Test Bank Lehnes Pharmacotherapeutics for
Advanced Practice Nursesand Physician
Assistants 2nd Edition complete guide Q&A
.Pharmacology nursing.
LEHNE’S PHARMACOTHERAPEUTICS FOR
ADVANCED PRACTICE NURSES AND
PHYSICIAN ASSISTANTS 2ND EDITION
ROSENTHAL TEST BANK
Prescriptive Authority
Test Bank
Multiple Choice
2nd
Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Providers, Ed.
Chapter : Drugs for Allergic Rhinitis, Cough, and Colds
Test Bank Multiple Choice
• A patient who has seasonal allergies in the spring and fall asks the nurse about
oral antihistamines. Which response by the nurse is correct?
A. “Anticholinergic effects are more common with second-generation antihistamines.”
B. “First-generation antihistamines, such as diphenhydramine [Benadryl], are more
C. effective.”
D. “Make sure you take antihistamines only when you have symptoms to minimize side
E. effects.”
,F. “You should take oral antihistamines daily during each allergy season to get maximum
effects
ANS: D
Antihistamines are most effective when they are taken prophylactically, and they should
be administered on a regular basis throughout the allergy season, even when symptoms
are not present. They are less helpful when taken after symptoms appear. Second-
generation antihistamines have fewer anticholinergic effects than first-generation
antihistamines. First- generation antihistamines are not more effective than second-
generation antihistamines. Oral antihistamines are not as effective when given on a PRN
basis.DIF: Cognitive Level: ApplicationREF: p. 696TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
• A patient admitted to the hospital has been using phenylephrine nasal spray [Neo-
Synephrine], 2 sprays every 4 hours, for a week. The patient complains that the medication
is not working, because the nasal congestion has increased. What will the nurse do?
A. Request an order for an oral decongestant to replace the intranasal phenylephrine.
B. Request an order for an intranasal glucocorticoid to be used while the
phenylephrine iswithdrawn.
C. Tell the patient to increase the dose of phenylephrine to 4 sprays every 4 hours.
D. Tellthe patient to stop using the phenylephrine and begin using an intranasal
antihistamine.
This patient is experiencing rebound congestion, which develops when topical
sympathomimetics are used for longer than a few days. Abrupt withdrawal can stop the
cycle of rebound congestion but is uncomfortable, so using an intranasal glucocorticoid,
beginning 1 week before discontinuing the decongestant, while withdrawing the
decongestant, is recommended. An oral decongestant is not recommended. Increasing the
dose of the intranasal decongestant will only compound the problem of rebound
congestion. Stopping the intranasal decongestant will only increase the congestion; using
an intranasal antihistamine will not help with congestion.DIF: Cognitive Level:
ApplicationREF: p. 698TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs
Category:Physiologic Integrity: Pharmacologic and Parenteral Therapies
• A nurse provides teaching to a patient with allergic rhinitis who will begin using
anintranasal glucocorticoid. Which statement by the patient indicates understanding of the
teaching?
A. “If the glucocorticoid causes burning or itching, I should use it every other day.”
B. “I should use a decongestant if necessary before using the glucocorticoid.”
,C. “I should use the glucocorticoid whenever I have symptoms.”
D. “I will probably develop systemic effects from the topical glucocorticoid.”
E.
ANS: B
Patients using intranasal glucocorticoids should be taught to use a decongestant to
unblock nasal passages if needed before using the medication. Intranasal glucocorticoids
should be used regularly on a daily basis to achieve optimal effects and not every other day
or as needed. Systemic effects from intranasal glucocorticoids can occur but are not
likely.DIF: Cognitive Level: ApplicationREF: p. 695TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
• A patient with allergic rhinitis is taking a compound product of
loratadine/pseudoephedrine [Claritin-D] every 12 hours. The patient complains of
insomnia. The nurse notes that the patient is restless and anxious. The patient’s heart rate
is 90 beats/minute, and the blood pressure is 130/85 mm Hg. The nurse will contact the
provider to:
A. discuss using an intranasal glucocorticoid and loratadine [Claritin].
B. report acute toxicity caused by pseudoephedrine.
C. suggest using an agent with a sympathomimetic drug only.
D. suggest using a topical decongestant to minimize systemic symptoms.
ANS: A
This patient is showing central nervous system (CNS) and cardiovascular side effects of
the pseudoephedrine. A better option would be to use single-ingredient products for each
symptom; an intranasal glucocorticoid and an oral antihistamine are considered first-line
treatments. This patient is demonstrating adverse effects but not acute toxicity. Using a
sympathomimetic agent would increase the adverse effects, because pseudoephedrine is a
sympathomimetic drug. Topical decongestants are not first-line drugs for allergic
rhinitis.DIF: Cognitive Level: ApplicationREF:
p. 698TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
• child who has perennial allergic rhinitis has been using an intranasal
glucocorticoid. The provider has ordered montelukast [Singulair] to replace the
glucocorticoid because the child has frequent nosebleeds. When teaching this child’s
parents about montelukast, the nurse will include which statement?
