STUVIA 2024/2025
Chapter 35: Upper Respiratory Disorders
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 that is available as a nasal spray?
a. Azelastine (Astelin)
b. Cetirizine (Zyrtec)
c. Chlorpheniramine maleate (Chlor-Trimeton)
d. Diphenhydramine (Benadryl) - ✔✔ANS: A
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.
The nurse is caring for a patient who is receiving diphenhydramine. The nurse notes that the patient
has not voided for 12 hours. What action will the nurse take?
a. Encourage the patient to drink more fluids.
b. Evaluate the bladder to check for distension.
c. Request an order for an intravenous fluid bolus.
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d. Request an order for urinary catheterization. - ✔✔ANS: B
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 diagnosed.
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?
a. Administer diphenhydramine.
b. Administer epinephrine.
c. Assess for urinary retention.
d. Assess heart rate, respiratory rate, and lung sounds. - ✔✔ANS: D
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.
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