Chapter 37
After teaching a client with allergic rhinitis about loratadine, the nurse determines that the client needs additional instruction when the client makes which statement?
I have to be careful because this drug will make me fairly sleepy
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
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
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
A client develops contact dermatitis in response to adhesive tape used to secure a dressing. The nurse interprets this reaction as an example of which type of hypersensitivity?
Type IV
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?
a delayed-type hypersensitivity that is mediated by T cells
antibody
a protein substance developed by the body in response to and interacting with a specific antigen
Which allergic reaction is potentially life threatening?
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
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
A client with a history of allergic rhinitis comes to the clinic for an evaluation. The client is prescribed triamcinolone. What will the nurse include when teaching the client about this drug?
be aware that some nasal burning and itching may occur
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?
blistering
serotonin
chemical mediator that acts as a potent vasoconstrictor and bronchoconstrictor.
The nurse is preparing to administer a medication that has an affinity for H1 receptors. Which medication would the nurse administer?
diphenhydramine
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 emergency department in anaphylactic shock after a bee sting. What should the nurse do? Select all that apply.
-insert an IV line -administer diphenhydramine -Have respiratory therapy provide an albuterol treatment
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?
-peanuts -tree nuts -shelfish -fish -milk -eggs -soy -wheat
allergen
substance that causes manifestation of allergy
antigen
substance that induces the production of antibodies
The nurse explains to a client that immunotherapy initally starts with injections at which interval?
weekly
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 hyperimmune response to something in the environment that is usually harmless
Which body substance causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle?
histamine
The nurse is teaching a client about latex allergies. What route of exposure from latex products occurs from use of latex condoms?
mucosal
Bradykinin
polypeptide that stimulates nerve fibers and causes pain
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?
Desensitizations
Which term refers to an incomplete antigen?
Hapten
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?
Intradermal
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 --> antihistamines and corticosteroids suppress skin test reactivity and should be stopped at least 48 hours before testing
Type III hypersensitivity reaction
associated with lupus erythematosus, rheumatoid arthritis, and certrain types of nephritis --> immune complexes are formed when antigens bind to antibodies.
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?
avoid potential 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
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 teaching a client about histamine release during an anaphylactic reaction. What does histamine release in anaphylaxis cause?
nasal congestion
Type II hypersensitivity
occurs when the system mistakenly identifies a normal body constituent as foreign --> myasthenia gravis, goodpasture's syndrome, of Rh-hemolytic disease of the newborn
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 most common cause of anaphylaxis is
penicillin
The nurse is teaching a client about contact dermatitis. What type of contact dermatitis requires light exposure in addition to allergen contact?
photoallergic
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 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 mdicamentosa
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?
total serum IgE levels 2.8mg/mL
The nurse is reviewing various medication with a client that can be used to treat allergic disorders. What medications will the nurse identify as an intranasal corticosteroid
fluticasone
A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder?
for their immunosuppressant effects
A client is scheduled to have a prick test to determine what specific allergens are creating problems for the client. What should the nurse inform the client is involved with the testing?
the skin will be scratched, and applying a small amount of liquid test antigen to the scratch, usually on the back
Which of the following is the most frequent route of exposure to a latex allergy
cutaneous
When assessing the skin of a client with allergic contact dermatitis, the nurse would most likley expect to find irritation at which area?
dorsal aspect of the hand
A client with an allergic disorder is in treatment for their disorder. What might their treatment be?
drug therapy
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 laryngeal edema
The nurse is administering intravenous vancomycin. What will the nurse initially assess the client for if an allergic reaction occurrs?
dyspnea, bronchospasm, and/or laryngeal edema
A patient was seen in the clinic for hypertension and received a prescription for a new antihypertensive medication. The patient arrived in the emergency department a few hours after taking the medication with severe angioedema. What medication prescribed may be responsible for the reaction?
ACE inhibitors
The nurse tells the client that is exposure to an allergen occurs around 8:00AM, then the client should expect a mild or moderate reaction by what time ?
10:00AM Mild and moderate reactions begin within 2 hours of exposure
While monitoring the patient's eosinophil level, the nurse suspects a definite allergic disorder when seeing an eosinophil value of what percentage of the total leukocyte count?
15% to 40%
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
Which body substance causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle?
Histamine -->When cells are damaged histamine is released
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 Antihistamines are contraindicated during the third trimester of pregnancy, in nursing mothers and in children and elderly people. major side effect is sedation
A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated?
IgE IgE--> involved with an allergic reaction
A client is prescribed an oral corticosteroid for 2 weeks to relieve asthma symptoms. The nurse educates the client about side effects, which include
adrenal suppression
desensitization
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
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
Which intervention is the single most important aspect for the client at risk for anaphylaxis
prevention
Type 1 hypersensitivity
refers to anaphylaxis and --> is seen with allergic rhinitis, asthma, and penicillin or latex allergy
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
