N368 Final Chapters 38-39 NCLEX Flashcards
The patient has been prescribed oxymetazoline (Afrin). The nurse understands that:
- The most serious side effect is rebound congestion.
- The average use is for 10 days.
- This drug should not be used in conjunction with antihistamines.
- This is an OTC drug and may be used as needed for congestion.
The most serious side effect is rebound congestion.
Rationale: Prolonged use of oxymetazoline causes hypersecretion of mucus and worsening nasal congestion, resulting in increased daily use. This medication should not be used for longer than 3 days and should be used only as directed.
A patient Is prescribed an intranasal corticosteroid for allergic rhinitis. The nurse’s teaching would include? (select
all that apply.)
1. there are no known side effects.
2. the spray is a consistent dose.
3. it could take 2 to 4 weeks before improvement in
symptoms is noticed.
4. it is contraindicated to use saline nasal sprays with this
medicine.
5. the medication can be used any time symptoms
increase.
(2.) the spray is a consistent dose.; (3.) it could take 2 to 4 weeks before improvement in
symptoms is noticed.
Rationale: The device delivers a metered spray that regulates the dosage and keeps it consistent. intranasal glucocorticoids may require 2 to 4 weeks. Side effects include drying and bleeding of the nasaI cavity. Saline nasal sprays may be used to alleviate drying. The medication should be used as prescribed.
A patient’s history includes taking a first-generation H1- receptor antagonist. Considering this history, the nurse assesses for which of the following findings?
- A history of heart disease
- Any recent weight gain
- A history of respiratory illnesses
- A history of peptic ulcer
A history of heart disease
Rationale: First-generation H1-receptor antagonists are contraindicated in patients with a history of dysrhythmias and heart failure. These medications can cause vasodilation of vessels due to H1 stimulation. These medications have no relationship to weight gain or peptic ulcer disease.
When teaching patients how to self-administer intranasal corticosteroids, which of the following must be included?
(select all that apply.)
1. Prime device prior to initial use.
2. Clear nose before administration.
3. Clear nose after administration.
4. Swallow any excess that drains into the mouth.
5. Spit out any excess that drains Into the mouth.
- Prime device prior to initial use. 2. Clear nose before administration. 5. Spit out any excess that drains Into the mouth.
Rationale:The device must be primed prior to initial use.The nose should be cleared prior to administration, not afterward, so that medication remains in the nasal cavity. Any excess that drains into the mouth must not be swallowed but should be spit out.
Prior to administration of antihistamines, the nurse assesses for:
Prostatic hypertrophy
Itching
Dry skin
Increased restlessness
Prostatic hypertrophy
Rationale: A major side effect of antihistamines relates to their anticholinergic effects. Anticholinergic effects can also cause urinary hesitancy and should not be used in patients with a history of prostatic hypertrophy.
Which of the following is the best advice that the nurse can give a patient with viral rhinitis who intends to purchase an OTC combination cold remedy?
- Dosages in these remedies provide precise dosing for each symptom that you are experiencing.
- These agents are best used in conjunction with an antibiotic.
- It is safer to use a single-agent preparation if you are only experiencing one symptom.
- Since these agents are available over the counter, it is safe to use any of them as long as needed.
It is safer to use a single-agent preparation if you are only experiencing one symptom.
Rationale:Single-symptom OTC preparations are preferred over multiuse preparations to avoid additional drugs that are not needed for symptom relief and to decrease risk of additional adverse effects. Dosing of any OTC preparation is carefully calculated to provide precise dosing for age and symptoms
The patient receives treatment for a respiratory condition through aerosol therapy. The nurse explains that the major advantage of this type of therapy is that:
- It has no systemic side effects.
- It delivers the medication to the site of action.
- It requires no skill to use it.
- It is safe for all patients.
It delivers the medication to the site of action.
Rationale: An aerosol is a suspension of minute liquid droplets or fine solid particles in a gas. Aerosol therapy can give immediate relief for bronchospasm or can loosen thick mucus. The major advantage of aerosol therapy is that it delivers medications to the immediate sites of action, thus reducing systemic side effects.
The patient is using a beta-adrenergic agonist for treatment of asthma. The nurse teaches that the action of this drug is:
- Reducing mucus production
- Relaxing bronchiole smooth muscle, thereby causing bronchodilation
- Liquefying mucus
- Reducing cough
Relaxing bronchiole smooth muscle, thereby causing bronchodilation.
Rationale: Beta-adrenergic agonists (sympathomimetics) act by relaxing bronchial smooth muscle, resulting in bronchodilation that lowers airway resistance and makes breathing easier for the patient. Beta-adrenergic agonists do not liquefy or reduce mucus production.
Patient teaching for patients on long-term therapy with beta-adrenergic agonists for treatment of asthma should include:
- Discontinuing the drug if the heart rate increases.
- Monitoring intake and output.
- Reducing the dosage of the drug if insomnia occurs.
- Notifying the health care provider if the drug no longer seems effective.
Notifying the health care provider if the drug no longer seems effective.
Rationale: Tolerance may develop to the therapeutic effects of the beta-adrenergic agonists; therefore, the patient must be instructed to seek medical attention if the drugs become less effective with continued use.Increased heart rate is a side effect of beta-adrenergic agonists.The patient should not change the medication dosage without first consulting the health care provider.
A 65-year-old male is prescribed ipratropium (Atrovent) for the treatment of asthma. An appropriate nursing intervention includes:
Teaching the patient to avoid caffeine in the diet.
Assessing for an enlarged liver.
Teaching the patient to report an inability to urinate.
Monitoring for development of diarrhea.
Teaching the patient to report an inability to urinate.
Rationale: Anticholinergic bronchodilators should be used cautiously in elderly men with benign prostatic hyperplasia and in patients with glaucoma. An enlarged liver and diarrhea have no relationship to the use of ipratropium.
Nursing assessment for a patient on long-term oral corticosteroids would include: (Select all that apply.)
- assessing liver function tests.
- assessing cardiac dysrhythmias.
- assessing for signs of peptic ulcers.
- monitoring blood glucose for hyperglycemia
- assessing for changes in level of consciousness.
- assessing for signs of peptic ulcers.
- monitoring blood glucose for hyperglycemia
* Rationale: If taken for longer than 10 days, oral glucocorticoids can produce significant adverse effects, including adrenal gland atrophy, peptic ulcers, and hyperglycemia. Long-term oral glucocorticoids can cause osteoporosis.
Changes in level of consciousness can be related to oxygenation levels and need to be reported to the health care provider *
Which of the following agents is most immediately helpful in treating a severe acute asthma attack?
- Beclomethasone (Qvar)
- Zileuton (Zyflo)
- Albuterol (Proventil,Ventolin)
- Salmeterol (Serevent)
Albuterol (Proventil,Ventolin)
Rationale: Beta-adrenergic drugs such as albuterol (Proventil, Ventolin) are most often used for rapid bronchodilation. Glucocorticoids such as beclomethasone, leukotriene modifiers such as zileuton, and long-acting beta agonists such as salmeterol may be used for maintenance therapy to prevent or control asthma attacks but do not act quickly enough for acute attacks.
