What intervention is appropriate for a patient experiencing respiratory alkalosis?

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.

A. Auscultation: This technique allows the nurse to identify diminished or absent breath sounds over the area where fluid has displaced lung tissue. While auscultation is vital for assessing ventilation, it does not provide the same structural information as percussion regarding the density of the space. It helps localize the area of decreased air entry.

B. Inspection: Visual assessment can reveal asymmetrical chest expansion or a bulging of the intercostal spaces in very large effusions. However, inspection is a superficial technique that cannot confirm the presence of internal fluid within the pleural cavity. It is a preliminary step that requires more specific follow-up.

C. Palpation: The nurse uses palpation to assess for tactile fremitus, which is typically decreased over a pleural effusion because fluid blocks sound transmission. While useful, palpation is subjective and less definitive than percussion for identifying fluid boundaries. It is often used to supplement other physical exam findings.

D. Percussion: This technique involves tapping the chest wall to produce sounds that reflect the density of the underlying structures. A dull or flat percussion note is a classic finding when fluid replaces the normally resonant, air-filled lung tissue. It is the most specific physical assessment for identifying pleural fluid.