NRNP 6540 Week 4 Assignment: Case Study 1 – A
76-year-old woman with nasal drainage Actual
Exam – Complete Solutions with Detailed
Rationales – Pass Guaranteed – A+ Graded
Foundations: Geriatric Assessment & Nasal Symptoms Differential
Q1: Which of the following age-related physiological changes in the respiratory system
most significantly increases an older adult's susceptibility to upper respiratory
infections?
A. Increased elasticity of the alveolar sacs
B. Decreased mucociliary clearance and weakened cough reflex
C. Hyperactive immune response due to immunosenescence
D. Increased nasal vascularity and edema
Correct Answer: B
Rationale: This is correct because as we age, the cilia that sweep mucus and
pathogens out of the airways become less effective, and the cough reflex weakens,
making it harder for older adults to clear infections like the common cold or sinusitis.
Q2: Immunosenescence refers to the gradual deterioration of the immune system. How
does this specifically impact a 76-year-old patient's presentation of a viral illness
compared to a younger adult?
A. The older adult is more likely to present with a high fever and significant myalgias.
B. The older adult often presents with more subtle symptoms, such as confusion or
fatigue, and may have a blunted febrile response.
C. The older adult will typically recover twice as fast due to a memory cell surplus.
D. The older adult is less likely to contract viral illnesses due to acquired immunity.
Correct Answer: B
Rationale: The best answer is that older adults often lack the robust "hallmark" signs of
infection like high fever; instead, they frequently exhibit nonspecific geriatric syndromes
like delirium, anorexia, or weakness, which makes assessment tricky.
Q3: When considering differential diagnoses for nasal drainage in an older adult, which
characteristic is most suggestive of allergic rhinitis rather than a viral upper respiratory
infection (URI)?
A. Purulent, greenish discharge
B. Onset associated with itchy eyes, palate, and sneezing
, C. Unilateral clear watery drainage
D. Presence of a low-grade fever and sore throat
Correct Answer: B
Rationale: This aligns with the typical presentation of allergies; the "triad" of itching
(eyes, nose, palate), sneezing, and clear rhinorrhea distinguishes allergic rhinitis from
viral URIs, which usually present with more systemic symptoms like fever or malaise.
Q4: What is the primary mechanism behind Rhinitis Medicamentosa?
A. A hypersensitivity reaction to corticosteroid nasal sprays
B. Rebound congestion caused by the overuse of topical nasal decongestant sprays
(oxymetazoline, phenylephrine)
C. A bacterial superinfection of the nasal turbinates
D. An autoimmune response to environmental allergens
Correct Answer: B
Rationale: This is correct because rhinitis medicamentosa is a common clinical problem
where patients use OTC nasal sprays (like Afrin) for more than 3 days, leading to
tachyphylaxis and severe rebound congestion that requires more frequent use.
Q5: Which of the following conditions in a 76-year-old patient is least likely to be a direct
cause of "vasomotor rhinitis" (non-allergic rhinitis)?
A. Sudden temperature changes
B. Spicy foods
C. High pollen count exposure
D. Emotional stress
Correct Answer: C
Rationale: This is correct because vasomotor rhinitis is triggered by non-allergic irritants
like temperature shifts, strong odors, or food, whereas high pollen counts would trigger
an IgE-mediated allergic response (allergic rhinitis).
Q6: Why are antihistamines with strong anticholinergic properties (e.g.,
diphenhydramine, hydroxyzine) generally avoided in older adults for managing nasal
congestion?
A. They have minimal effect on nasal secretions in geriatric patients.
B. They increase the risk of urinary retention, constipation, confusion, and falls.
C. They are contraindicated in patients with hypertension.
D. They interact dangerously with topical nasal steroids.
Correct Answer: B
Rationale: The best answer is that first-generation antihistamines are highly
anticholinergic; in a 76-year-old, this can lead to dangerous adverse effects like urinary
retention (especially in men with BPH), constipation, sedation, and delirium.
