Ch 33: Assessment and Management of Patients with Allergic Disorders

b) Avoid potential allergens Pg. 1047 Strict avoidance of potential allergens is the most important preventive measure for the patient at risk for anaphylaxis. People who have experienced food, medication, idiopathic, or exercise-induced anaphylactic reactions should always carry an emergency kit containing epinephrine for injection to prevent the onset of the reaction upon exposure, but avoiding potential allergens is more important. Desensitization, based on controlled anaphylaxis with a gradual release of mediators, is an effective treatment option, but it is more important to avoid allergic triggers. The medical alert bracelet will assist those rendering aid to the patient who has experienced an anaphylactic reaction, but it's better to avoid the reaction in the first place.

13. The nurse is teaching a client after a medication allergic reaction has occurred. What is the most important action for the nurse to teach the client to take to prevent anaphylaxis? a) Undergo desensitization treatment b) Avoid potential allergens c) Wear a medical alert bracelet d) Carry an emergency kit

d) Autoimmune Pg. 1041 Diseases are considered autoimmune disorders when they are characterized by unrelenting, progressive tissue damage without any verifiable etiology. The client did not have a previous disorder that has caused an exacerbation. An alloimmunity describes an immune response that is waged against transplanted organs and tissues that carry non self antigens. Because there is no identifiable cause, there can be no effect.

19. A client has been having joint pain and swelling in the left foot and is diagnosed with rheumatoid arthritis. The symptoms began suddenly without any identifiable cause, and the client has significant joint destruction. What type of disease is this considered? a) An exacerbation of a previous disorder b) An alloimmunity disorder c) A cause-and-effect relationship d) Autoimmune

a) Identify ways to manage allergy while dining out b) List symptoms of peanut allergy d) Carry EpiPen autoinjector at all times e) Wear a medic alert bracelet Pg. 1047 Wearing a medic alert bracelet allows others to be alerted of the allergy. Listing symptoms of the allergy makes the client aware of the allergic reaction if symptoms are being experienced. Identifying ways to manage allergies while dining out allows the client to be safe from a potential reaction. All food labels should be read not only baked items. The EpiPen autoinjector should be carried at all times in case it needs to be administered because of an allergic reaction.

23. The nurse is teaching a client newly diagnosed with a peanut allergy about how to manage the allergy. What information should be included in the teaching? Select all that apply. a) Identify ways to manage allergy while dining out b) List symptoms of peanut allergy c) Food labels on baked items are the only labels that need to be read d) Carry EpiPen autoinjector at all times e) Wear a medic alert bracelet

b) Desensitization Pg. 1054 Desensitization is another option. Desensitization is a form of immunotherapy in which a person receives weekly or twice-weekly injections of dilute but increasingly higher concentrations of an allergen without interruption. SLIT is a form of desensitization therapy. Options C and D are distractors for this question.

32. A client with an allergic disorder calls the nurse and asks what treatment is available for allergic disorders. The nurse explains to the client that there is more than one treatment available. What treatments would the nurse tell the client about? a) Sublingual-swallow immunotherapy (SLIT) b) Desensitization c) Sublingual-topical immunotherapy (STIT) d) Resensitization

a) February 15 Pg. 1050 The full benefit of fluticasone (Flonase) should occur no later than 14 days after the first dose. The drug was initiated on February 2. Thirteen days later would be February 15.

35. A health care provider prescribed fluticasone for a client with a severe case of allergic rhinitis. The client took a first dose on February 2. What is the latest date by which the drug will be fully effective? a) February 15 b) February 12 c) February 9 d) February 6

b) Only use the nasal spray for 3 to 4 days once every 12 hours Pg. 1050 Adrenergic agents, which are vasoconstrictors of mucosal vessels, are used topically in nasal (oxymetazoline [Afrin]) and ophthalmic (brimonidine [Alphagan P]) formulations in addition to the oral route (pseudoephedrine [Sudafed]). The topical route (drops and sprays) causes fewer side effects than oral administration; however, the use of drops and sprays should be limited to a few days to avoid rebound congestion.

36. A client has had a "stuffy nose" and obtained an oxymetazoline nasal spray. What education should the nurse provide to the client in order to prevent "rebound congestion"? a) Be sure to use the nasal spray for at least 10 days to ensure the stuffiness is gone b) Only use the nasal spray for 3 to 4 days once every 12 hours c) Use the medication every 4 hours to prevent congestion from recurring d) Drink plenty of fluids

b) Antihistamine Pg. 1050 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.

