug(s) as an alpha-adrenergic blocker used to treat BPH?

-Alfuzosin -Tamsulosin

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?

"The drug will suppress my cough so I can sleep easier" (the drug liquifies respiratory secretions, so it is easier for the client to expectorate or cough the mucous out of the respiratory tract)

The nurse is providing education to an older adult client regarding risk factors related to osteoporosis. What information should the nurse provide?

"This would be an excellent time for you to stop smoking"

A 68-year-old man has revealed to his care provider that he is distraught over his increasingly frequent inability to maintain an erection. Which teaching point is most warranted?

"While this problem is often a part of the aging process, it might be a result of some of the medications that you take"

The nurse is caring for a 48-year-old female client who asks, "How do you know when you have reached menopause?" Which statement is an appropriate response by the nurse?

"You are considered to be menopausal when you have not menstruated for a full year and the hormone that fluctuates with menstruation no longer fluctuates"

Atelectasis-risk factors

-Abdominal/chest surgery -Smoking -COPD -Asthma -Bronchiectasis (lungs & airways become damaged making it harder to clear mucus) -Cystic fibrosis -Weakened respiratory muscles -Use of medication causing shallowed breathing

Second generation antihistamines (Loratadine, Certizine, Fexofedadine)-contradictions

-Hypersensitivity to drug -Use with caution in clients who have asthma, seizure disorders, cardiac disease, renal disease, urinary retention, open-angle glaucoma, hypertension & prostate hypertrophy

COPD-complications

-Hypoxemia -Acidosis -Bronchiectasis (lungs & airways become damaged making it hard to clear mucus) -Cardiac dysrhythmias -Anxiety/depression

A community health nurse is leading a health promotion workshop during a community health fair. A participant has asked the nurse for advice on the necessity of calcium supplements. The nurse should respond in the knowledge that which demographic group most frequently require calcium supplements?

-Young women -Older women

Hypersensitivity reactions are grouped into four types according to the mechanisms by which they are produced. Type I hypersensitivity reaction for allergic rhinitis follows a specific pattern. Please place the following in order as they would occur.

1. First exposure to inhaled antigen 2. Formation of IgE antibody molecules 3. IgE binds to and sensitizes the surface of membranes of mast cells 4. Re-exposure of inhaled pollens or other antigens 5. Release of histamine and other chemical mediators 6. Nasal mucosa produces characteristic symptoms of allergic rhinitis

A nurse is instructing a client about vardenafil. The nurse would instruct the client to take the drug how many minutes before sexual stimulation?

60 minutes

A patient will take alendronate (Fosamax). The nurse knows that which of these statements regarding alendronate is correct?

Alendronate suppresses osteoclast activity

The nurse is counseling a group of perimenopausal and postmenopausal women about the pros and cons of hormone therapy (HT). Which member of the group should the nurse identify as likely to benefit most from HT while incurring the least risk?

A 49-year-old who is experiencing many menopausal symptoms (use of HT in younger, recently menopausal women appears less likely to result in the increased risk of cardiovascular events and breast cancer)

The nurse is caring for four clients. Select the client at risk for the development of a pulmonary embolism.

A 62-year-old male who is postoperative for repair of a fractured femur (a client with surgery to the lower extremities is at higher risk for the development of DVT that could lead to a pulmonary embolism)

Which client is most likely to benefit from the administration of a nasal steroid?

A client who has chronic allergic rhinitis (hay fever) (also used in order to relieve inflammation after the removal of nasal polyps)

Which client who presented to a walk-in medical clinic is most likely to be diagnosed with rhinosinusitis rather than a common cold?

A man complaining of general fatigue, a headache, and facial pain with a temperature of 100.9°F (38.2°C)

Antitussives (Dextromethorpan)-evaulation of effectiveness

Absence or decreased episodes of coughing

A client in the emergency department reports sudden onset of coughing with a feeling of chest tightness. Lung sounds are diminished with wheezing in all lung fields, skin is moist, and the client appears anxious. What is the first intervention the nurse should implement?

Administer a beta-2 agonist (a beta-2 agonists, such as albuterol, will relieve the bronchospasm within 30 minutes)

Acute-onset bronchial asthma causes wheezing and breathlessness as a result of which of the following?

Airway inflammation (bronchial asthma represents a reversible form of obstructive airway disease caused by narrowing of airways due to bronchospasms, inflammation, and increased airway secretions & this inflammatory process produces recurrent episodes of airway obstruction characterized by wheezing, breathlessness, chest tightness, and cough)

Second generation antihistamines (Loratadine, Certizine, Fexofedadine)-major interactions

Alcohol/CNS depressants = can cause additive CNS depression

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?

