PrepU Ch 32 Drug Therapy to Decrease Histamine Effects and Allergic Response
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? Select all that apply. a. "Histamines are located mainly in secretory granules of mast cells and basophils." b. "Histamines diffuse rapidly into other tissues once released." c. "Histamines are the last chemical mediators to be released in immune and inflammatory responses." d. "Histamines are synthesized and stored in most body tissues."
a, b, d
When developing the teaching plan for a client receiving an antihistamine, which would the nurse include? (Select all that apply.) a. Using sugarless candies or lozenges to combat dry mouth b. Stopping the drug after 3 days if no relief is obtained c. Advising the client to avoid alcohol consumption d. Encouraging the client to engage in usual activities such as driving
a, c
A 76-year-old client has been prescribed an oral antihistamine. What adverse effect presents a priority safety concern for older adult clients? a. Nasal burning b. Drowsiness c. Nonproductive cough d. Dry mouth
b
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? a. Ask the pharmacy technician for assistance in selecting an OTC medication. b. Read drug labels before taking OTC medications. c. Use only one pharmacy so the pharmacist can check drug interactions. d. Over-the-counter (OTC) medications are safe to use.
b
A 20-year-old woman calls the clinic at 5 PM and reports to the nurse that she forgot to take her morning dose of fexofenadine (Allegra). She usually takes her evening dose at 8 PM. She wants to know what she should do. The nurse will instruct her to a. double her evening dose. b. take the morning dose now and the evening dose at the regular time. c. forget about the morning dose and take the evening dose. d. skip the evening dose and start back in the morning.
c
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? a. Yes, but be sure to use a brand that mentions 'cold remedy' on the packaging. b. Antihistamines can be helpful when they're combined with an antibiotic. c. Antihistamines are not recommended for treating a cold. d. Yes, but it's important to monitor for adverse effects.
c
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 non-selectively binding to central and peripheral H1 receptors? a. Loratadine b. Fexofenadine c. Diphenhydramine d. Cetirizine
c
The pharmacology instructor is discussing the adverse effects of diphenhydramine. Which is not one of these effects? a. Blurred vision b. Dry mouth c. Drowsiness d. Excessive salivation
d
When caring for a patient with an allergic reaction following a blood transfusion, which of the following conditions should the nurse consider as a contraindication for antihistamine therapy? a. Open-angle glaucoma b. Bronchial asthma c. Impaired kidney function d. Stenosing peptic ulcer
d
When describing the effects of second-generation antihistamines, which would the nurse address as being decreased? a. Dry mouth b. Gastrointestinal upset c. Hypersensitivity d. Sedation
d
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? a. "I should avoid driving after taking this medication." b. "It's safe to take this medication with the nighttime sinus medication that I've been using." c. "Taking this medication shouldn't stop me from having my after-dinner drink." d. "This medication has no serious side effects."
a
A patient with vasomotor rhinitis has been prescribed an antihistamine. The patient is eager to know whether the prescribed antihistamine may cause excessive sedation. Which of the following antihistamines has very little sedative effect? a. Loratadine b. Chlorpheniramine c. Brompheniramine d. Clemastine
a
Antihistamines are not routinely used in the critically ill client population. Diphenhydramine, however, may be administered to a critically ill client for which reason? a. prior to discharge from the intensive care unit. b. prior to a blood transfusion. c. for sedation. d. prior to a blood test.
b
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? a. diphenhydramine b. epinephrine c. clemastine d. cetirizine
a
When considering possible side effects, which client should be considered for a prescription of cetirizine rather than diphenhydramine? a. Any adult older than 56-years-of age. b. A child younger than 10-years-of age c. A 36-year-old diagnosed with acute gastritis d. A 42-year-old client diagnosed with an acid reflux disorder
a
A client whose daily commute includes travel on a ferry boat has been prescribed diphenhydramine. During client teaching, the nurse should instruct the client to take the medication at what time? a. as soon as the ferry leaves the dock b. 30 to 60 minutes before the ferry trip c. when the client boards the ferry d. the night before each trip
b
What type of antihistamine is typically preferred for older adults? a. First-generation b. Second-generation c. Neither type is preferred over the other. d. Antihistamines are contraindicated in older adults.
b
An older adult client is administered dimenhydrinate. Which is the priority nursing intervention for this client? a. Maintain IV access. b. Encourage fluids with this client. c. Have the client void after administration. d. Protect from injury.