A. “Montelukast is also effective for treating infectious rhinitis.”
B. “Montelukast may cause behavior changes in your child.”
C. “Montelukast will treat both congestion and rhinitis.”
D. “Montelukast works best when combined with a topical decongestant.”
, ANS: B
Montelukast can cause rare but serious neuropsychiatric effects in patients, and parents
should be warned of this possibility. It is not useful for treating infectious rhinitis. It does
not affect congestion. It is not necessary to add a topical decongestant when using this
drug for allergic rhinitis.DIF: Cognitive Level: ApplicationREF: p. 700TOP: Nursing
Process: Planning MSC: NCLEX Client Needs Category: Pharmacologic and Parenteral
Therapies
• patient who has a viral upper respiratory infection reports having a runny nose
and a cough that prevents sleep and asks the nurse to recommend an over-the-counter
medication. Which medication will the nurse recommend?
A. Diphenhydramine [Benadryl]
B. Fexofenadine/pseudoephedrine [Allegra-D]
C. Guaifenesin [Mucinex]
D. Phenylephrine drops
ANS: A
Diphenhydramine is effective in suppressing cough and also has sedative effects when
used in doses to suppress cough. Fexofenadine/pseudoephedrine is a combination
antihistamine/decongestant and will not help with cough. Guaifenesin helps make coughs
more productive but will not suppress cough or help with sleep. Phenylephrine drops have
decongestant properties.DIF: Cognitive Level: ApplicationREF: p. 701TOP: Nursing
Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
• child with seasonal rhinitis has used budesonide [Rhinocort Aqua] for several
years. The parents are concerned that the child’s rate of growth has slowed. What will the
nurse do?
A. Reassure the parents that this is an expected side effect.
B. Suggest that the parents discuss using fluticasone [Flonase] with the provider.
C. Tell the parents to administer the drug only when symptoms are severe.
D. Tell the parents that antihistamines work as well as intranasal glucocorticoids.
ANS: B
A worrisome systemic effect of intranasal glucocorticoids is suppression of linear growth
in children. Although rare, it can occur; however, it is less likely with fluticasone and
mometasone, so these two preparations are better options for children. Reassuring parents
that this is an expected side effect is incorrect. Intranasal glucocorticoids should be given
daily and not as needed. Antihistamines are not as effective as glucocorticoids, because
antihistamines work only against one mediator of allergic inflammation.DIF: Cognitive
Advanced Practice Nursesand Physician
Assistants 2nd Edition complete guide Q&A
.Pharmacology nursing.
LEHNE’S PHARMACOTHERAPEUTICS FOR
ADVANCED PRACTICE NURSES AND
PHYSICIAN ASSISTANTS 2ND EDITION
ROSENTHAL TEST BANK
Prescriptive Authority
Test Bank
Multiple Choice
2nd
Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Providers, Ed.
Chapter : Drugs for Allergic Rhinitis, Cough, and Colds
Test Bank Multiple Choice
• A patient who has seasonal allergies in the spring and fall asks the nurse about
oral antihistamines. Which response by the nurse is correct?
A. “Anticholinergic effects are more common with second-generation antihistamines.”
B. “First-generation antihistamines, such as diphenhydramine [Benadryl], are more
C. effective.”
D. “Make sure you take antihistamines only when you have symptoms to minimize side
E. effects.”
,F. “You should take oral antihistamines daily during each allergy season to get maximum
effects
ANS: D
Antihistamines are most effective when they are taken prophylactically, and they should
be administered on a regular basis throughout the allergy season, even when symptoms
are not present. They are less helpful when taken after symptoms appear. Second-
generation antihistamines have fewer anticholinergic effects than first-generation
antihistamines. First- generation antihistamines are not more effective than second-
generation antihistamines. Oral antihistamines are not as effective when given on a PRN
basis.DIF: Cognitive Level: ApplicationREF: p. 696TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
• A patient admitted to the hospital has been using phenylephrine nasal spray [Neo-
Synephrine], 2 sprays every 4 hours, for a week. The patient complains that the medication
is not working, because the nasal congestion has increased. What will the nurse do?
A. Request an order for an oral decongestant to replace the intranasal phenylephrine.
B. Request an order for an intranasal glucocorticoid to be used while the
phenylephrine iswithdrawn.
C. Tell the patient to increase the dose of phenylephrine to 4 sprays every 4 hours.
D. Tellthe patient to stop using the phenylephrine and begin using an intranasal
antihistamine.