Antihistamines are not recommended for treating a cold

A patient is prescribed Ventolin (albuterol) for bronchospasm in chronic bronchial asthma. Which of the following nursing diagnoses would the nurse expect to see on the care plan as a result of the adverse effect of albuterol?

Anxiety

The parents of an infant bring the child to the emergency room 3 hours after they put the child to bed in apparent good health. The child is restless, the pulse is 140 beats/min, and lung sounds are diminished in all lung fields with intercostal retractions. What is the most likely cause of these symptoms?

Asthma (acute asthma symptoms may develop in children when the airway patency decreases at night & there is a sudden onset of symptoms such as a runny nose, irritability, a tight and nonproductive cough, wheezing, rapid respiratory rate, dyspnea, & use of accessory muscles to breath)

The nurse planning care for a menopausal woman should include interventions to decrease risk for:

Atherosclerosis

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?

Basophils (histamine is discharged from mast cells & basophils in response to certain stimuli such as allergic reactions, cellular injury, and extreme cold)

An adult client is suspected of having an androgen deficiency and has spoken with his primary care provider about the possibility of treatment with testosterone. The use of testosterone would be most complicated by the presence of what preexisting health problem?

Benign prostatic hypertrophy (testosterone use is contradicted in disorder of the prostate because men with an enlarged prostate may have additional enlargement)

What is the most common first-line therapy for relief of an acute asthma attack?

Beta-2-adrenergic agonists

A hospital client has developed a hypersensitivity reaction to a medication and the health care provider has prescribed "diphenhydramine 50 mg SC." What is the nurse's best action?

Clarify the route of administration with the health care provider (diphenhydramine can be administered PO, IV, or IM, but not sub-Q)

Shane, a 25-year-old man, is diagnosed with asthma. He began an albuterol MDI 2 weeks ago. He reports that his symptoms persist in spite of using albuterol MDI as prescribed. What advice should the nurse give the client?

Contact the health care provider to obtain adjunctive medications

A 70-year-old female client comes to the clinic with back pain. An x-ray reveals vertebral fractures and she is diagnosed with osteoporosis. Which factor most likely contributed to her condition?

Decreased estrogen levels (estrogen reduces the number and function of the osteoclasts, so the decrease in estrogen levels that occur at menopause results in increased resorption of bone)

The nurse is planning care for a client who is experiencing excessive respiratory tract secretions. What intervention should the nurse include?

Deep breathing and coughing exercises (mechanical measures are more likely to be effective than expectorant drug therapy)

The nursing instructor is describing the four types of hypersensitivity reactions. What alternate name might the instructor use to identify type IV hypersensitivity?

Delayed hypersensitivity (type IV hypersensitivity usually occurs several hours or days after exposure to the antigen & is a cell-mediated response in which sensitized T lymphocytes react with an antigen to cause inflammation mediated by the release of lymphokines, direct cytotoxicity, or both)

The U.S. Food and Drug Administration (FDA) has issued a Black Box Warning regarding the use of estrogen and its potential for causing which of the following?

Dementia in postmenopausal women

A 45-year-old female client is being seen in the health care provider's office for a dry, hacking cough that is keeping her up at night. The provider prescribes dextromethorphan for the cough. Which statement is true about dextromethorphan?

Dextromethorphan works in the medulla to suppress the cough reflex

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

Excessive salivation (adverse effects of first-generation antihistamines include urinary retention, drowsiness or sedation, dry mouth, blurred vision, and GI distress)

A client administers diphenhydramine to their 9-year-old child, who experiences seasonal allergies, before a baseball game. What may the child experience if a paradoxical effect to the medication occurs?

Excitation (excitation is a paradoxical effect that occurs occasionally, especially in children)

Antitussives (Dextromethorpan)-therapeutic use

For dry, non-productive cough suppression (that is persistent & disrupts sleep)

A client presents at the clinic with a dry, non-productive cough. The client is diagnosed with bronchitis, and it is determined that they will need help thinning sputum so that the cough can become productive. What does the nurse expect will be prescribed for the client?

Guaifenesin (expectorants are agents given orally to liquefy respiratory secretion & allow for easier removal)

Expectorants (Guifensen)-major interactions

Have patient read OTC box to check for major interactions

Antihistamines are used frequently in the home care setting for the treatment of allergies. Which of the following is most likely to be a responsibility of the nurse caring for a patient who is taking antihistamines for this indication?

Helping the patient identify environmental allergens (nurses assist the patient in identifying and avoiding factors that precipitate hypersensitivity reactions)

The nurse is caring for a client diagnosed with pneumonia. The client's arterial blood gas results identify decreased level oxygen and other laboratory work reveals an increase in lactic levels. How will the nurse interpret these findings?

