Chapter 30: Drugs Used to Treat Upper Respiratory Disease My Nursing Test Banks

Chapter 30: Drugs Used to Treat Upper Respiratory Disease

Test Bank

MULTIPLE CHOICE

1. Which is a serious adverse effect of decongestants?

a.

Hypotension

b.

Hypertension

c.

Orbital edema

d.

Facial flushing

ANS: B

Sympathomimetic decongestants cause stimulation of the alpha adrenergic receptors that can increase blood pressure. Excessive use of decongestants when taking a beta adrenergic blocking agent or monoamine oxidase inhibitor can cause significant hypertension. Alpha receptor stimulation does not cause hypotension, orbital edema, or facial flushing.

DIF: Cognitive Level: Knowledge REF: p. 477 OBJ: 3 | 5 | 6

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

2. The nurse is teaching a patient about the administration of antihistamines. The nurse will instruct the patient to take the medication at what time of day?

a.

PRN throughout the day

b.

After contact with an allergen

c.

45 minutes before exposure to an allergen

d.

Once nasal congestion begins

ANS: C

Allergies may be seasonal or perennial. People are commonly allergic to more than one antigen simultaneously, so seasons may overlap or occur more than once per year. Antihistamines do not prevent histamine release, but reduce the symptoms of an allergic reaction by competing with the histamines for receptor sites. Antihistamines are most effective when taken 45 to 60 minutes before anticipated exposure to the allergen or when symptoms first appear. PRN use of antihistamines, waiting until after contact with an allergen, or waiting until nasal congestion begins is not the most effective administration of antihistamines.

DIF: Cognitive Level: Knowledge REF: p. 477 OBJ: 6 | 7

TOP: Nursing Process Step: Planning

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

3. What can result if a patient overuses topical decongestants?

a.

Hypertensive crisis

b.

Allergic reaction

c.

Secondary congestion

d.

Permanent olfactory damage

ANS: C

Overuse of topical decongestants may lead to a rebound or increase in nasal secretions, causing a secondary congestion (known as rhinitis medicamentosa). This secondary congestion is thought to be caused by excessive vasoconstriction of blood vessels and direct irritation of the mucous membranes by the medication. As vasoconstriction wears off, the irritation triggers excessive blood flow to the passages, which in turn causes swelling and engorgement to reappear in greater intensity. Although decongestants can cause elevated blood pressure, they are not likely to cause hypertensive crisis. Allergic reaction is unlikely with decongestants. Damage to nasal tissues resulting from the use of decongestants is unlikely to be permanent.

DIF: Cognitive Level: Comprehension REF: pp. 473-475 OBJ: 4 | 6 | 7

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

4. A patient at sports camp is complaining of itchy and watery eyes, coughing, and sneezing when outdoors. The patients chart states that he has an allergy to grasses. Which medication will the nurse administer?

a.

Antitussive

b.

Expectorant

c.

Antihistamine

d.

Decongestant

ANS: C

Antihistamines are used for inflammation and swelling resulting from the release of histamine during an antigen antibody reaction. A grass allergy means that the patient experiences a release of histamine (antibody reaction) when exposed to the antigen, grass. Antitussive medications are for relief of cough. Expectorants are for the loosening of mucus so the patient can expel it by coughing. Decongestants would not help these symptoms as much as antihistamines.

DIF: Cognitive Level: Comprehension REF: p. 474 OBJ: 2 | 6 | 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

5. Which medication may be given to patients with allergic seasonal rhinitis who do not respond to antihistamines and sympathomimetics?

a.

Leukotrienes

b.

Mineralocorticoids

c.

Corticosteroids

d.

Cortisol

ANS: C

Corticosteroids, whether applied topically or administered systemically, have been shown to be highly effective for the treatment of allergic rhinitis. Leukotrienes, made in the body, are mediators of the inflammatory response. Mineralocorticoids do not affect allergic responses. Cortisol is not the steroid of choice for the treatment of an allergic response.

DIF: Cognitive Level: Knowledge REF: p. 474 OBJ: 3 | 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

6. What initiates the sneeze reflex?

a.

Stimulation of the vagus nerve

b.

Irritation of the nasal mucosa by foreign particulate matter

c.

Stimulation of the tonsils

d.

Enervation of the olfactory cranial nerve

ANS: B

Sneezing is a physiological reflex used by the body to clear the nasal passages of foreign matter. Stimulation of the vagus nerve, stimulation of the tonsils, and enervation of the olfactory cranial nerve are not what initiates the sneezing reflex.

