Drugs acting on the Upper Respiratory tract prep U - pharm 125

Decongestants should be used cautiously in clients with which conditions? (Select all that apply.)

Diabetes

Glaucoma

Clients with diabetes, heart disease, hypertension, hyperthyroidism, benign prostatic hypertrophy, and glaucoma should contact their health care provider before taking over-the-counter decongestants.

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

Explanation:

Nasal decongestants are rapidly effective because they come into direct contact with nasal mucosa. However, if used longer than the recommended 3 days or in excessive amounts, these products may produce rebound nasal congestion that result from the irritation and swelling of the nasal mucosa. The other options would present with distinctive symptomology.

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

Breathing pattern is regular and without difficulty.

Explanation:

A regular breathing pattern without difficulty would indicate that the drug is effective because oxymetazoline is a decongestant drug. Hydration of the skin, heart rate, and urine output are usually not affected by this drug.

An older adult client has reported "seeing things that aren't there" after starting to take over-the-counter dextromethorphan for a nonproductive cough associated with a cold. What assessment question will provide the most relevant information regarding the possible cause of this adverse effect?

"How much dextromethorphan have you been taking each day?"

Explanation:

At normal doses, dextromethorphan is known to cause nausea, drowsiness, rash, and difficulty breathing but doses exceeding recommendations can produce hallucinations and disassociation. The question concerning dosage is the most relevant regarding the cause of hallucinations.

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

“I'm glad that this medication will address all of my symptoms.”

Explanation:

Cystic fibrosis clients who receive dornase alfa should be cautioned about the need to continue all therapies for their cystic fibrosis because dornase alfa is only a palliative therapy that improves respiratory symptoms, and other therapies, such as coughing, postural drainage, and enzymes, are still needed. This medication will not relieve all of the client’s symptoms.

What is the chemical mediator released in immune and inflammatory response to allergic reactions?

Histamine

Explanation:

Histamine is the chemical mediator released in immune and inflammatory responses. Histamine is discharged from mast cells and basophils in response to certain stimuli (e.g., allergic reactions, cellular injury, extreme cold). This histamine is discharged by mast cells. Epinephrine is the drug of choice for treating severe anaphylaxis. Norepinephrine is a chemical released from the sympathetic nervous system in response to stress.

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

Retention of secretions

Explanation:

Retention of secretions commonly occurs with influenza, pneumonia, upper respiratory infections, acute and chronic bronchitis, emphysema, and acute attacks of asthma.

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?

“If you didn’t have allergies as a child, you won’t develop allergies later in life.”

Explanation:

Drug allergies can develop later in life, though many appear at a young age. All the other options contain accurate statements.

After teaching a group of parents about the use of over-the-counter cough and cold products with their children, which statement indicates the need for additional teaching?

We can use the adult brand, but we just have to decrease the amount.”

Explanation:

Parents should use the children’s, pediatric, or infant formulations of the drug. Over-the-counter cough and cold preparations should not be used in children under the age of 2 years. The parents need to read the label carefully to determine the dosage and frequency, and they need to use the device that comes with the drug to ensure a proper dosage.

Katie, 14 years old, is seen by the health care provider due to increased nasal congestion and a sore throat lasting 2 days. Katie reports to the provider that every fall at this time she has increased nasal congestion and pressure. Upon examination, the provider notes enlarged turbinates with excessive mucus in the nose and at the back of the throat and a reddened throat. The provider prescribes pseudoephedrine. Why is Katie being prescribed this medication?

To provide relief of the nasal congestion

Explanation:

Pseudoephedrine can reduce the volume of nasal mucus and is recommended for the temporary relief of nasal congestion related to the common cold, allergic rhinitis, and sinusitis. It also is used to relieve the pressure of otitis media by promoting drainage of the Eustachian tubes.

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

“I’m glad this medication will address all of my symptoms.”

Explanation:

Cystic fibrosis clients who receive dornase alfa should be cautioned about the need to continue all therapies for their cystic fibrosis because dornase alfa is only a palliative therapy that improves respiratory symptoms, and other therapies, such as coughing, postural drainage, and enzymes, are still needed. This medication will not relieve all of the client’s symptoms.

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.

Explanation:

Several OTC cough and cold medicines for use in infants have been recalled voluntarily due to concerns about possible misuse that could result in overdoses.

