Pharmacology Chapter 53 - Introduction to the Respiratory System

A client has expressed frustration stating, "I've been taking an over-the-counter (OTC) decongestant for several days and it still hasn't really cured my cold." What teaching point should the nurse convey to the client?

"Drugs like this can often relieve some of the symptoms of a cold, but they won't cure it."

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."

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."

What statement made by a client suggests a need for further teaching on the risk factors associated with drug allergies?

"If you didn't have allergies as a child, you won't develop allergies later in life."

Which statement by the parents of a child diagnosed with cystic fibrosis (CF) demonstrates an understand of the goal of the prescribed treatment?

"The secretions in her lungs can't be allowed to get too thick and block her airways."

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."

What home remedies are effective for mouth dryness and cough?

-Adequate fluid intake - Humidification of the environment -Sucking on hard candy or throat lozenges

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 patient receives dextromethorphan. The nurse would expect this drug to begin acting within which time frame?

25 to 30 minutes

After teaching a group of students about the lungs, the instructor determines that the teaching was successful when the students identify that the right lung has how many lobes?

3

A patient receives guaifenesin. The nurse would expect the drug to begin acting within which time frame?

30 minutes

A client asks the nurse about using dextromethorphan to relieve a cough. What type of cough would the nurse explain is best treated with the drug?

A dry, nonproductive cough

What client should the nurse monitor most closely for signs and symptoms of respiratory distress syndrome?

A premature neonate

The nurse is listening to a client's lungs and is having difficulty hearing anything. A review of the electronic medical records states that the client has developed atelectasis. Based on this information, what is the best description of atelectasis to tell the client?

Air or fluid accumulation in the pleural space

Acetylcysteine may be used as a mucolytic agent. What is an additional indication for the drug?

Antidote for acetaminophen poisoning

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 reports a hacking cough. The client asks if taking an antihistamine would be helpful. The nurse's best response is:

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

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.

The nurse would expect which clinical manifestations to be documented in the history of the patient with bronchiectasis?

Arthralgia Productive cough Fever

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?

Assess the client's pattern of antihistamine usage.

Which disorder would alter the ability to move gases in and out of the lungs? (Select all that apply.)

Atelectasis Bronchitis Respiratory distress syndrome Cystic fibrosis

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

A nurse is caring for a patient who has been prescribed a nasal decongestant. Which of the following factors should the nurse assess before administering the drug?

Blood pressure

A client is prescribed oxymetazoline. Which assessment data would indicate that the drug is effective?

Breathing pattern is regular and without difficulty.

The lower respiratory tract includes which structures?

Bronchial tree Alveoli

With which condition are the bronchial epithelial cells replaced by a fibrous scar tissue?

Bronchiectasis

An instructor is describing the respiratory membrane at the alveolar level. Which would the instructor include as a component?

Capillary endothelium

With bronchitis, proteins leak into the area due to

Changes in capillary permeability

Which would the nurse most likely expect as treatment for a pneumothorax?

Chest tube insertion

A female client is diagnosed with type 2 diabetes mellitus, hyperlipidemia, and mild hepatic impairment. She presents to the emergency department after taking promethazine, obtained from a friend, for motion sickness. The nurse would expect what adverse effect?

Cholestatic jaundice

The nurse is monitoring a premature infant diagnosed with respiratory distress syndrome (RDS). Which assessment finding will serve to demonstrate that the instillation of surfactin as a treatment has been effective?

Clear breath sounds

When instructing a client in how to use a topical nasal spray, what would the nurse emphasize to do first?

Clear the nasal passages.

In the pulmonary unit of your hospital, the nurse has several patients who are seasonal "frequent flyers" due to exacerbation of their COPD. Especially in emphysema, the lungs lose the ability to recoil to expel air. The ability to accommodate incoming air is called:

Compliance

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."

A client having an allergic reaction to mold, describes chest tightness and difficulty breathing. Which process is occurring?

Contraction of smooth muscle in the bronchi

The pulmonologist sees many patients daily who suffer from a variety of respiratory disorders. What are some of the common signs and symptoms many of these patients present?

Cough Increased secretions Mucosal congestion

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.

