Pharm: Respiratory, endocrine, antimicrobialNCLEX style questions

A client is instructed to take diphenhydramine after an allergic reaction. Which statement by the client indicates successful teaching concerning the safe and effective use of diphenhydramine? "I will still be able to have my after-dinner drink with this medication." "I will eat a diet low in sodium while taking this medication." "I should not drive my car after taking this medication." "I can take this medication every 2 hours until I feel better."

"I should not drive my car after taking this medication." Rationale - The administration of diphenhydramine causes drowsiness, and the client should not operate machinery, such as driving. The client should not combine diphenhydramine with alcohol due to central nervous system depression. The client will not need to limit sodium with this medication. The client should adhere to the dosing schedule and not take the medication every 2 hours.

Upper Respiratory symptoms caused by virus or allergy

Antihistamines Decongestants Intranasal glucocorticoids Antitussives Expectorants FLUIDS!

The nurse is teaching a 61-year-old client about the narcotic antitussive syrup that the health care provider has prescribed. Which client statement suggests understanding of what the nurse has taught? "I should take this medicine followed by a glass of water." "If this medicine works, I shouldn't cough at all." "If my cough doesn't improve right away, I'll increase my dose." "This medication might cause drowsiness, so I will avoid driving while I use it."

Rationale - "This medication might cause drowsiness, so I will avoid driving while I use it." Although narcotic antitussives include only small doses of narcotics, some of the adverse effects of that drug category (e.g., drowsiness, dizziness) are still possible. To decrease the risk of adverse effects, clients should take antitussives at the prescribed schedule and dosage. They should not dilute the medications with fluids or take them with food because doing so may clear the medications from the pharynx, reducing their benefit. Antitussives are intended to suppress only non-purposeful cough; suppression of all coughing can prevent the clearance of secretions.

A client is prescribed an antitussive agent with codeine. Which statement by the client indicates that the nurse's teaching has been effective? "I will take this medication whenever I am coughing." "This medication will make me anxious and nervous." "I will call my health care provider if I develop diarrhea when I take it." "This medication will cause drowsiness, and I will not drive."

Rationale - "This medication will cause drowsiness, and I will not drive." Antitussive agents suppress cough by depressing the cough center in the medulla oblongata or the cough receptors in the throat, trachea, or lungs. Since they are combined with codeine, they will also depress the CNS and induce drowsiness. The medication should not be given every time the client coughs. The medication is not known to cause anxiety and nervousness. The medication will cause constipation, not diarrhea.

What medication would be administered to counteract the effect of acetaminophen? oxymetazoline hydrochloride acetylcysteine daptomycin darbepoetin alfa

Rationale - Acetylcysteine Acetylcysteine is effective in the treatment of acetaminophen overdose. Oxymetazoline hydrochloride is used for nasal congestion, not acetaminophen overdose. Daptomycin is an antibiotic that fights bacteria in the body and used to treat bacterial infections of the skin and underlying tissues. Darbepoetin alfa injection causes the bone marrow to produce red blood cells.

When providing health education to an adult who is taking an over-the-counter (OTC) combination cold and cough remedy, the nurse should encourage the client to implement what intervention to best assure medication safety? Carefully read the label and adhere to the guidelines for use. Withhold the medication until a prescription is obtained from a care provider. Start with a low dose and gradually increase it until symptoms are relieved. Administer the medication with an additional dose of acetaminophen to potentiate therapeutic effects.

Rationale - Carefully read the label and adhere to the guidelines for use. In the interests of safety, it is imperative that clients follow the instructions on combination remedies carefully. A care provider's input is not always necessary, and it is unsafe to continually increase doses. Additional acetaminophen could be dangerous because many combination drugs already contain this drug

A patient arrives in the emergency room with an attack of acute bronchiectasis. The nurse knows that the principle pathological finding in the diagnosis of bronchiectasis includes: Increase in the red blood cell concentration in the blood Leakage of fluid into the alveolar interstitial spaces Chronic, irreversible dilation of the bronchi and bronchioles Obstruction of the pulmonary vasculature by a clot

Rationale - Chronic, irreversible dilation of the bronchi and bronchioles Bronchiectasis is a chronic disease that involves the bronchi and bronchioles. It is characterized by dilation of the bronchial tree and chronic infection and inflammation of the bronchial passages.