38. 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) Antidepressant d) Anti-inflammatory

a) Rh-hemolytic disease Pg. 1058 A type II hypersensitivity, or cytotoxic, reaction, which involves binding either the IgG or IgM antibody to a cell-bound antigen, may lead to eventual cell and tissue damage. The reaction is the result of mistaken identity when the system identifies a normal constituent of the body as foreign and activates the complement cascade. Examples of type II reactions are myasthenia gravis, Goodpasture syndrome, pernicious anemia, hemolytic disease of the newborn, transfusion reaction, and thrombocytopenia.

4. An infant is born to a mother who had no prenatal care during her pregnancy. What type of hypersensitivity reaction does the nurse understand may have occurred? a) Rh-hemolytic disease b) Bacterial endocarditis c) Lupus erythematosus d) Rheumatoid arthritis

b) Symptoms are localized to the area of exposure, usually the back of the hands Pg. 1062 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.

45. 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 worsen when hand lotion is applied before donning latex gloves b) Symptoms are localized to the area of exposure, usually the back of the hands c) Symptoms can be eliminated by changing glove brands d) Symptoms occur within minutes after exposure to latex

d) High IgE concentration Pg. 1044 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.

5. 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 white blood cell count b) High neutrophil count c) Low eosinophil count d) High IgE concentration

d) Client identifies methods for reducing exposure risk to allergens Pg. 1054 For the nursing diagnosis of deficient knowledge, the client's ability to identify methods for reducing the risk of allergen exposure indicates that the outcome has been met. The statement about coughing and deep breathing and an absence of symptoms would be appropriate for evaluating the nursing diagnosis of ineffective breathing pattern. Positive coping strategies would be an appropriate outcome for a nursing diagnosis of ineffective coping.

6. The nurse is evaluating the plan of care for a client with an allergic disorder who has a nursing diagnosis of deficient knowledge related to measures for allergy control. What client statement will indicate to the nurse that the outcome has been met? a) Client reports an absence of symptoms associated with the allergy b) Client states the need for coughing and deep breathing c) Client demonstrates appropriate coping strategies for dealing with a chronic disorder d) Client identifies methods for reducing exposure risk to allergens

a) Laryngeal swelling Pg. 1059 Diffuse swelling can affect many regions: lips, eyelids, cheeks, hands, feet, genitalia, tongue, larynx, bronchi, and the gastrointestinal canal. The most serious is the larynx because of the potential for compromised breathing. Abdominal pain, conjunctivitis and urticaria are not the most serious manifestations.

8. The nurse is caring for a client exposed to peanuts with a known allergy. What assessment is considered the most serious manifestation of angioneurotic edema? a) Laryngeal swelling b) Conjunctivitis c) Abdominal pain d) Urticaria

b) Route of exposure Pg. 1041 Clinical manifestations generally correlate with the manner in which the allergen enters the body. For example, inhaled allergens usually cause respiratory symptoms, including nasal congestion, runny nose, sneezing, coughing, dyspnea, and wheezing. Inhaled allergens often trigger asthma.

9. A pediatric client is recovering from an anaphylactic reaction to an allergen which brought him to the ED. The client's mother is quite concerned with the potential reoccurrence of her child's reaction. In attempting to narrow down the possible allergen, it is important to consider that clinical manifestations generally correlate with: a) Respiratory symptoms b) Route of exposure c) Systemic effects d) Skin reactions

b) Cutaneous Pg. 1062 Routes of exposure to latex products can be cutaneous, percutaneous, mucosal, parenteral, or aerosol. Allergic reactions are more likely with parenteral or mucous membrane exposure but can also occur with cutaneous contact or inhalation. The most frequent source of exposure is cutaneous, which usually involves the wearing of natural latex gloves.

25. Which of the following is the most frequent route of exposure to a latex allergy? a) Mucosal b) Cutaneous c) Parenteral d) Inhalation

c) Intradermal Pg. 1044 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.

26. 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) Intramuscular b) Subcutaneous c) Intradermal d) Intravenous

b) Histamine Pg. 1039 The pathophysiology of an allergic response involves a chain of events that includes responses from lymphocytes, IgE, mast cells, and basophils. All chemical mediators are participants in the response cycle, but histamine is the most important protein involved. Activated by a mast cell, it increases vessel permeability.

33. A nurse is working in a dermatology clinic with clients who have allergies. What is the most important chemical mediator involved in the allergic response? a) Prostaglandins b) Histamine c) Serotonin d) Leukotrienes

d) Do not overuse the medication as rebound congestion can occur Pg. 1052 Overusing oxymetazoline nasal spray can cause rebound congestion. The medication does not cause fungal infection. Corticosteroids should be tapered, but it is not necessary to taper oxymetazoline. Oxymetazoline does not cause sleepiness so the client can operate machinery or drive.