Hypoxemia (hypoxemia refers to a reduction in PO2 of the arterial blood & if the PO2 of the tissues falls below a critical level, aerobic metabolism ceases and anaerobic metabolism takes over, with formation and release of lactic acid)

An older adult man has moved to a long-term care facility, and the nurse is performing a medication reconciliation. The resident's current medication regimen includes alfuzosin. After considering the most likely indication for this drug, the nurse should include what potential problem in the resident's interdisciplinary plan of care?

Impaired urinary elimination (alfuzosin is classed as a nonreceptor subtype selective alpha-1 adrenergic blocker also used to treat BPH & impaired urinary elimination is the hallmark of BPH)

A client is brought to the emergency department and immediately diagnosed with a tension pneumothorax. The priority intervention would be:

Insertion of a large-bore needle or chest tube

Which statement accurately describes as aspect of serum sickness?

Is a delayed hypersensitivity reaction (serum sickness reactions are also often caused by drugs, symptoms usually develop within 7-10 days and include urticaria, lymphadenopathy, myalgia, arthralgia, and fever, & the reaction is usually resolved within a few days but may be severe or even fatal)

What is the most effective method used to monitor clients with asthma that they can use at home?

Peak-flow monitor

A client has been prescribed a medication to decrease the nighttime episodes of bronchoconstriction and prevent asthma attacks. What type of medication does the nurse suspect has been prescribed?

Leukotriene modifiers (they improve symptoms & pulmonary function tests, decrease nighttime symptoms, & decrease the use of beta-2 adrenergic drugs)

Which would bee most important to assess in a client receiving testosterone for a prolonged period of time?

Liver function studies (clients on long-term therapy with androgens should have hepatic function tests monitored regularly due to the increased risk of hepatocellular cancer)

The nurse is reviewing laboratory values of a 70-year-old female client and observes the client's low-density lipoprotein (LDL) level is elevated. The nurse understands a possible reason for this is:

Long-term estrogen deprivation (estrogens affect the composition of the plasma lipoproteins & they produce an increase in HDL, a slight reduction in LDL, and a reduction in cholesterol levels)

A group of students are reviewing information about antihistamines. The students demonstrate understanding of the information when they identify which agent as a second generation antihistamine?

Loratadine

Older adults are very susceptible to pneumonia in all its varieties. The symptoms that older adults exhibit can be very different than those of other age groups who have pneumonia. What signs and symptoms are older adults with pneumonia less likely to experience than people with pneumonia in other age groups?

Marked elevation in temperature

Rhinosinusitis-medications

Nasal decongestants

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

Obtain the client's blood pressure (Decongestants are used cautiously in clients with a history of hypertension because of the vasoconstrictive effects of the drug)

A postmenopausal women is administered estradiol for the purpose of preventing which condition?

Osteoporosis

Kalie, age 18, is prescribed progesterone for the treatment of primary amenorrhea. Which adverse effect would need to be reported immediately to the health care provider?

Pain in one leg (this could indicate thrombus formation)

After teaching a group of students about bisphosphonates, the students demonstrate understanding of the information when they identify which drug as an example?

Pamidronate

Expectorants (Guifensen)-expected pharmacological action

Promotes increased cough production by increasing & thinning mucous secretions = allows client to decrease chest congestion by coughing out secretions

The nurse is educating a client suffering from advanced emphysema on how to improve expiratory flow rates. Which breathing technique would the nurse describe as most effective?

Pursed-lip breathing (this breathing technique increases expiratory airway pressure and therefore enables an increased exhalation volume by keeping the alveoli open)

The nurse is teaching a group of clients with allergic rhinitis (hay fever) about medication use. What would be the most essential information to give these clients about preventing possible drug interactions?

Read drug label before taking OTC medications (in order to avoid inadvertent overdose)

A client, experiencing respiratory distress related to bronchi constriction, will benefit from what therapeutic action provided by anticholinergic medication therapy?

Relaxation of smooth muscle (anticholinergics are used as bronchodilators because of their effect on the vagus nerve, resulting in relaxation of smooth muscle in bronchi, which leads to bronchodilation)

A client is being evaluated for a possible diagnosis of emphysema. What client characteristic should the nurse monitor to provide evidence of the disorder?

Respiratory expiration (COPD is caused by emphysema & chronic bronchitis-both of which result in airflow obstruction on expiration as well as over inflation of the lungs and poor gas exchange)

When describing the effects of second-generation antihistamines, which would the nurse address as being decreased?

Sedation

A client diagnosed with COPD has been prescribed bronchodilators by nebulizer for home use. What should the nurse teach the client to do to best assure effective use of the nebulizer?