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

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

A client presents at the clinic with a dry, non-productive cough. The client is diagnosed with bronchitis, and it is determined that the client needs help thinning the sputum so the cough can become productive. What does the nurse expect the health care provider will prescribe? Benzonatate (Tessalon) Guaifenesin (Mucinex) Dextromethorphan (Benylin) Hydrocodone (Hycodan)

Rationale - Guaifenesin (Mucinex) Since this client needs to cough up respiration secretions, they would likely be prescribed guaifenesin. This drug is an expectorant, and it liquefies lower respiratory secretions, reducing the viscosity of the secretions and making it easier for a client to cough them up. Benzonatate, dextromethorphan, and hydrocodone are antitussives and are given to suppress the cough reflex.

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

Rationale - Overuse of nasal spray may cause rebound congestion. An adverse effect that accompanies frequent or prolonged use of decongestants is rebound vasodilation, 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 the patient should use the bottle.

Expectorants elicit their effect by which mechanism? Thinning respiratory secretions Breaking down thick mucus in the lower lungs Depressing the cough center in the brain Anesthetizing stretch receptors in the respiratory passages

Rationale - Thinning respiratory secretions Rationale - Thinning respiratory secretions is the mechanism of action for expectorants. Breaking down thick mucus in the lower lungs is the mechanism of action of mucolytics. Depressing the cough center in the brain is the mechanism of action for centrally acting antitussives. Anesthetizing stretch receptors in the respiratory passages is the mechanism of action for peripherally acting antitussives.

What type of cough is best treated with dextromethorphan? an occasional, productive cough a cough that is associated with an allergy to ragweed a cough that occurs when the client is exposed to airborne irritants a dry, nonproductive cough

Rationale - dry, hacking, nonproductive cough The major clinical indication for use of dextromethorphan is a dry, hacking, nonproductive cough that interferes with rest and sleep. It is not desirable to suppress a productive cough because the secretions need to be removed. The character, not cause, of the cough is relevant to its treatment with dextromethorphan.

Which preventive measure is most important to teach parents concerning the prevention of the common cold? frequent hand washing maintaining vaccinations taking 1200 grams of vitamin C taking Echinacea daily

Rationale - frequent hand washing Because of the way cold viruses are spread, frequent and thorough hand hygiene is the most important protective and preventive measure. There is not vaccine against the common cold. Neither the ingestion of vitamin C nor of Echinacea has been proven to be the most effective preventive measure for the common cold.

The nursing instructor is teaching students about the administration of nasal sprays. According to the instructor, the correct patient position for administering the sprays is closest to: supine. semi-Fowler's position. high Fowler's position. side-lying position.

Rationale - high Fowler's position. The patient should be standing or sitting during administration of nasal sprays. This is closest to high Fowler's position.

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. increased salivation and choking. severe constipation. insomnia.

Rationale - serious cardiovascular effects. Oral decongestants are contraindicated or (at minimum) used with caution in clients with severe cardiovascular disease or severe hypertension because of the risks for increased heart rate, blood pressure, and myocardial contractile force. History of constipation, insomnia and increased salivation/choking are not contraindications.

A nurse in a healthcare facility is preparing a teaching plan for a patient receiving an antitussive drug. What instructions should the nurse include in the teaching plan? Select all that apply. Take frequent sips of water Include a high protein diet Swallow capsules whole Suck on sugarless hard candy Take medication with milk

Rationale - sips of water, swallowing capsules whole, and sucking on sugarless hard candy Taking frequent sips of water, swallowing capsules whole, and sucking on sugarless hard candy are the instructions that the nurse should include in the teaching plan for a patient receiving antitussive drugs. The nurse need not include points such as taking high protein diets and taking medication with milk in the teaching plan of the patient receiving antitussive drugs.

Lower Respiratory COPD, emphysema, asthma

SABA LABA Anticholinergics Corticosteroids (inhaled or systemic) Theophylline and Aminophylline Leukotriene receptor antagonists Cromolyn Mucolytics

Tuberculosis latent and active

Single drug therapy Multi-drug therapy: --Isoniazid (empty stomach), rifampin (red/orange body fluids), rifabutin, rifapentine, pyrazinamide, ethambutol --Pyridoxine (Vit B6)

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 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.

The client should use caution and will likely require a lower dose of pseudoephedrine because of impaired renal function. Rationale - Because pseudoephedrine is excreted primarily via the kidneys, caution in clients with renal impairment is important. It may be necessary to reduce the dosage to avoid potential drug accumulation and drug toxicity. The presence of diabetes warrants caution, but it is not an absolute contraindication, and concern is not necessarily on the medication's effect on blood glucose levels.