14. A client calls the clinic and asks the nurse if using oxymetazoline nasal spray would be alright to relieve the nasal congestion he is experiencing due to seasonal allergies. What instructions should the nurse provide to the client to avoid complications? a) Do not operate machinery or drive while using the medication b) Report white patches in the mouth because the medication can cause a fungal infection c) Taper the dose when discontinuing the medication d) Do not overuse the medication as rebound congestion can occur

d) Diphenhydramine Pg. 1051 Certain medications are categorized by their action at these receptors. Diphenhydramine (Benadryl) is an example of an antihistamine, a medication that displays an affinity for H1 receptors. Cimetidine (Tagamet) and nizatidine (Axid) target H2 receptors to inhibit gastric secretions in peptic ulcer disease.

15. The nurse is preparing to administer a medication that has an affinity for H1 receptors. Which medication would the nurse administer? a) Cimetidine b) Nizatidine c) Omeprazole d) Diphenhydramine

b) Use a topical skin moisturizer daily Pg. 1057 The nurse should instruct the client to use a topical skin moisturizer daily to help keep the skin hydrated. Likewise, the client should be encouraged to bathe daily. To minimize irritation, the client should wear only cotton fabrics. The client should maintain a room temperature between 68° F (20° C) and 72° F (22.2° C).

1. A nurse is preparing a discharge teaching plan for a client with atopic dermatitis. Which instruction should the nurse include in the teaching plan? a) Keep the thermostat above 75° F (23.9° C) b) Use a topical skin moisturizer daily c) Bathe only three times per week d) Wear only synthetic fabrics

b) IgE Pg. 1039 Immunoglobulin E (IgE) is involved with an allergic reaction. IgA combines with antigens and activates complement. IgB coats the surface of B lymphocytes. IgG is the principal immunoglobulin formed in response to most infectious agents.

17. A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated? a) IgA b) IgE c) IgB d) IgG

a) 5 to 10 minutes Pg. 1040 Histamine's effects peak 5 to 10 minutes after antigen contact. The other time frames are inaccurate.

30. 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) 5 to 10 minutes b) 15 to 20 minutes c) 30 to 35 minutes d) 40 to 45 minutes

d) 10:00 AM Pg. 1050 Mild and moderate reactions begin within 2 hours of exposure.

31. The nurse tells the client that if exposure to an allergen occurs around 8:00 AM, then the client should expect a mild or moderate reaction by what time? a) 1:00 PM b) 11:00 AM c) 3:00 PM d) 10:00 AM

d) Angioedema Pg. 1059 Angioedema is potentially life threatening. Medical management would include intubation, subcutaneous epinephrine, and aminophylline in severe reactions.

43. Which allergic reaction is potentially life threatening? a) Contact dermatitis b) None of the listed allergic reactions is potentially life threatening c) Urticaria d) Angioedema

c) Adrenal suppression Pg. 1052 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.

46. 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) Adrenal suppression d) Diuresis

c) Type I Pg. 1041 There are four types of hypersensitivity responses, three of which are immediate. This is an example of Type I, atopic or anaphylactic, which is mediated by immunoglobulin E (IgE) antibodies.

47. A client is presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. What type of hypersensitivity did this client exhibit? a) Type IV b) Type II c) Type I d) Type III

a) Sedation Pg. 1049 Antihistamines are the major class of medications prescribed for the symptomatic relief of allergic rhinitis. The major side effect is sedation, although H1 antagonists are less sedating than earlier antihistamines.

18. A patient asks the nurse if it would be all right to take an over-the-counter antihistamine for the treatment of a rash. What should the nurse educate the patient is a major side effect of antihistamines? a) Sedation b) Palpitations c) Anorexia d) Diarrhea

c) Plant pollen Pg. 1049 Plant pollen (from trees, grass, and other plants) causes the most common form of allergic rhinitis, which is known as hay fever. Animal dander, dust mites, and mold spores can be triggers, but are not the most common causes.

24. The nurse is teaching a client about allergic rhinitis and its triggers. What is the most common trigger for the respiratory allergic response? a) Mold spores b) Dust mites c) Plant pollen d) Animal dander

d) "The full benefit of the medication may take up to 2 weeks to be achieved" Pg. 1050 Patients must be aware that full benefit of corticosteroid nasal sprays may not be achieved for several days to 2 weeks.

