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NURS 1141 EXAM 4 NEW CONTENT FINAL
PRACTICE FULLY EXPLAINED.
What body system will the nurse assess for known common adverse effects of traditional antihistamines? a. respiratory b. cardiovascular c. CNS d. GI Accurate Answer - c. CNS The most common adverse effect of antihistamines is drowsiness, but the sedative effects vary among the antihistamine drug class What advantage does loratadine (Claritin) have compared with traditional antihistamines such as diphenhydramine (Benadryl)? a. less sedative effect b. increase in bronchodilation c. minimal GI upset d. decreased risk of cardiac dysrhythmias Accurate Answer - a. less sedative effect Loratadine is a nonsedating antihistamine and it does not readily distribute into the CNS, which diminishes the sedative effects assoc. w/ traditional antihistamines A pt complains of worsening nasal congestion despite the use of oxymetazoline (Afrin) nasal spray every 2-4 hrs for the past 5 days. The nurse's response is based on the knowledge that: a. oxymetazoline is not an effective nasal decongestant b. sustained use of nasal decongestants over several days may result in rebound congestion
c. oxymetazoline should be administered in an hourly reginmen for severe congestion d. the patient is probably displaying an idiosyncratic reaction to oxymetazoline Accurate Answer - b. sustained use of nasal decongestants over several days may result in rebound congestion Oxymetazoline is an effective nasal decongestant, but overuse results in worsening or "rebound" congestion. It should not be used more than every 4 hrs. Which statement by the client demonstrates an understanding about beclomethasone diproprionate (Beconase) mechanism of action? a. I only need to take this medication when my symptoms get bad b. I will need to taper off the medication to prevent acute adrenal crisis c. This medication will help prevent the inflammatory response of my allergies d. I will monitor my blood sugar b/c I may develop drug-induced diabetes Accurate Answer - c. This medication will help prevent the inflammatory response of my allergies Beclamethason diproprionate is a steroid spray administered nasally. It is used to prevent and treat allergy symptoms. Its effect is localized, and therefore the client does not have systemic adverse effects with the recommended does. There is no need to taper off gradually as with oral corticosteroids The nurse is discussing use of antitussive medications with a client. What common adverse effect does the nurse include in the client teaching? a. tremors and palpitations b. drowsiness and dizziness c. diarrhea and abdominal cramping
a. Discontinue use 4 days before allergy testing. b. It may cause dry mouth and difficulty urinating. c. The medication treats the signs and symptoms but is not a cure. d. Do not use in children younger than 2 years of age unless prescribed. Accurate Answer - d. Do not use in children younger than 2 yrs of age unless prescribed. OTC medications for allergies are not recommended for children younger than 2 years of age unless prescribed by a health care provider. A client is making an appointment for allergy testing. The nurse instructs the client not take what class of medications at least 4 days before allergy testing? a Antitussives b Antihistamines c Decongestants d Bronchodilators Accurate Answer - b. Antihistamines An allergist will usually recommend discontinuation of antihistamine drug therapy at least 4 days before allergy testing. The nurse is providing education to a client with a history of chronic nasal congestion secondary to allergic rhinitis. Which class of medications should the nurse anticipate the provider would recommend for the client to use on a long-term basis? a Antitussives b Expectorants c Antihistamines d Intranasal steroids Accurate Answer - d. Intrnasal steroids Inhaled intranasal steroids and anticholinergic drugs are not associated with rebound congestion and are often used prophylactically to prevent nasal congestion in clients with chronic upper respiratory tract
