Pharmacology Ch. 54: Drugs Acting on the Upper Respiratory Tract QUESTIONS

A patient presents at the clinic with signs and symptoms of seasonal allergic rhinitis. The patient is prescribed a nasal steroid to relieve symptoms. Two days later, the patient calls the clinic and tells the nurse that he is frustrated and wants a new drug. What is the most appropriate response by the nurse?

A) "It may take up to 2 weeks to get the full clinical effect. Try to keep using the drug as ordered." Nasal steroids require about 2 weeks to reach their full clinical effect so the patient should be encouraged to use the drug for that length of time before changing drugs or giving up.

A patient has been prescribed an antihistamine for treatment of allergic rhinitis. What statements by the patient indicate an understanding of this medication? (Select all that apply.)

A) "This medication will work best if I take it before I eat anything." C) "I will use sugarless candies to help with the feelings of a dry mouth." D) "I will use a humidifier in the bedroom while I sleep." (Antihistamines should be taken on an empty stomach and the patient should force fluids, not drink less fluids. The patient may use sugarless candy to help with dry mouth and should increase room humidity.)

A student nurse is doing research consisting of chart audits of 25 patients with diagnosed chronic pharyngitis; she is attempting to determine what medication has been prescribed most frequently. What type of medication would this nurse expect to find in most of the chart audits?

A) Antitussives Antitussives are drugs that suppress the cough reflex. Many disorders involving the respiratory tract, including the common cold, sinusitis, pharyngitis, and pneumonia are accompanied by an uncomfortable, nonproductive cough.

The nurse is caring for a patient who is scheduled to receive acetylcysteine because of an acetaminophen overdose. The nurse would notify the physician before administering the medication if the patient had which condition? (Select all that apply.)

A) Bronchospasm D) Peptic ulcer E) Esophageal varices

A 71-year-old man with a history of heart disease and diabetes has had an antihistamine prescribed. The nurse is concerned with this prescription because of the risk for what?

A) Cardiac arrhythmias The patient has history of heart disease. Antihistamines have been associated with prolongation of the QT interval, which can lead to potentially fatal cardiac arrhythmias.

The nurse is giving discharge instructions to the mother of a 3-month-old infant who has an upper respiratory tract infection and has been prescribed a pseudoephedrine nasal solution. What instructions are most important for the nurse to give to this mother?

A) Instill the medication 20 to 30 minutes before feeding Oral decongestants are drugs that are taken by mouth to decrease nasal congestion related to the common cold, sinusitis, and allergic rhinitis. (They are also used to relieve the pain and congestion of otitis media. Opening of the nasal passage allows better drainage of the Eustachian tube, relieving pressure in the middle ear.) It should be given prior to a feeding so that infant is able to suck more effectively.

The nurse is caring for a patient who needs education on his medication therapy for allergic rhinitis. The patient is to take clemastine (Tavist) daily. In providing educational interventions regarding this medication, what is the most important instruction on the action of the medication?

A) It blocks the effects of histamine Clemastine blocks the effects of histamine at the histamine-1 receptor sites, decreasing the allergic response. It is prescribed to treat allergic rhinitis.

Parents who treat their children's cold and flu symptoms at home should be educated concerning the reading and understanding of over-the-counter (OTC) labels. Why is this statement true?

A) Many of these preparations contain the same active ingredients so that inadvertent overdose is a common problem. Parents need to be educated to read the labels of any OTC preparation they give their children. Many of these preparations contain the same ingredients and inadvertent overdose is a common problem.

The nurse advises that patient to avoid long-term use of nasal decongestants because it may lead to what condition?

A) Mucosal ulcerations Adverse effects associated with topical decongestants include LOCAL stinging and burning, which may occur the first few times the drug is used. (If the sensation does NOT resolve, the drug should be discontinued, because it may indicate lesions or erosion of the mucous membranes.)

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

A) Nausea B) Rash E) Headache Adverse effects of guaifenesin are nausea, vomiting, headache, dizziness, and rash.