27. A patient was seen in the clinic 3 days previously for allergic rhinitis and was given a prescription for a corticosteroid nasal spray. The patient calls the clinic and tells the nurse that the nasal spray is not working. What is the best response by the nurse? a) "You may be immune to the effects of this medication and will need something else in its place" b) "You need to come back to the clinic to get a different medication since this one is not working for you" c) "I am sorry that you are feeling poorly but this is the only medication that will work for your problem" d) "The full benefit of the medication may take up to 2 weeks to be achieved"

d) Serum IgE level Pg. 1044 Normally, serum IgE levels are below 1.0 mg/mL. The patient's level is significantly elevated suggesting allergic reaction. The other values are within normal parameters.

28. A patient with a history of allergies comes to the clinic for an evaluation. The following laboratory test findings are recorded in a patient's medical record: Total serum IgE levels: 2.8 mg/mL White blood cell count: 5,100/cu mm Eosinophil count: 4% Erythrocyte sedimentation rate: 20 mm/h The nurse identifies which result as suggesting an allergic reaction? a) Eosinophil count b) White blood cell count c) Erythrocyte sedimentation rate d) Serum IgE level

d) Dorsal aspect of the hand Pg. 1056 With allergic contact dermatitis, irritation is most common on the dorsal aspects of the hand. Irritant, phototoxic, and photoallergic types of contact dermatitis are commonly seen on the hands and lower arms.

42. When assessing the skin of a client with allergic contact dermatitis, the nurse would most likely expect to find irritation at which area? a) Ankles b) Plantar aspects of the feet c) Lower arms d) Dorsal aspect of the hand

c) For their immunosuppressant effects Pg. 1041 Drug therapy using anti-inflammatory and immunosuppressive agents is the mainstay for alleviating symptoms. Some antineoplastic (cancer) drugs also are used for their immunosuppressant effects. Antineoplastic drugs do not decrease the body's risk of infection; an autoimmune disease is not a neoplastic disease. Drugs are not ordered just so the client has strong drug therapy.

44. A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder? a) Because an autoimmune disease is a neoplastic disease b) To decrease the body's risk of infection c) For their immunosuppressant effects d) So the client has strong drug therapy

b) Fluticasone Pg. 1050 Fluticasone is an example of an intranasal corticosteroid. Cromolyn sodium is a mast cell stabilizer. Zileuton is a leukotriene-receptor inhibitor. Fexofenadine is a second-generation antihistamine.

7. The nurse is reviewing various medications with a client that can be used to treat allergic disorders. What medication will the nurse identify as an intranasal corticosteroid? a) Zileuton b) Fluticasone c) Cromolyn sodium d) Fexofenadine

c) "If I notice tingling in my lips or mouth, gargling may help the symptoms" Pg. 1046 The client requires further teaching if the client states, "I will gargle to help alleviate tingling in the lips or mouth." Allergy testing introduces potentially irritating substances to the client. Tingling in the mouth, lips, or throat indicates the onset of a severe reaction and the need for immediate medical intervention. The testing may cause irritation and itching at the test site. The health care provider may order an epinephrine pen (EpiPen) for the client to self-administer epinephrine if the client experiences an allergic reaction away from the office setting.

21. A client reports to a health care provider's office for intradermal allergy testing. Before testing, the nurse provides client teaching. Which client statement indicates a need for further education? a) "I may experience itching and irritation at the site of the testing" b) "I'll go directly to the pharmacy with my EpiPen prescription" c) "If I notice tingling in my lips or mouth, gargling may help the symptoms" d) "The test may be mildly uncomfortable"

a) Prevention Pg. 1047 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.

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

b) Penicillin Pg. 1046 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.

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

a) Hapten Pg. 1039 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.

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

d) The most common cause of anaphylaxis is penicillin Pg. 1046 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.

39. 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) Anaphylactoid (anaphylaxis-like) reactions are commonly fatal d) The most common cause of anaphylaxis is penicillin

a) Weekly Pg. 1053 Typically, immunotherapy begins with very small amounts and gradually increases, usually at weekly intervals until a maximum tolerated dose is attained. Then maintenance booster injections are administered at 2- to 4-week intervals, frequently for a period of several years.

40. The nurse explains to a client that immunotherapy initially starts with injections at which interval? a) Weekly b) Bi-monthly c) Daily d) Monthly

b) IgE-mediated hypersensitivity Pg. 1063 A type I, IgE-mediated hypersensitivity can cause severe reaction symptoms such as laryngeal edema and bronchospasm. Irritant and allergic contact dermatitis result in more localized skin reactions. IgG antibodies are important in fighting viral and bacterial infections.

41. The nurse is teaching a group of health care workers about latex allergies. What reaction will the nurse teach the workers to be most concerned about with laryngeal edema? a) Irritant contact b) IgE-mediated hypersensitivity c) Allergic contact d) IgG antibodies

b) 2:00 PM Pg. 1047 Rebound reactions can occur from 4 to 10 hours after an initial allergic reaction. Therefore the patient needs to be assessed from 2:00 PM to 8:00 PM.

