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    Ati lpn med surg midterm proctored exam

    A client taking decongestants for sinusitis reports rebound congestion after prolonged use. What action should the nurse recommend?

    Explanation & Rationale

    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.

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