Chapter 41 Drugs for Disorders of the Respiratory System
MULTIPLE CHOICE
1. A patient who has narrow-angle glaucoma asks the nurse to recommend a medication to
alleviate cold symptoms such as nasal congestion and runny nose. The nurse will suggest
the patient talk to the provider about which medication? a. Azelastine (Astelin)
b. Cetirizine (Zyrtec)
c. Chlorpheniramine maleate (Chlor-Trimeton)
d. Diphenhydramine (Benadryl)
ANS A
Antihistamines have anticholinergic effects, which are contraindicated in patients with narrow-
angle glaucoma. Cetirizine and azelastin are second-generation antihistamines, with fewer
anticholinergic side effects, but azelastine is a nasal spray and is less likely to have systemic
side effects.
DIF COGNITIVE LEVEL Applying (Application) REF dm 574 TOP
NURSING PROCESS Nursing Intervention
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
2. The nurse is caring for a patient who is receiving diphenhydramine. The nurse notes that
the patient has not voided for 12 hours. What action will the nurse take? a. Encourage the
patient to drink more fluids.
b. Evaluate the bladder to check for distension.
c. Request an order for an intravenous fluid bolus.
d. Request an order for urinary catheterization.
ANS B
Diphenhydramine has anticholinergic effects, including urinary retention. The nurse should
assess for bladder distension to determine if this is the case. Encouraging the patient to drink
more fluids or giving intravenous fluids may be necessary if the patient has oliguria secondary
to dehydration. Urinary catheterization is not indicated until urinary retention has been
identified.
DIF COGNITIVE LEVEL Applying (Application) REF dm 575
TOP NURSING PROCESS Evaluation/Nursing Intervention
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
3. A patient arrives in the emergency department after developing a rash, runny nose,
and sneezing after eating strawberries. What action will the nurse expect to take first? a.
Administer diphenhydramine.
b. Administer epinephrine.
c. Assess for urinary retention.
d. Assess heart rate, respiratory rate, and lung sounds.
ANS D
, The patient probably has a food allergy, since eating strawberries is the precipitating event.
The nurse should assess cardiac and respiratory status to determine whether the patient is
developing an anaphylactic reaction. Diphenhydramine will be given for mild allergic
symptoms of rash, runny nose, and sneezing, but epinephrine must be given for anaphylaxis.
Urinary retention is a side effect of diphenhydramine and will be assessed if diphenhydramine
is given.
DIF COGNITIVE LEVEL Applying (Application) REF dm 575 TOP
NURSING PROCESS Nursing Intervention
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
4. A patient who has seasonal allergies with a runny nose during the daytime reports
increasing nighttime symptoms of coughing and sneezing that are interfering with sleep. The
provider recommends diphenhydramine (Benadryl) at bedtime. What information will the
nurse include when teaching the patient about this medication?
a. Avoid fluids at bedtime to prevent urinary retention.
b. This will help clear your daytime symptoms, too.
c. You should be able to sleep better when you take this medication.
d. You should take this medication on an empty stomach.
ANS C
A side effect of diphenhydramine is drowsiness. Patients whose nighttime symptoms clear
should be able to sleep better, especially with drowsiness side effects. Avoiding fluids does
not prevent urinary retention. The half-life of diphenhydramine is short, so drug effects will
not last through the next day. There is no need to take the medication on an empty stomach.
DIF COGNITIVE LEVEL Understanding (Comprehension) REF dm 575
TOP NURSING PROCESS Nursing Intervention Patient Teaching
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
5. The parents of a 3-year-old child tell the nurse that they are planning to give their child
diphenhydramine (Benadryl) on a flight to visit the childs grandparents to help the child
sleep during the flight. What will the nurse tell the parents about giving this drug? a.
Administer 25 mg of diphenhydramine when using to induce sleep.
b. Diphenhydramine may have the opposite effect and could cause agitation.
c. Give the diphenhydramine about 5 minutes prior to takeoff.
d. Loratadine should be used instead of diphenhydramine to minimize side effects. ANS B
Diphenhydramine can cause excitation in some children. Parents should be advised to expect
this possible side effect. The correct dose of diphenhydramine for children at this age is 6.25
mg; 25 mg would be an overdose. Oral diphenhydramine has an onset of 15 to 45 minutes.
Loratadine is a second-generation antihistamine and does not cause drowsiness.