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

Explanation:

As a pre-administration assessment before giving a nasal decongestant, the nurse should assess the patient's blood pressure, pulse, and respiratory rates. Assessments for disturbed coordination, blurred vision, or auditory tests may be done as an ongoing assessment to check for signs of adverse effects.

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.

Explanation:

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

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?

antihistamine

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.

Which agent would the nurse instruct a client to use orally?

Pseudoephedrine

Explanation:

Pseudoephedrine is the only oral decongestant. Phenylephrine, tetrahydrozoline, and xylometazoline are topical decongestants.

A client has just been admitted for an overdose of pseudoephedrine. The nurse’s assessment of the client should prioritize what system?

cardiovascular

Explanation:

Because pseudoephedrine is a stimulant, cardiac symptoms are a notable adverse effect, especially in the acute stage of the overdose. All the other systems should be monitored, but the cardiac-related adverse reactions have priority.

A 62-year-old client has been prescribed an antihistamine to alleviate vasomotor rhinitis. The client reports gastric irritation after taking the tablet. Which instructions should the nurse provide to help alleviate the client's condition?

Take the tablet with food.

Explanation:

If the client has gastric irritation following ingestion of the antihistamine, the nurse should instruct the client to take the tablet with food and not before food. Taking an antacid before the tablet may reduce the absorption of the antihistamine. Drinking ample water before taking the tablet will not help to alleviate the patient's condition.

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.

Explanation:

Antitussive agents suppress cough by depressing the cough center in the medulla oblongata or the cough receptors in the throat, trachea, or lungs. Expectorants are agents given orally to liquefy respiratory secretions and allow for their easier removal.

A client is prescribed oxymetazoline, a decongestant, for the treatment of hay fever. What should the nurse evaluate to assess the efficacy of therapy?

Maintenance of effective airway clearance

Explanation:

Evaluation of the maintenance of effective airway clearance helps in assessing the efficacy of oxymetazoline, which is a decongestant drug. The hydration of the skin, the heart rate and the urine output are usually not changed in decongestant therapy.

The nursing instructor is discussing the use of nasal decongestants and shares what reason for their effectiveness?

They come into direct contact with nasal mucosa.

Explanation:

With nasal decongestants, topical preparations (i.e., nasal solutions or sprays) are often preferred for short-term use. They are rapidly effective because they come into direct contact with nasal mucosa.

A client is currently taking pseudoephedrine to help manage the nasal congestion resulting from seasonal allergies. When the client reports being extremely restless and having difficulty getting to sleep at night, what assessment question will the nurse ask to best provide interventions to minimize those effects?

"How much coffee, tea, and soda do you drink daily?"

Explanation:

Caffeine can enhance the adverse effects of pseudoephedrine. The client's coffee, tea, and soda consumption would tend to increase the client's risk for insomnia and restlessness. None of the other options are known to have this effect on those taking the decongestant.

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.

Explanation:

Dextromethorphan is related chemically to the opiate agonists and can suppress coughing as effectively as narcotics. Cough suppression occurs by several mechanisms, but mainly the drug directly affects the cough center in the medulla. Therapeutic doses do not affect ciliary activity.

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

Sedation

Explanation:

The adverse effects most often seen with antihistamine use are drowsiness and sedation. However, second-generation antihistamines are less sedating in many people. The anticholinergic effects associated with both generations include drying of the respiratory and gastrointestinal mucous membranes, gastrointestinal upset and nausea, arrhythmias, dysuria, urinary hesitancy, and skin eruption and itching associated with dryness.

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

Explanation:

A client who is having a blood transfusion or a diagnostic test may receive diphenhydramine, often by injection and usually as a single dose, to prevent allergic reactions. Epinephrine is the drug of choice for treating severe anaphylaxis once it has occurred. Clemastine is prescribed for allergic rhinitis and urticaria. Cetirizine is prescribed for the management of seasonal allergies.

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

Explanation:

Expectorants, such as guaifenesin, are agents given orally to liquefy respiratory secretions and allow for easier removal. Dextromethorphan and codeine are antitussives used to suppress coughing.

A client prescribed codeine for a persistent, debilitating cough tells the nurse, "I was sure that codeine was a narcotic that people take for pain." The nurse should cite what mechanism of action when describing this use of codeine?

