An older adult asks to take diphenhydramine every night as a sleep aid. What is the nurse's main concern?
Anticholinergic effects can cause confusion and falls
✓
It loses all effect after the first night
It strongly raises blood pressure at night
It causes dependence like an opioid
Correct Answer
Anticholinergic effects can cause confusion and falls
Diphenhydramine is strongly anticholinergic and sedating, and older adults clear it more slowly, so it can cause confusion, dizziness and falls; it is on lists of drugs to avoid in older adults. It loses all effect after the first night is not accurate. It strongly raises blood pressure at night is not a typical effect; hypotension is more likely. It causes dependence like an opioid is not a recognized risk of this drug.
Category: First-Generation Antihistamines
Question 2
A client asks to buy diphenhydramine for seasonal allergies. Which condition in the client's history should prompt the nurse to have the client check with the provider first?
Psoriasis
Angle-closure glaucoma
✓
Osteoarthritis
Iron deficiency anemia
Correct Answer
Angle-closure glaucoma
Diphenhydramine has strong anticholinergic effects that dilate the pupil and can trigger a rise in eye pressure in a client with angle-closure glaucoma, so the client should consult the provider before use. Psoriasis is a skin condition that does not interact with the drug's anticholinergic action. Osteoarthritis is joint wear that the drug does not worsen. Iron deficiency anemia is not affected by antihistamine use.
Category: First-Generation Antihistamines
Question 3
Why do second-generation antihistamines cause less drowsiness than first-generation drugs?
They block H2 receptors instead of H1 receptors
They are taken only at bedtime
They do not readily cross the blood-brain barrier
✓
They contain a stimulant that offsets sedation
Correct Answer
They do not readily cross the blood-brain barrier
Second-generation antihistamines act mainly on peripheral H1 receptors and enter the brain poorly, so sedation is much less common. They block H2 receptors instead of H1 receptors is wrong because allergy antihistamines block H1 receptors; H2 blockers reduce stomach acid. They are taken only at bedtime is wrong because most are taken once daily at any time. They contain a stimulant that offsets sedation is wrong because single-ingredient products contain no stimulant.
Category: Second-Generation Antihistamines
Question 4
A client taking fexofenadine also uses an antacid that contains aluminum and magnesium. What should the nurse teach?
Take them together to protect the stomach
Stop the antacid while taking fexofenadine
Take extra fexofenadine to make up the loss
Do not take the two at the same time
✓
Correct Answer
Do not take the two at the same time
Aluminum and magnesium antacids reduce fexofenadine absorption when taken together, so the doses should be taken at different times. Take them together to protect the stomach would lower the antihistamine's effect. Stop the antacid while taking fexofenadine is unnecessary when the doses are simply separated. Take extra fexofenadine to make up the loss is unsafe dosing advice that the client should never follow without the provider.
Category: Second-Generation Antihistamines
Question 5
Loratadine is used with caution in clients with which condition?
Liver or kidney impairment
✓
Hypothyroidism
Iron deficiency anemia
Osteoarthritis
Correct Answer
Liver or kidney impairment
Loratadine is cleared through the liver and kidneys, so impairment of either raises drug levels and calls for caution and provider guidance. Hypothyroidism does not alter loratadine use. Iron deficiency anemia is not a caution for this drug. Osteoarthritis has no interaction with loratadine.
Category: Second-Generation Antihistamines
Question 6
A client who takes cetirizine every day wants to add an over-the-counter nighttime cold medicine. What should the nurse advise?
Take both at double strength for faster relief
Check the label for a second antihistamine
✓
Switch to an antibiotic for the cold
Take the cold medicine with alcohol to sleep
Correct Answer
Check the label for a second antihistamine
Many combination cold products contain an antihistamine, so taking one with cetirizine can double the antihistamine and add sedation; clients should read labels and take only one antihistamine at a time. Take both at double strength for faster relief risks overdose. Switch to an antibiotic for the cold is wrong because colds are viral. Take the cold medicine with alcohol to sleep adds dangerous central nervous system depression.
Category: Antihistamine Use
Question 7
Which allergy symptoms do oral antihistamines relieve most effectively?
Severe nasal blockage alone
Wheezing from bronchospasm
Sneezing, itching and runny nose
✓
Facial pain from a sinus infection
Correct Answer
Sneezing, itching and runny nose
Histamine drives the sneezing, itching and watery drainage of allergic rhinitis, so blocking H1 receptors relieves these symptoms well. Severe nasal blockage alone responds better to a decongestant. Wheezing from bronchospasm needs a bronchodilator. Facial pain from a sinus infection calls for pain relief and, when bacterial, an antibiotic.
