EAQ 14 CH 36 Questions and Answers PDF

Which first-generation histamine1 (H1) antagonist is less likely than diphenhydramine to induce sleep?\ A. Hydroxyzine\ B. Promethazine\ C. Dimenhydrinate\ D. Chlorpheniramine Alkylamine antihistamines, including chlorpheniramine, are among the least sedating first-generation H1 blockers. 2. The...

Which first-generation histamine1 (H1) antagonist is less likely than diphenhydramine to induce sleep?\ A. Hydroxyzine\ B. Promethazine\ C. Dimenhydrinate\ D. Chlorpheniramine Alkylamine antihistamines, including chlorpheniramine, are among the least sedating first-generation H1 blockers. 2. The health care provider indicates that the patient will be ordered an opioid antitussive. Which medication does the nurse anticipate the provider will order?\ A. Codeine\ B. Benzonatate\ C. Levocetirizine\ D. Promethazine with dextromethorphan Codeine is classified as an opioid antitussive. Promethazine with dextromethorphan and benzonatate (Tessalon Perles) are both nonopioid antitussives. Levocetirizine (Xyzal) is an antihistamine. 3. Which medication can cause paradoxical reactions in children?\ \ 1 Antacid\ 2 Antitussive\ 3 Decongestant\ 4 Antihistamine An antihistamine can cause paradoxical reaction in children. Dizziness, confusion, sedation, and hypotension are symptoms associated with paradoxical reaction. An antacid may cause constipation or other reactions with an overdose. An antitussive can cause drowsiness or dizziness in the patient. A decongestant can cause rebound congestion with frequent use or overdose. 4. Which clinical finding is seen in a patient with nasal congestion caused by allergic rhinitis?\ \ 1 Increase in body secretions\ 2 Increase in capillary permeability\ 3 Inhibition of histamine production\ 4 Release of inflammatory mediators Allergic rhinitis begins when airborne allergens bind to antibodies on mast cells, triggering the release of inflammatory mediators, including histamine, leukotrienes, and prostaglandins. Once released, the inflammatory mediators dilate and engorge regional blood vessels, causing nasal congestion. Antihistamines inhibit histamine production by blocking the histamine receptors on the surfaces of basophils and mast cells. The release of excessive amounts of histamine may lead to an increased capillary permeability and an increase in body secretions. 5. The health care provider indicates that the patient will be prescribed an expectorant. Which medication does the nurse anticipate the provider will prescribe?\ \ 1 Guaifenesin\ 2 Brompheniramine maleate\ 3 Chlorpheniramine maleate\ 4 Dexchlorpheniramine maleate Guaifenesin is classified as an expectorant. Brompheniramine, chlorpheniramine, and dexchlorpheniramine are classified as traditional antihistamines. 6. Which symptom of allergic rhinitis is treated with fluticasone?\ \ 1 Bronchospasm\ 2 Fluid retention\ 3 Nasal congestion\ 4 Increased blood pressure Fluticasone relieves the symptoms of allergic rhinitis such as nasal congestion and hay fever. Bronchospasm is not a symptom of allergic rhinitis. Release of excessive amounts of histamine can lead to fluid retention because of vasodilatation and increased capillary permeability. Increased blood pressure is not a symptom of allergic rhinitis. Antihypertensives are used to lower blood pressure. 7. A patient is prescribed diphenhydramine for the treatment of an allergic disorder. After reviewing the patient\'s history, the nurse finds that the patient drinks alcohol. Why should the nurse instruct the patient to stop alcohol consumption?\ \ 1 Alcohol diminishes the action of diphenhydramine.\ 2 Alcohol increases central nervous system depression.\ 3 Alcohol increases diphenhydramine levels in the body.\ 4 Alcohol and diphenhydramine interaction produces skin rashes. Diphenhydramine and alcohol show an additive effect and increase central nervous system depression. Therefore, the nurse instructs the patient to stop alcohol consumption to prevent this condition. Alcohol does not diminish the action of diphenhydramine, because they show an additive effect. Alcohol does not inhibit the metabolism of diphenhydramine; therefore, it does not increase its level in the body. Alcohol and diphenhydramine interaction does not produce skin rashes. 8. Which antihistamine causes sedation an adverse drug effect?