Sit in a fully upright position when administering the medication

The nurse has completed teaching a client about the prescribed upper respiratory drug. The nurse determines additional teaching is warranted when the client chooses which finding as requiring further assessment?

Sputum appears clear (clear sputum is normal-the health care provider should be notified if the type of cough changes, sputum changes, color or increases, and shortness of breath occurs)

Antitussives (Dextromethorpan)-expected pharmacological action

Suppresses cough by depressing the cough center in the medulla oblongata or the cough receptors in the throat, trachea, or lungs

The nurse is caring for a client who has been taking prednisone for the treatment of asthma. The nurse is monitoring the client for increased levels of stress. When glucocorticoid levels are increased, what symptoms should the nurse monitor for?

Tachycardia

A client diagnosed with benign prostatic hypertrophy (BPH) is prescribe tamsulosin. The client communicates with the nurse about a friend that was prescribed sildenafil for his BPH. Which is the nurse's best response regarding the difference in the use of the two drugs for BPH?

Tamsulosin relaxes muscles in the prostate and bladder & increases ability to urinate

A client reports impotence and a lack of sexual desire. What medication does the nurse anticipate educating the client about?

Testosterone (used to treat androgen deficient states and in adult and post pubertal males, it is used to reestablish and maintain masculine characteristics and functions)

A 56-year-old client is prescribed fexofenadine for relief of symptoms associated with allergic rhinitis. Which finding in the client's medical record would be of concern?

The client has increased BUN and creatinine levels (this would indicate renal impairment and place the client at risk for toxicity of this medication & fexofenadine should be used with caution in clients with renal impairment because the drug's half-life is prolonged in these clients)

A client has experienced an atelectasis in the left lung. What explanation should the nurse provide the family regarding the cause of this condition?

The collapse of some of the alveoli in the left lung occurred as a result of outside pressure pushing against them (atelectasis is the collapse of once-expanded alveoli can occur as a result of outside pressure against the alveoli)

A 37-year-old woman has just experienced the end of a long-term relationship and has expressed a desire to begin using oral contraceptives. What aspect of this woman's current health status would contraindicate this treatment?

The woman takes an antiplatelet medication for coronary artery disease

Why are inhaled steroids used to treat asthma and COPD?

They act locally to decrease release of inflammatory mediators (when administered by inhalation, steroids decrease the effectiveness of inflammatory cells which causes decreased swelling associated with inflammation & promotion of beta-adrenergic receptor activity that can promote smooth muscle relaxation & inhibit bronchoconstriction)

Expectorants elicit their effect by which mechanism?

Thinning respiratory secretions

The nurse is educating the client about the use of pseudoephedrine. Which medication should the client be cautioned about taking concurrently with pseudoephedrine?

Thyroid preparations (thyroid preparations have the tendency to increase the risk of arrhythmias)

The nurse administers a glucocorticoid medication to a client with pneumonia. Which of these does the nurse teach the client is the purpose of the medication?

To decrease airway inflammation

A client is having an anaphylactic reaction to an insect sting. What type of hypersensitivity reaction is the client experiencing?

Type I

A 36-year-old woman is attending a lecture on women's health issues. The woman asks the nurse giving the lecture to identify steps that she can take to prevent osteoporosis. What might the nurse recommend?

Walk 30 minutes every day (regular weight-bearing exercise helps to strengthen bones, reducing the risk of osteoporosis)

The nurse is providing education to a client who has been newly diagnosed with osteoporosis. How should the nurse describe the role of the parathyroid on the development of the disorder?

When there is too much parathyroid hormone, the bones release their calcium into the blood at a rate that is too high, resulting in bones which have too little calcium (osteoporosis is associated with hyperparathyroidism is caused by the high parathyroid hormone that is secreted by the overactive parathyroid gland(s) & this excess hormone acts directly on the bones to remove calcium from the bones)

Pneumothorax-treatment

breathing tube

A nurse is providing education to a 56-year-old man who is admitted to the emergency department with an acute asthma attack. The nurse's initial assessment reveals that the patient has a history of pneumonia, drinks large quantities of coffee, and eats a high-calorie diet. Albuterol is prescribed for him. The important consideration when the nurse is preparing a teaching plan will be that the patient

has a high coffee intake (caffeine has sympathomimetic effects that may increase the risk for adverse effects with albuterol & the nurse should assess the patient's intake of caffeine through coffee, tea, soda, cocoa, candy, and chocolate)

An individual has sensitivity to perfumes and experiences shortness of breath when exposed to them. This occurs because:

stimulation of irritant receptors causes bronchoconstriction