Depression of the cough center in the medulla oblongata

Explanation:

Antitussives such as codeine suppress cough by depressing the cough center in the medulla oblongata. They do not influence blood flow or desensitize peripheral cough receptors. The RAS is not involved in the cough reflex.

Which condition would contraindicate the use of oxymetazoline?

hypertension

Explanation:

Oxymetazoline is contraindicated in clients with severe hypertension or coronary artery disease because of its cardiac stimulating and vasoconstricting effects. Oxymetazoline is prescribed for nasal congestion. Oxymetazoline is not contraindicated in cases that involve cough or skin rash.

A nurse administers an antitussive agent cautiously to a client with asthma for which reason?

A loss of respiratory reserve can occur.

Explanation:

Antitussives are used cautiously in clients with asthma because cough suppression can lead to accumulation of secretion and a loss of respiratory reserve. Airway maintenance is important for clients who have had surgery and need a cough to maintain the airway. Antitussives such as codeine and hydrocodone must be used cautiously in clients with a history of addiction. Increased sedation can be problematic for clients who need to drive or be alert.

A client comes to the clinic with what appears to be a cold. What group of upper respiratory drugs cause local vasoconstriction, which decreases blood flow and shrinks swollen membranes to improve air flow?

Decongestants

Explanation:

Decongestants cause local vasoconstriction that decrease blood flow to irritated and dilated capillaries of the mucous membranes lining the nasal passages and sinus cavities. The vasoconstriction leads to a shrinking of swollen membranes and opens clogged nasal passages promoting drainage of secretions and improved air flow. Antitussives either work directly on the medullary cough center of the brain or act as a local anesthetic on the respiratory passages blocking the effectiveness of the stretch receptors that stimulate a cough reflex. Expectorants liquefy the lower respiratory tract secretions, reducing the viscosity of the secretions and making it easier to cough them up. Mucolytics break down mucus to aid a person in coughing up thick tenacious secretions by separating cells that hold mucus material together.

What should the client be told about nasal spray? (Select all that apply.)

Sniff hard for a few minutes after administration.

Nasal burning or stinging may occur with the use of topical decongestants.

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

Explanation:

Loratadine is a second-generation antihistamine. Brompheniramine, promethazine, and meclizine are considered first-generation antihistamines.

After teaching a client who is receiving an antitussive about the drug, which statement indicates the need for additional teaching?

“I’ll keep the room warm and toasty.”

Explanation:

Measures to assist with cough control when using antitussives include cool temperatures, humidification, lozenges, and increased fluids.

What home remedies are effective for mouth dryness and cough? (Select all that apply.)

Adequate fluid intake

Humidification of the environment

Sucking on hard candy or throat lozenges

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.

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

ineffective airway clearance

Explanation:

Acetylcysteine reduces the viscosity of mucous secretions with the ultimate goal of allowing the client to establish and maintain a clear airway. This drug does not directly influence the pattern of breathing. Impaired tissue perfusion can have multiple causes, many of which are unrelated to the presence of mucus secretions.

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.”

Explanation:

Most people experience some relief, but clients should be made aware that cold medications do not cure the common cold; they only relieve some symptoms. Over-the-counter (OTC) cold remedies should not be used longer than 1 week. Such medications do not inhibit healing by masking symptoms.

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

Explanation:

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.

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

Clear the nasal passages.

Explanation:

Before administering the nasal spray, it would be important to clear the nasal passages to ensure that the medication reaches its intended target thereby promoting effectiveness.

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

Meclizine

Explanation:

Meclizine is used to relieve the nausea and vomiting associated with motion sickness. Clemastine, cyproheptadine, and hydroxyzine are used to provide relief of seasonal and perennial allergic rhinitis.

Expectorants elicit their effect by which mechanism?

Thinning respiratory secretions

Explanation:

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.

A client diagnosed with the common cold asks the nurse about taking an over-the-counter (OTC) cold medications. What statement should the nurse include in client teaching?

Follow the instructions on the label so that you don't end up making the congestion worse."

Explanation:

When taken according to their instructions, OTC medications can often be as safe and effective as prescribed medications and are sometimes suggested by the primary health care prescriber. However, clients should be informed that excessive or prolonged use may damage nasal mucosa and produce chronic nasal congestion. Over-the-counter (OTC) cold remedies should not be used longer than 1 week, and clients should be instructed not to use nose drops or sprays more often or longer than recommended on the label. While OTC medications may be cheaper in some cases, they will not cause more side effects. The length of the therapy is dependent on many factors, including the type and dose of the medication.

