Pharm Module 3 Chapter 30 PrepU
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."
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."
The doctor has ordered a medication to reduce inflammation for the client. Which of the following are used to reduce inflammation? SELECT ALL THAT APPLY A.Expectorant B.Mucolytic C.Antihistamine D.Antitussive E.Intranasal steroid (INS)
C.Antihistamine E.Intranasal steroid (INS) P.375 INSs and antihistamines are used to reduce inflammation; decongestants are used to reduce edema and swelling; and antitussives are used to eliminate cough. When congestion produces secretions in either the respiratory passages or the lungs, expectorants or mucolytics are used, respectively.
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
A client presents at the clinic with a dry, nonproductive 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
The nurse is teaching a group of clients with allergic rhinitis about the use of their medications. What would be the most essential information to give these clients about preventing possible drug interactions?
Read drug labels before taking OTC medications.
Second generation antihistamines may be preferred over first generation antihistamines because:
Second generation antihistamines are less sedating
When describing the action of decongestants, a nurse integrates knowledge of this class of drugs, identifying which mechanism?
Vasoconstriction of small blood vessels of the nasal membranes
Which condition would contraindicate the use of oxymetazoline?
hypertension
Common adverse effects of antitussive medications include:
sedation and drowsiness
A 76-year-old man has a history of heart disease, and has been prescribed an oral decongestant. The nurse is concerned with this prescription because of the risk for which?
serious cardiovascular effects.
Rebound congestion, or rhinitis medicamentosa, results from prolonged use of:
topical nasal decongestants
To prevent rhinitis medicamentosa for client with nasal decongestant, a nurse would recommend:
use the decongestant for as short a time as possible
A 25-year-old female client presents at the clinic with bronchitis. The health care provider orders guaifenesin. Which instruction should the clinic nurse offer when teaching the client about the medication?
"Drink at least two liters of fluids each day."
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
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.
An adult client has asked the nurse to recommend an OTC cold remedy. Before making a recommendation, the nurse should implement which intervention?
Assess the client for health problems that may contraindicate the use of a particular remedy.
When instructing the client who uses a lozenge as an antitussive, what should the nurse teach?
Avoid drinking fluids for 30 minutes after taking a lozenge.
A nurse caring for a client in the hospital is being discharged today with a prescription for benzonatate (Tessalon Perles) 200 mg one capsule 3 times daily. What would the nurse tell the client about this prescription during discharge counseling? (Select all that apply.)
Benzonatate can cause GI upset and sedation. The client should drink plenty fluids.
When describing the benefits of second-generation H1 receptor antagonists to those of first-generation H1 receptor antagonists, the nurse should cite what advantage?
Decreased sedation
What is the chemical mediator released in immune and inflammatory response to allergic reactions?
Histamine
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
What information should be obtained from the client by the nurse and documented prior to the recommendation of an antitussive? SELECT ALL THAT APPLY a)Type of cough b)Presence of sputum c)Home remedies used to treat the cough d)Vital signs of the last visit a year ago
a)Type of cough b)Presence of sputum c)Home remedies used to treat the cough
The client has a productive cough and the primary care provider will not order an antitussive. What should the client do to enhance the removal of secretions? Select all that apply.
change positions frequently increase fluids
What medication will thin or liquefy respiratory secretions so the client can cough them up?
guaifenesin
A client taking antitussives should be instructed to:
increase fluid intake
A common adverse effect of sympathomimetics, such as epinephrine, is:
restlessness
What is an adverse effect of oral decongestants?
tachycardia
A client is prescribed an antihistamine. The nurse determines that the drug would be contraindicated if the client had which condition? Select all that apply.
Angle-closure glaucoma Cardiovascular shock
A nurse instructing a client about use of an antitussive prescription at home should also include information about increasing fluids (unless contraindicated). How much fluid should the nurse tell this client to drink each day?
1500-2000 mL
The nurse is providing education to a client diagnosed with the common cold. What measure should the nurse recommend implementing to help liquefy cold-related secretions?
Increasing fluid intake
A client asks the nurse how long to use oxymetazoline (Afrin) nasal spray for nasal congestion. What is the nurse's best response?
