Allergic Rhinitis, Coughs & Colds Flashcards
A nurse provides teaching to a patient with allergic rhinitis who will begin using an intranasal glucocorticoid. Which statement by the patient indicates understanding of the teaching?
a. “If the glucocorticoid causes burning or itching, I should use it every other day.”
b. “I should clear secretions from my nose before using the glucocorticoid.”
c. “I should use the glucocorticoid whenever I have symptoms.”
d. “I will probably develop systemic effects from the topical glucocorticoid.”
B
Patients using intranasal glucocorticoids should be taught to clear secretions from the nasal passages before using the medication. Intranasal glucocorticoids should be used regularly on a daily basis to achieve optimal effects and not every other day or as needed. Systemic effects from intranasal glucocorticoids can occur but are not likely.
A child with seasonal rhinitis has used budesonide (Rhinocort Aqua) for several years. The parents are concerned that the child’s rate of growth has slowed. What will the nurse do?
a. Reassure the parents that this is an expected side effect.
b. Suggest that the parents discuss using fluticasone (Flonase) with the provider.
c. Tell the parents to administer the drug only when symptoms are severe.
d. Tell the parents that antihistamines work as well as intranasal glucocorticoids.
B
A worrisome systemic effect of intranasal glucocorticoids is suppression of linear growth in children. Although rare, it can occur; however, it is less likely with fluticasone and mometasone, so these two preparations are better options for children. Reassuring parents that this is an expected side effect is incorrect. Intranasal glucocorticoids should be given daily and not as needed. Antihistamines are not as effective as glucocorticoids, because antihistamines work only against one mediator of allergic inflammation.
A patient who has seasonal allergies in the spring and fall asks the nurse about oral antihistamines. Which response by the nurse is correct?
a. “Anticholinergic effects are more common with second-generation antihistamines.”
b. “First-generation antihistamines, such as diphenhydramine (Benadryl), are more effective.”
c. “Make sure you take antihistamines only when you have symptoms to minimize side effects.”
d. “You should take oral antihistamines daily during each allergy season to get maximum effects.”
D
Antihistamines are most effective when they are taken prophylactically, and they should be administered on a regular basis throughout the allergy season, even when symptoms are not present. Second-generation antihistamines have fewer anticholinergic effects than first-generation antihistamines. First-generation antihistamines are not more effective than second-generation antihistamines. Oral antihistamines are not as effective when given on a PRN basis.
A patient asks the nurse what type of medications would be most effective for treating seasonal and perennial rhinitis. Which response by the nurse is correct?
a. Pseudoephedrine (Sudafed)
b. Fluticasone propionate (Fluticasone)
c. Loratadine (Claritin)
d. Intranasal cromolyn sodium (Atrovent)
B
Intranasal glucocorticoids, such as fluticasone propionate, are the most effective drugs for prevention and treatment, because they prevent or suppress all the major symptoms of allergic rhinitis (congestion, rhinorrhea, sneezing, nasal itching, and erythema). Pseudoephedrine is an oral sympathomimetic used to reduce nasal congestion associated with allergic rhinitis. It has no effect on other symptoms. Loratadine, an oral antihistamine, reduces sneezing, rhinorrhea, and nasal itching only and is less effective than intranasal glucocorticoids. Intranasal cromolyn sodium is moderately effective in the treatment of allergic rhinitis, but the benefits are much less than those of intranasal glucocorticoids.
A parent asks a nurse about giving diphenhydramine (Benadryl) to a child to relieve cold symptoms. Which response by the nurse is correct?
a. “Benadryl must be given in higher doses to provide relief for cold symptoms.”
b. “Intranasal glucocorticoids are more effective for treating cold symptoms.”
c. “Nasal antihistamines are more effective for treating cold symptoms.”
d. “Because histamine doesn’t cause cold symptoms, Benadryl would not be effective.”
D
Histamine does not contribute to symptoms of infectious rhinitis; therefore, antihistamines are of no use in treating cold symptoms. Giving antihistamines in higher doses does not provide relief for infectious rhinitis. Intranasal glucocorticoids are not useful for infectious rhinitis. Nasal antihistamines are not effective for treating infectious rhinitis.
A patient admitted to the hospital has been using phenylephrine nasal spray (Neo-Synephrine), 2 sprays every 4 hours, for a week. The patient complains that the medication is not working, because the nasal congestion has increased. What will the nurse do?
a. Request an order for an oral decongestant to replace the intranasal phenylephrine.
b. Request an order for an intranasal glucocorticoid to be used while the phenylephrine is withdrawn.
c. Tell the patient to increase the dose of phenylephrine to 4 sprays every 4 hours.
d. Tell the patient to stop using the phenylephrine and begin using an intranasal antihistamine.
