Question 1

A patient who has narrow-angle glaucoma asks the nurse to recommend a medication to alleviate cold symptoms such as nasal congestion and runny nose.The nurse will suggest the patient talk to the provider about which medication?

Accepted Answer

Antihistamines have anticholinergic effects,which are contraindicated in patients with narrow-angle glaucoma.Cetirizine and azelastin are second-generation antihistamines,with fewer anticholinergic side effects,but azelastine is a nasal spray and is less likely to have systemic side effects.

Question 2

A patient who has a nonproductive cough will begin taking guaifenesin to help with secretions.When teaching this patient about the medication,the nurse will provide which instruction?

Accepted Answer

Guaifenesin is an expectorant,and patients taking this medication should be advised to increase fluid intake to at least 8 glasses of water per day.(Remember to assess for contraindications to increasing fluid intake [e.g.,heart failure,kidney failure with dialysis,etc.].)Guaifenesin does not cause drowsiness or urinary retention.Antihistamines will dry secretions,making them harder to expectorate.

Question 3

A patient who has seasonal allergies with a runny nose during the daytime reports increasing nighttime symptoms of coughing and sneezing that are interfering with sleep.The provider recommends diphenhydramine (Benadryl)at bedtime.What information will the nurse include when teaching the patient about this medication?

Accepted Answer

A side effect of diphenhydramine is drowsiness.Patients whose nighttime symptoms clear should be able to sleep better,especially with drowsiness side effects.Avoiding fluids does not prevent urinary retention.The half-life of diphenhydramine is short,so drug effects will not last through the next day.There is no need to take the medication on an empty stomach.

Question 4

A patient is admitted to the hospital after developing pneumonia.During the admission assessment,the patient reports having used a nasal decongestant spray for the past few weeks but thinks the nasal congestion is getting worse.The nurse will

Accepted Answer

Use of nasal decongestants longer than 3 days can cause rebound congestion.This will clear up when the decongestant spray is discontinued for several days or weeks.A systemic decongestant is not indicated.Continuing the spray will increase the congestion.Increasing fluid intake is not recommended.

Question 5

The nurse is caring for a patient who is hospitalized for an asthma exacerbation.The patient reports taking diphenhydramine at home at night to help with symptoms of allergic rhinitis and cough.The nurse will contact the patient's provider to request an order for which medication?

Accepted Answer

Cetirizine is an antihistamine,which is indicated for this patient's symptoms.Diphenhydramine is also an antihistamine but,because of its anticholinergic side effects,is contraindicated in patients with asthma.Benzonatate and dextromethorphan are anti-tussives and not antihistamines.

Question 6

A patient arrives in the emergency department after developing a rash,runny nose,and sneezing after eating strawberries.What action will the nurse expect to take first?

Accepted Answer

The patient probably has a food allergy,since eating strawberries is the precipitating event.The nurse should assess cardiac and respiratory status to determine whether the patient is developing an anaphylactic reaction.Diphenhydramine will be given for mild allergic symptoms of rash,runny nose,and sneezing,but epinephrine must be given for anaphylaxis.Urinary retention is a side effect of diphenhydramine and will be assessed if diphenhydramine is given.

Question 7

The parents of a 3-year-old child tell the nurse that they are planning to give their child diphenhydramine (Benadryl)on a flight to visit the child's grandparents to help the child sleep during the flight.What will the nurse tell the parents about giving this drug?

Accepted Answer

Diphenhydramine can cause excitation in some children.Parents should be advised to expect this possible side effect.The correct dose of diphenhydramine for children at this age is 6.25 mg; 25 mg would be an overdose.Oral diphenhydramine has an onset of 15 to 45 minutes.Loratadine is a second-generation antihistamine and does not cause drowsiness.

Question 8

A patient with chronic obstructive pulmonary disease (COPD)who has a persistent nonproductive cough asks about a medication that will not cause sedation.The nurse will encourage the patient to discuss which medication with the provider?

Accepted Answer

Benzonatate will not cause sedation and is safe for patients with COPD.Dextromethorphan is contraindicated in patients with COPD.Codeine and promethazine cause sedation.

Question 9

The nurse is providing teaching for a patient who will use intranasal dexamethasone (Decadron)after discharge home from the hospital.What information is important to include when teaching this patient about this drug?

Accepted Answer

Dexamethasone should not be used longer than 30 days because longer use increases the risk of systemic side effects.Dexamethasone should not be used year-round.It may be used in conjunction with antihistamines.Systemic side effects may occur.

Question 10

The patient who has nasal congestion asks the nurse to recommend a decongestant medication.The nurse performs a medication history and learns that the patient takes a beta blocker to treat hypertension.Which over-the-counter product will the nurse recommend?

Accepted Answer

NeoSynephrine Nasal is a topical decongestant and causes less systemic side effects than ephedrine,which should not be given with beta blockers.Diphenhydramine and loratadine are antihistamines,not decongestants.

Question 11

A patient asks the nurse about using dextromethorphan for cough.What information will the nurse include when teaching this patient about this drug?

Accepted Answer

Dextromethorphan is contraindicated in patients with COPD.It may cause sedation at low doses.If a cough lasts longer than 1 week,patients should be instructed to contact their provider and not to continue to treat with over-the-counter antitussives.Alcohol can cause excess sedation when taken with dextromethorphan.

Question 12

The nurse is caring for a patient who is receiving diphenhydramine.The nurse notes that the patient has not voided for 12 hours.What action will the nurse take?

Accepted Answer

Diphenhydramine has anticholinergic effects,including urinary retention.The nurse should assess for bladder distension to determine if this is the case.Encouraging the patient to drink more fluids or giving intravenous fluids may be necessary if the patient has oliguria secondary to dehydration.Urinary catheterization is not indicated until urinary retention has been identified.

Quiz 40: Drugs for Upper Respiratory Disorders