A parent asks an NP which over-the-counter medication would be ...

[berenicecastro]

A parent asks an NP which over-the-counter medication would be best to give to a 5-year-old child who has a viral respiratory illness with nasal congestion and a cough. The NP should recommend which of the following?
 
  a. Diphenhydramine (Benadryl)
  b. Increased fluids with a teaspoon of honey
  c. Over-the-counter pseudoephedrine with guaifenesin (Sudafed)
  d. An antitussive/expectorant combination such as Robitussin DM

Question 2

A patient who has atrial fibrillation (AF) has been taking warfarin (Coumadin). The primary care nurse practitioner (NP) plans to change the patient's medication to dabigatran (Pradaxa). To do this safely, the NP should:
 
  a. initiate dabigatran when the patient's international normalized ratio (INR) is less than 2.
  b. start dabigatran 7 to 14 days after discontinuing warfarin.
  c. begin giving dabigatran 1 week before discontinuing warfarin.
  d. order frequent monitoring of the patient's INR after dabigatran therapy begins.

[Li Jun]

Answer to Question 1

B
Nonpharmacologic treatments are recommended for children younger than 6 years. Adequate hydration can decrease cough, thin secretions, and hydrate tissues. A teaspoon of honey has been shown to be effective in reducing cough in small children. Diphenhydramine is an antihistamine that dries nasal secretions but does not aid in decongestion. Sudafed and Robitussin are not recommended in children younger than 6 years.

Answer to Question 2

A
There are no requirements for monitoring the INR or other measures for patients taking dabigatran. When changing from warfarin, it is recommended that dabigatran be initiated when the INR is less than 2.