Question 1

A patient who has seasonal allergies with a runny nose during the daytime reports increasing nighttime symptoms of coughing and sneezing that are interfering with sleep.The provider recommends diphenhydramine (Benadryl)at bedtime.What information will the nurse include when teaching the patient about this medication?

A) "Avoid fluids at bedtime to prevent urinary retention."
B) "This will help clear your daytime symptoms, too."
C) "You should be able to sleep better when you take this medication."
D) "You should take this medication on an empty stomach."

"You should be able to sleep better when you take this medication."

Accepted Answer

A side effect of diphenhydramine is drowsiness.Patients whose nighttime symptoms clear should be able to sleep better,especially with drowsiness side effects.Avoiding fluids does not prevent urinary retention.The half-life of diphenhydramine is short,so drug effects will not last through the next day.There is no need to take the medication on an empty stomach.

Question 2

A patient who has narrow-angle glaucoma asks the nurse to recommend a medication to alleviate cold symptoms such as nasal congestion and runny nose.The nurse will suggest the patient talk to the provider about which medication?

A) Azelastine (Astelin)
B) Cetirizine (Zyrtec)
C) Chlorpheniramine maleate (Chlor-Trimeton)
D) Diphenhydramine (Benadryl)

Azelastine (Astelin)

Accepted Answer

Antihistamines have anticholinergic effects,which are contraindicated in patients with narrow-angle glaucoma.If one needed to choose,cetirizine and azelastine are second-generation antihistamines,with fewer anticholinergic side effects.Of the two,azelastine is a nasal spray and is less likely to have systemic side effects.

Question 3

The nurse is caring for a patient who is hospitalized for an asthma exacerbation.The patient reports taking diphenhydramine at home at night to help with symptoms of allergic rhinitis and cough.The nurse will contact the patient's provider to request an order for which medication?

A) Benzonatate (Tessalon Perles)
B) Cetirizine (Zyrtec)
C) Dextromethorphan hydrobromide (Benylin DM)
D) Diphenhydramine (Benadryl)

Cetirizine (Zyrtec)

Accepted Answer

Cetirizine is an antihistamine,which is indicated for this patient's symptoms.Diphenhydramine is also an antihistamine but,because of its anticholinergic side effects,is contraindicated in patients with asthma.Benzonatate and dextromethorphan are antitussives and not antihistamines.

Question 4

The parents of a 3-year-old child tell the nurse that they are planning to give their child diphenhydramine (Benadryl)on a flight to visit the child's grandparents to help the child sleep during the flight.What will the nurse tell the parents about giving this drug?

A) Administer 25 mg of diphenhydramine when using to induce sleep.
B) Diphenhydramine may have the opposite effect and could cause agitation.
C) Give the diphenhydramine about 5 minutes prior to takeoff.
D) Loratadine should be used instead of diphenhydramine to minimize side effects.

Accepted Answer

Diphenhydramine can cause excitation in some children.Parents should be advised to expect this possible side effect.The correct dose of diphenhydramine for children at this age is 6.25 mg; 25 mg would be an overdose.Oral diphenhydramine has an onset of 15 to 45 minutes.Loratadine is a second-generation antihistamine and does not cause drowsiness.

Question 5

A patient who has a nonproductive cough will begin taking guaifenesin to help with secretions.When teaching this patient about the medication,the nurse will provide which instruction?&#10;A) &#34;Avoid driving or using heavy machinery.&#34;&#10;B) &#34;Drink extra water while taking the medication.&#34;&#10;C) &#34;Monitor urine output closely.&#34;&#10;D) &#34;Take with an oral antihistamine for better effects.&#34;

Accepted Answer

Guaifenesin is an expectorant,and patients taking this medication should be advised to increase fluid intake to at least 8 glasses of water per day.(Remember to assess for contraindications to increasing fluid intake [e.g.,heart failure,kidney failure with dialysis,etc.].)Guaifenesin does not cause drowsiness or urinary retention.Antihistamines will dry secretions,making them harder to expectorate.

