Chapter 37: Assessment and Management of Patients With Allergic Disorders

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." "The test may be mildly uncomfortable." "I may experience itching and irritation at the site of the testing." "I'll go directly to the pharmacy with my EpiPen

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

A client presents at the clinic with an allergic disorder. The client asks the nurse what an "allergic disorder" means. What would be the nurse's best response? "It is a harmless reaction to something in the environment." "It means you are very sensitive to something inside of yourself." "It is a muted response to something in the environment." "It is a hyperimmune response to something in the environment that is usually harmless."

"It is a hyperimmune response to something in the environment that is usually harmless."

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? Continue to monitor the client's vital signs. Administer epinephrine, as ordered. Insert an indwelling urinary catheter. Page an anesthesiologist immediately.

Administer epinephrine, as ordered.

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? Carry an emergency kit. Undergo desensitization treatment. Wear a medical alert bracelet. Avoid potential allergens.

Avoid potential allergens.

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 An alloimmunity disorder An exacerbation of a previous disorder A cause-and-effect relationship

Autoimmune

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? Sublingual-swallow immunotherapy (SLIT) Desensitization Sublingual-topical immunotherapy (STIT) Resensitization

Desensitization

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

Diphenhydramine

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? Do not operate machinery or drive while using the medication. Taper the dose when discontinuing the medication. Do not overuse the medication as rebound congestion can occur. Report white patches in the mouth because the medication can cause a fungal infection.

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 Plantar aspects of the feet Lower arms Ankles

Dorsal aspect of the hand

Which term refers to an incomplete antigen? Antigen Hapten Allergen Antibody

Hapten

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

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

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? Intramuscular Intravenous Intradermal Subcutaneous

Intradermal

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? Pushes down on the grey release cap to administer the medication Maintains pressure on the auto-injector for about 30 seconds after insertion Avoids massaging the injection site after administration Jabs the autoinjector into the outer thigh at a 90-degree angle

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

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? Diarrhea Palpitations Sedation Anorexia

Sedation

A nurse is reviewing the dietary history of a client who has experienced anaphylaxis. What would the nurse identify as a common cause of anaphylaxis? Select all that apply. Beef Chicken Shrimp Milk Eggs

Shrimp Milk Eggs

What are expected client outcomes the nurse would include in a plan of care for a client with allergic rhinitis? Select all that apply. The client will wear a dampened mask if dust is a problem The client reports no symptoms of peripheral tingling The client develops cachexia The client's lungs will have occasional crackles or rhonchi The client controls outdoor precipitating factors

The client will wear a dampened mask if dust is a problem The client reports no symptoms of peripheral tingling The client controls outdoor precipitating factors

What education should the nurse provide to the patient taking long-term corticosteroids? The patient should discontinue using the drug immediately if weight gain is observed. The patient should not stop taking the medication abruptly and should be weaned off of the medication. The patient should take the medication only as needed and not take it unnecessarily. Corticosteroids are relatively safe drugs with very few side effects.

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

T-cell deficiency occurs when which gland fails to develop normally during embryogenesis? Adrenal Thyroid Pituitary Thymus

Thymus

The nurse explains to a client that immunotherapy initially starts with injections at which interval? Daily Bi-monthly Monthly Weekly

Weekly

The parents of a child with contact dermatitis are asking questions about the reaction within the immune system. What description regarding contact dermatitis as a type IV hypersensitivity reaction is accurate? the involvement of immune complexes formed when antigens bind to antibodies a cross-reacting antibody that mistakes a normal constituent of the body as foreign the immediate release of chemical mediators a delayed-type hypersensitivity that is mediated by T cells

a delayed-type hypersensitivity that is mediated by T cells

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

a hereditary predisposition.

Which allergic reaction is potentially life threatening? contact dermatitis None of the listed allergic reactions is potentially life threatening. urticaria angioedema

angioedema

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 angioneurotic edema. contact dermatitis. urticaria. pitting edema.

angioneurotic edema.

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

avoidance of latex-based products.

A client visits the employee health department because of mild itching and a rash on both hands. What will the employee health nurse focus on during the assessment interview? laundry detergent or bath soap changes life stressors the nurse may be experiencing medication allergies chemical and latex glove use

chemical and latex glove use

A client comes to the emergency department complaining of difficulty breathing and feeling strange after eating a shrimp cocktail. The client is leaning forward with a respiratory rate of 36 breaths per minute. The nurse suspects anaphylaxis. What is the nurse's priority action? maintaining an open airway providing pain relief measures decreasing anxiety encouraging activity