\ \ 1 Loratadine\ 2 Fexofenadine\ 3 Desloratadine\ 4 Diphenhydramine The most common adverse effects with diphenhydramine include sedation and antimuscarinic effects, including dry mouth, urinary retention, and constipation. The newer antihistamines such as loratadine, fexofenadine, and desloratadine are usually less sedating because of reduced distribution to the central nervous system. 9. A patient is prescribed disulfiram for alcohol abuse. During the assessment, the nurse finds that the patient is also taking echinacea for wound healing. What should the nurse instruct the patient to do? 1 \"Stop using echinacea.\" 2 "Increase carbohydrate intale" 3 "Increase the dose of disulfiram" 4 "Take both drugs simultaneously" Echinacea should not be administered if the patient is on the disulfiram treatment, because it may result in acetaldehyde syndrome. Therefore the nurse would instruct the interaction. Disulfiram should not be administered in a higher dose to the patient, because it causes severe drug-drug interaction. 10. Which drug will the primary health care provider prescribe for a patient who has nighttime insomnia and motion sickness?\ \ 1 Cetirizine\ 2 Loratadine\ 3 Fexofenadine\ 4 Diphenhydramine Diphenhydramine should be prescribed for the patient, because this drug is useful for treating nighttime insomnia as well as motion sickness. Diphenhydramine s a traditional antihistamine and works both peripherally and centrally. It has anticholinergic and sedative effects. Cetirizine, loratadine, and fexofenadine are nonsedating antihistamines. These drugs work peripherally and do not have a sedating effect. Therefore, these drugs are not helpful in treating nighttime insomnia. 11. The use of fexofenadine is contraindicated in patients with which conditions?\ \ 1 Skin rashes\ 2 Renal impairment\ 3 Vitamin C deficiency\ 4 Vitamin A deficiency Fexofenadine is contraindicated in patients with renal impairment, because it may be accumulated in the patient\'s body and cause complications from overdose. Fexofenadine is not contraindicated in patients with skin rashes or vitamin C or A deficiency, because it does not cause any interaction in those cases. 12. Which side effect would the nurse watch for in a patient with motion sickness, who has been prescribed diphenhydramine?\ \ 1 pruritis\ 2 headache\ 3 dry mouth\ 4 lightheadedness 13. The nurse observes a mild cough in a patient after hernia repair. Which medication should the nurse expect the provider to prescribe for this patient?\ \ 1 Antitussive\ 2 Expectorant\ 3 Decongestant\ 4 Antihistamine Antitussives are used to suppress cough. A patient who has undergone hernia repair needs to keep the abdominal muscles relaxed, and coughing can strain the abdominal muscles and worsen the hernia. Expectorants are used to thin secretions and promote coughing out secretions. Decongestants are used to relieve congestion of the upper and lower respiratory tract. Antihistamines are used to treat allergic symptoms. 14. Which patients are the best candidates to receive antitussive cough medication?\ \ 1 Patients with pharyngitis and rhinitis\ 2 Patients with chronic paranasal sinusitis\ 3 Patients who have undergone hernia surgery\ 4 Patients with bronchitis with productive cough Antitussives are administered to patients who have recently undergone hernia surgery to enhance their comfort and reduce respiratory distress. Expectorants are used to relieve productive cough in patients with pharyngitis and bronchitis. Nasal decongestants are used to relieve nasal congestion in patients with rhinitis. In patients with chronic paranasal sinusitis, expectorants are used for cough suppression. 15. The primary health care provider prescribes oxymetazoline to a patient with sinusitis who complains of nasal congestion and difficulty in breathing. About which possible adverse effect should the nurse teach to the patient?\ \ 1 Dry mouth\ 2 Palpitations\ 3 Constipation\ 4 Gastrointestinal irritation Oxymetazoline impairs blood flow and can cause cardiovascular disorders such as palpitations and hypertension. Oxymetazoline does not have anticholinergic action and does not cause dry mouth or constipation. Oxymetazoline does not increase acidic levels of gastric fluid and does not cause gastrointestinal irritation. 