Brunner Review Ch. 33

What is the most common cause of anaphylaxis? a. Penicillin b. Radiocontrast agent c. Opioids d. NSAIDs

A Rationale: Penicillin is the most common cause of anaphylaxis, accounting for about 75% of fatal anaphylactic reactions in the United States each year. Opioids, NSAIDs, and radiocontrast agents are some of the medications that are frequently reported as causing anaphylaxis.

Which statement describes the clinical manifestations of a delayed hypersensitivity (type IV) allergic reaction to latex? a. They can be eliminated by changing glove brands or using powder-free gloves. b. They occur within minutes after exposure to latex. c. They are localized to the area of exposure, usually the back of the hands. d. They may worsen when hand lotion is applied before donning latex gloves.

C Rationale: Clinical manifestations of a delayed hypersensitivity reaction are localized to the area of exposure. Clinical manifestations of an irritant contact dermatitis can be eliminated by changing glove brands or using powder-free gloves. With an irritant contact dermatitis, avoid use of hand lotion before donning gloves; this may worsen symptoms, as lotions may leach latex proteins from the gloves. Described as a latex allergy, when clinical manifestations occur within minutes after exposure to latex, an immediate hypersensitivity (type I) allergic reaction has occurred.

The nurse observes diffuse swelling involving the deeper skin layers in a client who has experienced an allergic reaction. The nurse would correctly document this finding as a. urticaria. b. contact dermatitis. c. angioneurotic edema. d. pitting edema.

C Rationale: The area of skin demonstrating angioneurotic edema may appear normal, but often has a reddish hue and does not pit. Urticaria (hives) is characterized as edematous skin elevations that vary in size, shape, and itch, which cause local discomfort. Contact dermatitis refers to inflammation of the skin caused by contact with an allergenic substance such as poison ivy. Pitting edema, the result of increased interstitial fluid, is associated with disorders such as congestive heart failure.

Which term refers to an incomplete antigen? a. Hapten b. Antigen c. Antibody d. Allergen

A Rationale: A hapten is an incomplete antigen. An allergen is a substance that causes manifestations of allergy. An antigen is a substance that induces the production of antibodies. An antibody is a protein substance developed by the body in response to and interacting with a specific antigen.

The nurse is caring for a client with myasthenia gravis. The nurse generates a plan of care for the client based on which type of hypersensitivity reaction? a. Cytotoxic b. Delayed c. Anaphylactic d. Immune complex

A Rationale: Cytotoxic hypersensitivity occurs when the body mistakenly identifies a part of the body as foreign, as in myasthenia gravis, where the body mistakenly identifies normal nerve endings as foreign. Delayed hypersensitivity reactions occur 24 to 72 hours after exposure. Immune complex hypersensitivity involves immune complexes formed when antigens bind to antibodies. Anaphylactic hypersensitivity is an immediate reaction characterized by edema in many tissues, often with hypotension, bronchospasm, and cardiovascular collapse.

Which cells present the antigen to T cells and initiate the immune response? a. Macrophages b. B cells c. Antigens d. Hapten

A Rationale: Macrophages initiate the immune response. B cells are programmed to produce one specific antibody. Antigens are substances that induce the production of antibodies. Haptens are incomplete antigens.

The nurse is creating a discharge teaching plan for a client with a latex allergy. Which information should be included? Select all that apply. a. Avoidance of latex-based products b. Administration of emergency epinephrine c. Administration of antihistamines d. Radioallergosorbent testing (RAST)

A, B, C Rationale: The nurse should include in the discharge teaching plan avoidance of latex-based products. Additionally, the nurse should include administration of antihistamines and an emergency epinephrine. RAST testing would not be indicated; it is a diagnostic test for allergies, and the client's latex allergy is already diagnosed.

The nurse is evaluating a client's complete blood cell count and differential along with the serum immunoglobulin E (IgE) concentration. Which result might indicate that the client has an allergic disorder? a. Low eosinophil count b. Low white blood cell count c. High neutrophil count d. High IgE concentration

D Rationale: A high total IgE concentration and/or a high percentage of eosinophils may indicate an allergic disorder. However, normal IgE levels do not exclude the diagnosis of an allergic disorder. The amounts of neutrophils and white blood cells are not affected by allergic disorders.

Which is a primary chemical mediator of hypersensitivity? a. Serotonin b. Heparin c. Bradykinin d. Histamine

D Rationale: Histamine is a primary chemical mediator of hypersensitivity. Secondary mediators include serotonin, heparin, and bradykinin.

