Unit7: Chapter 54 (Karch 7th Ed) - Drugs Acting on the Upper Respiratory Tract Flashcards
- A patient comes to the clinic with symptoms as seen in a cold. What group of upper respiratory drugs
causes local vasoconstriction, which decreases blood flow and shrinks swollen membranes to improve
air flow?
A) Antitussives
B) Decongestants
C) Expectorants
D) Mucolytics
Ans: B
Feedback:
Decongestants cause local vasoconstriction that decreases blood flow to irritated and dilated capillaries
of the mucous membranes lining the nasal passages and sinus cavities. This 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 lower respiratory tract secretions, reducing the
viscosity of the secretions and so 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 mucous material
together.
- What would be the nurse’s best response if a patient calls the clinic and reports that he has had a
persistent cough for 2 weeks and asks the nurse for a recommendation for a cough medicine?
A) Look for dextromethorphan as an ingredient in any OTC cough preparation.
B) The doctor could order an antihistamine, which might dry up your secretions and stop the cough.
C) You should come to the clinic to be evaluated. A cough that lasts that long might be an indication
of an underlying medical problem.
D) Drink a lot of fluids and take aspirin, which should reduce the irritation in your throat
Ans: C
Feedback: A cough that has persisted for 2 weeks could be indicative of an underlying medical condition that
should be addressed before treating the cough. The patient should be asked to come in for an
evaluation. Dextromethorphan could help stop the cough, but suppressing the cough might not be in the
patient’s best interest. Drying the mucosa with an antihistamine could aggravate the cough. Aspirin
would not be indicated for relieving throat irritation.
- The nurse is caring for a patient who is receiving acetylcysteine (Mucomyst) by face mask. What
would be an appropriate nursing diagnosis?
A) Impaired swallowing
B) Risk for impaired skin integrity
C) Risk for falls
D) Sleep deprivation
Ans: B
Feedback:
A patient receiving acetylcysteine by face mask should have the residue wiped off the face mask and
her face with plain water to prevent skin breakdown. The appropriate nursing diagnosis would be risk
for impaired skin integrity. Acetylcysteine does not cause impaired swallowing, produce any CNS
effects that could increase the risk for falls, or impair the patient’s ability to sleep
- A nurse is caring for a 15-year-old patient with cystic fibrosis who has been prescribed dornase alfa
(Pulmozyme) to relieve the buildup of secretions and keep airways open and functioning longer. What
will the nurse instruct the patient to do concerning the use of this drug?
A) Use in home nebulizer up to four times a day if needed.
B) Stop all other medications while using the drug.
C) Store the drug in the refrigerator, protected from light.
D) Expect a severe headache after each use
Ans: C
Feedback:
Patients using dornase alfa should be cautioned to store the drug in the refrigerator, protected from
light. Heat and light can cause the drug to break down and can decrease its therapeutic value. The drug
should only be used up to two times a day and the patient should continue all other medications while
using it. Dornase alfa is only a palliative therapy that improves respiratory symptoms. A severe
headache is not associated with this drug.
- A nurse in a three drops with respiratory problems has received orders for four patients. What
medication order will the nurse question?
A) Tetrahydrozoline (Tyzine) three drops in each nostril for an 8-year-old child
B) Hydrocodone (Hycodan) 10 mg PO for a 5-year-old child
C) Pseudoephedrine (Dorcol) 15 mg PO for a 2-year-old child
D) Diphenhydramine (Benadryl) 5 mg/kg IM for a 10-year-old child
Ans: B
Feedback:
The nurse should question the order for hydrocodone. The ordered dose, 10 mg, is an adult dose and
should not be given to a 5-year-old. Patients from 2 to 12 years of age should be given between 1.25
and 5 mg/dose. The other medications are all correct dosages for the age of the child for whom they
were prescribed
- Parents who treat their children’s cold and flu symptoms at home should be educated concerning the
reading and understanding of over-the-counter (OTC) labels. Why is this statement true?
A) Many of these preparations contain the same active ingredients so that inadvertent overdose is a
common problem.
B) Each product is best used for alleviating a particular symptom.
C) Some of these products do not contain any drugs.
D) Some of these products could interfere with breast-feeding
Ans: A
Feedback:
Parents need to be educated to read the labels of any OTC preparation they give their children. Many of
these preparations contain the same ingredients and inadvertent overdose is a common problem. Giving
a child a drug should not interfere with the mother’s milk production. All these products contain
chemicals, which are drugs; many can be used to treat more than one symptom
- A patient presents at the clinic with a dry nonproductive cough. The patient is diagnosed with
bronchitis and it has been determined that assistance is needed in thinning the sputum so the cough can
become productive. What does the nurse expect the physician will prescribe?
A) Benzonatate (Tessalon)
B) Guaifenesin (Mucinex)
C) Dextromethorphan (Benylin)
D) Hydrocodone (Hycodan)
Ans: B
Feedback:
Because this patient needs to cough up respiratory secretions, he would likely be prescribed
guaifenesin. This drug is an expectorant that liquefies lower respiratory secretions by reducing their
viscosity and so making it easier for a patient to cough them up. Benzonatate, dextromethorphan, and
hydrocodone are antitussives and are given to suppress the cough reflex.
- A patient presents at the clinic with signs and symptoms of seasonal allergic rhinitis. The patient is
prescribed a nasal steroid to relieve symptoms. Two days later, the patient calls the clinic and tells the
nurse that he is frustrated and wants a new drug. What is the most appropriate response by the nurse?