DIF: Cognitive Level: Comprehension REF: p. 472 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

7. What occurs in the nasal structures when cholinergic fibers are stimulated?

a.

Dryness of mucous membranes in the nostrils

b.

Bleeding in the mucous membranes in the nostrils

c.

Production of serous and mucous secretions in the nostrils

d.

Enhanced olfactory perception in the mucous membranes of the nostrils

ANS: C

The cholinergic fibers innervate the secretory glands; when stimulated, they produce serous and mucous secretions within the nostrils. Nasal dryness is the result of treatment with anticholinergic medications. Bleeding may be a result of overtreatment with anticholinergic medications, as a result of dryness of the nasal mucous membranes. Medications tend to dull olfactory function rather than enhance it.

DIF: Cognitive Level: Comprehension REF: p. 471 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

8. What process in the antigen antibody reaction causes the symptoms of allergies?

a.

Release of antihistamines

b.

Production of antibodies

c.

Suppression of histamine

d.

Release of histamine

ANS: D

One of the major causes of symptoms associated with an allergy is the release of histamine during the antigen antibody reaction. Antihistamines suppress the symptoms of allergic reactions. Antibodies are not responsible for the allergic symptoms. Suppressing histamine diminishes the symptoms of allergies.

DIF: Cognitive Level: Comprehension REF: p. 473 OBJ: 1 | 2

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

9. Which instruction will the nurse include when teaching a patient with seasonal rhinitis and blocked nasal passages about intranasal corticosteroid therapy?

a.

Clear your nasal passage after administration.

b.

Anticipate a therapeutic benefit within 24 hours.

c.

Use a decongestant prior to administration.

d.

Report nasal burning to your health care provider.

ANS: C

Use of a decongestant just before intranasal corticosteroid administration ensures adequate penetration. The patient should clear the nasal passages before, not after, administration. The therapeutic benefit occurs after 24 hours. Nasal burning tends to resolve with continued therapy.

DIF: Cognitive Level: Application REF: p. 479 OBJ: 3 | 6 | 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

10. The clinic nurse is assessing a patient being seen for a severe allergic reaction to environmental allergens. Which symptom should the nurse prioritize as the most important?

a.

Hypotension

b.

Urticaria

c.

Dyspnea

d.

Rhinorrhea

ANS: C

Dyspnea (difficulty breathing) caused by constriction and spasm of the bronchial tubes is the priority. Hypotension (low blood pressure), urticaria (severe itching), and rhinorrhea (running nose) can occur during a severe allergic reaction, but are not the priority.

DIF: Cognitive Level: Analysis REF: p. 473 OBJ: 2

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment; Physiological Integrity

11. A college student is being seen at an outpatient clinic with reports of allergic rhinitis and conjunctivitis. The health care provider orders fexofenadine. When providing information regarding this medication, the nurse will include statements indicating that:

a.

fexofenadine is one of the least sedating antihistamines.

b.

tolerance will not develop.

c.

antihistamines are more effective if taken after histamine is released.

d.

histamine release will be prevented by this medication.

ANS: A

Fexofenadine is one of the least sedating antihistamines. Occasionally, a tolerance to antihistaminic effects will develop. Antihistamines are more effective if taken before histamine is released. Histamine release is not prevented by this medication. Symptoms are reduced.

DIF: Cognitive Level: Application REF: p. 477 OBJ: 6 | 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

12. When does allergic rhinitis occur? (Select all that apply.)

a.

Nasal mucosa become inflamed.

b.

Exposure as a result of an allergen produces inflammation.

c.

Histamine is released following allergen exposure.

d.

The weather is cold during the winter.

e.

A person has an initial exposure to an antigen.

ANS: A, B, C

Allergic rhinitis is inflammation resulting from an allergic reaction. Following allergen exposure, and with subsequent inhalation of the allergen, an antigen antibody reaction occurs, causing inflammation and swelling of the nasal passages. Histamine is released during the allergic reaction. Allergic rhinitis can occur during any season, depending on when the allergen is most abundant in the air. Allergic rhinitis occurs in patients who have experienced previous exposure to one or more allergens and have developed antibodies.

DIF: Cognitive Level: Comprehension REF: p. 473 OBJ: 2

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

13. Which action(s) is/are true of antihistamines? (Select all that apply.)

a.

Reduce inflammation locally

b.

Antagonize H1 receptors

c.

May be administered orally

d.

Are systemically distributed

e.

Reduce nasal congestion

ANS: A, B, C, D

Antihistamines reduce the symptoms of nasal itching, sneezing, rhinorrhea, lacrimation, and conjunctival itching through local and systemic actions. Antihistamines are H1 antagonists or blockers, may be administered orally, are distributed systemically, and do not reduce nasal congestion.