16. Which information would the nurse give a patient who mentions being afraid to take antihistamines because of being a truck driver?\ \ a. \"take the medication only when you are not driving.\"\ b. \"you are correct; you should not take antihistamines.\"\ c. \"take a lower dose than normal when you have to drive.\"\ d. \"you may be able to safely take a nonsedating antihistamine.\" Nonsedating antihistamines may be safer for the patient to take, but the patient should still monitor for signs of sedation. If sedation occurs, the patient should be instructed to avoid taking these drugs while driving. Taking a lower dose will decrease the drug's effectiveness. 17. Which instruction would the nurse provide a patient who reports feeling drowsy after beginning drug therapy with diphenhydramine?\ \ 1 \"Use caution when driving.\"\ 2 \"This may worsen over time.\"\ 3 \"Stop taking the drug immediately.\"\ 4 \"Take a stimulant to combat fatigue.\" The sedative effects of diphenhydramine can be problematic for patients who are involved in activities such as driving that require mental alertness. The side effect will not worsen over time; the side effects diminish when the medication is terminated. The nurse should not advise the patient to stop taking the drug, because drowsiness is an expected effect of the drug. The nurse should not advise the patient to take a stimulant if it is not prescribed by the primary health care provider. 18. Which response is appropriate when a patient complains of worsening nasal congestion despite the use of oxymetazoline nasal spray every 2 hours? 1 "Oxymetazoline is not an effective nasal decongestant" 2 \"Overuse of nasal decongestants results in rebound congestion.\" 3 "You are probably displaying an unexpected reaction to oxymetazoline." 4 "Oxymetazoline should be administered every hour for severe congestion." Oxymetazoline is an effective nasal decongestant, but overuse results in worsening or rebound congestion. To prevent future rebound congestion with nasal sprays, it is recommended that they be used for no mores thatn 3 to 5 days. 19. Which side effect of a histamine (H1) antagonist is used therapeutically for patients with allergic rhinitis?\ \ 1 Dryness\ 2 Drowsiness\ 3 Palpitations\ 4 Constipation H1 antagonists exert anticholinergic effects, including constipation, dry mouth, and blurred vision. The drugs\' capacity for drying the mucous membranes makes them useful in treating upper respiratory infections and allergic rhinitis. Drowsiness, palpitations, and constipation are adverse effects of H1 antagonists that should be reported immediately to the primary health care provider. 20. Which condition is an adverse effects of echinacea? Select all that apply.\ \ 1 Dizziness\ 2 Headache\ 3 Dermatitis\ 4 Mucosal ulceration\ 5 Emotional instability Echinacea is an herbal medicine commonly used for stimulation of the immune system and antisepsis and to treat viral infections, influenza-like respiratory tract infections, and chronic ulcerations. Dizziness, headache, and dermatitis are adverse effects of echinacea. Mucosal ulceration and emotional instability are adverse effects of goldenseal. 21. A patient who reports nasal congestion is prescribed naphazoline, 2 drops in each nostril, every 6 hours, for 5 days. The patient reports increased nasal congestion after 10 days. On assessment the nurse learns that the patient had increased the drug frequency to every 3 hours for 10 days. What should the nurse interpret from this information?\ \ 1 The patient has developed an allergic reaction.\ 2 The patient has developed rebound congestion.\ 3 The patient has developed paradoxical reaction. 22. Which instruction would the nurse give to a patient who is prescribed dextromethorphan for treatment of cough. What instruction should the nurse give to the patient for safe administration of the drug?\ \ 1 \"Use a humidifier while sleeping.\"\ 2 \"Elevate your bed while sleeping.\"\ 3 \"Increase your fluid intake to 3000 mL per day.\"\ 4 \"Restrict activities that require mental alertness.