Category: Antihistamine Use
Question 8
Which teaching should the nurse give a client starting pseudoephedrine for nasal congestion?
Take it with coffee to boost its effect
Expect it to cause marked drowsiness
Use it in place of blood pressure medicine
Avoid taking a dose close to bedtime
✓
Correct Answer
Avoid taking a dose close to bedtime
Pseudoephedrine is a sympathomimetic that can cause restlessness and insomnia, so clients avoid taking it shortly before bed. Take it with coffee to boost its effect adds caffeine, which worsens nervousness and sleeplessness. Expect it to cause marked drowsiness is wrong because it is stimulating. Use it in place of blood pressure medicine is wrong because it can raise blood pressure.
Category: Decongestants
Question 9
Dextromethorphan labeling tells clients to ask a provider before using it for which kind of cough?
A chronic cough from smoking or asthma
✓
A cough from a common cold
A cough from minor throat irritation
A cough from inhaled irritants
Correct Answer
A chronic cough from smoking or asthma
A chronic cough, such as one from smoking, asthma or emphysema, needs evaluation and treatment of its cause, so the label tells clients to ask a provider before using dextromethorphan for it. A cough from a common cold is one of the labeled uses. A cough from minor throat irritation is also a labeled use. A cough from inhaled irritants is a labeled use as well.
Category: Nonopioid Antitussives
Question 10
Why might a topical nasal decongestant be chosen instead of an oral decongestant?
It can be used for many weeks without problems
It works quickly with little systemic effect
✓
It treats the bacterial cause of sinusitis
It prevents allergen exposure for a full season
Correct Answer
It works quickly with little systemic effect
Sprays such as oxymetazoline act directly on the nasal mucosa, so relief comes quickly and effects elsewhere in the body are minimal. It can be used for many weeks without problems is wrong because short-term use avoids rebound congestion. It treats the bacterial cause of sinusitis is wrong because decongestants only shrink swollen tissue. It prevents allergen exposure for a full season is wrong because no decongestant prevents exposure.
Category: Decongestants
Question 11
Which instruction should the nurse include when teaching a client to use a nasal decongestant spray?
Lie flat for a while after each spray
Share the bottle with family members
Blow the nose gently before spraying
✓
Sniff hard so the spray reaches the throat
Correct Answer
Blow the nose gently before spraying
Gently clearing the nose first lets the drug reach the swollen mucosa. Lie flat for a while after each spray lets the drug run down the throat. Share the bottle with family members spreads infection. Sniff hard so the spray reaches the throat sends the drug away from the nasal tissue, where it is needed, and into the throat, where it is swallowed.
Category: Decongestants
Question 12
A client using oxymetazoline nasal spray reports brief burning in the nose after each dose. How should the nurse explain this?
It signals a severe allergic reaction to the drug
It means the spray has caused high blood pressure
It shows the spray is treating a bacterial infection
Temporary burning or stinging is a common local effect
✓
Correct Answer
Temporary burning or stinging is a common local effect
Brief burning or stinging, sneezing and a short increase in nasal discharge are common local effects of topical decongestant sprays. It signals a severe allergic reaction to the drug is unlikely without hives, swelling or trouble breathing. It means the spray has caused high blood pressure is wrong because burning is a local effect. It shows the spray is treating a bacterial infection is wrong because decongestants do not kill bacteria.
Category: Decongestants
Question 13
After inhaled acetylcysteine, a client with a weak cough cannot clear the large volume of loosened secretions. What should the nurse use?
Mechanical suction
✓
A cough suppressant
An extra acetylcysteine dose
A cool-mist humidifier
Correct Answer
Mechanical suction
Acetylcysteine can greatly increase the volume of liquefied bronchial secretions, and when the cough is too weak to clear them, the airway is kept open by mechanical suction. A cough suppressant would leave even more secretions in the airway. An extra acetylcysteine dose would loosen still more mucus. A cool-mist humidifier adds moisture but cannot remove secretions.
Category: Mucolytics
Question 14
Which measure supports a client taking an antitussive for a dry, irritating cough?
