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Chapter 35: Upper Respiratory Disorders
McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 10th
Edition
MULTIPLE CHOICE
1. 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.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. 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?
N
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.
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.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Evaluation/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. 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
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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.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. 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.”
ANS: C
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.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Nursing N
Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. 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.
ANS: B
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.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
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6. 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)
ANS: B
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 acute asthma. Benzonatate and dextromethorphan are
antitussives and not antihistamines.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
7. A patient is admitted to the hospital after developing pneumonia. During the admission
assessment, the patient reports having used a topical 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 eventually clear up after stopping the spray.
d. tell the patient to increase oral fluid intake.
ANS: C
N
Use of nasal decongestants longer than 3 days can cause rebound congestion. This will
eventually clear up when the decongestant spray is discontinued for several days or weeks. A
systemic decongestant is not indicated. Continuing the spray will increase the congestion.
Increasing fluid intake is not recommended.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
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 of the over-the-counter products below would be most
appropriate to recommend?
a. Diphenhydramine (Benadryl)
b. Ephedrine HCl (Pretz-D)
c. Phenylephrine nasal (Neo-Synephrine Nasal)
d. Loratadine (Claritin)
ANS: C
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.
DIF: Cognitive Level: Applying (Application)
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TOP: Nursing Process: Nursing Intervention
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9. A patient asks the nurse about using dextromethorphan for cough. Which of the following is
FALSE regarding dextromethorphan?
a. Psychosis, tachycardia and seizures are potential adverse reactions
b. It should be used with caution in patients with asthma or bronchitis
c. Dextromethorphan is administered orally
d. It is classified as an antihistamine
ANS: D
Dextromethorphan is classified as an expectorant, not an antihistamine.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
10. A patient with a persistent nonproductive cough asks about a medication that will help with
her cough but not cause sedation. The nurse will encourage the patient to discuss which
medication with the provider?
a. Benzonatate HCl (Tessalon Perles)
b. Diphenhydramine (Benadryl)
c. Guaifenesin and codeine
d. Promethazine with dextromethorphan
ANS: A
Benzonatate HCl (Tessalon Perles) is less likely to cause sedation. Diphenhydramine would
likely not help with the cough aNnd is sedating. Codeine and promethazine cause sedation.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
11. 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?
a. “Avoid driving or using heavy machinery.”
b. “Drink extra water while taking the medication.”
c. “Monitor urine output closely.”
d. “Take with an oral antihistamine for better effects.”
ANS: B
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.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
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Chapter 36: Lower Respiratory Disorders
McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 10th
Edition
MULTIPLE CHOICE
1. The nurse is caring for a patient recently diagnosed with mild emphysema and provides
teaching about the disease and medications for treatment. Which statement by the patient
indicates understanding of the medication regimen?
a. “I should use albuterol when my symptoms worsen.”
b. “I will need to take oral prednisone on a daily basis.”
c. “My provider will frequently prescribe prophylactic antibiotics.”
d. “My symptoms are reversible with proper medications.”
ANS: A
Albuterol is used to treat bronchospasm during symptom flares. Oral prednisone is given for
acute flares but not generally on a daily basis until symptoms are chronic and severe because
of the risk of adrenal suppression. Prophylactic antibiotics are not given regularly because of
the risk of antibiotic resistance. Symptoms of emphysema are not reversible.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. The nurse is preparing to administer epinephrine to a patient who is experiencing an acute
bronchospasm. The nurse understands that because epinephrine is a nonselective alpha- and
N
beta-adrenergic agonist, the patient will experience which effects?
a. Decreased blood pressure
b. Anticholinergic effects
c. A shorter duration of therapeutic effects
d. Cardiac and pulmonary effects
ANS: D
Nonselective sympathomimetic epinephrine is an alpha1, beta1, and beta2 agonist that is
given to promote bronchodilation and elevate blood pressure. It does not have anticholinergic
effects.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. A patient will be discharged home with albuterol (Proventil) to use for asthma symptoms.
What information will the nurse include when teaching this patient about this medication?
a. Failure to respond to the medication indicates a need for a higher dose.
b. Monitor for hypoglycemia symptoms when using this medication.
c. Palpitations are common with this drug even at normal, therapeutic doses.
d. Overuse of this medication can result in airway narrowing and bronchospasm.
ANS: D
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