"Consult with your primary care provider." Explanation: Overuse of topical nasal decongestants, such as Afrin, can make the symptoms worse, causing rebound congestion. The client should consult with the primary care provider. Not all over-the-counter medications are safe for long-term use. Afrin should not be used long term without nasal burning or stinging, or until symptoms are relieved. The primary care provider should be notified to provide medication use information.
A client is in the clinic for seasonal allergic rhinitis. Loratadine (Claritin) is prescribed. Which statement will the nurse include when providing education concerning this drug?
"Determine if the drug is going to make you drowsy before you drive." Explanation: Loratadine (Claritin) is a second-generation antihistamine and does not usually cause drowsiness like the first-generation medications; however, the client should take it for at least a day to determine the drug's effect before driving. Loratadine should be taken on an empty stomach to increase absorption. The drug is taken only once a day. Brompheniramine, a nonselective H1 blocker (first-generation antihistamine) is taken every 4 to 6 hours. Fexofenadine can be taken twice daily.
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." Explanation: The nurse needs to clarify the statement that the client made regarding taking pseudoephedrine PO in addition to the nasal spray the prescriber provided. The client has a history of hypertension and coronary artery disease, both contraindications for the adrenergic drug, pseudoephedrine. Pseudoephedrine would increase blood pressure, heart rate, and cause heart muscle irritability. Topical decongestants are chosen for clients with cardiovascular disease for this reason. The other statements are correct. Blowing the nose clears the passage, so the drug is more effective. The spray tip needs rinsed off after each use. The drug causes rebound congestion if used more often than recommended on the package or longer than 3 days.
A client with the medical conditions of hypertension and dyslipidemia, is currently taking the medications metoprolol (Toprol XL) 50 mg every day, hydrochlorothiazide 25 mg every morning, and simvastatin 2 mg every day. The client sends an email to the physician's office to inquire about what can be taken for nasal congestion. The triage nurse returns the email and asks if any self-remedies have been tried and when the last vital sign recordings have been? The client tells the triage nurse nothing has been taken yet for the nasal congestion, and the client's Apple Watch records a blood pressure of 125/80 mm Hg and pulse of 70 beats/minute. The client denied any other symptoms.
1.Was the client's call warranted? Even though most medications to treat nasal congestion are available over the counter without a prescription, this client has hypertension, and decongestants should not be used by those with hypertension unless approved by the client's physician. 2.What additional information does the triage nurse need to elicit from the client? · What actions or home remedies were used to treat the nasal congestion (the name of each product and frequency of use)? · Blood pressure and pulse would also be helpful if available. · What is the level of the nasal congestion? · How long has the nasal congestion been present? · Are there any other symptoms present with congestion? 3.The physician recommends an over-the-counter nasal spray for the nasal congestion. Why is this the most appropriate treatment for this client? Because decongestants should be used cautiously in patients with hypertension, the use of a nasal preparation allows for local effects of the decongestant with minimal systemic side effects that can occur with use of an oral decongestant. 4.What counseling should the triage nurse offer the client? The client should be instructed on the proper use of a nasal spray. They should be warned about rebound congestion and nasal burning, which can occur with the use of topical decongestants. The client should be told not to use the nasal spray more frequently than directed on the packaging and that they may experience insomnia, restlessness, nervousness, nausea, or vomiting. They should also be counseled to continue to monitor the blood pressure and pulse and to call if symptoms do not improve in 7 days or are accompanied by a high fever
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?
Antihistamines Explanation: Antitussives that contain an antihistamine may cause drowsiness. The others are not found in antitussives and therefore do not cause the adverse reaction of drowsiness.
A 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
Given below, in random order are the steps of the inflammatory response to injury. Arrange the steps of the inflammatory response in the order they are likely to occur in most situations. a)Dilation of the arterioles b)Increased capillary permeability c)Release of histamine d)Escape fluid from blood vessels e)Localized redness f)Localize swelling
c)Release of histamine a)Dilation of the arterioles e)Localized redness b)Increased capillary permeability d)Escape fluid from blood vessels f)Localize swelling P. 368 Histamine is produced in response to an allergic reaction or tissue injury. The release of histamine produces an inflammatory response. Dilation of small arterioles results in localized redness. An increase in the permeability of small blood vessels promotes an escape of fluid from these blood vessels into the surrounding tissues, which produces localized swelling.
