A client taking decongestants for sinusitis reports rebound congestion after prolonged use. What action should the nurse recommend?
Increase the dose of the decongestant to combat rebound symptoms.
Add mucolytics to the treatment regimen to thin mucus production.
Stop using decongestants and consult the provider for an alternative treatment plan.
Switch to antihistamines to manage congestion temporarily.
The Correct Answer is C
A. Increase the dose of the decongestant: Escalating the dosage of a topical sympathomimetic would exacerbate the physiological dependence of the nasal mucosa on the drug. This would worsen rhinitis medicamentosa, a condition where the vasculature remains chronically dilated without the stimulant. Increasing the dose leads to a cycle of progressively severe mucosal edema.
B. Add mucolytics to the treatment regimen: Mucolytics function by breaking disulfide bonds in mucus to decrease its viscosity and facilitate clearance from the respiratory tract. While helpful for clearing secretions, they do not address the underlying localized vasodilation and tissue swelling characteristic of rebound congestion. They provide no mechanism for restoring normal nasal vascular tone.
C. Stop using decongestants and consult the provider: The primary treatment for rhinitis medicamentosa is the immediate cessation of the causative intranasal vasoconstrictor to allow the nasal mucosa to recover. A healthcare provider can then prescribe intranasal corticosteroids to manage the resulting inflammation and transition the patient to a safer therapy. This approach addresses the root cause of the congestion.
D. Switch to antihistamines: Antihistamines are primarily indicated for allergic rhinitis by blocking the H1 receptor-mediated response to allergens. They do not possess the vasoconstrictive properties needed to counteract the profound mucosal engorgement seen in rebound congestion from decongestant overuse. They are ineffective for treating drug-induced nasal vascular dysfunction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Asthma:While asthma causes wheezing due to bronchoconstriction, it does not typically cause a global decrease in breath sounds unless the attack is severe and air movement is minimal. In many cases of asthma, breath sounds are audible but adventitious. Decreased sounds suggest a more significant barrier to air transmission.
B. Normal lung function:Normal lung function is characterized by clear, vesicular breath sounds in the periphery and bronchial sounds over the larger airways. Decreased or absent breath sounds are always an abnormal finding that requires further investigation. They indicate an interruption in the normal transmission of sound through the lung tissue.
C. Bronchitis:Bronchitis typically manifests as loud, coarse rhonchi or wheezes caused by mucus and inflammation in the large airways. Breath sounds are usually present but distorted by the adventitious noises. It does not typically result in the diminished intensity of sound associated with "decreased" breath sounds.
D. Pleural effusion:The accumulation of fluid in the pleural space acts as a physical barrier that dampens the transmission of sound from the lungs to the chest wall. This results in significantly diminished or absent breath sounds over the area of the effusion. It is a classic clinical finding for this pathological state.
Correct Answer is B
Explanation
A. Adjust the timing of the dose: While adjusting the timing might help the client cope with drowsiness, it does not address the physiological cause or the discomfort of the dry mouth. It also doesn't provide a comprehensive strategy for managing the drug's predictable side effects. The nurse should prioritize symptomatic relief for the side effects.
B. Increase fluid intake to counteract dry mouth: Diphenhydramine is a first-generation antihistamine with significant anticholinergic properties, which commonly cause dry mouth and sedation. The nurse should explain that these are expected pharmacological effects. Encouraging fluids and using sugarless candy are appropriate nursing interventions to maintain comfort while the medication works.
C. Switch to antibiotics: Antibiotics are indicated for bacterial infections and have no therapeutic effect on seasonal allergies, which are an IgE-mediated hypersensitivity response. Suggesting antibiotics for allergies is medically incorrect and contributes to the global problem of antibiotic resistance. Allergic rhinitis requires antihistamines or corticosteroids.
D. Discontinue the medication immediately: Drowsiness and dry mouth are common, non-life-threatening side effects of diphenhydramine and do not usually warrant immediate discontinuation of the therapy. Unless the patient is performing safety-sensitive tasks, the nurse should first provide education on side effect management. Discontinuation should only be done after consulting a provider.
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