A group of students are reviewing the mechanics of oxygen and carbon dioxide exchange in the alveoli. The students demonstrate understanding when they identify which mechanism as being responsible?

Diffusion

A patient has been exercising during his cardiac rehabilitation. What process is noted when oxygen and carbon dioxide are transferred between alveoli and blood in this patient?

Diffusion

What term is defined as the process by which oxygen and carbon dioxide are transferred between alveoli and blood and between blood and body cells?

Diffusion

Which mechanism is involved in the movement of oxygen and carbon dioxide at the alveolar level?

Diffusion

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?

Diphenhydramine

An adult client has reported experiencing a dry mouth and urinary retention after several nights of taking an over-the-counter (OTC) sleep aid. The nurse should suspect that this medication contains what antihistamine?

Diphenhydramine

A group of students are reviewing the role of mast cells with respiratory function. The students demonstrate a need for additional review when they identify which substance as being released by these cells?

Dopamine

A female client is prescribed a first-generation antihistamine for her allergies. The nurse would expect her to experience what adverse effect?

Dry mouth

Chronic obstructive pulmonary disease (COPD) encompasses which disease processes?

Emphysema Bronchitis

The perioperative nurse is caring for a postsurgical client, and the nurse has identified a risk for atelectasis. What are the nurse's best actions to prevent the development of atelectasis?

Encourage deep breathing and coughing. Help the client to ambulate as soon as possible.

In a bedridden, non-mobile patient, which activities would be most beneficial to preventing atelectasis?

Encourage to cough and deep breathe several times per hour

A nurse on rounds observes that a client has been eating food rather hastily. Based on this information the nurse knows that what structure of the respiratory system prevents foreign matter from entering the lower respiratory system?

Epiglottis

A patient has an increased carbon dioxide level. Which cells combine with carbon dioxide to eliminate it from the body?

Erythrocytes

Carbon dioxide combines with which cell types for elimination from the body?

Erythrocytes

Which would the nurse understand as being responsible for the increased mucus production with the common cold?

Goblet cells

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?

Guaifenesin

A group of nursing students are reviewing information about expectorants. The students demonstrate understanding when they identify which medication as an example?

Guaifenesin

A client experiences bronchospasm with asthma. The nurse understands that this is due to:

Histamine

When describing the mast cells to a group of students, an instructor would include what as being released by these cells? (Select all that apply.)

Histamine Serotonin Adenosine triphosphate

Which would the nurse identify as being involved with asthma?

Hyperactive airways

The nurse is encouraging a client to cough frequently and complete deep breathing exercises. The nurse knows that many factors can cause a decrease of gas exchange for clients. Based on this information, what factors can cause a decrease in gas exchange? Select all that apply.

Immobility Thoracic/pulmonary surgery Pneumonia

A nurse is describing the events associated with a common cold to a local community group. Which would the nurse include?

Increased activity of the goblet cells

As a result of dehydration, a client's epithelial cells are producing insufficient amounts of mucus. Consequently, the client's mucociliary blanket is compromised. Which change would a care provider most reasonably anticipate as a direct result of this change?

Increased amounts of bacteria in the lungs

A patient has an increased respiratory rate. Which causes an increased respiratory rate?

Increased carbon dioxide

Sympathetic nervous system stimulation of the respiratory tract would result in:

Increased respiratory rate

The nurse is reviewing with a group of clients about the regulators of breathing and how they function. What is the best explanation by the nurse to the clients about the role of the medulla in the regulation of respirations?

Involuntary control of the depth and rate of respirations

A nurse is assigned to care for a client who is prescribed dextromethorphan. The client's history reveals that the client is also taking a monoamine oxidase inhibitor for depression. The nurse would assess the client for which effect?

Jerking leg motions

Which respiratory structure contains the vocal cords?

Larynx

What are some advantages of using a second-generation antihistamine over a first-generation antihistamine?

Less sedation Fewer anticholinergic effects

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

A client reports increased sedation after the initiation of chlorpeniramine to treat her allergies. Which antihistamines could the nurse recommend to the client to treat her allergy symptoms that would result in less sedation? (Select all that apply.)