\" Dextromethorphan is a nonopioid antitussive drug that may also cause sedation, drowsiness, or dizziness. The nurse should advise the patient to avoid activities that require mental alertness. It helps prevent injury to the patient. Use of a humidifier helps maintain hydration levels, but does not reduce the risk of injury to the patient. Elevating one\'s head while sleeping helps with lung expansion and promotes breathing. Fluid intake should be increased when decongestants are administered, because fluids help liquefy secretions and make it easier to cough up secretions. 23. During the assessment of a patient, the nurse finds symptoms of dizziness, confusion, sedation, and hypotension. After reviewing the patient\'s medical history, the nurse finds that the patient is taking diphenhydramine for treatment of nighttime insomnia. What should the nurse interpret from the assessment?\ \ 1 Allergic reaction.\ 2 Dystonic reaction.\ 3 Rebound congestion.\ 4 Paradoxical reaction. Diphenhydramine is an antihistaminic drug. Antihistaminic drugs may produce paradoxical reactions such as dizziness, confusion, sedation, and hypotension in older adults. These are not allergic reactions to the drug. In cases of dystonic reaction, sustained muscle contractions cause twisting and repetitive movements or abnormal postures. Rebound congestion results from long-term use, or overdose, of nasal decongestants. 24. A patient complains that symptoms of allergic rhinitis are persistent even after taking fexofenadine. After checking the patient\'s history, the nurse finds that the patient is taking phenytoin for the treatment of seizures. What should the nurse interpret from this information?\ \ 1 It indicates drug tolerance.\ 2 It indicates dystonic reaction.\ 3 It indicates paradoxical reaction.\ 4 It indicates drug-drug interaction. Phenytoin decreases the fexofenadine level in the body. Therefore, the drug does not have the desired therapeutic effect. The persistent allergic rhinitis is caused by drug interaction, not drug tolerance. Dystonic reaction is related to muscle contractions. Twisting and repetitive movements or abnormal postures can be observed in this condition. Paradoxical reaction is observed in older adults and children from the use of antihistaminic drugs. 25. The nurse observes that a patient who is taking phenylephrine and vitamin C tablets has developed rebound congestion. What is the probable reason for rebound congestion?\ \ 1 Drug-drug interaction\ 2 Phenylephrine tolerance\ 3 Allergic reaction to vitamin C\ 4 Frequent use of phenylephrine Rebound congestion results from frequent, long-term use or overdose of decongestants. Phenylephrine and vitamin C do not cause any drug-drug interaction. Rebound congestion does not indicate that the patient has phenylephrine tolerance. Rebound congestion is not associated with allergy to vitamin C. 26. Which type of drug should the nurse expect to prescribe for a patient in the emergency department with urticaria after contact with shrubs?\ \ 1 Antitussive\ 2 Expectorant\ 3 Decongestant\ 4 Antihistamine Urticaria after contact with shrubs indicates an allergic reaction. All allergic reactions are mediated by histamines. Therefore, an antihistamine should be included in the treatment plan. Antitussives are medications that help to suppress the cough reflex. Expectorants help in coughing up excessive mucus and clearing the airway. Decongestants usually relieve congestion of the upper and lower respiratory tract. 27. For which possible reason would an older adult who presents with a cough be instructed not to use diphenhydramine?\ \ 1 Diphenhydramine causes seizures.\ 2 Diphenhydramine causes constipation.\ 3 Diphenhydramine causes lightheadedness.\ 4 Diphenhydramine causes a \"hangover\" effect. 28. Which treatment is best to manage a cough associated with allergic rhinitis for the patient who takes several other medications?\ \ 1 Loratadine\ 2 Guaifenesin\ 3 Benzonatate\ 4 Dextromethorphan **Guaifenesin is the best treatment for a patient who takes many medications because it can help thin secretions when taken with sufficient water and facilitates expectoration of the secretions to stop the cough. ** Loratadine, benzonatate, and dextromethorphan have more adverse effects and potential drug interactions than guaifenesin, which could be especially problematic for a patient who takes many medications. 