A) It may take up to 2 weeks to get the full clinical effect. Try to keep using the drug as ordered.
B) The drug must not work for you. Let’s change to an oral steroid.
C) You probably are administering the drug incorrectly. Come in and we can review the process.
D) You probably need to try a different nasal steroid. This one should be effective by now.
Ans: A
Feedback:
Nasal steroids require about 2 weeks to reach their full clinical effect so the patient should be
encouraged to use the drug for that length of time before changing drugs or giving up. The other
responses could be appropriate if after 2 weeks the patient is still not getting relief.
- A patient has an important presentation to make in 4 hours and he needs relief from the congestion of
seasonal rhinitis. The patient calls the nurse, explains the situation, and tells the nurse that he cannot
afford to be drowsy. Which antihistamine would be a good choice for this patient?
A) Diphenhydramine (Benadryl)
B) Dexchlorpheniramine (Polaramine)
C) Loratadine (Claritin)
D) Hydroxyzine (Atarax)
Ans: C
Feedback:
The first-generation antihistamines, including diphenhydramine, dexchlorpheniramine, and
hydroxyzine, are associated with drowsiness. Loratadine is one of the second-generation antihistamines,
which have fewer anticholinergic effects and are less likely to cause drowsiness.
- A 71-year-old man with a history of heart disease and diabetes has had an antihistamine prescribed. The
nurse is concerned with this prescription because of the risk for what?
A) Cardiac arrhythmias
B) Increased salivation and choking
C) Severe constipation
D) Insomnia
Ans: A
Feedback:
The patient has history of heart disease. Antihistamines have been associated with prolongation of the
QT interval, which can lead to potentially fatal cardiac arrhythmias. Antihistamines dry the mucosa and
are not associated with increased salivation or choking, can cause drowsiness, and are not associated
with insomnia or severe constipation.
- A 29-year-old female patient has sinusitis, so the physician orders a topical nasal decongestant. What
instructions should be given?
A) Avoid becoming pregnant during decongestant therapy.
B) Increase fluids to 2 L/d.
C) Restrict fluids to 500 mL/d.
D) Take the medication with meals.
Ans: B
Feedback:
Institute other measures to help relieve the discomfort of congestion (e.g., humidity, increased fluid
intake, cool environment, avoidance of smoke-filled areas) as appropriate. The medication does not
need to be taken with meals or to restrict fluids. It would be inappropriate to tell the patient to avoid
becoming pregnant.
- What statement by a 61-year-old patient who is to take an antitussive with codeine indicates that the
nurse’s teaching has been effective?
A) I will take this medication anytime I start to cough.
B) This medication may make me anxious and nervous.
C) I should call the physician if I develop nausea, diarrhea, or stomach cramps while taking this
medication.
D) This medication can cause drowsiness, so I will avoid driving or using power equipment while I
take it.
Ans: D
Feedback:
Codeine is a CNS depressant and should not be combined with driving or heavy machinery activities.
Antitussives are not intended to be taken with every coughing episode because the patient may
overdose on the medication. The medication usually makes the patient drowsy rather than nervous and
anxious. Codeine may cause GI upset, although it is usually constipating; some patients may complain
of nausea and stomach distress while taking this medication.
- What statement by the patient leads the nurse to believe that he needs additional instruction regarding
his nasal decongestant?
A) I will blow my nose before instilling the nasal spray.
B) I will report any dizziness, drowsiness, or rapid pulse.
C) I will drink 2,000 to 3,000 mL of fluid daily.
D) I will use it only when I have nasal discharge.
Ans: D
Feedback:
Decongestants decrease overproduction of secretions by causing local vasoconstriction to the upper respiratory tract (See Table 54.2). This vasoconstriction leads to a shrinking of swollen mucous
membranes and tends to open clogged nasal passages, providing relief from the discomfort of a blocked
nose and promoting drainage of secretions and improved airflow. The patient must understand proper
administration, which includes clearing the nasal passages before inhaling the medication and
increasing fluid intake and reporting adverse effects. The medication must be used on a regular basis to
be effective. Option B is a distracter.
- The nurse is giving discharge instructions to a patient with an upper respiratory infection who has been
advised to take an over-the-counter (OTC) topical nasal decongestant. The nurse advises the patient
about what common adverse reaction to these medications?
A) Diarrhea
B) Rhinitis medicamentosa
C) Rash
D) Headache
Ans: B
Feedback:
An adverse effect that accompanies frequent or prolonged use of topical nasal decongestants is rebound
congestion, technically called rhinitis medicamentosa. Other adverse reactions include disorientation,
confusion, nausea, vomiting, fever, and dyspnea. Diarrhea, rash, and headache are not commonly
associated with these drugs, however.
- The nurse is caring for a patient who is taking dextromethorphan for cough suppression. The nurse will
assess this patient for hypotension if he also takes which other medication?
A) Calcium-channel blockers
B) Monoamine oxidase (MAO) inhibitors
C) Beta-blockers
D) Thiazide diuretics
Ans: B
Feedback:
Dextromethorphan should not be used in conjunction with MAO inhibitors because hypotension, fever,
nausea, myoclonic jerks, and coma could occur. No known drug drug interaction exists between
dextromethorphan and calcium-channel blockers, beta-blockers, and thiazide diuretics