NUR 378: EXAM 2
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 Having direct action on the cough center
Dextromethorphan suppresses the cough reflex through a direct action on the cough center. The
other options are incorrect.
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?
a. Constipation
b. Abdominal cramps
c. Drowsiness
d. Decreased libido - ANS Drowsiness
Drowsiness is usually the main side effect that bothers people who take antihistamines.
A gardener needs a decongestant because of sinus 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?
a. Immediate onset
b. A more potent effect
c. Lack of rebound congestion
d. Shorter duration - ANS c. Lack of rebound congestion
,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.
A patient is taking guaifenesin as part of treatment for a sinus infection. Which instruction will the
nurse include during patient teaching?
a. Increase fluid intake 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. - ANS Increase fluid intake to help loosen and
liquefy secretions.
Increasing fluid intake 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.
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?
a. Heartburn
b. Bradycardia
c. Drowsiness
d. Palpitations - ANS Palpitations
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.
,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?
a. Guaifenesin
b. Benzonatate
c. Diphenhydramine
d. Dextromethorphan - ANS Guaifenesin
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.
A patient has been advised to add an adrenergic decongestant nasal spray to treat a cold. The nurse
will include which instruction?
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." - ANS "Limit use of this spray to 3 to 5 days."
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.
A patient asks the nurse about the uses of the herbal product echinacea. Which use will the nurse
include in the response?
a. Memory enhancement
b. Boosting the immune system
c. Improving mood
d. Promoting relaxation - ANS Boosting the immune system
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.
, 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 ANS: C, D, F
c. "Take the medication with food to minimize gastrointestinal distress."
d. "Drink extra fluids if possible."
f. "Avoid activities that require alertness until you know how adverse effects are
tolerated."
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. OTC 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.
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.)
a. Taking a proton-pump inhibitor
b. Nasal congestion
c. Hypothyroidism
d. Taking an antihypertensive drug
e. Sinus infections
f. Pregnancy - ANS ANS: A, D, F
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 Having direct action on the cough center
Dextromethorphan suppresses the cough reflex through a direct action on the cough center. The
other options are incorrect.
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?
a. Constipation
b. Abdominal cramps
c. Drowsiness
d. Decreased libido - ANS Drowsiness
Drowsiness is usually the main side effect that bothers people who take antihistamines.
A gardener needs a decongestant because of sinus 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?
a. Immediate onset
b. A more potent effect
c. Lack of rebound congestion
d. Shorter duration - ANS c. Lack of rebound congestion
,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.
A patient is taking guaifenesin as part of treatment for a sinus infection. Which instruction will the
nurse include during patient teaching?
a. Increase fluid intake 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. - ANS Increase fluid intake to help loosen and
liquefy secretions.
Increasing fluid intake 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.
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?
a. Heartburn
b. Bradycardia
c. Drowsiness
d. Palpitations - ANS Palpitations
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.
,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?
a. Guaifenesin
b. Benzonatate
c. Diphenhydramine
d. Dextromethorphan - ANS Guaifenesin
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.
A patient has been advised to add an adrenergic decongestant nasal spray to treat a cold. The nurse
will include which instruction?
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." - ANS "Limit use of this spray to 3 to 5 days."
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.
A patient asks the nurse about the uses of the herbal product echinacea. Which use will the nurse
include in the response?
a. Memory enhancement
b. Boosting the immune system
c. Improving mood
d. Promoting relaxation - ANS Boosting the immune system
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.
, 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 ANS: C, D, F
c. "Take the medication with food to minimize gastrointestinal distress."
d. "Drink extra fluids if possible."
f. "Avoid activities that require alertness until you know how adverse effects are
tolerated."
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. OTC 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.
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.)
a. Taking a proton-pump inhibitor
b. Nasal congestion
c. Hypothyroidism
d. Taking an antihypertensive drug
e. Sinus infections
f. Pregnancy - ANS ANS: A, D, F
