Ch. 36 & Ch. 37 Flashcards
. During a routine checkup, a patient states that she is unable to take the prescribed antihistamine
because of one of its most common adverse effects. The nurse suspects that which adverse effect
has been bothering this patient?
a. Constipation
b. Abdominal cramps
c. Drowsiness
d. Decreased libido
ANS: C
Drowsiness is usually the chief complaint of people who take antihistamines
A gardener needs a decongestant because of seasonal allergy problems and asks the nurse
whether he should take an oral form or a nasal spray. Which of these is a benefit of orally
administered decongestants?
a. Immediate onset
b. A more potent effect
c. Lack of rebound congestion
d. Shorter duration
ANS: C
Drugs administered by the oral route produce prolonged decongestant effects, but the onset of
action is more delayed and the effect less potent than those of decongestants applied topically.
However, the clinical problem of rebound congestion associated with topically administered
drugs is almost nonexistent with oral dosage forms.
A patient is taking guaifenesin (Humibid) as part of treatment for a sinus infection. Which
instruction will the nurse include during patient teaching?
a. Force fluids to help loosen and liquefy secretions.
b. Report clear-colored sputum to the prescriber.
c. Avoid driving a car or operating heavy machinery because of the sedating effects.
d. Report symptoms that last longer than 2 days
ANS: A
Forcing fluids helps to loosen and liquefy secretions. The patient must be fully aware that any
fever, chest tightness, change in sputum from clear to colored, difficult or noisy breathing,
activity intolerance, or weakness needs to be reported. The patient must also report to the
prescriber a fever of higher than 100.4° F (38° C) or symptoms that last longer than 3 to 4 days.
Decongestants do not cause sedation, and therefore the patient does not need to avoid driving a
car or operating heavy machinery.
The nurse will instruct patients about a possible systemic effect that may occur if excessive
amounts of topically applied adrenergic nasal decongestants are used. Which systemic effect
may occur?
a. Heartburn
b. Bradycardia
c. Drowsiness
d. Palpitations
ANS: D
Although a topically applied adrenergic nasal decongestant can be absorbed into the
bloodstream, the amount absorbed is usually too small to cause systemic effects at normal
dosages. Excessive dosages of these medications, however, are more likely to cause systemic
effects elsewhere in the body. These may include cardiovascular effects, such as hypertension
and palpitations, and central nervous system effects such as headache, nervousness, and
dizziness. The other options are incorrect.
A patient with a tracheostomy has difficulty removing excessive, thick mucus from the
respiratory tract. The nurse expects that which drug will be ordered to aid in the removal of
mucus?
a. Guaifenesin (Humibid)
b. Benzonatate (Tessalon Perles)
c. Diphenhydramine (Benadryl)
d. Dextromethorphan (Robitussin DM)
ANS: A
Expectorants such as guaifenesin work to loosen and thin sputum and the bronchial secretions,
thereby indirectly diminishing the tendency to cough. The other drugs listed do not have this
effect
A patient has been advised to add a nasal spray (an adrenergic decongestant) to treat a cold. The
nurse will include which instruction?
a. “You won’t see effects for at least 1 week.”
b. “Limit use of this spray to 3 to 5 days.”
c. “Continue the spray until nasal stuffiness has resolved.”
d. “Avoid use of this spray if a fever develops.”
ANS: B
Frequent, long-term, or excessive use of adrenergic nasal decongestants may lead to rebound
congestion if used beyond the recommended time. The other instructions are incorrect.
When teaching a patient who will be receiving antihistamines, the nurse will include which
instructions? (Select all that apply.)
a. “Antihistamines are generally safe to take with over-the-counter medications.”
b. “Take the medication on an empty stomach to maximize absorption of the drug.”
c. “Take the medication with food to minimize gastrointestinal distress.”
d. “Drink extra fluids if possible.”
e. “Antihistamines may cause restlessness and disturbed sleep.”
f. “Avoid activities that require alertness until you know how adverse effects are
tolerated.”
ANS: C, D, F
Antihistamines should be taken with food, even though this slightly reduces the absorption of the
drug, so as to minimize the gastrointestinal upset that can occur. Over-the-counter medications
must not be taken with an antihistamine unless approved by the physician because of the serious
drug interactions that may occur. Drinking extra fluids will help to ease the removal of
secretions, and activities that require alertness, such as driving, must not be engaged in until the
patient knows how he or she responds to the sedating effects of antihistamines.
A patient is taking intravenous aminophylline for a severe exacerbation of chronic obstructive
pulmonary disease. The nurse will assess for which therapeutic response?
a. Increased sputum production
b. Increased heart rate
c. Increased respiratory rate
d. Increased ease of breathing
ANS: D
The therapeutic effects of bronchodilating drugs such as xanthine derivatives include increased
ease of breathing. The other responses are incorrect.
