Sherpath Chapter 8, Drugs for Allergy and Respiratory Problems: Drug Therapy for Allergy

Question 1 of 22

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Which response would the nurse provide when asked, “What causes allergies?”

• • “They occur as the body attempts to heal a disease.”Allergies are not an attempt by the body to heal a disease.
• • “They indicate a malfunction in the immune system.”The development of an allergy indicates an appropriate immune response.
• Correct
  • “They are a reaction to substances in the environment.”Allergies occur when the immune system overacts and develops a response to substances in the environment.
• • “They are a precursor to a severe respiratory condition.”Allergies do not indicate a pending severe respiratory condition.

Question 2 of 22

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Which term describes substances that initiate the immune response?

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  • AntigenLiving and nonliving substances that the body views as disease-causing or dangerous are known as antigens.
• • AntibodyAn antibody is a substance made by the body to combat an offending antigen.
• • LymphocyteLymphocytes are cells that make antibodies.
• • ImmunoglobulinImmunoglobulins are substances made by lymphocytes to defend the body against allergens.

Question 3 of 22

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Which assessment finding indicates that a histamine has been released in a patient with an allergy? Select all that apply. One, some, or all responses may be correct.

• • PainPain is not a symptom of histamine release.
• Correct
  • SwellingHistamine starts the inflammatory process when exposed to an antigen. Histamine causes swelling to occur.
• Correct
  • RednessHistamine is an internal chemical that is released in response to an antigen. Histamine causes redness to occur.
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  • Tissue irritationHistamine causes inflammation in response to an antigen. It is this chemical that causes tissue irritation.
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  • Mucus productionHistamine is released in response to an antigen. Evidence of histamine release is the production of mucus.

Question 4 of 22

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Which body chemical is released in response to an antigen that maintains the inflammatory process?

• • Mast cellsMast cells produce chemical mediators to start and continue the inflammatory process.
• Correct
  • LeukotrieneLeukotriene is a chemical mediator that works with histamine to keep the inflammatory response going after it has started.
• • LymphocyteLymphocytes produce antibodies in response to exposure to an antigen.
• • ImmunoglobulinImmunoglobulins are antibodies made by lymphocytes in response to an antigen.

Question 5 of 22

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Which antihistamine decreases allergic symptoms without causing central nervous system depression?

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  • Loratadine (Claritin)Loratadine (Claritin) is a second-generation antihistamine that decreases allergic symptoms without causing central nervous system depression.
• • Montelukast (Singulair)Montelukast (Singulair) is a leukotriene inhibitor, not an antihistamine.
• • Diphenhydramine (Benadryl)Diphenhydramine (Benadryl) is a first-generation antihistamine that decreases allergic symptoms but causes central nervous system depression.
• • Brompheniramine (Dimetapp)Brompheniramine (Dimetapp) is a first-generation antihistamine that decreases allergic symptoms but causes central nervous system depression.

Question 6 of 22

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Which medication stops the release of histamine and leukotriene during an allergic reaction?

• • Zileuton (Zyflo)Zileuton (Zyflo) is a leukotriene inhibitor that stops allergic symptoms and prevents bronchoconstriction in asthma.
• • Zafirlukast (Accolate)Zafirlukast (Accolate) is a leukotriene inhibitor that stops allergic symptoms and prevents bronchoconstriction in asthma.
• • Montelukast (Singulair)Montelukast (Singulair) is a leukotriene inhibitor that stops allergic symptoms and prevents bronchoconstriction in asthma.
• Correct
  • Nedocromil sodium (Tilade)Nedocromil sodium (Tilade) is a mast cell stabilizer that stops the release of histamine and leukotriene during an allergic reaction.

Question 7 of 22

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Which assessment finding indicates that an antihistamine is blocking a patient’s H1 receptors? Select all that apply. One, some, or all responses may be correct.

• Correct
  • Reduced eye rednessAntihistamines block histamine receptors on tissues. Blocking H1 receptors reduces blood vessel dilation, resulting in less redness of the eyes.
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  • Improved air exchangeAntihistamines block histamine receptors on tissues. Blocking H1 receptors reduces bronchoconstriction, improving air exchange.
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  • Improved nasal swellingAntihistamines block histamine receptors on tissues. Blocking H1 receptors limits swelling, which improves breathing through the nose because of less nasal swelling.
• • Reduced epigastric distressBlocking H2 receptors decreases stomach acid production, reducing epigastric distress.
• • Reduced mucus productionBlocking H2 receptors limits the release of acetylcholine, which produces a drying effect in the bronchioles and reduces mucus production.

