Transcript
Chapter 15: Upper Respiratory Agents
Test Bank
MULTIPLE CHOICE
1. A patient tells a nurse practitioner (NP) that several coworkers have upper respiratory infections and asks about the best way to avoid getting sick. The NP should recommend which of the following?
a.
Echinacea
b.
Frequent hand washing
c.
Zinc gluconate supplements
d.
Normal saline nasal irrigation
ANS: B
Hand washing is the most effective way to prevent the spread of viral upper respiratory illness (VURI). Echinacea has not been shown to be effective in preventing VURI. Zinc gluconate may decrease the duration of a VURI if taken within 24 hours of onset, but it does not prevent infection. Normal saline irrigation is helpful for symptomatic relief after a VURI has begun.
DIF: Cognitive Level: Applying (Application) REF: 189
2. A patient comes to the clinic with a 3-day history of fever and a severe cough that interferes with sleep. The patient asks the NP about using a cough suppressant to help with sleep. The NP should:
a.
order a narcotic antitussive to suppress cough.
b.
obtain a thorough history of the patient?s symptoms.
c.
suggest that the patient try a guaifenesin-only over-the-counter product.
d.
prescribe an antibiotic to treat the underlying cause of the patient?s cough.
ANS: B
It is important to determine the underlying disorder that is causing the cough to rule out serious causes of cough. The NP should obtain a thorough history before prescribing any treatment. A narcotic antitussive may be used after serious causes are ruled out. Guaifenesin may be used to make nonproductive coughs more productive. Antibiotics are indicated only for a proven bacterial infection.
DIF: Cognitive Level: Applying (Application) REF: 192
3. An NP prescribes azelastine for a patient who has allergic rhinitis. The NP will teach the patient that this drug:
a.
may cause a bitter aftertaste.
b.
will not provide maximum relief for a few weeks.
c.
will cause rebound congestion if withdrawn suddenly.
d.
can cause many systemic side effects such as drowsiness.
ANS: A
Azelastine is a topical antihistamine with few adverse systemic side effects. Patients may experience relief from symptoms within 30 minutes. Decongestants can cause rebound congestion if withdrawn suddenly. Topical antihistamines rarely cause systemic side effects.
DIF: Cognitive Level: Applying (Application) REF: 198
4. A parent asks an NP which over-the-counter medication would be best to give to a 5-year-old child who has a viral respiratory illness with nasal congestion and a cough. The NP should recommend which of the following?
a.
Diphenhydramine (Benadryl)
b.
Increased fluids with a teaspoon of honey
c.
Over-the-counter pseudoephedrine with guaifenesin (Sudafed)
d.
An antitussive/expectorant combination such as Robitussin DM
ANS: B
Nonpharmacologic treatments are recommended for children younger than 6 years. Adequate hydration can decrease cough, thin secretions, and hydrate tissues. A teaspoon of honey has been shown to be effective in reducing cough in small children. Diphenhydramine is an antihistamine that dries nasal secretions but does not aid in decongestion. Sudafed and Robitussin are not recommended in children younger than 6 years.
DIF: Cognitive Level: Applying (Application) REF: 198
5. A child with chronic allergic symptoms uses an intranasal steroid for control of symptoms. At this child?s annual well-child checkup, the NP should carefully review this child?s:
a.
urinalysis.
b.
blood pressure.
c.
height and weight.
d.
liver function tests.
ANS: C
Intranasal corticosteroids can cause growth suppression in children. When using intranasal steroids in children, the lowest dosage should be used for the shortest period of time necessary, and growth should be routinely monitored. It is not necessary to evaluate urine, blood pressure, or liver function because of intranasal steroid use.
DIF: Cognitive Level: Applying (Application) REF: 191
6. An NP sees a patient who reports persistent seasonal symptoms of rhinorrhea, sneezing, and nasal itching every spring unrelieved with diphenhydramine (Benadryl). The NP should prescribe:
a.
azelastine (Astelin).
b.
triamcinolone (Nasacort AQ).
c.
phenylephrine (Neo-Synephrine).
d.
cromolyn sodium (Nasalcrom).
ANS: B
According to randomized controlled trials in patients with allergic rhinitis, oral antihistamines are used first to help control itching, sneezing, rhinorrhea, and stuffiness in most patients. Intranasal corticosteroids are indicated for patients who do not respond to antihistamines. Azelastine is a topical antihistamine. Phenylephrine is a decongestant, and this patient does not have congestion. Cromolyn sodium is less effective than intranasal corticosteroids.
DIF: Cognitive Level: Applying (Application) REF: 188 - 189
7. A 70-year-old patient asks an NP about using diphenhydramine (Benadryl) to control intermittent allergic symptoms that include runny nose and sneezing. The NP should counsel this patient to:
a.
take the lowest recommended dose initially.
b.
monitor for hypertension while taking the drug.
c.
take the antihistamine with a decongestant for best effect.
d.
watch for symptoms of paradoxical excitation with this medication.
ANS: A
Antihistamines are more likely to cause excessive sedation, syncope, dizziness, confusion, and hypotension in elderly patients; a decrease in dose is usually necessary. Hypotension is likely; there is no need to monitor for hypertension. This patient does not have symptoms of congestion. Paradoxical excitation occurs in some young children but is not an identified risk in elderly patients.
DIF: Cognitive Level: Applying (Application) REF: 191
8. A patient asks an NP about using an oral over-the-counter decongestant medication for nasal congestion associated with a viral upper respiratory illness. The NP learns that this patient uses loratadine (Claritin), a b-adrenergic blocker, and an intranasal corticosteroid. The NP would be concerned about which adverse effects?
a.
Liver toxicity
b.
Excessive drowsiness
c.
Rebound congestion
d.
Tremor, restlessness, and insomnia
ANS: D
b-Adrenergic blockers and monoamine oxidase inhibitors may potentiate the effects of decongestants, such as tremor, restlessness, and insomnia. Liver toxicity, excessive drowsiness, and rebound congestion are not known adverse effects of drug interactions.
DIF: Cognitive Level: Analyzing (Analysis) REF: 195