DIF: Cognitive Level: Knowledge REF: p. 477 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

14. The nurse is preparing education for a patient who has developed rebound nasal congestion resulting from use of topical decongestants. What information will the nurse include? (Select all that apply.)

a.

For future topical decongestant use, follow the dosage directions daily. Do not overuse.

b.

Stop the topical decongestant at once.

c.

A decrease in congestion will occur immediately.

d.

Nasal steroid solutions can be used but may take several days to reduce inflammation and congestion.

e.

Use nasal saline spray to moisturize irritated mucosa.

ANS: A, B, D, E

The best treatment for rebound nasal congestion caused by use of topical decongestants is prevention. Further use of the medication will exacerbate the nasal congestion. Nasal steroid solutions may help gradually reduce the congestion without exacerbating the symptoms. Nasal saline spray will bring comfort to the irritated nasal mucosa by moisturizing them. A decrease in the nasal congestion will occur gradually.

DIF: Cognitive Level: Application REF: p. 473 OBJ: 6 | 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

15. Which patient(s) would be able to take an alpha adrenergic decongestant safely? (Select all that apply.)

a.

24-year-old woman with allergic rhinitis

b.

18-year-old man with cold symptoms

c.

64-year-old woman with a history of heart disease

d.

70-year-old woman with glaucoma

e.

56-year-old man with prostatic hypertrophy

ANS: A, B

A 24-year-old woman with allergic rhinitis and an 18-year-old man with cold symptoms should be able to take an alpha adrenergic decongestant safely. Alpha adrenergic decongestants will stimulate alpha receptors throughout the body. Therefore, oral therapy should be prescribed with caution in patients with a history of cardiac disease, intraocular pressure, or prostatic hypertrophy.

DIF: Cognitive Level: Analysis REF: p. 474 | p. 476

OBJ: 5 | 6 | 7 TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

16. Which principle(s) will the nurse include in a teaching plan for antihistamine therapy? (Select all that apply.)

a.

It is typical to experience an increase in energy.

b.

Dietary fiber and fluids should be increased.

c.

Do not take with prescription medications unless approved by a physician.

d.

Blurred vision is an expected adverse effect.

e.

Over the counter (OTC) medications are safe to use with any currently prescribed prescription medications.

ANS: B, C, D

All histamines cause anticholinergic adverse effects such as dry mouth, constipation, and urinary retention. Therefore, fluids and fiber should be increased in the diet when taking antihistamines. It is important to seek approval from the health care provider if currently using other scheduled medications with antihistamines. Blurred vision is an adverse effect of antihistamine use; patients should be urged to use caution because their cognitive and sensory abilities are impaired. Because of the sedative effect of most antihistamines, patients feel a decrease in energy. OTC medications must be approved by the health care provider to prevent drug interactions.

DIF: Cognitive Level: Application REF: p. 475 OBJ: 6 | 7

TOP: Nursing Process Step: Planning

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

17. Which topically active aerosol steroids are highly effective for reducing sneezing, nasal itching, stuffiness, and rhinorrhea? (Select all that apply.)

a.

Beclomethasone (Beconase AQ)

b.

Prednisone (Deltasone)

c.

Fluticasone (Flonase)

d.

Flunisolide (Nasarel)

e.

Budesonide (Rhinocort Aqua)

ANS: A, C, D, E

Beclomethasone, fluticasone, flunisolide, and budesonide are drugs used to reduce sneezing, nasal itching, stuffiness, and rhinorrhea. Prednisone is not used to treat these symptoms.

DIF: Cognitive Level: Comprehension REF: p. 480 OBJ: 3 | 6 | 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

18. The nurse is providing counseling to a patient on cromolyn sodium (Nasalcrom) nasal spray. Information relayed to the patient will include that: (Select all that apply.)

a.

cromolyn must be taken immediately following exposure to the stimulus.

b.

the patient should blow the nose before nasal instillation.

c.

therapeutic effects are immediate.

d.

inhalation will cause coughing.

e.

the maximum is six sprays in each nostril daily.

ANS: B, E

Patients should blow their noses before nasal instillation. The maximum is six sprays in each nostril daily. Cromolyn must be taken before exposure to the stimulus that initiates an attack or allergic rhinitis. Therapeutic effects require regular use and are usually evident within 2 to 4 weeks. Coughing is not an expected adverse effect. The health care provider should be notified if inhalation causes coughing.

DIF: Cognitive Level: Application REF: pp. 480-481 OBJ: 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

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