This patient is experiencing rebound congestion, which develops when topical
sympathomimetics are used for longer than a few days. Abrupt withdrawal can stop the
cycle of rebound congestion but is uncomfortable, so using an intranasal glucocorticoid,
beginning 1 week before discontinuing the decongestant, while withdrawing the
decongestant, is recommended. An oral decongestant is not recommended. Increasing the
dose of the intranasal decongestant will only compound the problem of rebound
congestion. Stopping the intranasal decongestant will only increase the congestion; using
an intranasal antihistamine will not help with congestion.DIF: Cognitive Level:
ApplicationREF: p. 698TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs
Category:Physiologic Integrity: Pharmacologic and Parenteral Therapies
• A nurse provides teaching to a patient with allergic rhinitis who will begin using
anintranasal glucocorticoid. Which statement by the patient indicates understanding of the
teaching?
A. “If the glucocorticoid causes burning or itching, I should use it every other day.”
B. “I should use a decongestant if necessary before using the glucocorticoid.”
,C. “I should use the glucocorticoid whenever I have symptoms.”
D. “I will probably develop systemic effects from the topical glucocorticoid.”
E.
ANS: B
Patients using intranasal glucocorticoids should be taught to use a decongestant to
unblock nasal passages if needed before using the medication. Intranasal glucocorticoids
should be used regularly on a daily basis to achieve optimal effects and not every other day
or as needed. Systemic effects from intranasal glucocorticoids can occur but are not
likely.DIF: Cognitive Level: ApplicationREF: p. 695TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
• A patient with allergic rhinitis is taking a compound product of
loratadine/pseudoephedrine [Claritin-D] every 12 hours. The patient complains of
insomnia. The nurse notes that the patient is restless and anxious. The patient’s heart rate
is 90 beats/minute, and the blood pressure is 130/85 mm Hg. The nurse will contact the
provider to:
A. discuss using an intranasal glucocorticoid and loratadine [Claritin].
B. report acute toxicity caused by pseudoephedrine.
C. suggest using an agent with a sympathomimetic drug only.
D. suggest using a topical decongestant to minimize systemic symptoms.
ANS: A
This patient is showing central nervous system (CNS) and cardiovascular side effects of
the pseudoephedrine. A better option would be to use single-ingredient products for each
symptom; an intranasal glucocorticoid and an oral antihistamine are considered first-line
treatments. This patient is demonstrating adverse effects but not acute toxicity. Using a
sympathomimetic agent would increase the adverse effects, because pseudoephedrine is a
sympathomimetic drug. Topical decongestants are not first-line drugs for allergic
rhinitis.DIF: Cognitive Level: ApplicationREF:
p. 698TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
• child who has perennial allergic rhinitis has been using an intranasal
glucocorticoid. The provider has ordered montelukast [Singulair] to replace the
glucocorticoid because the child has frequent nosebleeds. When teaching this child’s
parents about montelukast, the nurse will include which statement?
A. “Montelukast is also effective for treating infectious rhinitis.”
B. “Montelukast may cause behavior changes in your child.”
C. “Montelukast will treat both congestion and rhinitis.”
D. “Montelukast works best when combined with a topical decongestant.”
, ANS: B
Montelukast can cause rare but serious neuropsychiatric effects in patients, and parents
should be warned of this possibility. It is not useful for treating infectious rhinitis. It does
not affect congestion. It is not necessary to add a topical decongestant when using this
drug for allergic rhinitis.DIF: Cognitive Level: ApplicationREF: p. 700TOP: Nursing
Process: Planning MSC: NCLEX Client Needs Category: Pharmacologic and Parenteral
Therapies
• patient who has a viral upper respiratory infection reports having a runny nose
and a cough that prevents sleep and asks the nurse to recommend an over-the-counter
medication. Which medication will the nurse recommend?
A. Diphenhydramine [Benadryl]
B. Fexofenadine/pseudoephedrine [Allegra-D]
C. Guaifenesin [Mucinex]
D. Phenylephrine drops
ANS: A
Diphenhydramine is effective in suppressing cough and also has sedative effects when
used in doses to suppress cough. Fexofenadine/pseudoephedrine is a combination
antihistamine/decongestant and will not help with cough. Guaifenesin helps make coughs
more productive but will not suppress cough or help with sleep. Phenylephrine drops have
decongestant properties.DIF: Cognitive Level: ApplicationREF: p. 701TOP: Nursing
Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
• child with seasonal rhinitis has used budesonide [Rhinocort Aqua] for several
years. The parents are concerned that the child’s rate of growth has slowed. What will the
nurse do?
A. Reassure the parents that this is an expected side effect.
B. Suggest that the parents discuss using fluticasone [Flonase] with the provider.
C. Tell the parents to administer the drug only when symptoms are severe.
D. Tell the parents that antihistamines work as well as intranasal glucocorticoids.
ANS: B
A worrisome systemic effect of intranasal glucocorticoids is suppression of linear growth
in children. Although rare, it can occur; however, it is less likely with fluticasone and
mometasone, so these two preparations are better options for children. Reassuring parents
that this is an expected side effect is incorrect. Intranasal glucocorticoids should be given
daily and not as needed. Antihistamines are not as effective as glucocorticoids, because
antihistamines work only against one mediator of allergic inflammation.DIF: Cognitive