29. If a pt is experiencing an allergic rxn to a medication, which change noted during this rxn would be inhibited by the administration of antihistamines? Select all\ \ 1 Vasoconstriction\ 2 Smooth muscle constriction\ 3 Increased BP\ 4 Diminished capillary permeability\ 5 Decreased production of secretion 30. If a pt asks about using echinacea to treat cold sxs which cue in pt\'s health hx would make the use of this drug a contraindication?\ \ 1 Emphysema\ 2 Hypertension\ 3 Multiple Sclerosis\ 4 Enlarged prostate Echinacea is contraindicated for pts with Multiple Sclerosis and other connective tissue diseases. 31. Which info would the nurse provide as to the adverse effects when teaching a pt about the use of diphenhydramine in tx of seasonal allergies? Select all\ \ 1 Can trigger urticaria\ 2 Avoid driving after use\ 3 Change positions slowly\ 4 Causes nausea and vomiting\ 5 Use hard candy for dry mouth 32. Based on the med administration record for a pt who reports using goldenseal to treat allergies, which action would the nurse perform due to possible drug interaction?\ \ MAR\ Atenolol 25 mg PO daily\ Atorvastatin 10 mg PO every night\ Venlafaxine ER 75 mg PO daily\ Goldenseal 500 mg PO TID\ Finasteride 5 mg PO daily\ \ 1 Assess oral cavity\ 2 Monitor urine output\ 3 Obtain BP\ 4 Auscultate breath sounds Goldenseal can reduce the efficacy of antihypertensive meds 33. Which info is important for the nurse to provide a pt prescribed an otc nasal spray with oxymetazoline to relieve nasal congestion due to cold?\ \ 1 Monitor BP\ 2 Med cures the cold\ 3 Use 2 spray 4x daily\ 4 Do not take drug more than 3 times a day Oxymetazoline is nasal decongestant that if overused can cause rebound congestion. 34. After reviewing the health record of 4 pts who present with cold sxs which pt would it be contraindicated to give oxymetolazine?\ \ 1 40 yo pt with depression\ 2 50 yo pt with hyperthyroidism\ 3 60 yo pt with rheumatoid arthritis\ 4 70 yo pt with bilateral cataracts oxymetalazine is contraindicated for hyperthyroidism, HTN and narrow angle glaucoma. 35. Pt with bronchitis asks about meds to suppress dry cough that is keeping pt up at night. After reviewing health record which med would be safe to administer?\ \ MAR\ Lisinopril 10 mg PO daily\ Selegiline 1.25 mg PO every AM\ \ Past medical Hx\ HTN\ Bipolar disorder\ Renal insufficiency\ \ Benzonatate\ Promethazine\ Dextromethorphan\ Codeine with hydrocodone 36. Which frequency would the nurse instruct a pt to take Robitussin with dextromethorphan 30 mg PO to suppress a cough due to influenza?\ \ 1 Every hr\ 2 Every 2 hr\ 3 Every 3 hr\ 4 Every 6 hr 37. After reviewing health record of pt with pneumonia who asks for a codeine-containing cough suppressant to alleviate to cough, which medical diagnosis would make the administration of codeine contraindicated? Select all\ \ Past medical hx 1 Depression 2 HTN\ 3 Seizure disorder 4 Diabetes Mellitus\ 5 Seasonal allergies 38. Which med would the nurse instruct a pt scheduled to undergo allergy testing to hold a least 4 days prior to test?\ \ 1 Guaifenesin\ 2 Benzonatate\ 3 Fexofenadine\ 4 Dextromethorphan 39. Which info would the nurse provide to pt taking otc guaifenesin who informs the nurse that the drug does not last very long?\ \ 1 Add an antihistamine once a day\ 2 Switch to sustained release form of drug\ 3 Use oxymetolazine nasal spray twice daily\ 4 Contact provider for prescription 40. The nurse is planning care for pt receiving decongestants. Which parameter would nurse assess prior to giving dose of medication? Select all\ \ 1 Cough\ 2 Secretions\ 3 Oral cavity\ 4 Mental status\ 5 Breath sounds 41. A patient is prescribed guaifenesin for treatment of productive cough. What instruction should the nurse give to the patient for maximum therapeutic effect?\ \ 1 \"Increase your fluid intake.\"\ 2 \"Increase your fiber intake.\"\ 3 \"Increase your protein intake.\"\ 4 \"Increase your carbohydrate intake. The nurse should instruct the patient to increase fluid intake, because it helps to liquefy secretions, assists in breaking up thick secretions, and makes it easier to cough up secretions. The nurse may advise an increase in dietary fiber to prevent constipation. The nurse may advise an increase in proteins and carbohydrates in the patient\'s diet if there is a deficiency of these nutrients. 42. The nurse is providing care for multiple patients who are prescribed nasal decongestants. For which patients does the nurse need to obtain a change of prescription? Select all that apply.