Which group of mediators initiates the inflammatory response? a. Leukotrienes b. Mast cells c. Lymphokines d. Prostaglandins

A Rationale: Leukotrienes are a group of chemical mediators that initiate the inflammatory response. Lymphokines are substances released by sensitized lymphocytes when they contact specific organs. Mast cells are connective tissue that contains heparin and histamine in their granules. Prostaglandins are unsaturated fatty acids that have a wide assortment of biologic activity.

The nurse is evaluating a client's readiness for allergy skin testing. The nurse determines that the testing will need to be postponed when it is revealed that the client took which classification of medication the night before? a. Anticoagulant b. Antihistamine c. Anti-inflammatory d. Antidepressant

B Rationale: Antihistamines and corticosteroids suppress skin test reactivity and should be stopped at least 48 hours before testing, some experts state 72 hours to 96 hours before testing. It is best to check with the primary care provider regarding the use of antihistamines and corticosteroids and false negatives can occur during the skin testing.

The maximum intensity of histamine occurs within which time frame after contact with an antigen? a. 40 to 45 minutes b. 5 to 10 minutes c. 15 to 20 minutes d. 30 to 35 minutes

B Rationale: Histamine's effects peak 5 to 10 minutes after antigen contact. The other time frames are inaccurate.

The nurse is caring for a client experiencing an anaphylactic reaction. The nurse prepares for the maximum intensity of histamine response to occur within which time frame? a. 40 to 45 minutes b. 5 to 10 minutes c. 15 to 20 minutes d. 30 to 35 minutes

B Rationale: Histamine's effects peak 5 to 10 minutes after antigen contact. The other time frames are inaccurate.

Which chemical mediators initiate and mediate the inflammatory response? a. Complement b. Leukotrienes c. Prostaglandins d. Cytokines

B Rationale: Leukotrienes are chemical mediators from constituents of cell membranes. Cytokines are nonantibody proteins that act as intercellular mediators, as in the generation of the immune response. Prostaglandins are lipid-soluble molecules synthesized from constituents of cell membranes. Complement is a plasma protein associated with immunologic reactions.

The nurse observes diffuse swelling involving the deeper skin layers in a client who has experienced an allergic reaction. The nurse would correctly document this finding as a. pitting edema. b. angioneurotic edema. c. urticaria. d. contact dermatitis.

B Rationale: The area of skin demonstrating angioneurotic edema may appear normal but often has a reddish hue and does not pit. Urticaria (hives) is characterized as edematous skin elevations that vary in size and shape, itch, and cause local discomfort. Contact dermatitis refers to inflammation of the skin caused by contact with an allergenic substance such as poison ivy. Pitting edema is the result of increased interstitial fluid and associated with disorders such as congestive heart failure.

Which test indicates the quantity of allergen necessary to evoke an allergic reaction? a. Intradermal test b. Serum-specific IgE test c. Scratch test d. Provocative testing

B Rationale: The serum-specific IgE test, formerly known as RAST, is a radioimmunoassay that measures allergen-specific IgE. It indicates the quantity of allergen necessary to evoke an allergic reaction. Provocative testing involves the direct administration of the suspected allergen to the sensitive tissue such as the conjunctiva. The scratch test does not indicate the quantity of allergen.

The nurse is conducting an initial assessment of a hospitalized client who states that he has a latex allergy. The nurse notes that the skin of the client's hands is dry, thick, and cracked. The nurse documents the client's reaction to latex as which condition? a. Allergic contact dermatitis b. Latex allergy c. Irritant contact dermatitis d. Latex hyperplasia

C Rationale: Dry, thickened, and cracked skin is a symptom of a chronic irritant contact dermatitis, a common reaction to latex. Symptoms of allergic contact dermatitis in reaction to latex include pruritus, swelling, crusting and thickened skin, blisters, and other lesions. Symptoms of latex allergy include rhinitis, flushing, urticaria, laryngeal edema, bronchospasms, asthma, and cardiovascular collapse.

Atopic allergic disorders are characterized by... a. production of a systemic reaction. b. a response to physiologic allergens. c. a hereditary predisposition. d. an IgA-mediated reaction.

C Rationale: Atopic allergic disorders are characterized by a hereditary predisposition and production of a local reaction to IgE antibodies produced in response to common environmental allergens. Atopic and nonatopic allergic disorders are IgE-mediated allergic reactions.

The nurse working in an allergy clinic is preparing to administer skin testing to a client. Which route is the safest for the nurse to use to administer the solution? a. Intravenous b. Subcutaneous c. Intradermal d. Intramuscular

C Rationale: The intradermal route is the correct route of administration for skin testing and therefore a safe route. Another safe route is epicutaneous. The type of skin testing being performed determines whether the nurse will administer the solution via the epicutaneous or intradermal route.