The family nurse practitioner is caring for a Hispanic woman who is 83 years old. The patient has been noncompliant with the care regimen the nurse practitioner has previously outlined for treatment of sinusitis. What should the nurse practitioner do that can assist the patient in being more compliant with the prescribed treatment regimen?

A) Provide instructions in writing The nurse instructs the patient about signs and symptoms that require follow-up and provides these instructions verbally and in writing.

An individual calls the nurse help line and asks what the drug diphenhydramine is used for. The nurse knows that the medication is prescribed for which conditions? (Select all that apply.)

A) Urticaria B) Vasomotor rhinitis D) Motion sickness E) Angioedema (Diphenhydramine is used for the symptomatic relief of perennial and seasonal rhinitis, vasomotor rhinitis, allergic conjunctivitis, urticaria, and angioedema; it is also used for treating motion sickness and parkinsonism, as a nighttime sleep aid, and to suppress cough.)

A patient presents at the clinic with a dry nonproductive cough. The patient is diagnosed with bronchitis and it has been determined that assistance is needed in thinning the sputum so the cough can become productive. What does the nurse expect the physician will prescribe?

B) Guaifenesin (Mucinex) This patient needs to cough up respiratory secretions, he would likely be prescribed guaifenesin. This drug is an expectorant that liquefies lower respiratory secretions by reducing their viscosity and so making it easier for a patient to cough them up.

A nurse in a three drops with respiratory problems has received orders for four patients. What medication order will the nurse question?

B) Hydrocodone (Hycodan) 10 mg PO for a 5-year-old child The nurse should question the order for hydrocodone. The ordered dose, 10 mg, is an adult dose and should not be given to a 5-year-old. Patients from 2 to 12 years of age should be given between 1.25 and 5 mg/dose of this medication

A 29-year-old female patient has sinusitis, so the physician orders a topical nasal decongestant. What instructions should be given?

B) Increase fluids to 2 L/d Institute other measures to help relieve the discomfort of congestion (such as, humidity, increased fluid intake, cool environment, avoidance of smoke-filled areas) as appropriate.

The nurse is caring for a patient who is taking dextromethorphan for cough suppression. The nurse will assess this patient for hypotension if he also takes which other medication?

B) Monoamine oxidase (MAO) inhibitors Dextromethorphan should NOT be used in conjunction with MAO inhibitors because hypotension, fever, nausea, myoclonic jerks, and coma could occur.

A patient has been prescribed a nasal steroid and asks the nurse what the most common reason that this medication is used to treat. What is the nurse's best response?

B) Nasal steroids are used to treat allergic rhinitis. Nasal steroids block the inflammatory response, their use is contraindicated in the presence of acute infections. (The most common reason they are prescribed is for the treatment of allergic rhinitis or to relieve inflammation after the removal of nasal polyps.)

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

B) Rhinitis medicamentosa An adverse effect that accompanies frequent or prolonged use of topical nasal decongestants is rebound congestion, technically called rhinitis medicamentosa.

The nurse is caring for a patient who is receiving acetylcysteine (Mucomyst) by face mask. What would be an appropriate nursing diagnosis?

B) Risk for impaired skin integrity A patient receiving acetylcysteine by face mask should have the residue wiped off the face mask and her face with plain water to prevent skin breakdown.

The nurse is writing a care plan for a patient who has been prescribed a nasal steroid. What would be an appropriate nursing diagnosis for this patient?

B) Risk for injury related to suppression of inflammatory reaction

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

B)Decongestants

The nurse is caring for a patient with cystic fibrosis who is receiving dornase alfa by nebulizer to help thin secretions. What statement by the patient indicates a need for further instruction?

C) "I'm glad that this medication will solve all of my problems." Dornase alfa is only a palliative therapy that improves respiratory symptoms, and other therapies, such as coughing, postural drainage and enzymes, are still needed.

The nurse is caring for a patient who does not have a respiratory disorder but has been prescribed acetylcysteine. What is an additional indication for acetylcysteine (Mucomyst)?

C) Antidote for acetaminophen poisoning Acetylcysteine is used orally to protect liver cells from being damaged during episodes of acetaminophen toxicity because it normalizes hepatic glutathione levels and binds with a reactive hepatotoxic metabolite of acetaminophen.