Question 8 of 22

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Which response would the nurse make when a patient taking fexofenadine (Allegra) says, “This medication has done nothing for my stuffy nose?”

• • “The medication has to be taken with meals to be effective.”Fexofenadine (Allegra) is a second-generation antihistamine that is best absorbed on an empty stomach.
• • “The quick-dissolve tablet works when taken with a glass of water.”Quick-dissolve tablets need to dissolve to promote the best absorption. The patient should not eat or drink anything until the medication has dissolved.
• • “The medication has to be taken around the clock to be effective.”Second-generation antihistamines are taken either twice a day or once a day if in the extended-release form.
• Correct
  • “The antihistamine you are taking is second generation, which is less effective against nasal congestion.”Second-generation antihistamines are newer and usually have a more rapid onset of relief of symptoms. In general, they are less effective against nasal congestion than first-generation antihistamines.

Question 9 of 22

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Which assessment finding indicates that an older patient is experiencing anticholinergic effects from an antihistamine? Select all that apply. One, some, or all responses may be correct.

• Correct
  • Dry mouthOlder adults often have pronounced anticholinergic effects from antihistamines. These effects include a dry mouth.
• • DrowsinessDrowsiness is an expected side effect for most antihistamines.
• • Dilated pupilsDilated pupils are an expected side effect for most antihistamines.
• Correct
  • Urinary retentionOlder adults often have pronounced anticholinergic effects from antihistamines. These effects include urinary retention, especially in men.
• Correct
  • New onset of constipationOlder adults often have pronounced anticholinergic effects from antihistamines. These effects include constipation.

Question 10 of 22

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For which reason would the nurse question giving an antihistamine to a patient who is receiving streptomycin?

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  • Masks the symptoms of ototoxicityWhen antihistamines are used along with ototoxic drugs such as streptomycin, the antihistamine may relieve some of the symptoms of ototoxicity; however, important symptoms may be masked.
• • Reduces the effects of streptomycinAntihistamines do not reduce the effects of streptomycin.
• • Enhances the effects of streptomycinAntihistamines do not enhance the effects of streptomycin.
• • Potentiates the effects of the antihistamineStreptomycin does not potentiate the effects of the antihistamine.

Question 11 of 22

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For which condition would the nurse question giving a patient an antihistamine? Select all that apply. One, some, or all responses may be correct.

• Correct
  • AsthmaAntihistamines should not be taken for conditions that can be exacerbated by the actions of the medication. Asthma is a contraindication for taking antihistamines.
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  • GlaucomaAntihistamines should not be taken for conditions that can be exacerbated by the actions of the medication. Glaucoma is a contraindication for taking antihistamines because of the risk of increasing intraocular pressure.
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  • Cardiac diseaseAntihistamines should not be taken for conditions that can be exacerbated by the actions of the medication. Cardiac disease is a contraindication for taking antihistamines because of the risk of a rapid heart rate.
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  • Prostatic hypertrophyAntihistamines should not be taken for conditions that can be exacerbated by the actions of the medication. Prostatic hypertrophy is a contraindication for taking antihistamines because of the anticholinergic effects.
• Correct
  • Bladder neck obstructionAntihistamines should not be taken for conditions that can be exacerbated by the actions of the medication. Bladder neck obstruction is a contraindication for taking antihistamines because of the anticholinergic effects.

Question 12 of 22

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Which statement indicates to the nurse that teaching provided to a patient about a prescribed antihistamine was effective? Select all that apply. One, some, or all responses may be correct.

• Correct
  • “I will avoid alcohol while taking this drug.”The patient needs to avoid alcohol while taking an antihistamine because the central nervous system effects of the antihistamine may be increased.
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  • “I will not drive while taking this medication.”The patient needs to avoid tasks such as driving because antihistamines can cause drowsiness.
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  • “I will drink extra fluid while taking this medication.”The patient should increase fluids to prevent drying of the respiratory tract that occurs when using an antihistamine.
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  • “I will take the medication with food if I get an upset stomach.”The patient can take the medication with meals or milk to decrease gastric upset.
• Correct
  • “I will tell my health care provider of other medications I take.”The patient should not take any other medication without letting the health care provider know.