76-year-old woman with nasal drainage Actual
Exam – Complete Solutions with Detailed
Rationales – Pass Guaranteed – A+ Graded
Foundations: Geriatric Assessment & Nasal Symptoms Differential
Q1: Which of the following age-related physiological changes in the respiratory system
most significantly increases an older adult's susceptibility to upper respiratory
infections?
A. Increased elasticity of the alveolar sacs
B. Decreased mucociliary clearance and weakened cough reflex
C. Hyperactive immune response due to immunosenescence
D. Increased nasal vascularity and edema
Correct Answer: B
Rationale: This is correct because as we age, the cilia that sweep mucus and
pathogens out of the airways become less effective, and the cough reflex weakens,
making it harder for older adults to clear infections like the common cold or sinusitis.
Q2: Immunosenescence refers to the gradual deterioration of the immune system. How
does this specifically impact a 76-year-old patient's presentation of a viral illness
compared to a younger adult?
A. The older adult is more likely to present with a high fever and significant myalgias.
B. The older adult often presents with more subtle symptoms, such as confusion or
fatigue, and may have a blunted febrile response.
C. The older adult will typically recover twice as fast due to a memory cell surplus.
D. The older adult is less likely to contract viral illnesses due to acquired immunity.
Correct Answer: B
Rationale: The best answer is that older adults often lack the robust "hallmark" signs of
infection like high fever; instead, they frequently exhibit nonspecific geriatric syndromes
like delirium, anorexia, or weakness, which makes assessment tricky.
Q3: When considering differential diagnoses for nasal drainage in an older adult, which
characteristic is most suggestive of allergic rhinitis rather than a viral upper respiratory
infection (URI)?
A. Purulent, greenish discharge
B. Onset associated with itchy eyes, palate, and sneezing
, C. Unilateral clear watery drainage
D. Presence of a low-grade fever and sore throat
Correct Answer: B
Rationale: This aligns with the typical presentation of allergies; the "triad" of itching
(eyes, nose, palate), sneezing, and clear rhinorrhea distinguishes allergic rhinitis from
viral URIs, which usually present with more systemic symptoms like fever or malaise.
Q4: What is the primary mechanism behind Rhinitis Medicamentosa?
A. A hypersensitivity reaction to corticosteroid nasal sprays
B. Rebound congestion caused by the overuse of topical nasal decongestant sprays
(oxymetazoline, phenylephrine)
C. A bacterial superinfection of the nasal turbinates
D. An autoimmune response to environmental allergens
Correct Answer: B
Rationale: This is correct because rhinitis medicamentosa is a common clinical problem
where patients use OTC nasal sprays (like Afrin) for more than 3 days, leading to
tachyphylaxis and severe rebound congestion that requires more frequent use.
Q5: Which of the following conditions in a 76-year-old patient is least likely to be a direct
cause of "vasomotor rhinitis" (non-allergic rhinitis)?
A. Sudden temperature changes
B. Spicy foods
C. High pollen count exposure
D. Emotional stress
Correct Answer: C
Rationale: This is correct because vasomotor rhinitis is triggered by non-allergic irritants
like temperature shifts, strong odors, or food, whereas high pollen counts would trigger
an IgE-mediated allergic response (allergic rhinitis).
Q6: Why are antihistamines with strong anticholinergic properties (e.g.,
diphenhydramine, hydroxyzine) generally avoided in older adults for managing nasal
congestion?
A. They have minimal effect on nasal secretions in geriatric patients.
B. They increase the risk of urinary retention, constipation, confusion, and falls.
C. They are contraindicated in patients with hypertension.
D. They interact dangerously with topical nasal steroids.
Correct Answer: B
Rationale: The best answer is that first-generation antihistamines are highly
anticholinergic; in a 76-year-old, this can lead to dangerous adverse effects like urinary
retention (especially in men with BPH), constipation, sedation, and delirium.