A patient is in an urgent care center with an acute asthma attack. The nurse expects that which
medication will be used for initial treatment?
a. An anticholinergic such as ipratropium (Atrovent)
b. A short-acting beta2 agonist such as albuterol (Proventil)
c. A long-acting beta2 agonist such as salmeterol (Serevent)
d. A corticosteroid such as fluticasone (Flovent)
ANS: B
The short-acting beta2 agonists are commonly used during the acute phase of an asthmatic attack
to reduce airway constriction quickly and to restore airflow to normal levels. The other drugs
listed are not appropriate for acute asthma attacks. Anticholinergic drugs and long-acting beta2
agonists are used to prevent attacks; corticosteroids are used to reduce airway inflammation
After receiving a nebulizer treatment with a beta agonist, the patient complains of feeling slightly
nervous and wonders if her asthma is getting worse. What is the nurse’s best response?
a. “This is an expected adverse effect. Let me take your pulse.”
b. “The next scheduled nebulizer treatment will be skipped.”
c. “I will notify the physician about this adverse effect.”
d. “We will hold the treatment for 24 hours.”
ANS: A
Nervousness, tremors, and cardiac stimulation are possible and expected adverse effects of beta
agonists. The other options are incorrect responses.
- A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a
corticosteroid. Which instruction regarding these inhalers will the nurse give to the patient?
a. “Take the corticosteroid inhaler first.”
b. “Take the bronchodilator inhaler first.”
c. “Take these two drugs at least 2 hours apart.”
d. “It does not matter which inhaler you use first.”
ANS: B
An inhaled bronchodilator is used before the inhaled corticosteroid to provide bronchodilation
before administration of the anti-inflammatory drug.
- When evaluating a patient’s use of a metered-dose inhaler (MDI), the nurse notes that the patient
is unable to coordinate the activation of the inhaler with her breathing. What intervention is most
appropriate at this time?
a. Notify the doctor that the patient is unable to use the MDI.
b. Obtain an order for a peak flow meter.
c. Obtain an order for a spacer device.
d. Ask the prescriber if the medication can be given orally.
ANS: C
The use of a spacer may be indicated with metered-dose inhalers, especially if success with
inhalation is limited. The other options are not appropriate interventions.
The nurse is providing instructions about the Advair inhaler (fluticasone propionate and
salmeterol) . Which statement about this inhaler is accurate?
a. It is indicated for the treatment of acute bronchospasms.
b. It needs to be used with a spacer for best results.
c. Patients need to avoid drinking water for 1 hour after taking this drug.
d. It is used for the prevention of bronchospasms.
ANS: D
Salmeterol is a long-acting beta2 agonist bronchodilator, while fluticasone is a corticosteroid. In
combination, they are used for the maintenance treatment of asthma and COPD. As a long-acting
inhaler, Advair is not appropriate for treatment of acute bronchospasms. The other statements are
incorrect.
The nurse is reviewing medications for the treatment of asthma. Which drugs are used for acute
asthma attacks? (Select all that apply.)
a. Salmeterol (Serevent) inhaler
b. Albuterol (Proventil) nebulizer solution
c. Epinephrine
d. Montelukast (Singulair)
e. Fluticasone (Flovent) Rotadisk inhaler
ANS: B, C
Albuterol (a short-acting beta2 agonist) and epinephrine (a beta1 and beta2 agonist) are used for
acute bronchospasms. Salmeterol is a long-acting beta2 agonist that is indicated for maintenance
treatment, not acute episodes. Fluticasone is an inhaled corticosteroid; montelukast is a
leukotriene receptor antagonist (LTRA). These types of medications are used for asthma
prophylaxis.
The nurse is providing instructions to a patient who has a new prescription for a corticosteroid
metered-dose inhaler. Which statement by the patient indicates that further instruction is needed?
(Select all that apply.)
a. “I will rinse my mouth with water after using the inhaler and then spit out the
water.”
b. “I will gargle after using the inhaler and then swallow.”
c. “I will clean the plastic inhaler casing weekly by removing the canister and then
washing the casing in warm soapy water. I will then let it dry before
reassembling.”
d. “I will use this inhaler for asthma attacks.”
e. “I will continue to use this inhaler, even if I am feeling better.”
f. “I will use a peak flow meter to measure my response to therapy.”
ANS: B, D
The inhaled corticosteroid is a maintenance drug used to prevent asthma attacks; it is not
indicated for acute asthma attacks. Rinsing the mouth with water is appropriate and necessary to
prevent oral fungal infections; the water is not to be swallowed after rinsing. The patient needs to
be given instructions about keeping the inhaler clean, including removing the canister from the
plastic casing weekly and washing the casing in warm soapy water. Once the casing is dry, the
canister and mouthpiece may be put back together and the cap applied. The glucocorticoid may
predispose the patient to oral fungal overgrowth, thus the need for implicit instructions about
cleaning inhaling devices. Use of a peak flow meter assists in monitoring the patient’s response
to therapy. The medication needs to be taken as ordered every day, regardless of whether the
patient is feeling better
A patient has a metered-dose inhaler that contains 200 actuations (‘puffs’), and it does not have a
dose counter. He is to take two puffs two times a day. If he does not take any extra doses,
identify how many days will this inhaler last at the prescribed dose. _______
ANS:
50 days
Note the number of doses in the canister, and then calculate the number of days that the canister
will last. For this question, assuming that two puffs are taken two times a day, and the inhaler has
a capacity of 200 inhalations. Two puffs two times a day equal four inhalations per day. Four
divided into 200 yields 50; that is, the inhaler will last approximately 50 days.