DIF COGNITIVE LEVEL Applying (Application) REF dm 577
TOP NURSING PROCESS Nursing Intervention
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
MULTIPLE CHOICE
1. A patient who has narrow-angle glaucoma asks the nurse to recommend a medication to
alleviate cold symptoms such as nasal congestion and runny nose. The nurse will suggest
the patient talk to the provider about which medication? a. Azelastine (Astelin)
b. Cetirizine (Zyrtec)
c. Chlorpheniramine maleate (Chlor-Trimeton)
d. Diphenhydramine (Benadryl)
ANS A
Antihistamines have anticholinergic effects, which are contraindicated in patients with narrow-
angle glaucoma. Cetirizine and azelastin are second-generation antihistamines, with fewer
anticholinergic side effects, but azelastine is a nasal spray and is less likely to have systemic
side effects.
DIF COGNITIVE LEVEL Applying (Application) REF dm 574 TOP
NURSING PROCESS Nursing Intervention
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
2. The nurse is caring for a patient who is receiving diphenhydramine. The nurse notes that
the patient has not voided for 12 hours. What action will the nurse take? a. Encourage the
patient to drink more fluids.
b. Evaluate the bladder to check for distension.
c. Request an order for an intravenous fluid bolus.
d. Request an order for urinary catheterization.
ANS B
Diphenhydramine has anticholinergic effects, including urinary retention. The nurse should
assess for bladder distension to determine if this is the case. Encouraging the patient to drink
more fluids or giving intravenous fluids may be necessary if the patient has oliguria secondary
to dehydration. Urinary catheterization is not indicated until urinary retention has been
identified.
DIF COGNITIVE LEVEL Applying (Application) REF dm 575
TOP NURSING PROCESS Evaluation/Nursing Intervention
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
3. A patient arrives in the emergency department after developing a rash, runny nose,
and sneezing after eating strawberries. What action will the nurse expect to take first? a.
Administer diphenhydramine.
b. Administer epinephrine.
c. Assess for urinary retention.
d. Assess heart rate, respiratory rate, and lung sounds.
ANS D
, The patient probably has a food allergy, since eating strawberries is the precipitating event.
The nurse should assess cardiac and respiratory status to determine whether the patient is
developing an anaphylactic reaction. Diphenhydramine will be given for mild allergic
symptoms of rash, runny nose, and sneezing, but epinephrine must be given for anaphylaxis.
Urinary retention is a side effect of diphenhydramine and will be assessed if diphenhydramine
is given.
DIF COGNITIVE LEVEL Applying (Application) REF dm 575 TOP
NURSING PROCESS Nursing Intervention
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
4. A patient who has seasonal allergies with a runny nose during the daytime reports
increasing nighttime symptoms of coughing and sneezing that are interfering with sleep. The
provider recommends diphenhydramine (Benadryl) at bedtime. What information will the
nurse include when teaching the patient about this medication?
a. Avoid fluids at bedtime to prevent urinary retention.
b. This will help clear your daytime symptoms, too.
c. You should be able to sleep better when you take this medication.
d. You should take this medication on an empty stomach.
ANS C
A side effect of diphenhydramine is drowsiness. Patients whose nighttime symptoms clear
should be able to sleep better, especially with drowsiness side effects. Avoiding fluids does
not prevent urinary retention. The half-life of diphenhydramine is short, so drug effects will
not last through the next day. There is no need to take the medication on an empty stomach.
DIF COGNITIVE LEVEL Understanding (Comprehension) REF dm 575
TOP NURSING PROCESS Nursing Intervention Patient Teaching
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
5. The parents of a 3-year-old child tell the nurse that they are planning to give their child
diphenhydramine (Benadryl) on a flight to visit the childs grandparents to help the child
sleep during the flight. What will the nurse tell the parents about giving this drug? a.
Administer 25 mg of diphenhydramine when using to induce sleep.
b. Diphenhydramine may have the opposite effect and could cause agitation.
c. Give the diphenhydramine about 5 minutes prior to takeoff.
d. Loratadine should be used instead of diphenhydramine to minimize side effects. ANS B
Diphenhydramine can cause excitation in some children. Parents should be advised to expect
this possible side effect. The correct dose of diphenhydramine for children at this age is 6.25
mg; 25 mg would be an overdose. Oral diphenhydramine has an onset of 15 to 45 minutes.
Loratadine is a second-generation antihistamine and does not cause drowsiness.
DIF COGNITIVE LEVEL Applying (Application) REF dm 577
TOP NURSING PROCESS Nursing Intervention
MSC NCLEX Physiological Integrity Pharmacological and Parenteral Therapies