Question 6

A patient with COPD who has a persistent nonproductive cough asks about a medication that will not cause sedation.The nurse will encourage the patient to discuss which medication with the provider?&#10;A) Benzonatate HCl (Tessalon Perles)&#10;B) Dextromethorphan hydrobromide (Benylin DM)&#10;C) Guaifenesin and codeine&#10;D) Promethazine with dextromethorphan

Accepted Answer

Benzonatate HCl (Tessalon Perles)is less likely to cause sedation and is safe for patients with COPD.Dextromethorphan is contraindicated in patients with COPD.Codeine and promethazine cause sedation.

Question 7

A patient arrives in the emergency department after developing a rash,runny nose,and sneezing after eating strawberries.What action will the nurse expect to take first?&#10;A) Administer diphenhydramine.&#10;B) Administer epinephrine.&#10;C) Assess for urinary retention.&#10;D) Assess heart rate, respiratory rate, and lung sounds.

Accepted Answer

The patient probably has a food allergy,since eating strawberries is the precipitating event.The nurse should assess cardiac and respiratory status to determine whether the patient is developing an anaphylactic reaction.Diphenhydramine will be given for mild allergic symptoms of rash,runny nose,and sneezing,but epinephrine must be given for anaphylaxis.Urinary retention is a side effect of diphenhydramine and will be assessed if diphenhydramine is given.

Question 8

The patient who has nasal congestion asks the nurse to recommend a decongestant medication.The nurse performs a medication history and learns that the patient takes a beta blocker to treat hypertension.Which over-the-counter product will the nurse recommend?

A) Diphenhydramine (Benadryl)
B) Ephedrine HCl (Pretz-D)
C) Phenylephrine nasal (Neo-Synephrine Nasal)
D) Loratadine (Claritin)

Accepted Answer

Neo-Synephrine Nasal is a topical decongestant and causes less systemic side effects than ephedrine,which should not be given with beta blockers.Diphenhydramine and loratadine are antihistamines,not decongestants.

Question 9

The nurse is caring for a patient who is hospitalized for an asthma exacerbation.The patient reports taking diphenhydramine at home at night to help with symptoms of allergic rhinitis and cough.The nurse will contact the patient's provider to request an order for which medication?

A) Benzonatate (Tessalon Perles)
B) Cetirizine (Zyrtec)
C) Dextromethorphan hydrobromide (Benylin DM)
D) Diphenhydramine (Benadryl)

Accepted Answer

Diphenhydramine has anticholinergic effects,including urinary retention.The nurse should assess for bladder distension to determine if this is the case.Encouraging the patient to drink more fluids or giving intravenous fluids may be necessary if the patient has oliguria secondary to dehydration.Urinary catheterization is not indicated until urinary retention has been identified.

Question 10

A patient asks the nurse about using dextromethorphan for cough.What information will the nurse include when teaching this patient about this drug?&#10;A) &#34;It does not cause sedation except at high doses.&#34;&#10;B) &#34;It may be used to treat cough for up to 2 weeks.&#34;&#10;C) &#34;It is non-narcotic, and it is OK to consume alcohol while taking this drug.&#34;&#10;D) &#34;It should not be taken by patients who have chronic obstructive pulmonary disease (COPD).&#34;

Accepted Answer

Dextromethorphan is contraindicated in patients with COPD.It may cause sedation at low doses.If a cough lasts longer than 1 week,patients should be instructed to contact their provider and not to continue to treat with over-the-counter antitussives.Alcohol can cause excess sedation when taken with dextromethorphan.

Question 11

A patient is admitted to the hospital after developing pneumonia.During the admission assessment,the patient reports having used a nasal decongestant spray for the past few weeks but thinks the nasal congestion is getting worse.The nurse will

A) request an order for a systemic decongestant medication.
B) request an order so the patient can continue to use the decongestant spray.
C) tell the patient the congestion will clear up after stopping the spray.
D) tell the patient to increase oral fluid intake.

Accepted Answer

The answer of A patient is admitted to the hospital...

Deck 35: Upper Respiratory Disorders