symptoms. Local intranasal steroids would have the least likely possible systemic adverse effects of all the medication classes possible to use for chronic and long term use. The nurse is discussing with the client the management of symptoms of an upper respiratory tract infection. Which classes of medications are often used in treating the symptoms of upper respiratory tract infections? (Select all that apply.) a Antibiotics b Antitussives c Expectorants d Antihistamines e Nasal decongestants Accurate Answer - antitussives, expectorants, antihistamines, nasal decongestants Treatment of the common symptoms of upper respiratory tract infections involves the combined use of antihistamines, nasal decongestants, antitussives, and expectorants. Upper respiratory tract infections are often viral or allergic in nature and the symptoms would not be managed with antibiotics. The nurse is discussing use of antihistamines for allergic rhinitis. Which medications would be included in the list of H1 antagonists used in the treatment of allergic rhinitis? (Select all that apply.) a Nizatidine (Axid) b Cetirizine (Zyrtec) c Ranitidine (Zantac) d Loratadine (Claritin) e Fexofenadine (Allegra) Accurate Answer - Cetirizine Loratadine Fexofenadine
a. a pt w/ a productive cough b. a pt w/ a chronic paranasal sinusitis c. a pt who has had recent abd surgery d. a pt who has influenza Accurate Answer - c. a pt who has had recent abd surgery A pt is taking a decongestant to help reduce symptoms of a cold. The nurse will instruct the pt to observe for which possible symptom, which may indicate an adverse effect of this drug? a. increased cough b. dry mouth c. slower heart rate d. heart palpitations Accurate Answer - d. heart palpitations The nurse is giving an antihistamine and will observe the pt for which side effects? (SATA) a. HTN b. dizziness c. hangover effect d. drowsiness e. tachycardia f. dry mouth Accurate Answer - dizziness hangover effect drowsiness dry mouth The nurse notes in a pt's medication history that the pt is taking benzonatate (Tessalon Perles) as needed. Based on this finding, the nurse interprets that the pt has which problem? a. cough b. seasonal allergies
c. chronic rhinitis d. motion sickness Accurate Answer - cough An older adult pt is dicussing the use of guaifenesin w/ the nurse. He asks, "What else can I do to fight this terrible cold? I don't want to just take a pill." What is the nurse's best answer? Accurate Answer -
- Report fevers above 100.4° F (38º C) to the prescriber as soon as possible.
- Try to cough up the secretions as much as possible; the increase in the intake of fluids and the humidification may help to liquefy and loosen secretions. Force fluids only if not contraindicated (i.e., fluid overload).
- If secretions change from a clear color to a yellow or green color, report it immediately to the prescriber because an infection may be developing. The patient may need different treatment at this time to prevent pneumonia and other respiratory complications. A pt is recovering from an emergency exploratory laparotomy b/c of an abd mass. He had a cold before his surgery and is now coughing up large amounts of whitish sputum. He is receiving IV fluids. He asks the nurse for something to make him stop coughing. The nurse reviews the medication sheet and sees both and expectorant and an antitussive ordered. Which medication would be the best choice at this time? Explain your answer Accurate Answer - In these situations it may enhance patient comfort and reduce respiratory distress to inhibit the cough by the use of an antitussive drug. Severe coughing may cause his abdominal incision to weaken and perhaps rupture. The nurse needs to ensure that the patient is well hydrated and given the antitussive drug to help reduce the severity of the cough during this immediate postoperative period. the common cold is treated w/ empiric therapy, which means... a. the medications cure the cold b. the medications only treat the symptoms c. herbal medications are useful to eliminate symptoms
A pt w/ a tracheostomy developed pneumonia. It is very difficult for the pt to cough up the thick, dry secretions he had developed. The nurse identifies which drug as being most effective in helping this pt? a. Benzonatate (Tessalon Perles) b. Dextromethorphan (Robitussin-DM) oral solution c. Codeine cough syrup d. guaifenesin (Mucinex) Accurate Answer - d. guaifenesin (Mucinex) The nurse receives laboratory values for a client with a theophylline level of 14 mcg/mL. How does the nurse interpret this theophylline level? a Toxic b Therapeutic c Subtherapeutic d Life threatening Accurate Answer - b therapeutic The therapeutic theophylline level is 10 to 20 mcg/mL. But most providers now recommend 5-15 mcg/mL Discharge teaching to a patient receiving a beta-agonist bronchodilator should emphasize reporting which side effect? a Tachycardia b Nonproductive cough c Hypoglycemia d Sedation Accurate Answer - a - tachycardia A beta-agonist bronchodilator stimulates the beta receptors of the sympathetic nervous system, resulting in tachycardia, bronchodilation, hyperglycemia, and increased alertness.