The nursing instructor is teaching the lab students the best position for the administration of nasal sprays. What position would the instructor teach the students?

C) High Fowler's Teach the patient to sit upright and press a finger over one nostril to close it. This body position is important to prevent excessive amounts of the medication running down the back of the throat.

A patient has an important presentation to make in 4 hours and he needs relief from the congestion of seasonal rhinitis. The patient calls the nurse, explains the situation, and tells the nurse that he cannot afford to be drowsy. Which antihistamine would be a good choice for this patient?

C) Loratadine (Claritin) Loratadine is one of the second-generation antihistamines, which have fewer anticholinergic effects and are less likely to cause drowsiness.

The pharmacology instructor questions the students as to which classification of drugs is commonly found in over-the-counter (OTC) combination cold medications?

C) Oral decongestants Oral decongestants are found in many OTC cold and flu preparations so that care must be taken to avoid inadvertent overdose when more than one such drug is used.

The nurse is teaching a group of patients with allergic rhinitis about the use of their medications. What would be the most essential information to give these patients about preventing possible drug interactions?

C) Read drug labels before taking OTC medications. Teach patients to read the OTC labels to avoid inadvertent overdose.

A nurse is caring for a 15-year-old patient with cystic fibrosis who has been prescribed dornase alfa (Pulmozyme) to relieve the buildup of secretions and keep airways open and functioning longer. What will the nurse instruct the patient to do concerning the use of this drug?

C) Store the drug in the refrigerator, protected from light. Patients using dornase alfa should be cautioned to store the drug in the refrigerator, protected from light. Heat and light can cause the drug to break down and can decrease its therapeutic value.

What would be the nurse's best response if a patient calls the clinic and reports that he has had a persistent cough for 2 weeks and asks the nurse for a recommendation for a cough medicine?

C)"You should come to the clinic to be evaluated. A cough that lasts that long might be an indication of an underlying medical problem." A cough that has persisted for 2 weeks could be indicative of an underlying medical condition that should be addressed before treating the cough.

What statement by the patient leads the nurse to believe that he needs additional instruction regarding his nasal decongestant?

D) "I will use it only when I have nasal discharge." Decongestants decrease overproduction of secretions by causing local vasoconstriction to the upper respiratory tract. This vasoconstriction leads to a shrinking of swollen mucous membranes and tends to open clogged nasal passages, providing relief from the discomfort of a blocked nose and promoting drainage of secretions and improved airflow.

What statement by a 61-year-old patient who is to take an antitussive with codeine indicates that the nurse's teaching has been effective?

D) "This medication can cause drowsiness, so I will avoid driving or using power equipment while I take it." Codeine is a CNS depressant and should not be combined with driving or heavy machinery activities. Antitussives are not intended to be taken with every coughing episode because the patient may overdose on the medication.

What disorders would the pharmacology instructor tell the nursing students may be exacerbated by the use of nasal decongestants?

D) Hypothyroidism (Assess for possible contraindications or cautions; any history of allergy to the drug or a component of the drug vehicle) glaucoma, hypertension, diabetes, thyroid disease, coronary disease, and prostate problems, all of which could be exacerbated by the sympathomimetic effects.

The clinic nurse is caring for a patient who has been prescribed fexofenadine for hay fever. When the nurse is assessing this patient's medication history, what drug would make the nurse question the order for fexofenadine?

D) Ketoconazole The interaction of fexofenadine with ketoconazole or erythromycin may raise fexofenadine concentrations to toxic levels.

The nursing instructor is discussing the administration of nasal spray with the nursing students. What information is most important to include in this discussion?

D) Overuse of nasal spray may cause rebound congestion An adverse effect that accompanies frequent or prolonged use of decongestants is rebound vasodilation, clinically called rhinitis medicamentosa.

A patient visits the clinic and is diagnosed with acute sinusitis. To promote sinus drainage, what medication might be ordered?

D) Topical decongestants Topical decongestants are sympathomimetics, meaning that they imitate the effects of the sympathetic nervous system to cause vasoconstriction, leading to decreased edema and reduced inflammation of the nasal membranes.