Chapter 33: Assessment and Management of Patients with Allergic Disorders

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?

High IgE concentration

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?

laryngeal swelling

The nurse is working with a client with allergies. What will the nurse use to confirm allergies and decrease the risk of anaphylaxis?

intradermal testing

A client presents to the clinic with reports of itching and hives after taking an aspirin this morning. What medication does the nurse anticipate administering that blocks histamine receptors?

Diphenhydramine

Which of the following is the most frequent route of exposure to a latex allergy?

Cutaneous

The nurse is preparing to administer a medication that has an affinity for H1 receptors. Which medication would the nurse administer?

Diphenhydramine

A client calls the clinic and asks the nurse if using oxymetazoline nasal spray would be all right to relieve the nasal congestion the client is experiencing due to seasonal allergies. What instructions should the nurse provide to the client to avoid complications?

Do not overuse the medication as rebound congestion can occur.

When assessing the skin of a client with allergic contact dermatitis, the nurse would most likely expect to find irritation at which area?

Dorsal aspect of the hand

A patient is experiencing an allergic reaction to a dose of penicillin. What should the nurse look for in the patient's initial assessment?

Dyspnea, bronchospasm, and/or laryngeal edema.

Which term refers to an incomplete antigen?

Hapten

Which body substance causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle?

Histamine

The clinic nurse is caring for a client with an allergic disorder who has received the first sensitizing dose of a new drug. Now, the client is given a second dose. What nursing action is most important at this stage of transition?

Monitor the client for reactions.

What is the most common cause of anaphylaxis?

Penicillin

Which intervention is the single most important aspect for the client at risk for anaphylaxis?

Prevention

A client has been taking a decongestant for allergic rhinitis. During a follow-up visit, which finding suggests that the decongestant has been effective?

Reduced sneezing

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

Rhinitis medicamentosa

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?

Sedation

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?

Symptoms are localized to the area of exposure, usually the back of the hands.

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?

The most common cause of anaphylaxis is penicillin.

What education should the nurse provide to the patient taking long-term corticosteroids?

The patient should not stop taking the medication abruptly and should be weaned off of the medication.

When evaluating a client's knowledge about use of antihistamines, what statement indicates further education is required?

"If I am pregnant, I should take half the dose."

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?

"If I notice tingling in my lips or mouth, gargling may help the symptoms."

Which statement would alert the nurse to suspect a client is experiencing a mild anaphylactic reaction?

"My throat feels like it's full."

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?

"The full benefit of the medication may take up to 2 weeks to be achieved."

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?

10:00 AM

The nurse working on a pulmonary unit has an order to administer zafirlukast 20 mg twice a day to a client who was admitted with an exacerbation of asthma. Order: Accolate 20 mg oral (po) two times a day (bid) Dose on hand: 10 mg/tablet How many tablets should the nurse give at each dose?

2

A patient comes to the clinic with pruritus and nasal congestion after eating shrimp for lunch. The nurse is aware that the patient may be having an anaphylactic reaction to the shrimp. These symptoms typically occur within how many hours after exposure?

2 hours

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:

2:00 PM.

A client has been hospitalized for diagnostic testing. The client has just been diagnosed with multiple sclerosis, which the physician explains is an autoimmune disorder. How would the nurse explain an autoimmune disease to the client?

A disorder where killer T cells and autoantibodies attack or destroy natural cells—those cells that are "self."

A client presents to the emergency department in anaphylactic shock after a bee sting. What should the nurse do? Select all that apply.

Administer Diphenhydramine. Insert an intravenous line. Have respiratory therapy provide an albuterol treatment.

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?

Autoimmune

The nurse is creating a discharge teaching plan for a client with a latex allergy. Which information should be included? Select all that apply.

Avoidance of latex-based products Administration of antihistamines Administration of emergency epinephrine

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?

Client identifies methods for reducing exposure risk to allergens.

While interviewing a client with an allergic disorder, the client tells the nurse about an allergy to animal dander. The nurse knows that animal dander is what type of substance?

Complete protein antigen

A client has begun sensitivity testing to determine the allergen which caused an anaphylactic reaction 3 weeks ago. In scratch testing, which part of the body is more sensitive to allergens?

back

The nurse is working in an allergy clinic with a client with tuberculosis. What other reaction is a type IV hypersensitivity disorder?

contact dermatitis

The nurse is administering intravenous vancomycin. What will the nurse initially assess the client for if an allergic reaction occurs?

dyspnea, bronchospasm, and/or laryngeal edema

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?

histamine

The nurse is teaching a client about allergic rhinitis and its triggers. What is the most common trigger for the respiratory allergic response?

plant pollen

The nurse is teaching a client about chemical mediators released during an allergic response. What substance will the nurse explain as a primary mediator?

prostaglandins

After receiving a dose of penicillin, a client develops dyspnea and hypotension and the nurse suspects the client is experiencing anaphylactic shock. What is the nurse's first action?

Administer epinephrine, as ordered.

The nurse is educating a patient with allergic rhinitis about how the condition is induced. What should the nurse include in the education on this topic?

Airborne pollens or molds

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?

Antihistamine

A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated?

IgE

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?

Rh-hemolytic disease

A nurse is preparing a discharge teaching plan for a client with atopic dermatitis. Which instruction should the nurse include in the teaching plan?

Use a topical skin moisturizer daily.

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?

fluticasone

A client is presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. What type of hypersensitivity did this client exhibit?

type I

After teaching a client how to self-administer epinephrine, the nurse determines that the teaching plan has been successful when the client demonstrates which action?

Jabs the autoinjector into the outer thigh at a 90-degree angle

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"?

Only use the nasal spray for 3 to 4 days once every 12 hours.

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?

IgE-mediated hypersensitivity

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?

Desensitization