Loratadine (Claritin) Cetirizine (Zyrtec)

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

Meclizine

When describing the major control mechanism for the inspiratory muscle contraction, which would be included?

Medulla

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.

A client with cystic fibrosis may use which type of medication to reduce the viscosity of respiratory secretions?

Mucolytic

Which would contraindicate the use of a topical nasal decongestant?

Nasal ulceration

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

Which statement best conveys an aspect of the respiratory pressures that govern ventilation?

Negative intrapleural pressure holds the lungs against the chest wall

The pathway for external breathing is given to the nurse in random order after the nurse educator dropped the note cards on the floor. What is the correct sequence for the pathway for external breathing to the alveoli level in the pathway?

Nose Pharynx Larynx Trachea Bronchi Bronchioles

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.

Which is classified as a decongestant?

Oxymetazoline (Afrin)

Which condition would be the result of air in the pleural space?

Pneumothorax

Which would a nurse identify as being involved with acute respiratory distress syndrome?

Progressive loss of lung compliance

Some antihistamines can produce significant sedation. Which drug is most likely to cause this adverse effect?

Promethazine

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?

Pseudoephedrine

Which term would the nurse use to describe the delivery of blood to the alveoli?

Pulmonary perfusion

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

Due to complications, a male postoperative patient has been unable to mobilize for several days following surgery and has developed atelectasis. Which process would his care team anticipate with relation to his health problem?

Redirection of blood flow into the lung regions that are hypoxic

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

A male client is diagnosed with chronic bronchitis. What would the nurse expect to be one of his physical reports?

Retention of secretions

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

A group of students are reviewing the common conditions associated with the upper respiratory tract. The students demonstrate understanding of the material when they identify what as a response to a specific antigen?

Seasonal rhinitis

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

Sedation

An instructor is teaching a class about the disorders that may affect the movement of gases into and out of the lungs. The instructor determines the need for additional teaching when the students identify which condition as being involved?

Sinusitis

A 42-year-old male client has a history of smoking for 20 years. The client states he is feeling fine and asks why stopping smoking is necessary. What information might the nurse share with the client about smoking?

Smoking decreases the size of the tubes leading to the lungs

First-generation antihistamines may be effective against what symptoms? (Select all that apply.)

Sneezing Rhinorrhea Cough

When the use of antihistamines result in dryness of the mouth, the nurse should recommend which to relieve the dryness? Select all that apply.

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

Which is used in the treatment of respiratory distress syndrome (RDS) to prevent atelectasis?

Surfactant

A neonate develops respiratory distress syndrome. Which would be used?

Surfactant replacements

Your patient, a 73-year-old Hispanic man, has a 40 pack/year history of cigarette smoking and was admitted with an exacerbation of COPD. As his nurse, you understand the efficacy of his respiratory system depends on:

The ability of the lungs to expand and contract.

A client is experiencing an episode of status asthmaticus. What is the primary challenge facing the staff as they attempt to manage the client's respiratory crisis?

The bronchospasm does not respond to usual treatment measures

A restaurant patron starts coughing uncontrollably after consuming a beverage. What malfunctioning structure causes this?

The larynx

A male client presents to the health care provider's office for his annual visit. When questioned about over-the-counter medication use, he states that he uses echinacea to prevent colds. What statement is true about echinacea?

There is limited or no support for the use of echinacea to prevent or treat symptoms of the common cold.

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.

Expectorants elicit their effect by which mechanism?

Thinning respiratory secretions

When describing the structure of the lungs, the nurse would identify the left lung as consisting of how many lobes?

Two

The alveolar cells that synthesize pulmonary surfactant are the

Type II alveolar cells

Which cranial nerve is responsible for stimulating the diaphragm to contract and relax?

Vagus

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 would a nurse identify as being found in the larynx?

Vocal cords Epiglottis

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

cardiovascular

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

Cystic fibrosis is a hereditary disease that affects the respiratory system. In people with the disease, breathing performance is affected by:

excessive secretions

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?

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

Which condition would contraindicate the use of or oxymetazoline?

hypertension

Which nursing diagnosis would provide the clearest indication for the administration of inhaled acetylcysteine?

ineffective airway clearance

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