Chapter 36: Antihistamines, Decongestants, Antitussives, and Expectorants
Lilley: Pharmacology and the Nursing Process, 10th Edition
1. A patient with a tracheostomy has difficulty removing excessive, thick mucus
from the respiratory tract. The nurse expects that which drug will be ordered to
aid in the removal of mucus?
A. Guaifenesin
B. Benzonatate
C. Diphenhydramine
D. Dextromethorphan
Answer: A
Explanation: Guaifenesin is an expectorant that increases the water content of respiratory
tract secretions, reducing their viscosity and making them easier to expel, which is beneficial
for a patient with a tracheostomy.
2. A patient has been advised to add an adrenergic decongestant nasal spray to
treat a cold. The nurse will include which instruction?
A. –You won’t see effects for at least 1 week.I
B. –Limit use of this spray to 3 to 5 days.‖
C. –Continue the spray until nasal stuffiness has resolved.I
D. –Avoid use of this spray if a fever develops.I
Answer: B
Explanation: To prevent rebound congestion, the use of topical adrenergic decongestant
sprays should be limited to 3-5 days. Prolonged use leads to decreased effectiveness and
worsening congestion upon discontinuation.
3. During a routine checkup, a patient states that she is unable to take the
prescribed antihistamine because of one of its most common adverse effects. The
nurse suspects that which adverse effect has been bothering this patient?
A. Constipation
B. Abdominal cramps
C. Drowsiness
D. Decreased libido
Answer: C
Explanation: First-generation (sedating) antihistamines like diphenhydramine readily cross
the blood-brain barrier, causing significant drowsiness, which is their most common and
often most bothersome adverse effect.
, 4. A gardener needs a decongestant because of sinus problems and asks the nurse
whether he should take an oral form or a nasal spray. Which of these is a benefit
of orally administered decongestants?
A. Immediate onset
B. A more potent effect
C. Lack of rebound congestion
D. Shorter duration
Answer: C
Explanation: Topical nasal decongestant sprays can cause rebound congestion (rhinitis
medicamentosa) with prolonged use (>3-5 days). Oral decongestants do not cause this
localized effect, making them preferable for longer-term use.
5. When giving dextromethorphan, the nurse understands that this drug
suppresses the cough reflex by which mechanism of action?
A. Causing depression of the central nervous system
B. Anesthetizing the stretch receptors
C. Having direct action on the cough center
D. Decreasing the viscosity of the bronchial secretions
Answer: C
Explanation: Dextromethorphan is a centrally-acting antitussive. It works by directly
depressing the cough center located in the medulla of the brain stem, thereby reducing the
urge to cough.
6. A patient is taking guaifenesin as part of treatment for a sinus infection. Which
instruction will the nurse include during patient teaching?
A. Increase fluid intake to help loosen and liquefy secretions.
B. Report clear-colored sputum to the prescriber.
C. Avoid driving a car or operating heavy machinery because of the sedating effects.
D. Report symptoms that last longer than 2 days.
Answer: A
Explanation: Guaifenesin is an expectorant that helps thin respiratory secretions. Adequate
hydration enhances this effect, making it easier to clear mucus from the airways.
7. The nurse will instruct patients about a possible systemic effect that may occur if
excessive amounts of topically applied adrenergic nasal decongestants are used.
Which systemic effect may occur?
, A. Heartburn
B. Bradycardia
C. Drowsiness
D. Palpitations
Answer: D
Explanation: Topical decongestants (e.g., oxymetazoline) can be systemically absorbed,
especially with overuse. This can lead to sympathomimetic effects such as tachycardia,
palpitations, and hypertension.
8. A patient asks the nurse about the uses of the herbal product echinacea. Which
use will the nurse include in the response?
A. Memory enhancement
B. Boosting the immune system
C. Improving mood
D. Promoting relaxation
Answer: B
Explanation: Echinacea is commonly used to stimulate the immune system and is often taken
to prevent or reduce the severity of the common cold and other upper respiratory infections.
9. A patient tells the nurse that she wants to start taking the herbal product
goldenseal to improve her health. The nurse will assess for which potential
cautions or contraindications to goldenseal? (Select all that apply.)
A. Taking a proton-pump inhibitor
B. Nasal congestion
C. Hypothyroidism
D. Taking an antihypertensive drug
E. Sinus infections
F. Pregnancy
Answer: A, D, F
Explanation: Goldenseal can reduce the effectiveness of acid-suppressing drugs like PPIs. It
may counteract antihypertensive medications due to potential vasoconstrictive effects. It is
contraindicated in pregnancy because it may stimulate uterine contractions.
10. When teaching a patient who will be receiving antihistamines, the nurse will
include which instructions? (Select all that apply.)
