Chapter 40: Drugs for Upper Respiratory Disorders Nursing School Test Banks

Chapter 40: Drugs for Upper Respiratory Disorders
Test Bank

MULTIPLE CHOICE

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?
a. Azelastine (Astelin)
b. Cetirizine (Zyrtec)
c. Chlorpheniramine maleate (Chlor-Trimeton)
d. Diphenhydramine (Benadryl)
ANS: A
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.

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TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. 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?
a. Encourage the patient to drink more fluids.
b. Evaluate the bladder to check for distension.
c. Request an order for an intravenous fluid bolus.
d. Request an order for urinary catheterization.
ANS: B
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 575
TOP: NURSING PROCESS: Evaluation/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. 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?
a. Administer diphenhydramine.
b. Administer epinephrine.
c. Assess for urinary retention.
d. Assess heart rate, respiratory rate, and lung sounds.
ANS: D
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 575
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. 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?
a. Avoid fluids at bedtime to prevent urinary retention.
b. This will help clear your daytime symptoms, too.
c. You should be able to sleep better when you take this medication.
d. You should take this medication on an empty stomach.
ANS: C
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.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 575
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. 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 childs grandparents to help the child sleep during the flight. What will the nurse tell the parents about giving this drug?
a. Administer 25 mg of diphenhydramine when using to induce sleep.
b. Diphenhydramine may have the opposite effect and could cause agitation.
c. Give the diphenhydramine about 5 minutes prior to takeoff.
d. Loratadine should be used instead of diphenhydramine to minimize side effects.
ANS: B
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 577
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. 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 patients provider to request an order for which medication?
a. Benzonatate (Tessalon Perles)
b. Cetirizine (Zyrtec)
c. Dextromethorphan hydrobromide (Benylin DM)
d. Diphenhydramine (Benadryl)
ANS: B
Cetirizine is an antihistamine, which is indicated for this patients 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.

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TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. 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
a. request an order for a systemic decongestant medication.
b. request an order so the patient can continue to use the decongestant spray.
c. tell the patient the congestion will clear up after stopping the spray.
d. tell the patient to increase oral fluid intake.
ANS: C
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 577
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. 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?
a. Diphenhydramine (Benadryl)
b. Ephedrine HCl (Pretz-D)
c. Phenylephrine nasal (NeoSynephrine Nasal)
d. Loratadine (Claritin)
ANS: C
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 578
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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?
a. Dexamethasone may be used for year-round symptoms.
b. Dexamethasone should be discontinued after 30 days.
c. Dexamethasone should not be taken with antihistamines.
d. Dexamethasone should not cause systemic steroid side effects.
ANS: B
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.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 578
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. A patient asks the nurse about using dextromethorphan for cough. What information will the nurse include when teaching this patient about this drug?
a. It does not cause sedation except at high doses.
b. It may be used to treat cough for up to 2 weeks.
c. It is non-narcotic, and it is OK to consume alcohol while taking this drug.
d. It should not be taken by patients who have chronic obstructive pulmonary disease (COPD).
ANS: D
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.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 579
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. 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?
a. Benzonatate HCl (Tessalon Perles)
b. Dextromethorphan hydrobromide (Benylin DM)
c. Guaifenesin and codeine
d. Promethazine with dextromethorphan
ANS: A
Benzonatate will not cause sedation and is safe for patients with COPD. Dextromethorphan is contraindicated in patients with COPD. Codeine and promethazine cause sedation.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 580
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. 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?
a. Avoid driving or using heavy machinery.
b. Drink extra water while taking the medication.
c. Monitor urine output closely.
d. Take with an oral antihistamine for better effects.
ANS: B
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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 578
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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