Question 13 of 22

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For which reason would a patient be prescribed a leukotriene modifier? Select all that apply. One, some, or all responses may be correct.

• Correct
  • AsthmaA leukotriene modifier blocks the leukotriene response and lessens or prevents the symptoms of asthma.
• • PneumoniaA leukotriene modifier is not used to treat an infection that causes pneumonia.
• • EmphysemaA leukotriene modifier is not used to treat a chronic lung condition such as emphysema.
• Correct
  • Allergic rhinitisA leukotriene modifier blocks the leukotriene response and lessens or prevents the symptoms of allergic rhinitis.
• Correct
  • BronchoconstrictionUse of these inhibitors can relax respiratory smooth muscle and increase airflow through the bronchial tubes.

Question 14 of 22

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Which medication would the nurse question giving a patient who takes a leukotriene inhibitor? Select all that apply. One, some, or all responses may be correct.

• • AspirinAspirin is not identified as causing liver dysfunction when taken with a leukotriene inhibitor.
• Correct
  • RifampinAlthough adverse reactions to the leukotriene inhibitors are rare, liver dysfunction is possible with long-term use. The leukotriene inhibitors interact with drugs that stimulate liver metabolism, such as rifampin.
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  • PhenytoinAlthough adverse reactions to the leukotriene inhibitors are rare, liver dysfunction is possible with long-term use. The leukotriene inhibitors interact with drugs that stimulate liver metabolism, such as phenytoin.
• Correct
  • PhenobarbitalAlthough adverse reactions to the leukotriene inhibitors are rare, liver dysfunction is possible with long-term use. The leukotriene inhibitors interact with drugs that stimulate liver metabolism, such as phenobarbital.
• Correct
  • CarbamazepineAlthough adverse reactions to the leukotriene inhibitors are rare, liver dysfunction is possible with long-term use. The leukotriene inhibitors interact with drugs that stimulate liver metabolism, such as carbamazepine.

Question 15 of 22

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For which reason would the nurse delay giving a patient a dose of a prescribed leukotriene inhibitor?

• • SneezingSneezing is not a reason to delay giving a dose of a leukotriene inhibitor.
• • Eating a mealSome leukotriene inhibitors can be taken with or without food.
• • Having diarrheaDiarrhea is a common side effect of leukotriene inhibitors.
• Correct
  • Experiencing an acute asthma attackLeukotriene inhibitors are not started if the patient is having an acute asthma attack. They are given as part of an asthma treatment regimen, but they will not relieve an acute attack of asthma.

Question 16 of 22

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By which route would the nurse expect to provide a mast cell stabilizer to a patient with allergies?

• • OralMast cell stabilizers are not provided as oral medications to treat allergies.
• • TopicalMast cell stabilizers are not provided as topical drugs.
• Correct
  • InhalationFor nasal allergies, mast cell stabilizers are used as inhaled drugs.
• • IntramuscularMast cell stabilizers are not given through an intramuscular injection.

Question 17 of 22

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Which outcome indicates that a sympathomimetic decongestant has been effective?

• • Productive coughSympathomimetic decongestants would reduce pulmonary secretions.
• • Edema around the eyesSympathomimetic decongestants would reduce edema around the eyes.
• Correct
  • Reduced nasal congestionSympathomimetics are drugs that produce or mimic stimulation of the sympathetic (adrenergic) nervous system and have the same action as the body’s own adrenaline. When blood vessels are stimulated by the sympathetic nervous system (alpha receptors), they shrink (constrict). After the blood vessels shrink, the secretions in the membranes of the nose can drain better, and stuffiness and pressure are relieved.
• • Production of yellow-tinged mucusYellow-tinged mucus indicates an infection. Sympathomimetic drugs are not used to treat infections.

Question 18 of 22

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For which reason would the nurse question giving a patient an inhaled corticoid decongestant?

• • The patient has nasal stuffiness.An inhaled corticosteroid decongestant would help reduce nasal stuffiness.
• • The patient is experiencing rhinorrhea.An inhaled corticosteroid decongestant would help reduce the amount of rhinorrhea.
• • The patient reports itchiness of the eyes.A corticosteroid decongestant in an oral form would help reduce the itchiness of the eyes.
• Correct
  • The patient is diagnosed with a sinus infection.Corticosteroid decongestants stabilize the membranes of the white blood cells that produce the histamine and leukotrienes causing inflammation. They work on the white blood cells that help fight infection. Therefore, they are not used for people with sinus infections.