d
Which client is most likely to benefit from the administration of a nasal steroid? a. A client who has a deviated nasal septum b. A client with an acute sinus infection c. A client who is recovering from a tonsillectomy d. A client who has chronic allergic rhinitis
d
A 15-year-old patient is prescribed an antihistamine for allergic rhinitis. However, antihistamines used to treat allergic reactions may themselves cause allergy. The nurse needs to educate the patient to be aware of symptoms suggesting allergy. Which of the following is an allergic reaction to antihistamines? a. Skin rash and urticaria b. Disturbed coordination c. Dryness of mouth d. Drowsiness and sedation
a
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? a. Helping the patient identify environmental allergens b. Administering the antihistamine c. Ensuring that the patient uses a second-generation antihistamine d. Removing environmental allergens
a
Mr. Zee is prescribed an inhaled nasal steroid to relieve his symptoms associated with seasonal allergies. What is true about inhaled nasal steroids? a. Inhaled nasal steroids are more effective than oral medications in treating the global symptoms associated with allergies. b. Inhaled nasal steroids are used only to treat seasonal allergies. c. Inhaled nasal steroids do not have any adverse effects. d. Inhaled nasal steroids produce a significant systemic effect.
a
Second-generation H1 antagonists cause less CNS depression because they are selective for peripheral H1 receptors and because of which other property? a. They do not cross the blood-brain barrier. b. They are metabolized by the liver. c. They cross the blood-brain barrier. d. They are excreted by the renal system.
a
The nurse is aware that clients who use OTC fexofenadine would use which class of antibacterial that would cause an increased plasma concentration of the fexofenadine? a. Macrolides b. Penicillins c. Cephalosporins d. Tetracyclines
a
The nurse is providing education to a client regarding the use of an over-the-counter (OTC) antihistamine. Which client statement demonstrates a need for additional teaching? a. "When I feel a cold coming on, I know to take an antihistamine." b. "When I know I'm going to spend time outdoors, I take an antihistamine." c. "I always need an antihistamine when I visit family members who own pets." d. "I take the medication to manage my itchy, watery eyes."
a
The nursing instructor is describing the four types of hypersensitivity reactions. What alternate name might the instructor use to identify type IV hypersensitivity? a. Delayed hypersensitivity b. Immediate hypersensitivity c. Cytotoxic reaction d. Serum sickness
a
An older adult client is prescribed an antihistamine for the relief of allergic rhinitis. Which findings would the nurse likely assess in this client? Select all that apply. a. Confusion b. Sedation c. Hypertension d. Bradycardia e. Dry throat
a, b, e
A professor teaching pharmacology conducts a lecture regarding allergic drug reactions. Which of the following statements made by students verifies the lecture was effective? Select all that apply. a. "Virtually any drug may induce an immunologic response." b. "Very specific characteristics identify if a reaction is drug-related." c. "Allergic drug reactions are complex and diverse and may include any of the types of hypersensitivity." d. "Reactions to drugs and plants are identical."
a, c
First-generation H1 receptor antagonists are chemically diverse antihistamines that bind to both central and peripheral H1 receptors and can cause CNS depression or stimulation. Which of the following are examples of these drugs? Choose all that apply. a. chlorpheniramine (Chlor-Trimeton) b. azelastine (Astelin) c. hydroxyzine (Vistaril) d. diphenhydramine (Benadryl) e. promethazine (Phenergan)
a, c, d, e
A female client is prescribed a first-generation antihistamine for her allergies. The nurse would expect her to experience what adverse effect? a. Diarrhea b. Dry mouth c. Slurred speech d. Incontinence
b
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? a. Ask about nausea and vomiting. b. Obtain the client's blood pressure. c. Observe for swelling in nasal passages. d. Ask about history of hay fever.
b
The clinic nurse is caring for a client who has been prescribed fexofenadine for hay fever. When the nurse is assessing this client's medication history, what drug would make the nurse question the order for fexofenadine? a. Tetracycline b. Ketoconazole c. Penicillin d. Gentamicin
b
The nurse is caring for a client with allergic rhinitis who takes clemastine daily. What should the nurse teach the client about the action of the medication? a. It increases the tone of smooth muscle in the bronchi. b. It blocks the effects of histamine. c. It changes the viscosity of mucus. d. It promotes the development of mast cells.
b
The nurse is providing education regarding food allergies to the parent of a preschool-age child. What statement made by the parent would indicate a need for further education on the subject? a. "Children allergic to milk or soy will often outgrow their allergy." b. "Foods have an equal risk of causing an allergic response." c. "Certain fruits and vegetables have been identified as allergens." d. "Food allergies are often an immune response to the ingestion of a protein."
b
The nursing instructor is explaining the four types of allergic reaction to the nursing students. The instructor explains that allergic rhinitis is a a. type III hypersensitivity reaction.. b. type I hypersensitivity reaction. c. type IV hypersensitivity reaction. d. type II hypersensitivity reaction.
