Expectorants and Mucolytics

Every question here, with the answer

1. A client with asthma is receiving inhaled acetylcysteine. Which finding requires the nurse's immediate attention?

   1. New wheezing and shortness of breath
   2. Thinner sputum
   3. Coughing up more mucus
   4. A mild headache

   Answer: New wheezing and shortness of breath

   Clients receiving acetylcysteine, especially those with asthma, are monitored closely for bronchospasm, so new wheezing and dyspnea need immediate action. Thinner sputum and more productive coughing are the intended effect.

2. A client with a history of esophageal varices has an order for acetylcysteine for thick secretions. What should the nurse do?

   1. Give it with food to prevent all side effects.
   2. Give it; it has no gastrointestinal effects.
   3. Clarify the order because acetylcysteine commonly causes vomiting.
   4. Double the dose to shorten therapy.

   Answer: Clarify the order because acetylcysteine commonly causes vomiting.

   Acetylcysteine commonly causes vomiting and should be strictly avoided in clients with peptic ulcer disease, esophageal varices, and Mallory-Weiss tears. Giving it with food or at a higher dose does not remove the risk.

3. A client with a dry, nonproductive cough asks whether to buy guaifenesin. What should the nurse explain?

   1. Expectorants are used for productive coughs to loosen and clear mucus.
   2. Guaifenesin works only in cystic fibrosis.
   3. Guaifenesin suppresses dry coughs very well.
   4. Guaifenesin requires a prescription.

   Answer: Expectorants are used for productive coughs to loosen and clear mucus.

   Expectorants do not suppress the cough and should only be used with productive coughs to loosen and clear mucus. Guaifenesin is available over the counter and is not limited to cystic fibrosis.

4. A nurse is teaching a client who is taking an expectorant. Which instructions should be included? Select all that apply.

   1. Take the drug only for the time indicated.
   2. Report symptoms that last longer than one week.
   3. Increase deep breathing exercises.
   4. Drink fluids to help loosen secretions.
   5. Limit fluids so the mucus stays thick.

   Answer: Take the drug only for the time indicated., Report symptoms that last longer than one week., Increase deep breathing exercises., Drink fluids to help loosen secretions.

   Clients drink fluids, increase deep breathing, take the drug only as prescribed, and report symptoms lasting longer than a week. Limiting fluids works against loosening secretions.

5. In which situations might the nurse expect a mucolytic to be ordered? Select all that apply.

   1. Cystic fibrosis with thick, sticky mucus
   2. Acetaminophen toxicity
   3. Preparation for a bronchoscopy
   4. Routine tracheostomy care
   5. A dry cough from allergies

   Answer: Cystic fibrosis with thick, sticky mucus, Acetaminophen toxicity, Preparation for a bronchoscopy, Routine tracheostomy care

   Mucolytics help clients with tracheostomies, clear the airway before bronchoscopy, and thin mucus in cystic fibrosis, and acetylcysteine is also the antidote for acetaminophen toxicity. A dry allergic cough does not call for thinning mucus.

6. A client with cystic fibrosis asks how dornase alfa helps. Which response is accurate?

   1. It suppresses the cough reflex in the medulla.
   2. It kills bacteria directly.
   3. It opens the airways like a bronchodilator.
   4. It thins thick, sticky mucus, which lowers the number of lung infections.

   Answer: It thins thick, sticky mucus, which lowers the number of lung infections.

   Dornase alfa acts like a natural lung enzyme to thin thick, sticky mucus; removing mucus reduces the breeding ground for bacteria and so the number of infections. It is not a cough suppressant, antibiotic, or bronchodilator.