Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1 | MCQ
Clinical Scenario:
A 72-year-old female patient with a history of benign prostatic
hyperplasia, glaucoma, and hypertension presents to the clinic
with seasonal allergic rhinitis. She reports severe nasal
congestion, sneezing, and watery eyes that have been
interfering with her sleep and daily activities for the past week.
She has been using over-the-counter diphenhydramine 25 mg
every 6 hours for symptom relief but reports minimal
improvement and complains of excessive drowsiness, dry
mouth, and difficulty urinating.
Question Stem:
The nurse should anticipate that the healthcare provider will
prescribe which medication as the most appropriate first-line
treatment for this patient?
Answer Options:
A. Continue diphenhydramine and increase the dose to 50 mg
every 6 hours
B. Loratadine 10 mg orally once daily
C. Fexofenadine 180 mg orally once daily
D. Cetirizine 10 mg orally once daily
Correct Answer: C. Fexofenadine 180 mg orally once daily
,Comprehensive Rationale:
Pharmacologic Principles:
Fexofenadine is a second-generation (peripherally selective) H₁-
receptor antagonist that blocks the effects of histamine at
peripheral H₁ receptors without significant central nervous
system penetration. It is highly selective for peripheral H₁
receptors and does not cross the blood-brain barrier
appreciably, making it non-sedating.
Mechanism of Action:
Fexofenadine competitively blocks histamine binding at H₁
receptor sites, preventing the characteristic allergic response
cascade including vasodilation, increased capillary permeability,
and smooth muscle contraction in the respiratory tract. Unlike
first-generation antihistamines, it does not block muscarinic,
serotonergic, or alpha-adrenergic receptors, which accounts for
its reduced side effect profile.
Pharmacokinetics:
• Onset of action: 1-3 hours
• Peak effect: 2-3 hours
• Duration: 24 hours
• Metabolism: Minimal hepatic metabolism (approximately
5%)
, • Excretion: Primarily unchanged in feces (80%) and urine
(11%)
• Half-life: 14.4 hours
Therapeutic Considerations:
This patient requires an antihistamine that will provide effective
allergy symptom relief without exacerbating her existing
comorbidities. Fexofenadine offers several advantages:
• Non-sedating properties (does not penetrate CNS)
• No anticholinergic effects (does not worsen BPH or
glaucoma)
• No significant cardiovascular effects
• Once-daily dosing improves adherence
• Safe in older adults when prescribed at appropriate doses
Nursing Assessment Priorities:
• Evaluate severity of allergic symptoms (nasal congestion,
sneezing, rhinorrhea, ocular symptoms)
• Assess baseline vital signs, particularly blood pressure
• Review medication reconciliation for potential interactions
• Evaluate renal function (fexofenadine requires dose
adjustment in renal impairment)
• Assess patient's understanding of medication therapy
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1 | MCQ
Clinical Scenario:
A 72-year-old female patient with a history of benign prostatic
hyperplasia, glaucoma, and hypertension presents to the clinic
with seasonal allergic rhinitis. She reports severe nasal
congestion, sneezing, and watery eyes that have been
interfering with her sleep and daily activities for the past week.
She has been using over-the-counter diphenhydramine 25 mg
every 6 hours for symptom relief but reports minimal
improvement and complains of excessive drowsiness, dry
mouth, and difficulty urinating.
Question Stem:
The nurse should anticipate that the healthcare provider will
prescribe which medication as the most appropriate first-line
treatment for this patient?
Answer Options:
A. Continue diphenhydramine and increase the dose to 50 mg
every 6 hours
B. Loratadine 10 mg orally once daily
C. Fexofenadine 180 mg orally once daily
D. Cetirizine 10 mg orally once daily
Correct Answer: C. Fexofenadine 180 mg orally once daily
,Comprehensive Rationale:
Pharmacologic Principles:
Fexofenadine is a second-generation (peripherally selective) H₁-
receptor antagonist that blocks the effects of histamine at
peripheral H₁ receptors without significant central nervous
system penetration. It is highly selective for peripheral H₁
receptors and does not cross the blood-brain barrier
appreciably, making it non-sedating.
Mechanism of Action:
Fexofenadine competitively blocks histamine binding at H₁
receptor sites, preventing the characteristic allergic response
cascade including vasodilation, increased capillary permeability,
and smooth muscle contraction in the respiratory tract. Unlike
first-generation antihistamines, it does not block muscarinic,
serotonergic, or alpha-adrenergic receptors, which accounts for
its reduced side effect profile.
Pharmacokinetics:
• Onset of action: 1-3 hours
• Peak effect: 2-3 hours
• Duration: 24 hours
• Metabolism: Minimal hepatic metabolism (approximately
5%)
, • Excretion: Primarily unchanged in feces (80%) and urine
(11%)
• Half-life: 14.4 hours
Therapeutic Considerations:
This patient requires an antihistamine that will provide effective
allergy symptom relief without exacerbating her existing
comorbidities. Fexofenadine offers several advantages:
• Non-sedating properties (does not penetrate CNS)
• No anticholinergic effects (does not worsen BPH or
glaucoma)
• No significant cardiovascular effects
• Once-daily dosing improves adherence
• Safe in older adults when prescribed at appropriate doses
Nursing Assessment Priorities:
• Evaluate severity of allergic symptoms (nasal congestion,
sneezing, rhinorrhea, ocular symptoms)
• Assess baseline vital signs, particularly blood pressure
• Review medication reconciliation for potential interactions
• Evaluate renal function (fexofenadine requires dose
adjustment in renal impairment)
• Assess patient's understanding of medication therapy