Question 19 of 22

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Which assessment finding indicates that a patient is experiencing an adverse effect from a sympathomimetic decongestant? Select all that apply. One, some, or all responses may be correct.

• Correct
  • PalpitationsOral sympathomimetic decongestants can have adverse side effects related to mimicking the sympathetic nervous system response. The adverse effects that can be seen include palpitations.
• Correct
  • Irregular heart rateOral sympathomimetic decongestants can have adverse side effects related to mimicking the sympathetic nervous system response. The sympathetic nervous system (beta1 receptors) increases heart rate and increase the speed of electrical conduction in the heart, causing an irregular heart rate.
• • Development of thrushCorticosteroid nasal sprays can reduce the protective immune response in the nose and throat, which can cause an overgrowth of oral fungus, leading to a yeast infection, or thrush.
• Correct
  • Elevated blood pressureOral sympathomimetic decongestants can have adverse side effects related to mimicking the sympathetic nervous system response. The sympathetic nervous system (beta1 receptors)
    constricts the blood vessels, which can cause hypertension.
• Correct
  • Exacerbation of nasal stuffinessSympathomimetic nasal decongestants can cause rebound congestion if overused or used for longer than 3–5 days.

Question 20 of 22

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Which medication would the nurse question giving a patient who takes a prescribed sympathomimetic decongestant? Select all that apply. One, some, or all responses may be correct.

• Correct
  • SelegilineDrugs that interact with sympathomimetic decongestants will cause hypertension and increase the heart rate with dysrhythmias. Selegiline is one of these medications that should not be given.
• Correct
  • LinezolidDrugs that interact with sympathomimetic decongestants will cause hypertension and increase the heart rate with dysrhythmias. Linezolid is one of these medications that should not be given.
• • AntibioticAntibiotics should not be given with corticosteroid nasal sprays.
• Correct
  • ErgotamineDrugs that interact with sympathomimetic decongestants will cause hypertension and increase the heart rate with dysrhythmias. Ergotamine is one of these medications that should not be given.
• Correct
  • AmphetamineDrugs that interact with sympathomimetic decongestants will cause hypertension and increase the heart rate with dysrhythmias. An amphetamine is one of these medications that should not be given.

Question 21 of 22

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Which teaching would the nurse provide to a patient prescribed a sympathomimetic decongestant? Select all that apply. One, some, or all responses may be correct.

• Correct
  • “Do not use the nasal spray for longer than 3 days.”Nasal sprays should be used for only 3 days because of the risk of developing rebound stuffiness.
• Correct
  • “Report any palpitations to your health care provider.”Palpitations could indicate sympathetic nervous system irritation and should be reported.
• Correct
  • “Do not take this medication within 4 hours of bedtime.”Sympathomimetic decongestants can act as a stimulant and could interfere with sleep.
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  • “Do not use this medication if you have a history of an enlarged prostate.”Sympathomimetic decongestants can affect the beta1 receptors and affect an enlarged prostate.
• Correct
  • “Avoid caffeine and other stimulants while taking this medication.”Caffeine is a stimulant that will increase the heart rate and blood pressure when taken with a sympathomimetic decongestant.

Question 22 of 22

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Which statement indicates that teaching provided to a patient prescribed a corticosteroid nasal spray has been effective? Select all that apply. One, some, or all responses may be correct.

• Correct
  • “I will report any flu-like symptoms.”The patient should be instructed to report the development of flu-like symptoms as this could be an indication of immunosuppression from the corticosteroid spray.
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  • “I will report any development of a fever.”The patient should be instructed to report the development of a fever as this could be an indication of immunosuppression from the corticosteroid spray.
• Correct
  • “I will not use the nasal spray if I am prescribed an antibiotic.”A corticosteroid nasal spray should not be used with antibiotics because of the risk of developing immunosuppression.
• Correct
  • “I will report any development of white patches in my mouth.”White patches in the mouth indicate an overgrowth of oral fungus caused by immunosuppression.
• Correct
  • “I will not use the spray if my ophthalmologist tells me that I have cataracts.”Corticosteroids should not be used or taken if the patient has cataracts.