\ \ 1 Patients with skin disease\ 2 Patients with hypertension\ 3 Patients with hyperthyroidism\ 4 Patients with genitourinary disease\ 5 Patients with narrow-angle glaucoma Nasal decongestants are contraindicated in patients who have hypertension, hyperthyroidism, or narrow-angle glaucoma. Nasal decongestants act on alpha-adrenergic receptors and increase blood pressure. In hypertension, hyperthyroidism, and narrow-angle glaucoma conditions, blood pressure is high; if nasal decongestants are administered, these conditions may worsen. Nasal decongestants can be administered to patients with skin or genitourinary diseases, because they do not worsen these conditions 43. Which antitussive would be administer to a patient with peripheral arterial disease (PAD)?\ \ 1 Codeine\ 2 Benzonatate\ 3 Diphenhydramine\ 4 Dextromethorphan Codeine is the best choice of antitussive for a patient with PAD, because it does not have the side effect profile of the nonopioid antitussive agents. It is less sedating and, therefore, less likely to result in a fall or patient injury from sedation. Benzonatate is a nonopioid antitussive and is less effective than opioid drugs. Diphenhydramine is a first-generation histamine1 (H1) blocker that can help relieve a cough caused by postnasal drip or upper respiratory congestion but has no antitussive effect. Dextromethorphan is a nonopioid antitussive. 44. A patient who presents with cough and difficulty breathing is prescribed decongestants and antitussives. Which assessment findings in the follow-up visit will the nurse immediately report to the primary health care provider? Select all that apply.\ \ 1 Temperature of 100.8° F\ 2 Change in color of the sputum\ 3 Increased expectoration of mucus\ 4 Respiratory rate of 30 breaths/min\ 5 Clear breath sounds on auscultation After the treatment of cough and difficulty breathing, the nurse should look for signs of worsening during the follow-up visit. Temperature of 100.8° F indicates fever and is a sign of infection. A change in color of the sputum indicates infection and should be immediately reported. The normal respiratory rate is 12 to 20 breaths/min. The respiratory rate of 30 breaths/min indicates dyspnea and difficulty breathing. Increased expectoration of mucus indicates treatment effectiveness. Clear breath sounds indicate that lungs are clear of secretions. 45. An older adult with pneumonia is experiencing a cough that is disrupting rest and sleep. Which type of medication would the nurse expect to administer to this pt to promote sleep and rest? Select all\ \ 1 Codeine\ 2 Fluticasone\ 3 Guaifenesin\ 4 Fexofenadine\ 5 Pseudoephedrine 46. A pt who underwent coronary artery bypass surgery 2 mos ago has an acute upper respiratory infection and is losing sleep because of a cough. Which instruction would the nurse give to manage the URI if the pt is using codeine as an antitussive? Select all\ \ 1 Maintain hydration\ 2 Take an expectorant\ 3 Take a decongestant\ 4 Take an antihistamine\ 5 Productively cough 47. Which instruction would the nurse include for a pt who will be using an expectorant?\ \ 1 Take the med daily at bedtime\ 2 Restrict your fluids to decrease mucus production\ 3 Increase your fiber and fluid intake to prevent constipation\ 4 Increase your fluid intake to decrease viscosity of secretions 48. Which instruction would the nurse include for a pt prescribed an antitussive med?\ \ 1 Watch for diarrhea and abdominal cramping\ 2 This med may cause tremors and anxiety\ 3 Headache and HTN are common SE\ 4 This med may cause drowsiness and dizziness 49. A pt who has allergic rhinitis comes to the clinic for a scheduled allergy test. After performing a health hx the nurse informs the pt that the allergy test will have to be rescheduled. Which statement explains the reason for this?\ \ 1 Pt is afraid of injections\ 2 Pt has severe sxs of rhinitis\ 3 Pt is being treated with antihistamine drugs\ 4 Pt is being treated with oral antibiotic drugs 50. The nurse makes a home visit to middle-aged pt who has hx of asthma. Pt\'s spouse purchased otc antihistamine. Nurse instructs spouse not to administer drug to pt. Which complication is the nurse trying to prevent?\ \ 1 Paradoxical reactions\ 2 Collapse of lung alveoli\ 3 Decrease in RR\ 4 Allergic reactions to drug