A client is prescribed an oral corticosteroid for 2 weeks to relieve asthma symptoms. The nurse educates the client about side effects, which include a. hypotension. b. hypoglycemia. c. diuresis. d. adrenal suppression.

D Rationale: The nurse should instruct the client that side effects of oral corticosteroid therapy include adrenal suppression, fluid retention, weight gain, glucose intolerance, hypertension, and gastric irritation.

Which type of hypersensitivity occurs when the system mistakenly identifies a normal constituent of the body as foreign? a. Immune complex b. Anaphylactic c. Delayed d. Cytotoxic

D Rationale: Cytotoxic hypersensitivity occurs when the system mistakenly identifies a normal constituent of the body as foreign. Anaphylactic hypersensitivity is the most severe immune-mediated reaction. Delayed hypersensitivity occurs 24 to 72 hours after exposure to an allergen. Immune complex hypersensitivity involves immune complexes that are formed when antigens bind to antibodies.

The nurse working in the emergency department is asked to explain allergy testing to a client who experienced an allergic reaction to an unknown allergen. Which test indicates the quantity of allergen necessary to evoke an allergic reaction? a. Intradermal test b. Scratch test c. Serum-specific IgE test d. Provocative testing

C Rationale: The serum-specific IgE test, formerly known as RAST, is a radioimmunoassay that measures allergen-specific IgE. It indicates the quantity of allergen necessary to evoke an allergic reaction. Provocative testing involves the direct administration of the suspected allergen to the sensitive tissue such as the conjunctiva. The scratch test does not indicate the quantity of allergen.

The nurse is completing the intake assessment of a client new to the allergy clinic. The client states that he was taking nose drops six times a day to relieve his nasal congestion. The nasal congestion increased, causing him to increase his usage of the nasal spray to eight times a day. But again the congestion worsened. The nurse communicates to the health care provider that the client experienced a. Atopic dermatitis b. Tolerance to nose drops c. Rhinitis medicamentosa d. Leukotriene modifier

C Rationale: Rhinitis medicamentosa is a rebound reaction from overuse of sympathomimetic nose drops or sprays that worsen the congestion, causing the client to use more of the medication, thereby leading to more nasal congestion. This differs from tolerance, when more medication is needed to achieve the desired effect. Leukotriene modifiers are a category of medications used to treat allergies. Atopic dermatitis is a type I hypersensitivity involving inflammation of the skin evidenced by itching, erythema, and skin lesions

The nurse is conducting a community education program on allergies and anaphylactic reactions. The nurse determines that the participants understand the education when they make which statement about anaphylaxis? a. The most common food item that causes anaphylaxis is chocolate. b. Systemic reactions include urticaria and angioedema. c. The most common cause of anaphylaxis is penicillin. d. Anaphylactoid (anaphylaxis-like) reactions are commonly fatal.

C Rationale: The most common cause of anaphylaxis is penicillin, accounting for about 75% of fatal anaphylactic reactions in the United States. Although possibly severe, anaphylactoid reactions are rarely fatal. Food items that are common causes of anaphylaxis include peanuts, tree nuts, shellfish, fish, milk, eggs, soy, and wheat. Local reactions usually involve urticaria and angioedema at the site of the antigen exposure. Systemic reactions, which occur within about 30 minutes of exposure, involve cardiovascular, respiratory, gastrointestinal, and integumentary organ systems.

What is the most common cause of anaphylaxis? a. Penicillin b. Opioids c. Radiocontrast agent d. NSAIDs

A Rationale: Penicillin is the most common pharmacological cause of anaphylaxis and accounts for about 75% of fatal anaphylactic reactions in the United States each year. Opioids, NSAIDs, and radiocontrast agents are some of the medications that are frequently reported as causing anaphylaxis.

Which intervention is the single most important aspect for the client at risk for anaphylaxis? a. Prevention b. Desensitization c. Use of antihistamines d. Wearing a medical alert bracelet

A Rationale: Prevention involves strict avoidance of potential allergens for the individual at risk for anaphylaxis. If avoidance of or exposure to allergens is impossible then the individual should be prepared with an emergency kit containing epinephrine for injection to prevent the onset of the reaction upon exposure. While helpful, there must be no lapses in desensitization therapy because this may lead to the reappearance of an allergic reaction when the medication is reinstituted. A medical alert bracelet will assist those rendering aid to a client who has experienced an anaphylactic reaction. antihistamines may not be effective in preventing anaphylaxis.