b
What causes the inflammation of nasal mucosa that is seen in allergic rhinitis? a. Type IV hypersensitivity reaction to inhaled allergens b. Type I hypersensitivity reaction to Inhaled allergens c. Type II hypersensitivity reaction to inhaled allergens d. Type III hypersensitivity reaction to inhaled allergens
b
What is one of the benefits related to second generation antihistamine administration in older adults? a. They reduce the number of falls in clients diagnosed with osteoporosis. b. They do not impair thinking. c. They do not affect oxygenation. d. They increase the ability of clients with dementia to perform ADLs.
b
A nursing professor teaching sophomore students conducts a lecture regarding allergic food reactions. Which of the following statements made by the students verifies the lecture was effective? Select all that apply. a. "Kids never outgrow their food allergies." b. "Shellfish and eggs are examples of allergens that may have a high risk for anaphylaxis." c. "They usually are an immune response to the ingestion of a protein." d. "The sooner you expose your baby to these potential allergens, the less likely they are to develop allergies."
b, c
An older adult client is administered dimenhydrinate. Which is the priority nursing intervention for this client? a. Have the client void after administration. b. Encourage fluids with this client. c. Protect from injury. d. Maintain IV access.
c
The nurse is providing instructions to a client who will be taking second-generation antihistamines at home. Which statement by the client indicates a need for further instruction? a. "If I miss a dose of medication, I will wait until the next scheduled time to take the medication." b. "I will check the prescription bottle and follow the directions carefully." c. "I will take this medication with apple juice." d. "I will be careful to take the medication exactly as it comes."
c
What hospital procedure has the greatest potential to cause an anaphylactoid reaction? a. administration of intravenous fluids rapidly b. administration of bronchodilators by nebulizer c. administration of contrast media for diagnostic tests d. administration of low molecular weight heparin
c
Which of the following are included in the pre-administration assessment of an antihistamine? Select all that apply: a. Checking visual acuity. b. Auscultation of heart sounds c. Asking about symptoms. d. Asking about prescription medications. e. Auscultation of bowel sounds.
c, d
A client reports increased sedation after the initiation of chlorpheniramine 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.) a. Diphenhydramine (Benadryl) b. Clemastine c. Loratadine (Claritin) d. Phenylephrine (Neo-Synephrine) e. Cetirizine (Zyrtec)
c, e
A client has begun taking an antihistamine for the treatment of seasonal allergies. What dietary guidelines should the nurse provide to the client? a. Eat several small meals instead of three larger meals in case of GI upset b. Avoid grapefruit juice until at least 48 hours after treatment is complete c. Increase intake of foods that are high in vitamin C d. Avoid drinking alcohol while taking antihistamines
d
A client receives diphenhydramine orally. The nurse would expect this drug to begin acting within which time frame? a. 60 to 75 minutes b. 45 to 60 minutes c. 30 to 45 minutes d. 15 to 30 minutes
d
A client reports nasal congestion, sneezing, watery drainage from the nose, and itching of the throat, eyes, and ears. The nurse recognizes that these are consistent with what disorder? a. a histamine reaction b. anaphylaxis c. sinus infection d. allergic rhinitis
d
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? a. Meclizine b. Brompheniramine c. Promethazine d. Loratadine
d
A male client presents to the emergency department with symptoms of a gastrointestinal bleed. The health care provider orders a blood transfusion. The client has a history of anaphylaxis. The provider orders the administration of what drug before the blood transfusion? a. Desloratadine b. Azelastine c. Cetirizine d. Diphenhydramine
d
A male client presents to the health care provider's office with allergy-related symptoms that interfere with his job as a car salesman. What nasal spray does the nurse expect to be ordered? a. Cetirizine (Zyrtec) b. Loratadine (Claritin) c. Desloratadine (Clarinex) d. Azelastine (Astelin)
d
A patient presents at the emergency department with symptoms that lead the triage nurse to suspect serum sickness. What is one of the symptoms the nurse may have observed? a. Disorientation b. Paresthesia c. Hypothermia d. Myalgia
d
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? a. Joint pain b. Central nervous system depression c. Hypotension d. Nausea and vomiting
d
The health care provider has prescribed medication to prevent posttransfusion reaction in a client with a history of the disorder. Which medication would the nurse anticipate being administered? a. Ibuprofen b. Furosemide c. Epinephrine d. Diphenhydramine
d
The nurse is teaching a client about the potential for allergic drug reaction. What statement made by a client suggests a need for further teaching? a. "All drugs have the potential to cause an allergic reaction." b. "Virtually any drug may induce an immunologic response in a susceptible person." c. "The additives that are in drugs can also cause allergic reactions." d. "If you didn't have allergies as a child, you won't develop allergies later in life."
d
Which statement accurately describes an aspect of serum sickness? a. Symptoms include sensitivity to light resulting in optic pain. b. Sensitization to the antigen will diminish the reaction. c. It can develop in 1 to 2 days. d. Is a delayed hypersensitivity reaction.
d
