Nokea
A client with allergic rhinitis is prescribed an antihistamine. The nurse instructs the client to suck on sugarless hard candy to address which of the following?
- A. Drowsiness and sedation
- B. Threkening of the bronchial secretions
- C. Altered sensation of taste
- D. Dryness of the oral mucosa and the throat
Correct Answer: D
Rationale: The nurse should instruct the client to suck on a sugarless hard candy to prevent dryness of the oral mucosa and the throat, which is a side effect of antihistamine therapy. Sucking on candy does not relieve drowsiness, sedation, and thickening of the bronchial mucosa seen with antihistamine therapy. Altered sense of taste does not occur with most antihistamines.
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A client has been prescribed a nasal decongestant for nasal stuffiness due to a common cold. The client is also taking an antidepressant that is a monoamine oxidase inhibitor. The nurse would warn the client about which of the following.
- A. Hypotension
- B. Severe headache
- C. Sedation
- D. Bradycardia
Correct Answer: B
Rationale: The nurse should warn the client of the possibility of severe headache due to an interaction between the two drugs. Such an interaction may also result in hypertensive crisis instead of hypotension. Sedation and bradycardia do not occur when an MAOI and decongestant are used together.
When describing the actions of upper respiratory system drugs, a nursing instructor explains that which of the following exerts its effect by increasing the production of secretions, thereby decreasing the viscosity? Select all that apply.
- A. Benzonatate
- B. Guaifenesin
- C. Codeine
- D. Potassium iodide
- E. Dextromethorphan
Correct Answer: A,D
Rationale: Benzonatate and potassium iodide are expectorants, which increase the production of secretions, thus making the secretions less viscous. Guaifenesin, codeine, and dextromethorphan are antitussives, which suppress cough.
A client has been prescribed a decongestant drug for congestion associated with rhinitis. When teaching the client about this drug, which of the following would the nurse include as a possible adverse reaction?
- A. Decreased pulse rate
- B. Blurred vision
- C. Drowsiness
- D. Dryness of throat
Correct Answer: B
Rationale: The nurse should inform the client that blurred vision is a possible adverse reaction of decongestant drugs. Additionally, an increased and not decreased pulse rate may also be seen. Drowsiness is not seen with decongestant usage. Dryness of the nasal mucosa and not the throat may be seen with decongestant drugs, which are used mostly as topical sprays and drops.
A client has a nursing diagnosis of Ineffective Airway Clearance. Which of the following would the nurse include in the client's plan of care? Select all that apply.
- A. Encouraging increased fluid intake
- B. Assisting the client in taking deep, diaphragmatic breaths
- C. Discouraging client movement
- D. Instructing the client to avoid coughing
- E. Encouraging the client to change positions
Correct Answer: A,B,E
Rationale: Clients should be encouraged to change positions frequently, breathe deeply, and increase fluid intake to aid in effectively clearing the airway of sputum. Coughing helps to move mucus.
Before administering an antitussive to a client, which of the following would the nurse assess? Select all that apply.
- A. Temperature
- B. Sputum presence
- C. Type of cough
- D. Bowel sounds
- E. Heart sounds
Correct Answer: A,B,C
Rationale: Vital signs, type of cough, presence of sputum, color and amount of sputum, home remedies used, and actions taken should be assessed prior to initiation of an antitussive. Bowel and heart sounds are not part of the preadministration assessment.