Which herbal product, when taken with theophylline, can decrease theophylline's serum drug levels? a Garlic b Echinacea c Peppermint oil d St. John's wort Accurate Answer - d - St. John's wort St. John's wort has been shown to enhance the rate of theophylline metabolism, thus decreasing serum levels. The nurse is providing care to a client prescribed a nonselective adrenergic agonist bronchodilator. Which condition documented in the client's medical history would alert the nurse to question this prescription? a Thrombocytopenia b Coronary artery disease c Mycobacterium tuberculosis d Chronic obstructive pulmonary disease Accurate Answer - b - Coronary artery disease Nonselective adrenergic agonist bronchodilators stimulate beta receptors in the heart and beta2 receptors in the lungs. Stimulation of beta1 receptors can increase heart rate and contractility, increasing oxygen demand. This increased oxygen demand may lead to angina or myocardial ischemia in clients with coronary artery disease. ID: 10068745085 A nurse is providing education to a client taking two different bronchodilator medications. The nurse identifies which characteristic as the advantage of salmeterol (Serevent) over other beta2 agonists such as albuterol (Proventil)? a Quicker peak action
Corticosteroids can suppress the immune system. They do not directly affect bronchodilation but rather prevent bronchoconstriction as a response to inflammation. Which statement by a client best indicates an understanding of the teaching on flunisolide (AeroBid)? a "I will rinse my mouth with water after each use." b "I will wash the plastic inhaler casing once a month." c "I will take two puffs to treat an acute asthma attack." d "I will not use my albuterol inhaler while I am taking AeroBid." Accurate Answer - a "I will rinse my mouth with water after each use." Flunisolide is an inhaled corticosteroid. Rinsing the mouth immediately after each use of the inhaler or nebulizer will help prevent oral candidal infections. It is not used to treat an acute asthma attack and should be taken with the client's bronchodilator medications. The plastic inhaler casing is washed in warm, soapy water every week. Which statement by the nurse should be included when teaching a client about the proper use of metered-dose inhalers? a "After you inhale the medication once, repeat until you obtain relief." b "Wait 1 to 2 minutes before you take a second puff of the same drug." c "Make sure that you puff out air several times after you inhale the medication." d "Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler." Accurate Answer - b "Wait 1 to 2 minutes before you take a second puff of the same drug." If a second puff of the same drug is ordered, instruct the client to wait 1 to 2 minutes between puffs. If a second type of inhaled drug is
prescribed, instruct the client to wait 2 to 5 minutes between the medications or to take as prescribed. The nurse performs discharge teaching with a client who is prescribed the anticholinergic inhaler ipratropium bromide (Atrovent). Which statement by the client indicates to the nurse that teaching has been successful? a "I will not drink grapefruit juice while taking this drug." b "I may gain weight as a result of taking this medication." c "This inhaler is not to be used alone to treat an acute asthma attack." d "Nausea and vomiting are common adverse effects of this medication." Accurate Answer - c "This inhaler is not to be used alone to treat an acute asthma attack." Although ipratropium works to prevent bronchoconstriction and thus secondarily leads to bronchodilation, a direct-acting bronchodilator is needed to treat an acute asthma attack. Which laboratory value would the nurse assess before administering zafirlukast (Accolate) to a client? a Liver enzymes b Cardiac enzymes c Renal function tests d Complete blood count Accurate Answer - a - liver enzymes Because use of zafirlukast may lead to liver dysfunction, liver enzyme levels should be monitored regularly, especially early in the course of therapy. Before administering an LTRA medication, the nurse would assess the client for allergies to which substance? (Select all that apply.) a Latex
a. CNS depression b. sinus tachycardia c. increased appetite d. temporary urinary retention Accurate Answer - b. sinus tachycardia During a teaching session for a pt who will be receiving a new prescription for the LTRA montelukast (Singulair), the nurse will tell the pt hat the drug has which therapeutic effect? a. improves the respiratory drive b. loosens and removes thickened secretions c. reduces inflammation in the airway d. stimulates immediate bronchodilation Accurate Answer - c. reduces inflammation in the airway After the pt takes a dose of an inhaled corticosteroid, such as fluticasone (Flovent), what is the most important action the pt needs to do next? a. hold the breath for 60 secs b. rinse out the mouth w/ water c. follow the corticosteroid w/ a bronchodilator inhaler, if needed d. repeat the dose in 15 min if the pt feels short of breath. Accurate Answer - b. rinse out the mouth w/ water The nurse is teaching a pt about the inhaler Advair (salmeterol/fluticasone). Which statements by the pt indicate a correct understanding of this medication? (SATA) a. I will rinse my mouth with water after each dose b. I need to use this inhaler whenever I feel short of breath, but not less than 4 hours between doses c. This medication is taken twice a day, every 12 hours