A. –Antihistamines are generally safe to take with over-the-counter medications.I
B. –Take the medication on an empty stomach to maximize absorption of the drug.‖
Lilley: Pharmacology and the Nursing Process, 10th Edition
1. A patient with a tracheostomy has difficulty removing excessive, thick mucus
from the respiratory tract. The nurse expects that which drug will be ordered to
aid in the removal of mucus?
A. Guaifenesin
B. Benzonatate
C. Diphenhydramine
D. Dextromethorphan
Answer: A
Explanation: Guaifenesin is an expectorant that increases the water content of respiratory
tract secretions, reducing their viscosity and making them easier to expel, which is beneficial
for a patient with a tracheostomy.
2. A patient has been advised to add an adrenergic decongestant nasal spray to
treat a cold. The nurse will include which instruction?
A. –You won’t see effects for at least 1 week.I
B. –Limit use of this spray to 3 to 5 days.‖
C. –Continue the spray until nasal stuffiness has resolved.I
D. –Avoid use of this spray if a fever develops.I
Answer: B
Explanation: To prevent rebound congestion, the use of topical adrenergic decongestant
sprays should be limited to 3-5 days. Prolonged use leads to decreased effectiveness and
worsening congestion upon discontinuation.
3. During a routine checkup, a patient states that she is unable to take the
prescribed antihistamine because of one of its most common adverse effects. The
nurse suspects that which adverse effect has been bothering this patient?
A. Constipation
B. Abdominal cramps
C. Drowsiness
D. Decreased libido
Answer: C
Explanation: First-generation (sedating) antihistamines like diphenhydramine readily cross
the blood-brain barrier, causing significant drowsiness, which is their most common and
often most bothersome adverse effect.
, 4. A gardener needs a decongestant because of sinus problems and asks the nurse
whether he should take an oral form or a nasal spray. Which of these is a benefit
of orally administered decongestants?
A. Immediate onset
B. A more potent effect
C. Lack of rebound congestion
D. Shorter duration
Answer: C
Explanation: Topical nasal decongestant sprays can cause rebound congestion (rhinitis
medicamentosa) with prolonged use (>3-5 days). Oral decongestants do not cause this
localized effect, making them preferable for longer-term use.
5. When giving dextromethorphan, the nurse understands that this drug
suppresses the cough reflex by which mechanism of action?
A. Causing depression of the central nervous system
B. Anesthetizing the stretch receptors
C. Having direct action on the cough center
D. Decreasing the viscosity of the bronchial secretions
Answer: C
Explanation: Dextromethorphan is a centrally-acting antitussive. It works by directly
depressing the cough center located in the medulla of the brain stem, thereby reducing the
urge to cough.
6. A patient is taking guaifenesin as part of treatment for a sinus infection. Which
instruction will the nurse include during patient teaching?
A. Increase fluid intake to help loosen and liquefy secretions.
B. Report clear-colored sputum to the prescriber.
C. Avoid driving a car or operating heavy machinery because of the sedating effects.
D. Report symptoms that last longer than 2 days.
Answer: A
Explanation: Guaifenesin is an expectorant that helps thin respiratory secretions. Adequate
hydration enhances this effect, making it easier to clear mucus from the airways.
7. The nurse will instruct patients about a possible systemic effect that may occur if
excessive amounts of topically applied adrenergic nasal decongestants are used.
Which systemic effect may occur?
, A. Heartburn
B. Bradycardia
C. Drowsiness
D. Palpitations
Answer: D
Explanation: Topical decongestants (e.g., oxymetazoline) can be systemically absorbed,
especially with overuse. This can lead to sympathomimetic effects such as tachycardia,
palpitations, and hypertension.
8. A patient asks the nurse about the uses of the herbal product echinacea. Which
use will the nurse include in the response?
A. Memory enhancement
B. Boosting the immune system
C. Improving mood
D. Promoting relaxation
Answer: B
Explanation: Echinacea is commonly used to stimulate the immune system and is often taken
to prevent or reduce the severity of the common cold and other upper respiratory infections.
9. A patient tells the nurse that she wants to start taking the herbal product
goldenseal to improve her health. The nurse will assess for which potential
cautions or contraindications to goldenseal? (Select all that apply.)
A. Taking a proton-pump inhibitor
B. Nasal congestion
C. Hypothyroidism
D. Taking an antihypertensive drug
E. Sinus infections
F. Pregnancy
Answer: A, D, F
Explanation: Goldenseal can reduce the effectiveness of acid-suppressing drugs like PPIs. It
may counteract antihypertensive medications due to potential vasoconstrictive effects. It is
contraindicated in pregnancy because it may stimulate uterine contractions.
10. When teaching a patient who will be receiving antihistamines, the nurse will
include which instructions? (Select all that apply.)
A. –Antihistamines are generally safe to take with over-the-counter medications.I
B. –Take the medication on an empty stomach to maximize absorption of the drug.‖
