Upper Respiratory 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
B) Decongestants
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.
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.
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.
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.
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.
A) Many of these preparations contain the same active ingredients so that inadvertent overdose is a common problem.
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)
B) Guaifenesin (Mucinex)
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
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.
A) It may take up to 2 weeks to get the full clinical effect. Try to keep using the drug as ordered.
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.
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)
C) Loratadine (Claritin)
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
A) Cardiac arrhythmias
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
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.
B) Increase fluids to 2 L/d.
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.
D) This medication can cause drowsiness, so I will avoid driving or using power equipment while I take it.
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.
D) I will use it only when I have nasal discharge.
Decongestants decrease overproduction of secretions by causing local vasoconstriction to the upper respiratory tract
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.
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
B) Rhinitis medicamentosa
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.
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
B) Monoamine oxidase (MAO) inhibitors
Dextromethorphan should not be used in conjunction with MAO inhibitors because hypotension, fever, nausea, myoclonic jerks, and coma could occur.
The nursing instructor is teaching the lab students the best position for the administration of nasal sprays. What position would the instructor teach the students?
A) Supine
B) Semi-Fowler’s
C) High Fowler’s
D) Side-lying
C) High Fowler’s
Teach the patient to sit upright and press a finger over one nostril to close it. This body position is important to prevent excessive amounts of the medication running down the back of the throat. It needs to be in direct contact with the greatest amount of nasal mucosa and the high Fowler’s position provides that.
The nursing instructor is teaching the lab students the best position for the administration of nasal sprays. What position would the instructor teach the students?
A) Supine
B) Semi-Fowler’s
C) High Fowler’s
D) Side-lying
C) High Fowler’s
Teach the patient to sit upright and press a finger over one nostril to close it. This body position is important to prevent excessive amounts of the medication running down the back of the throat. It needs to be in direct contact with the greatest amount of nasal mucosa and the high Fowler’s position provides that.
The nurse advises that patient to avoid long-term use of nasal decongestants because it may lead to what condition?
A) Mucosal ulcerations
B) Decreased drainage
C) Increased risk of infection
D) Asthma
D) Asthma
Adverse effects associated with topical decongestants include local stinging and burning, which may occur the first few times the drug is used. If the sensation does not resolve, the drug should be discontinued, because it may indicate lesions or erosion of the mucous membranes.
What disorders would the pharmacology instructor tell the nursing students may be exacerbated by the use of nasal decongestants?
A) Pneumonia
B) Rheumatoid arthritis
C) Acid reflux
D) Hypothyroidism
D) Hypothyroidism
Assess for possible contraindications or cautions; any history of allergy to the drug or a component of the drug vehicle;
glaucoma,
hypertension,
diabetes,
thyroid disease,
coronary disease, and
prostate problems, all of which could be exacerbated by the sympathomimetic effects.
The pharmacology instructor questions the students as to which classification of drugs is commonly found in over-the-counter (OTC) combination cold medications?
A) Stimulants
B) Opioids
C) Oral decongestants
D) Antitussives
C) Oral decongestants
Oral decongestants are found in many OTC cold and flu preparations so that care must be taken to avoid inadvertent overdose when more than one such drug is use
A patient visits the clinic and is diagnosed with acute sinusitis. To promote sinus drainage, what medication might be ordered?
A) Topical nasal steroid decongestants
B) First-generation antihistamines
C) Second-generation antihistamines
D) Topical decongestants
D) Topical decongestants
Topical decongestants are sympathomimetics, meaning that they imitate the effects of the sympathetic nervous system to cause vasoconstriction, leading to decreased edema and reduced inflammation of the nasal membranes. They are available as nasal sprays that are used to relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis, and allergic rhinitis
The nursing instructor is discussing the administration of nasal spray with the nursing students. What information is most important to include in this discussion?
A) Finish the bottle of nasal spray to clear the infection effectively.
B) Nasal spray can be shared between family members only.
C) Administer the nasal spray in a prone position.
D) Overuse of nasal spray may cause rebound congestion.
D) Overuse of nasal spray may cause rebound congestion.
The clinic nurse is caring for a patient who has been prescribed fexofenadine for hay fever. When the nurse is assessing this patient’s medication history, what drug would make the nurse question the order for fexofenadine?
A) Tetracycline
B) Penicillin
C) Gentamicin
D) Ketoconazole
D) Ketoconazole
Drugdrug interactions vary among antihistamines. For example, anticholinergic effects may be prolonged if diphenhydramine is taken with a monoamine inhibitor and the interaction of fexofenadine with ketoconazole or erythromycin may raise fexofenadine concentrations to toxic levels.
A student nurse is doing research consisting of chart audits of 25 patients with diagnosed chronic pharyngitis; she is attempting to determine what medication has been prescribed most frequently. What type of medication would this nurse expect to find in most of the chart audits?
A) Antitussives
B) Nasal sprays
C) Oral decongestants
D) Mucolytics
A) Antitussives
Antitussives are drugs that suppress the cough reflex. Many disorders involving the respiratory tract, including the common cold, sinusitis, pharyngitis, and pneumonia are accompanied by an uncomfortable, nonproductive cough
The nurse is teaching a group of patients with allergic rhinitis about the use of their medications. What would be the most essential information to give these patients about preventing possible drug interactions?
A) Over-the-counter (OTC) medications are safe to use.
B) Use only one pharmacy so the pharmacist can check drug interactions.
C) Read drug labels before taking OTC medications.
D) Ask the pharmacy tech for assistance in selecting an OTC medication.
C) Read drug labels before taking OTC medications.
Teach patients to read the OTC labels to avoid inadvertent overdose. It would be inappropriate to teach the patient to use only one pharmacy for OTC medications.
A patient has been prescribed a nasal steroid and asks the nurse what the most common reason that this medication is used to treat. What is the nurse’s best response?
A) Nasal steroids are only used to treat a sinus infection.
B) Nasal steroids are used to treat allergic rhinitis.
C) Nasal steroids are used for an infection in the adenoids.
D) Nasal steroids are used for all acute upper respiratory infections.
B) Nasal steroids are used to treat allergic rhinitis.
Because nasal steroids block the inflammatory response, their use is contraindicated in the presence of acute infections. The most common reason they are prescribed is for the treatment of allergic rhinitis or to relieve inflammation after the removal of nasal polyps.
SATA
A patient has been using guaifenesin for a cough that accompanied a common cold. The patient calls the nurse help line and states that she thinks she is having an adverse reaction to the medication. The nurse knows that which symptoms are adverse effects of this medication? (Select all that apply.)
Nausea
Rash
Constipation
Bleeding
Headache
nausea
rash
headache
Adverse effects of guaifenesin are nausea, vomiting, headache, dizziness, and rash.