B
This patient is experiencing rebound congestion, which develops when topical sympathomimetics are used for longer than a few days. Abrupt withdrawal can stop the cycle of rebound congestion but is uncomfortable, so using an intranasal glucocorticoid while withdrawing the decongestant is recommended. An oral decongestant is not recommended. Increasing the dose of the intranasal decongestant will only compound the problem of rebound congestion. Stopping the intranasal decongestant will only increase the congestion; using an intranasal antihistamine will not help with congestion.
A patient with allergic rhinitis is taking a compound product of loratadine/pseudoephedrine (Claritin-D) every 12 hours. The patient complains of insomnia. The nurse notes that the patient is restless and anxious. The patient’s heart rate is 90 beats per minute, and the blood pressure is 130/85 mm Hg. The nurse will contact the provider to:
a. discuss using an intranasal glucocorticoid and loratadine (Claritin).
b. report acute toxicity caused by pseudoephedrine.
c. suggest using an agent with a sympathomimetic drug only.
d. suggest using a topical decongestant to minimize systemic symptoms.
A
This patient is showing central nervous system (CNS) and cardiovascular side effects of the pseudoephedrine. A better option would be to use single-ingredient products for each symptom; an intranasal glucocorticoids and an oral antihistamine are considered first-line treatments. This patient is demonstrating adverse effects but not acute toxicity. Using a sympathomimetic agent would increase the adverse effects, because pseudoephedrine is a sympathomimetic drug. Topical decongestants are not first-line drugs for allergic rhinitis.
What is ipratropium bromide (Atrovent)?
a. A cholinergic agent used for perennial rhinitis
b. An anticholinergic used for allergic rhinitis and colds
c. A medication that is used only in patients with asthma
d. A drug that is inappropriate for use in patients with allergic rhinitis
B
Ipratropium bromide is an anticholinergic that is indicated for allergic rhinitis, asthma, and the common cold. The drug reduces rhinorrhea. Ipratropium bromide is an anticholinergic. In addition to asthma, ipratropium bromide can be used for allergic rhinitis and the common cold. Ipratropium bromide can be used for allergic rhinitis.
A parent asks a nurse to recommend an intranasal decongestant for a 6-year-old child. Which response by the nurse is correct?
a. “Decongestants are too sedating for children and should not be used.”
b. “Decongestants should not be given to children under 7 years old.”
c. “Decongestant drops are recommended instead of decongestant sprays.”
d. “Decongestant sprays should be used no longer than 5 to 10 days.”
C
Decongestant drops are recommended for children, because the number of drops can be controlled precisely. When sprays are used, the amount given is not well controlled. Decongestants cause CNS excitation. Decongestants may be given to children over the age of 4 years. Intranasal decongestants should not be used for longer than 5 days.
A patient with a cough has been advised to use guaifenesin. The patient asks the nurse to explain the purpose of the drug. The nurse will explain that guaifenesin:
a. dries secretions to help suppress coughing so patients can rest.
b. helps stimulate the flow of secretions to increase cough productivity.
c. helps to relieve chest pain associated with a cough.
d. stimulates the body’s natural immune responses.
B
Expectorants stimulate the flow of respiratory tract secretions to improve cough productivity. Guaifenesin does not dry secretions, because it does not have anticholinergic effects. Guaifenesin does not alleviate pain associated with cough. Guaifenesin does not stimulate immune responses.
A child who has perennial allergic rhinitis has been using an intranasal glucocorticoid. The provider has ordered montelukast (Singulair) to replace the glucocorticoid, because the child has frequent nosebleeds. When teaching this child’s parents about montelukast, the nurse will include which statement?
a. “Montelukast is also effective for treating infectious rhinitis.”
b. “Montelukast may cause behavior changes in your child.”
c. “Montelukast will treat both congestion and rhinitis.”
d. “Montelukast works best when combined with a topical decongestant.”
B
Montelukast can cause rare but serious neuropsychiatric effects in patients, and parents should be warned of this possibility. It is not useful for treating infectious rhinitis. It does not affect congestion. It is not necessary to add a topical decongestant when using this drug for allergic rhinitis.
A 7-year-old child has a cough, runny nose, congestion, and fever, and the parents ask the nurse to recommend an over-the-counter product. Which response by the nurse is correct?
a. “Any product will be effective when combined with vitamin C and zinc.”
b. “It is best to use single-agent medications to treat individual symptoms.”
c. “The fever indicates that your child may need an antibiotic; you should call your provider.”
d. “You should ask your provider to prescribe a combination product that will treat multiple symptoms.”
B
Combination medications may provide ingredients that are not needed or may provide ingredients that are either excessive or subtherapeutic. It is best to use single-agent drugs to treat individual symptoms. The efficacy of vitamin C and zinc for treating colds in children has not been established. Fever may accompany viral respiratory infections and not necessarily bacterial infections that need an antibiotic.