Limiting fluids to dry the airway
Avoiding smoke and other airway irritants
✓
Doubling the dose if the cough continues
Lying flat right after each dose
Correct Answer
Avoiding smoke and other airway irritants
Smoke and other irritants keep the airway inflamed and worsen coughing, so avoiding them helps the drug work; extra fluids also soothe the airway. Limiting fluids to dry the airway thickens secretions and irritates the throat. Doubling the dose if the cough continues risks toxicity, and a lasting cough should be reported instead. Lying flat right after each dose offers no benefit and can worsen postnasal drainage.
Category: Nonopioid Antitussives
Question 15
A client taking an over-the-counter antihistamine for hives develops wheezing and swelling of the tongue. What should the nurse tell the client to do?
Take a second antihistamine dose
Apply a cool compress and rest
Get emergency help right away
✓
Switch to a nasal decongestant
Correct Answer
Get emergency help right away
Hives with wheezing, tongue or throat swelling or trouble swallowing can signal anaphylaxis, and hives product labeling tells clients to get emergency help at once because an antihistamine may not relieve it and does not replace a prescribed epinephrine injector. Take a second antihistamine dose delays emergency care. Apply a cool compress and rest does nothing for a swelling airway. Switch to a nasal decongestant does not treat anaphylaxis.
Category: Antihistamine Use
Question 16
Antitussives that contain codeine carry an FDA boxed warning about which risk?
Severe liver failure
Agranulocytosis
Tendon rupture
Addiction, abuse and misuse
✓
Correct Answer
Addiction, abuse and misuse
Codeine is an opioid, and codeine-containing antitussives carry a boxed warning for addiction, abuse and misuse, along with respiratory depression. Severe liver failure is the major danger of acetaminophen overdose. Agranulocytosis is a known risk of drugs such as clozapine. Tendon rupture is a boxed warning for fluoroquinolone antibiotics.
Category: Opioid Antitussives
Question 17
Why does the nurse start fall precautions for an older adult taking an opioid antitussive?
It can cause dizziness, drowsiness and hypotension
✓
It causes sudden muscle rigidity
It sharply raises the blood glucose
It blocks the sense of balance in the inner ear
Correct Answer
It can cause dizziness, drowsiness and hypotension
Older adults are more sensitive to opioids, which can cause dizziness, drowsiness and low blood pressure that raise fall risk. It causes sudden muscle rigidity is not a typical effect of these doses. It sharply raises the blood glucose is not an opioid effect. It blocks the sense of balance in the inner ear describes ototoxic drugs, not opioids.
Category: Opioid Antitussives
Question 18
Which instruction should the nurse give a client taking benzonatate?
Chew the capsule to speed relief
Swallow the capsule whole without chewing
✓
Open the capsule into applesauce
Let the capsule dissolve in the mouth
Correct Answer
Swallow the capsule whole without chewing
Benzonatate is a local anesthetic, so releasing it in the mouth can numb the mouth and throat and cause choking or a severe reaction; the capsule must be swallowed whole. Chew the capsule to speed relief releases the drug in the mouth. Open the capsule into applesauce has the same danger. Let the capsule dissolve in the mouth also numbs the throat.
Category: Nonopioid Antitussives
Question 19
A client with esophageal varices is ordered inhaled acetylcysteine to loosen thick secretions. Why should the nurse question this order?
It often raises blood pressure sharply
It suppresses the cough reflex
It commonly causes vomiting
✓
It causes severe constipation
Correct Answer
It commonly causes vomiting
Nausea and vomiting are common with acetylcysteine, and the forceful retching can rupture fragile esophageal varices or worsen peptic ulcer disease, so the drug is avoided in these clients. It often raises blood pressure sharply is wrong because acetylcysteine is not a vasopressor; tachycardia is its cardiovascular effect. It suppresses the cough reflex is wrong because a mucolytic thins mucus so it can be coughed out. It causes severe constipation is not a recognized effect of the drug.
Category: Mucolytics
Question 20
Before giving a mucolytic, which assessment should the nurse complete?
Visual acuity and color vision in both eyes
Deep tendon reflexes in the arms and legs
Skin turgor and capillary refill in the feet
Respiratory status and the amount and type of sputum
✓
Correct Answer
Respiratory status and the amount and type of sputum
Mucolytics are given to thin secretions, so the nurse assesses breathing, signs of distress and the amount and character of sputum before and during therapy. Visual acuity and color vision in both eyes are unrelated to mucolytic therapy. Deep tendon reflexes in the arms and legs are checked for drugs such as magnesium sulfate. Skin turgor and capillary refill in the feet assess hydration and circulation, not airway secretions.
Category: Mucolytics