11. A patient received epinephrine in response to an anaphylactic reaction at 10:00 AM. The nurse knows to observe the patient for a "rebound" reaction that may occur as early as: a) 4:00 PM b) 2:00 PM c) 10:00 PM d) 6:00 PM

b) Cytotoxic Pg. 1041 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.

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

c) "If I am pregnant, I should take half the dose" Pg. 1051 Antihistamines are contraindicated during the third trimester of pregnancy, in nursing mothers and newborns, in children and elderly people, and in patients whose conditions may be aggravated by muscarinic blockade (e.g., asthma, urinary retention, open-angle glaucoma, hypertension, prostatic hyperplasia). The major side effect is sedation, although H1 antagonists are less sedating than earlier antihistamines. Additional side effects include nervousness, tremors, dizziness, dry mouth, palpitations, anorexia, nausea, and vomiting.

10. When evaluating a client's knowledge about use of antihistamines, what statement indicates further education is required? a) "This medication may be taken with food" b) "I should be careful when driving" c) "If I am pregnant, I should take half the dose" d) "Hard candy will relieve my dry mouth"

d) Dyspnea, bronchospasm, and/or laryngeal edema Pg. 1046 Severe systemic, anaphylactic reactions have an abrupt onset with the same signs and symptoms described previously. These symptoms progress rapidly to bronchospasm, laryngeal edema, severe dyspnea, cyanosis, and hypotension. Dysphagia (difficulty swallowing), abdominal cramping, vomiting, diarrhea, and seizures can also occur. Cardiac arrest and coma may follow.

2. A patient is experiencing an allergic reaction to a dose of penicillin. What should the nurse look for in the patient's initial assessment? a) The severity of cutaneous warmth and flushing b) Hypotension and tachycardia c) The presence and location of pruritus d) Dyspnea, bronchospasm, and/or laryngeal edema

c) Macrophages Pg. 1039 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.

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

c) Blistering Pg. 1064 Manifestations associated with allergic contact dermatitis related to latex include blisters, pruritus, erythema, swelling, and crusting or other skin lesions. Laryngeal edema, rhinitis, and angioedema would be noted with a latex allergy.

37. A nurse comes to the employee health center for evaluation and is diagnosed with allergic contact dermatitis related to latex. What manifestation would the nurse most likely exhibit? a) Laryngeal edema b) Angioedema c) Blistering d) Rhinitis

c) Apply an allergy bracelet and flag the chart Pg. 1047 The nurse asks each client about the existence of any allergies. If any are reported, the nurse flags the medical record and applies a wristband with the appropriate information. Throughout the client's care, the nurse observes for signs of an allergic reaction, especially when administering medication, applying substances such as tape or adhesive patches to the skin. Medication should never be left in the client's room. The responsibility for medications with the identified allergens lies with the healthcare personnel in the acute care facility. The physician does not need to be called if the chart is flagged.

29. The nurse is interviewing a client being admitted to the hospital and inquires about any allergies the client has. The client states he is allergic to aspirin and penicillin. What intervention should the nurse provide immediately to prevent complications related to allergies? a) Inform the client not to take any medications with those substances in them b) Call the physician c) Apply an allergy bracelet and flag the chart d) Tape an EpiPen to the head of the bed

b) Jab the EpiPen autoinjector firmly into the outer thigh e) After administering the injection, massage the area for 10 seconds f) Hold the EpiPen autoinjector against the thigh for 10 seconds Pg. 1048 The EpiPen autoinjector is administered pointing downward not upward. The EpiPen autoinjector is firmly jabbed into the outer thigh to ensure the needle pierces the skin. The needle needs to be at a 90-degree angle, not at a 30-degree angle. The medication may not work as well if the injection is given in the buttocks. The preferred site is the thigh to avoid hitting bone, nerves, vessels or organs. Massaging the area for 10 seconds after administering the injection increases the speed of absorption. Holding the EpiPen autoinjector against the thigh for 10 seconds gives the medication time to be fully administered.

16. The nurse is teaching a client how to self-administer epinephrine using an EpiPen autoinjector. What information should be included in the teaching? Select all that apply. a) The needle should be at a 30 degree angle b) Jab the EpiPen autoinjector firmly into the outer thigh c) Grasp the EpiPen autoinjector pointing upward d) The buttocks can be used as an injection site e) After administering the injection, massage the area for 10 seconds f) Hold the EpiPen autoinjector against the thigh for 10 seconds

a) Histamine Pg. 1038 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.

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