Review Practice Exercise 1

Acute Respiratory Disorders > Adult Health

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Practice Exercise 1

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Total Questions : 4

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Question 1:

A nurse teaches a client with intermittent allergic rhinitis that which of the following interventions is the most effective way to decrease allergic symptoms?

A. Undergo weekly immunotherapy. B. Identify and avoid triggers of the allergic reaction. C. Use cromolyn nasal spray prophylactically year-round. D. Use over-the-counter antihistamines and decongestants during an acute attack.

Answer and Explanation

Choice A:

Undergo weekly immunotherapy. Immunotherapy can modify the immune response to allergens over time, but it is a long-term strategy that requires months to years of therapy and is not the most immediately effective intervention for symptom reduction in intermittent allergic rhinitis.

Choice B:

Identify and avoid triggers of the allergic reaction. Avoidance of allergens directly reduces exposure to the inciting antigens, preventing activation of mast cells and subsequent release of histamine and other inflammatory mediators. This intervention addresses the root cause of intermittent allergic rhinitis and is the most effective method to decrease the frequency and severity of symptoms.

Choice C:

Use cromolyn nasal spray prophylactically year-round. Cromolyn sodium stabilizes mast cells and prevents mediator release, but it is less effective than allergen avoidance and must be used frequently and consistently before allergen exposure. Year-round use is not always practical or necessary for intermittent symptoms.

Choice D:

Use over-the-counter antihistamines and decongestants during an acute attack. These medications provide symptomatic relief but do not prevent allergic reactions or reduce long-term symptom frequency. They are adjunctive rather than primary interventions for controlling allergic rhinitis.

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Question 2:

A nurse teaches a client with allergic rhinitis who reports severe nasal congestion, sneezing, and watery, itchy eyes and nose at various times of the year about symptom control. Which instruction should the nurse include?

A. Avoid all intranasal sprays and oral antihistamines. B. Limit the usage of nasal decongestant spray to 10 days. C. Use oral decongestants at bedtime to prevent symptoms during the night. D. Keep a diary of when the allergic reaction occurs and what precipitates it.

Answer and Explanation

Choice A:

Avoid all intranasal sprays and oral antihistamines. This is incorrect because pharmacologic treatments such as intranasal corticosteroids and oral antihistamines are effective for controlling symptoms. Complete avoidance of these medications may lead to uncontrolled allergic reactions and reduced quality of life.

Choice B:

Limit the usage of nasal decongestant spray to 10 days. While limiting decongestant use is important to prevent rebound congestion (rhinitis medicamentosa), this instruction addresses only one type of medication, not the overall symptom control strategy.

Choice C:

Use oral decongestants at bedtime to prevent symptoms during the night. Oral decongestants may help with nasal congestion, but they do not target the underlying allergic response. Additionally, using them at night can cause insomnia or cardiovascular side effects, making this a less safe and less effective recommendation.

Choice D:

Keep a diary of when the allergic reaction occurs and what precipitates it. Tracking symptom patterns and associated triggers allows the client and healthcare provider to identify specific environmental or seasonal allergens. This information supports individualized interventions, including avoidance strategies and targeted pharmacologic therapy, thereby improving symptom management and reducing unnecessary medication use.

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Question 3:

A nurse is teaching a client with allergic rhinitis about trigger avoidance. Which environmental factor is most likely to worsen allergic rhinitis?

A. Sudden temperature changes B. Exposure to pollen C. Strong emotional stress D. Cold, dry air

Answer and Explanation

Choice A:

Sudden temperature changes. Rapid temperature fluctuations may trigger vasomotor rhinitis or transient nasal irritation, but they do not activate IgE-mediated allergic pathways and are less likely to produce the full spectrum of allergic rhinitis symptoms.

Choice B:

Exposure to pollen. Pollen contains proteins recognized by IgE antibodies in sensitized individuals. Contact with these proteins stimulates mast cells and basophils, releasing histamine and other inflammatory mediators. This immune activation produces the characteristic symptoms of allergic rhinitis and is a primary environmental factor worsening the condition.

Choice C:

Strong emotional stress. Stress can influence immune function and may exacerbate perception of symptoms, but it is not a direct allergen and does not reliably trigger histamine-mediated allergic responses.

Choice D:

Cold, dry air. Exposure to cold or dry air can cause nasal dryness or irritation, which may worsen congestion temporarily, but it is not an allergen and does not initiate the immune cascade responsible for allergic rhinitis.

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Question 4:

A nurse is assessing a client with acute viral rhinitis. Which findings should the nurse expect? Select all that apply

A. Clear, watery nasal discharge B. Fever greater than 102°F (39°C) C. Sneezing D. Nasal congestion E. Purulent nasal drainage lasting 10 days

Answer and Explanation

Choice A:

Clear, watery nasal discharge. Early in viral rhinitis, mucosal inflammation and increased glandular secretion produce a clear, watery rhinorrhea, which is a hallmark symptom of viral infection.

Choice B:

Fever greater than 102°F (39°C). Viral rhinitis typically causes low-grade or absent fever. High-grade fever is more consistent with influenza or bacterial infections rather than uncomplicated viral rhinitis.

Choice C:

Sneezing. Viral infection of the nasal mucosa triggers reflex sneezing as part of the body’s mechanism to expel pathogens from the upper airway.

Choice D:

Nasal congestion. Inflammation and edema of the nasal mucosa reduce airway patency, causing obstruction and the sensation of congestion.

Choice E:

Purulent nasal drainage lasting 10 days. Purulent drainage persisting longer than 7–10 days suggests bacterial sinusitis or secondary bacterial infection, not uncomplicated viral rhinitis.

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Practice Exercise 1

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