Answer to Question 1
ANS: C
Rebound congestion can occur when intranasal sympathomimetics are used for prolonged periods, requiring the patient to increase the frequency of doses. This can be stopped by abrupt decongestant withdrawal, which can be extremely uncomfortable. A less drastic approach is to discontinue the drug in one nostril at a time.
Rebound congestion develops when topical agents are used for longer than a few days. Restarting the spray would cause the patient to use progressively larger and more frequent doses to overcome the rebound congestion. This would not be an appropriate recommendation.
Glucocorticoids would not reverse the rebound congestion.
Intranasal sympathomimetics are appropriate for allergic rhinitis, but their use should be limited to 3 to 5 days to minimize rebound congestion.
Answer to Question 2
ANS: B
A bitter taste in the mouth occurs in about 20 of patients using azelastine nasal spray. Patients should be informed of this side effect.
Hemoptysis, cough, and increased nasal stuffiness are not common side effects.
A physician uses a portable electronic tablet to enter patient data while in the examination room.
Role-Playing a Situation in Which a Patient Is from Another Culture
ROM exercises on a patient’s wrist: flexion.
Common patient positions.
(a) Chicken pox vesicles. (b) Chicken pox on back of young patient.
Koplik spots in the mouth of a patient with measles.