Chapter 70: Chronic Nasal Congestion and Discharge Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient reports persistent nasal blockage, nasal discharge, and facial pain lasting on the right side for the past 5 months. There is no history of sneezing or eye involvement. The patient has a history of seasonal allergies and takes a non-sedating antihistamine. What does the provider suspect is the cause of these symptoms?

a. Allergic rhinitis b. Autoimmune vasculitides c. Chronic rhinosinusitis d. Rhinitis medicamentosa

ANS: C a. Intranasal corticosteroids b. Oral decongestants c. Systemic corticosteroids d. Topical decongestants

Chronic rhinosinusitis is present when symptoms occur longer than 12 weeks. Sneezing and itchy, watery eyes tend to occur with allergic rhinitis. Autoimmune vasculitides affects upper and lower respiratory tracts as well as the kidneys. Rhinitis medicamentosa occurs with use of nasal decongestants and not oral antihistamines.

2. A provider determines that a patient has chronic rhinosinusitis without nasal polyps. What is the first-line treatment for this condition?

ANS: A

NURSINGTB.COM a. Intranasal corticosteroids b. Prophylactic antibiotics c. Saline lavage d. Topical decongestants

Intranasal corticosteroids are the mainstay of treatment for CRS. Oral decongestants should be used sparingly, only when symptoms are intolerable. Topical decongestants can cause rebound symptoms. Systemic steroids are not indicated.

3. A pregnant woman develops nasal congestion with chronic nasal discharge. What is the recommended treatment for this patient?

ANS: C

Saline lavage is recommended for pregnancy rhinitis; the condition will resolve after delivery. There is no human data on the safety of intranasal corticosteroids during pregnancy. Prophylactic antibiotics are not indicated; this is not an infectious condition. Topical decongestants can cause rebound symptoms.