d. I can take this inhaler if I get short of breath while exercising e. I will call my doctor if I notice white patches inside my mouth Accurate Answer - a. I will rinse my mouth with water after each dose c. This medication is taken twice a day, every 12 hours e. I will call my doctor if I notice white patches inside my mouth A pt who is taking a xanthine derivative for chronic bronchitis asks the nurse, "I miss my morning coffee. I can't wait to go home and have some." What is the nurses's best response? a. I know how you feel. I'd miss my coffee too. b. I can get some coffee for you. I'll be right back
c. It's important not to take coffee or other caffeinated products w/ this medicine as it may cause an increased heart rate as well as other problems. d. You've been on this medicine for a few days. I can call your prescriber to ask whether you can have some coffee. Accurate Answer - c. It's important not to take coffee or other caffeinated products w/ this medicine as it may cause an increased heart rate as well as other problems. A pt was prescribed an oral leukotriene receptor antagonist (LTRA) 1 month ago At today's follow-up appointment, he tells the nurse, "I don't think this pill works. I took it when I was short of breath, but it did not help." What is the nurse's priority action when answering the pt's concerns? Accurate Answer -. A patient has to understand that leukotriene receptor antagonists are used for prophylaxis in asthmatic attacks when taken on a long-term basis. They are not used to treat acute attacks. The priority answer is to discuss with the patient that this medication must be taken regularly for best effects, even if the symptoms improve and the patient is feeling better. In addition, it takes several weeks for full therapeutic effects to occur. In addition, the nurse needs to review with the patient that this medication is for prevention
1 min in between puffs of the same medication The nurse is providing teaching to a group of individuals w/ COPD at a community center. Which statement by one of the attendees indicates tat further teaching is needed? a. If I develop a puffy face, I will stop taking methylprednisolone (Medrol) immediately b. I will inform my prescriber of any weight gain of 2 lb or more in 24 hrs or 5 lb or more in a week c. I use omalizumab (Xolair) to control my asthma but not for an acute asthma attack d. When taking theophylline (Theo-Dur), I will advise my prescriber if I experience epigastric pain. Accurate Answer - a. If I develop a puffy face, I will stop taking methylprednisolone (Medrol) immediately On of the attendees expresses concern regarding her granddaughter's asthma. The attendee tells the nurse that she is afraid that she will not know which of her granddaughter's medications to give first in case of an asthma attack. Which medication should the nurse inform the attendee to administer first for an acute asthma attack? a. ipratropium (Atrovent) b. albuterol (Proventil) c. budesonide (Pulmicort Turbuhaler) d. montekulast (Singulair) Accurate Answer - b. albuterol - Proventil Which drug is contraindicated in a pt who has Addison's disease? a. Naphazoline b. benzonatate c. fexofenadine d. hydrocodone Accurate Answer - d. hydrocodone
Hydrocodone is contraindicated in a patient who has Addison's disease, because administration of hydrocodone may worsen the disease condition. Naphazoline, fexofenadine, and benzonatate can be administered to the patient, because they do not worsen the symptoms of Addison's disease. A pt w/ chronic paranasal sinusitis and cough is found to have glaucoma. What is the vest choice of treatment for mgmt of cough in this situation? a. loratadine b. naphazoline c. guaifenesin d. fexofenadine Accurate Answer - c. guaifenesin Guaifenesin is the best choice of treatment for management of cough associated with chronic paranasal sinusitis. It works by loosening and thinning the secretions and facilitating expectoration of the secretions. Loratadine, naphazoline, and fexofenadine are contraindicated in patients with glaucoma. A pt who takes several medications experiences a troublesome cough assoc. w/ allergic rhinitis. Which is the best choice of treatment to manage the cough? a. loratadine b. guaifenesin c. benzonatate d. dextromethorphan Accurate Answer - b. guaifenesin 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
