The nurse is instructing a client on the proper use of an ...

[debasdf]

The nurse is instructing a client on the proper use of an intranasal decongestant. The nurse's caution about rebound effect will center primarily on:
 
  1. concerns about chest pain with repeated use.
  2. the need to minimize the drug's systemic effects.
  3. the need to count the number of sprays of medication at each application.
  4. the need to stop the medication after three to five days of use.

Question 2

Which point should the nurse include when instructing a client in the use of a budesonide (Rhinocort) nasal preparation?
 
  1. Use this preparation before your nasal decongestant.
  2. Avoid the use of ultrasonic humidifiers with this preparation.
  3. You should see improvement in your symptoms in about a week.
  4. You could experience nosebleeds.

[katkat_flores]

Answer to Question 1

Correct Answer: 4
Rationale 1: If chest pain occurs, it is unrelated to the topical preparation the client is using.
Rationale 2: This topical preparation is not systemically absorbed.
Rationale 3: Another concern is greater than the need to count the number of sprays per application.
Rationale 4: The primary concern with rebound effect is associated with an increase in congestion if the drug is used continuously for more than five days.
Global Rationale: Intranasal sympathomimetics produce few systemic effects because only minimal amounts of these drugs are absorbed in the circulation. The most serious, limiting adverse effect of the intranasal preparations is rebound congestion. In almost all patients, prolonged use causes hypersecretion of mucus and worsening nasal congestion once the drug effects wear off. This leads to a cycle of increased drug use as the condition worsens to obtain the desired effect from these drugs. Because of this rebound congestion, intranasal sympathomimetics should be used for no longer than 3 to 5 days. If chest pain occurs, it is unrelated to the topical preparation the client is using. Another concern is greater than the need to count the number of sprays per application.

Answer to Question 2

Correct Answer: 4
Rationale 1: The nasal decongestant should be used first, then the steroid.
Rationale 2: Moisture in the air can help prevent excess drying; a humidifier is a good idea.
Rationale 3: Improvement is not apparent for several weeks in most clients.
Rationale 4: Intranasal corticosteroids can cause excessive drying of the nasal mucosa, resulting in nosebleeds.
Global Rationale: In order to achieve maximum effect, decongestant nasal sprays should be used first, before a nasal steroid. Transient nasal irritation, burning, sneezing, dryness are common adverse effects of nasal steroids. Nasal ulceration leading to nosebleeds may occur. Moisture in the air can help prevent excess drying; a humidifier is a good idea. Improvement is not apparent for several weeks in most clients.

[debasdf]

Gracias!

[bblaney]

Excellent