maintaining an open airway

A nurse is providing care to a client with a history of atopic dermatitis who has numerous lesions on the arms, neck, and legs. The client states, "My skin is so ugly. I can't imagine what people must think when they look at me. I can't look at myself sometimes." What will the nurse include on the client's plan of care? pain disturbed body image deficient knowledge feelings of depression

disturbed body image

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 hypotension and tachycardia the presence and location of pruritus the severity of cutaneous warmth and flushing

dyspnea, bronchospasm, and/or laryngeal edema

The nurse is teaching a client about histamine release during an anaphylactic reaction. What does histamine release in anaphylaxis cause? stomach cramps feeling of impending doom urinary urgency nasal congestion

nasal congestion

The nurse is teaching a client about allergic rhinitis and its triggers. What is the most common trigger for the respiratory allergic response? mold spores plant pollen animal dander dust mites

plant pollen

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/mLWhite blood cell count: 5,100/cu mmEosinophil count: 4%Erythrocyte sedimentation rate: 20 mm/hThe nurse identifies which result as suggesting an allergic reaction? Serum IgE level Erythrocyte sedimentation rate Eosinophil count White blood cell count

Serum IgE level

A nurse is teaching a client about allergic rhinitis. What client statements indicate teaching has been effective? Select all that apply. "I will remove as much carpet from my house as I can." "I need to reduce my exposure to people that have upper respiratory infections." "I am allowed to miss only one desensitization appointment before my treatment is affected." "I should use my medication for allergy exacerbation only when my allergy is apparent." "I can only have one alcoholic drink while I am taking my antihistamine."

"I will remove as much carpet from my house as I can." "I need to reduce my exposure to people that have upper respiratory infections." "I should use my medication for allergy exacerbation only when my allergy is apparent."

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? serotonin histamine prostaglandins leukotrienes

histamine

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 nasal smear peripheral blood smears punch biopsy

intradermal testing

The nurse is teaching a client with allergic rhinitis about medications. What medication is a mast cell stabilizer used in the treatment of allergic rhinitis? intranasal cromolyn sodium oxymetazoline hydrochloride tetrahydrozoline hydrochloride pseudoephedrine hydrochloride

intranasal cromolyn sodium

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

For their immunosuppressant effects

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? Low eosinophil count Low white blood cell count High neutrophil count High IgE concentration

High IgE concentration

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

Histamine

A client is prescribed montelukast as part of a treatment plan for an allergic disorder. The nurse understands that this drug belongs to which class? Nonsedating antihistamine Corticosteroid Mast cell stabilizer Leukotriene-receptor antagonist

Leukotriene-receptor antagonist

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

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

The nurse is teaching a client about a recent order for loratadine to help with seasonal allergies. What client statements indicate no further teaching is required? Select all that apply. "Drinking two or three alcoholic drinks a week is okay." "Sucking on ice chips will help if my mouth is dry." "It is recommended that I buy a humidifier for my bedroom." "Being careful driving is important after taking the medication." "Taking my medication on an empty stomach is a must."

"Sucking on ice chips will help if my mouth is dry." "It is recommended that I buy a humidifier for my bedroom." "Being careful driving is important after taking the medication." "Taking my medication on an empty stomach is a must."

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." "You need to come back to the clinic to get a different medication since this one is not working for you." "I am sorry that you are feeling poorly but this is the only medication that will work for your problem." "You may be immune to the effects of this medication and will need something else in its place."

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

Which of the following is the most frequent route of exposure to a latex allergy? Cutaneous Mucosal Parenteral Inhalation

Cutaneous

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. Use the medication every 4 hours to prevent congestion from recurring. Be sure to use the nasal spray for at least 10 days to ensure the stuffiness is gone. Drink plenty of fluids.

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

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

Prevention

A client comes to the clinic reporting nasal congestion and states, "I've been using an over-the-counter nasal spray that seemed to help at first, but then I got even more congested than before I started the medication. I continued the nasal spray, but it seems to be worse." What reaction will the nurse suspect? Development of a new allergy Drug overdose Tolerance to the medication Rhinitis medicamentosa

Rhinitis medicamentosa

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

The most common cause of anaphylaxis is penicillin.

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. Bathe only three times per week. Keep the thermostat above 75° F (23.9° C). Wear only synthetic fabrics.

Use a topical skin moisturizer daily.

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. Use of sedatives to treat reactions Wearing a medical alert bracelet Avoiding allergens Desensitization to allergen

Wearing a medical alert bracelet Avoiding allergens

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. Client states the need for coughing and deep breathing. Client demonstrates appropriate coping strategies for dealing with a chronic disorder. Client reports an absence of symptoms associated with the allergy.

Client identifies methods for reducing exposure risk to allergens.

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? irritant contact IgG antibodies allergic contact IgE-mediated hypersensitivity

IgE-mediated hypersensitivity