Which type of hypersensitivity reaction involves immune complexes forming when antigens bind to antibodies? a. Type III b. Type II c. Type I d. Type IV

A Rationale: Type III hypersensitivity is associated with systemic lupus erythematosus, rheumatoid arthritis, serum sickness, certain types of nephritis, and some types of bacterial endocarditis. Type I, or anaphylactic hypersensitivity, is an immediate reaction, beginning within minutes of exposure to an antigen. Type II, or cytotoxic, hypersensitivity occurs when the system mistakenly identifies a normal constituent of the body as foreign. Type IV, or delayed-type, hypersensitivity occurs 24 to 72 hours after exposure to an allergen

The nurse is conducting discharge teaching for a client who is being discharged from the emergency department after an anaphylactic reaction to peanuts. Which education should the nurse include in the teaching? Select all that apply. a. Avoiding allergens b. Wearing a medical alert bracelet c. Desensitization to allergen d. Use of sedatives to treat reactions

A & B Rationale: People who have experienced food, medication, idiopathic, or exercise-induced anaphylactic reactions should make every attempt to strictly avoid the allergen. Additionally, they should wear a medical alert bracelet and carry an emergency kit containing epinephrine for injection to prevent the onset of the reaction on exposure. Sedatives are not used to treat anaphylactic reactions, and desensitization is not used for peanut allergies.

The nurse is working with a colleague who has a delayed hypersensitivity (type IV) allergic reaction to latex. Which statement describes the clinical manifestations of this reaction? a. Symptoms can be eliminated by changing glove brands. b. Symptoms worsen when hand lotion is applied before donning latex gloves. c. Symptoms are localized to the area of exposure, usually the back of the hands. d. Symptoms occur within minutes after exposure to latex.

C Rationale: Clinical manifestations of a delayed hypersensitivity reaction are localized to the area of exposure. Clinical manifestations of an irritant contact dermatitis can be eliminated by changing glove brands or using powder-free gloves. With an irritant contact dermatitis, avoid use of hand lotion before donning gloves; this may worsen symptoms, as lotions may leach latex proteins from the gloves. When clinical manifestations occur within minutes after exposure to latex, which is described as a latex allergy, an immediate hypersensitivity (type I) allergic reaction has occurred.

Which acts as a potent vasoconstrictor and causes bronchial smooth muscle to contract? a. Prostaglandin b. Bradykinin c. Serotonin d. Platelet-activating factor

C Rationale: Serotonin acts as a potent vasoconstrictor and causes contraction of bronchial smooth muscle. Bradykinin is a polypeptide with the ability to cause increased vascular permeability, vasodilation, hypotension, and contraction of many types of smooth muscle, such as the bronchi. Prostaglandin is a polypeptide that stimulates nerve fibers and causes pain. Platelet-activating factor is responsible for initiating platelet aggregation and leukocytes, as well as vasodilation and increased capillary permeability.

The nurse knows the best strategy for latex allergy is a. corticosteroids. b. antihistamines. c. avoidance of latex-based products. d. epinephrine from an emergency kit.

C Rationale: The best strategy available for latex allergy is to avoid latex-based products, but this is often difficult because of their widespread use. Antihistamines and an emergency kit containing epinephrine should be provided to these clients, along with instructions about emergency management of latex allergy.

The nurse teaches the client with allergies about anaphylaxis, including which statement? a. Anaphylactoid (anaphylaxis-like) reactions are commonly fatal. b. Systemic reactions include urticaria and angioedema. c. The most common cause of anaphylaxis is penicillin. d. The most common food item that causes anaphylaxis is chocolate.

C Rationale: The most common cause of anaphylaxis, accounting for about 75% of fatal anaphylactic reactions in the United States, is penicillin. Although possibly severe, anaphylactoid reactions are rarely fatal. Food items that are common causes of anaphylaxis include peanuts, tree nuts, shellfish, fish, milk, eggs, soy, and wheat. Local reactions usually involve urticaria and angioedema at the site of the antigen exposure. Systemic reactions occur within about 30 minutes of exposure involving cardiovascular, respiratory, gastrointestinal, and integumentary organ systems.

Which body substance causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle? a. Prostaglandin b. Serotonin c. Histamine d. Bradykinin

C Rationale: When cells are damaged, histamine is released. Bradykinin is a polypeptide that stimulates nerve fibers and causes pain. Serotonin is a chemical mediator that acts as a potent vasoconstrictor and bronchoconstrictor. Prostaglandins are unsaturated fatty acids that have a wide assortment of biologic activities.