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

Antidote for acetaminophen poisoning

Explanation:

Oral acetylcysteine is widely used in the treatment of acetaminophen overdosage.

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 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.”

Explanation:

Frequent, long-term, or excessive use of decongestants induces rebound congestion. Rebound congestion occurs when the nasal passages become congested as the drug effect wears off and the body compensates by vasodilating the same nasal arterioles that the drug constricted. This does not occur because of the ineffectiveness of decongestants, however. Dosing should be based on the instructions provided.

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?

Antihistamines are not recommended for treating a cold.

Explanation:

Although antihistamines are popular over-the-counter drugs, studies have demonstrated that they are not successful or recommended for the treatment of the common cold. An antibiotic should not be prescribed for the treatment of the common cold, which is a viral disorder.

A group of students demonstrate understanding of topical decongestants, identifying them as:

Sympathomimetics

Explanation:

Topical decongestants are sympathomimetics, imitating the effects of the sympathetic nervous system to cause vasoconstriction.

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

Mucolytic

Explanation:

Mucolytic drugs may be used by patients suffering from conditions such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, pneumonia, or tuberculosis to reduce the viscosity of respiratory secretions by direct action on the mucus. Mucolytic drugs increase or liquefy respiratory secretions to aid the clearing of the airways in high-risk respiratory patients who are coughing up thick, tenacious secretions.

Expectorants increase the production of respiratory secretions, which in turn appear to decrease the viscosity of the mucus. This helps to raise secretions from the respiratory passages. Antitussives are cough suppressants. Antihistamines are used to treat allergic reactions.

Which agent acts directly on the medullary cough center?

Codeine

Explanation:

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.

Which would contraindicate the use of a topical nasal decongestant?

Nasal ulceration

Explanation:

Any lesion or erosion in the mucous membranes is a contraindication because of the increased risk for systemic drug absorption. Topical nasal decongestants should be used cautiously in patients with hypertension. Topical nasal decongestants should be used cautiously in patients with diabetes. Topical nasal decongestants should be used cautiously in patients with glaucoma.

The pharmacology instructor is discussing the adverse effects of diphenhydramine. Which is not one of these effects?

Excessive salivation

Explanation:

Adverse effects of first-generation antihistamines include urinary retention, drowsiness or sedation, dry mouth, blurred vision, and gastrointestinal distress.

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.

Explanation:

The adverse effects of benzonatate include sedation, headache, dizziness, constipation, nausea, GI upset, pruritus, and nasal congestion. It is recommended that patients with cough drink plenty of fluids (1500 to 2000 mL daily) unless fluids are contraindicate due to another disease state. Benzonatate should not be crushed or chewed due to a local anesthetic effect resulting in possible choking. Consumption of alcohol while taking benzonatate can increase CNS depression and increased sedation. The maximum daily dose of benzonatate is 600 mg daily.

A client administers diphenhydramine to their 9-year-old child, who experiences seasonal allergies, before a baseball game. What may the child experience if a paradoxical effect to the medication occurs?

excitation

Explanation:

First-generation antihistamines (e.g., diphenhydramine) commonly cause drowsiness and decreased mental alertness. Excitation is a paradoxical effect that occasionally occurs, especially in children. Diphenhydramine isn't associated with exacerbation of allergic symptoms or an effect on reflexes.

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

Explanation:

Histamine is discharged from mast cells and basophils in response to certain stimuli, such as allergic reactions, cellular injury, and extreme cold. Lymphocytes and platelets do not release histamine. CD4 cells (often called T cells or T-helper cells) are a type of white blood cells that play a major role in protecting the body from infection.

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.”

Explanation:

Antihistamines mitigate the signs and symptoms of allergies, but they do not cure the problem. Second-generation antihistamines are more expensive than earlier drugs. It is prudent to screen for potential interactions with herbal remedies. Because second-generation drugs do not cause sedation, they may generally be taken at any time.

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.

Explanation:

Sudafed is a decongestant. Decongestants are used cautiously in clients with a history of hypertension because of the vasoconstrictive effects of the drug. Swelling of nasal passages is a symptom of congestion. A history of hay fever is not a contraindication to taking decongestants. Nausea and vomiting are potential adverse effects but are not as important as assessing blood pressure.