Chapter 36: Antihistamines, Decongestants, Antitussives, and Expectorants

Multiple Choice

1. When giving dextromethorphan, the nurse understands that this drug suppresses the cough reflex by which mechanism of action?

a. Causing depression of the central nervous system b. Anesthetizing the stretch receptors c. Having direct action on the cough center d. Decreasing the viscosity of the bronchial secretions

ANS: C

Dextromethorphan suppresses the cough reflex through a direct action on the cough center. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Constipation b. Abdominal cramps c. Drowsiness d. Decreased libido

2. During a routine checkup, a patient states that she is unable to take the prescribed antihistamine because of one of its most common adverse effects. The nurse suspects that which adverse effect has been bothering this patient?

ANS: C

Drowsiness is usually the chief complaint of people who take antihistamines.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Immediate onset b. A more potent effect c. Lack of rebound congestion d. Shorter duration

3. A gardener needs a decongestant because of seasonal allergy problems and asks the nurse whether he should take an oral form or a nasal spray. Which of these is a benefit of orally administered decongestants?

ANS: C

Drugs administered by the oral route produce prolonged decongestant effects, but the onset of action is more delayed and the effect less potent than those of decongestants applied topically. However, the clinical problem of rebound congestion associated with topically administered drugs is almost nonexistent with oral dosage forms.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Force fluids to help loosen and liquefy secretions. b. Report clear-colored sputum to the prescriber. c. Avoid driving a car or operating heavy machinery because of the sedating effects. d. Report symptoms that last longer than 2 days.

4. A patient is taking guaifenesin (Humibid) as part of treatment for a sinus infection. Which instruction will the nurse include during patient teaching?

ANS: A

Forcing fluids helps to loosen and liquefy secretions. The patient must be fully aware that any fever, chest tightness, change in sputum from clear to colored, difficult or noisy breathing, activity intolerance, or weakness needs to be reported. The patient must also report to the prescriber a fever of higher than 100.4° F (38° C) or symptoms that last longer than 3 to 4 days. Decongestants do not cause sedation, and therefore the patient does not need to avoid driving a car or operating heavy machinery.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort a. Heartburn b. Bradycardia c. Drowsiness d. Palpitations

5. The nurse will instruct patients about a possible systemic effect that may occur if excessive amounts of topically applied adrenergic nasal decongestants are used. Which systemic effect may occur?

ANS: D

Although a topically applied adrenergic nasal decongestant can be absorbed into the bloodstream, the amount absorbed is usually too small to cause systemic effects at normal dosages. Excessive dosages of these medications, however, are more likely to cause systemic effects elsewhere in the body. These may include cardiovascular effects, such as hypertension and palpitations, and central nervous system effects such as headache, nervousness, and dizziness. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Guaifenesin (Humibid) b. Benzonatate (Tessalon Perles) c. Diphenhydramine (Benadryl) d. Dextromethorphan (Robitussin DM)

6. A patient with a tracheostomy has difficulty removing excessive, thick mucus from the respiratory tract. The nurse expects that which drug will be ordered to aid in the removal of mucus?

ANS: A

Expectorants such as guaifenesin work to loosen and thin sputum and the bronchial secretions, thereby indirectly diminishing the tendency to cough. The other drugs listed do not have this effect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. “You won’t see effects for at least 1 week.” b. “Limit use of this spray to 3 to 5 days.” c. “Continue the spray until nasal stuffiness has resolved.” d. “Avoid use of this spray if a fever develops.”

7. A patient has been advised to add a nasal spray (an adrenergic decongestant) to treat a cold. The nurse will include which instruction?

ANS: B

Frequent, long-term, or excessive use of adrenergic nasal decongestants may lead to rebound congestion if used beyond the recommended time. The other instructions are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Memory enhancement b. Boosting the immune system c. Improving mood d. Promoting relaxation

8. A patient asks the nurse about the uses of echinacea. Which use will the nurse include in the response?

ANS: B

Common uses of echinacea include stimulation of the immune system, antisepsis, treatment of viral infections and influenza-like respiratory tract infections, and promotion of the healing of wounds and chronic ulcerations. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Multiple Response

1. When teaching a patient who will be receiving antihistamines, the nurse will include which instructions? (Select all that apply.)

a. “Antihistamines are generally safe to take with over-the-counter medications.” b. “Take the medication on an empty stomach to maximize absorption of the drug.” c. “Take the medication with food to minimize gastrointestinal distress.” d. “Drink extra fluids if possible.” e. “Antihistamines may cause restlessness and disturbed sleep.” f. “Avoid activities that require alertness until you know how adverse effects are tolerated.”

ANS: C, D, F

Antihistamines should be taken with food, even though this slightly reduces the absorption of the drug, so as to minimize the gastrointestinal upset that can occur. Over-the-counter medications must not be taken with an antihistamine unless approved by the physician because of the serious drug interactions that may occur. Drinking extra fluids will help to ease the removal of secretions, and activities that require alertness, such as driving, must not be engaged in until the patient knows how he or she responds to the sedating effects of antihistamines.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Taking a proton-pump inhibitor b. Nasal congestion c. Hypothyroidism d. Hypertension e. Sinus infections f. Pregnancy

2. A patient tells the nurse that she wants to start taking the herbal product goldenseal to improve her health. The nurse will assess for which potential cautions or contraindications to goldenseal?

(Select all that apply.)

ANS: A, D, F

Goldenseal is contraindicated in patients with acute or chronic gastrointestinal disorders and during pregnancy (because it has uterine stimulant properties). It should be used with caution by those with cardiovascular disorders. Potential drug interactions may occur with gastric acid suppressors such as antacids, histamine H2 blockers (e.g., ranitidine), and proton pump inhibitors (e.g., omeprazole), theoretically because of their reduced effectiveness resulting from the acidpromoting effect of the herb, and with antihypertensive drugs (because of the vasoconstrictive activity of the herb). Goldenseal is potentially useful for sinus infections and chronic nasal allergies.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

Completion

1. A child will be receiving diphenhydramine (Benadryl), 5 mg/kg/day, in divided doses, every 6 hours. The child weighs 80 pounds. Identify how many milligrams of medication will the child receive with each dose. (record answer using one decimal place) _______

ANS:

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A patient will be receiving diphenhydramine (Benadryl) via a PEG tube, 25 mg, every 8 hours for an allergic rash. The medication is available as a 12.5 mg/5 mL syrup. Identify how many milliliters will the nurse administer with each dose.

ANS:

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies