Chapter 38: PrepU - Nursing Management: Patients With Allergic Disorders

Which intervention is the single most important aspect for the client at risk for anaphylaxis? 1- Use of antihistamines 2- Desensitization 3- Wearing a medical alert bracelet 4- Prevention

4

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? 1- High IgE concentration 2- High neutrophil count 3- Low eosinophil count 4- Low white blood cell count

1

A patient with seasonal allergies has told the nurse that a colleague recommended pseudoephedrine hydrochloride (Sudafed) as a means of controlling signs and symptoms. The nurse should be aware that this drug provides relief for many patients but adverse effects include a risk of: 1- Anxiety 2- Decreased urine output 3- Depression 4- Gastritis

1

Which body substance causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle? 1- Histamine 2- Bradykinin 3- Serotonin 4- Prostaglandin

1

Which of the following is the most frequent route of exposure to a latex allergy? 1- Cutaneous 2- Inhalation 3- Mucosal 4- Parenteral

1

What education should the nurse provide to the patient taking long-term corticosteroids? 1- The patient should not stop taking the medication abruptly and should be weaned off of the medication. 2- The patient should take the medication only as needed and not take it unnecessarily. 3- Corticosteroids are relatively safe drugs with very few side effects. 4- The patient should discontinue using the drug immediately if weight gain is observed.

1

A nurse is assessing a client who is experiencing an allergic reaction. What will the nurse identify as resulting from the release of histamine? 1- Pruritus 2- Vasodilation 3- Hypotension 4- Constipation

1

An occupational health nurse is assessing a woman who experienced an anaphylactic reaction to a dip that contained crab during an office celebration. Because the woman promptly self-administered epinephrine, her status has normalized and she is now resting in a colleague's office. What action should the nurse perform? 1- Liaise with the woman's family and arrange for her to return home. 2- Have the woman transported to a nearby emergency department. 3- Encourage the woman to limit her physical activity for the next 24 to 48 hours. 4- Provide reassurance to limit the woman's anxiety.

2

The nurse explains to a client that immunotherapy initally starts with injections at which interval? 1- Daily 2- Weekly 3- Bi-monthly 4- Monthly

2

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? 1- Intramuscular 2- Intradermal 3- Subcutaneous 4- Intravenous

2

A client comes to the clinic complaining of a rash on the arms, chest and upper thighs. Inspection reveals pink, raised lesions of varying sizes and shapes. The client reports that the lesions are "quite itchy and uncomfortable." The client's medication history is unremarkable. The nurse would document these lesions as: 1- urticaria 2- dermatitis medicamentosa 3- serum sickness 4- Angioneurotic edema

1

A nurse who works on a busy medical unit has been experiencing dry, itchy, reddened hands that she believes are a result of the frequent hand-washing that her job requires. What should the nurse's colleague recommend for the relief of this problem? 1- Use of a different type of soap 2- Over-the-counter antihistamines 3- Topical corticosteroids 4- Handwashing with water alone

1

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? 1- 2 hours 2- 6 hours 3- 12 hours 4- 24 hours

1

The nurse is preparing to administer a medication that has an affinity for H1 receptors. Which medication would the nurse administer? 1- Diphenhydramine 2- Omeprazole 3- Cimetidine 4- Ranitidine

1

Which term refers to an incomplete antigen? 1- Hapten 2- Allergen 3- Antigen 4- Antibody

1

The nurse is administering a sympathomimetic drug to a patient. What areas of concern does the nurse have when administering this drug? (Select all that apply.) 1- Causes bronchodilation 2- Constricts integumentary smooth muscle 3- Dilates the muscular vasculature 4- Causes bronchoconstriction 5- Causes laryngospasm

1,2,3

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. 1- Wear a medic alert bracelet. 2- List symptoms of peanut allergy. 3- Identify ways to manage allergy while dining out. 4- Food labels on baked items are the only labels that need to be read. 5- Carry EpiPen autoinjector at all times.

1,2,3,5

A nurse is preparing a discharge teaching plan for a client with atopic dermatitis. Which instruction should the nurse include in the teaching plan? 1- Wear only synthetic fabrics. 2- Use a topical skin moisturizer daily. 3- Bathe only three times per week. 4- Keep the thermostat above 75° F (23.9° C).

2

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? 1- Laryngeal edema 2- Rhinitis 3- Blistering 4- Angioedema

3

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"? 1- Be sure to use the nasal spray for at least 10 days to ensure the stuffiness is gone. 2- Use the medication every 4 hours to prevent congestion from recurring. 3- Drink plenty of fluids. 4- Only use the nasal spray for 3 to 4 days once every 12 hours.

4

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? 1- February 6 2- February 9 3- February 12 4- February 15

4

A patient in his 40s is considering immunotherapy as a treatment for his longstanding allergic rhinitis, a problem which is taking an increasing toll on his quality of life. The nurse at the allergy clinic should ensure that the patient knows that allergy control by this method usually requires treatment for how long? 1- Six to eight months 2- One year to 18 months 3- Two to three years 4- Three to five years

4

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? 1- 10:00 AM 2- 11:00 AM 3- 1:00 PM 4- 3:00 PM

1

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 1- urticaria. 2- contact dermatitis. 3- pitting edema. 4- angioneurotic edema.

4

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? 1- 5 to 10 minutes 2- 15 to 20 minutes 3- 30 to 35 minutes 4- 40 to 45 minutes

1

The nurse is planning the care of an 8-year-old boy who has been diagnosed with atopic dermatitis. In the boy's plan of nursing care, what nursing diagnosis should the nurse prioritize? 1- Acute pain related to atopic dermatitis 2- Risk for delayed development related to atopic dermatitis 3- Risk for impaired skin integrity related to atopic dermatitis 4- Chronic pain related to atopic dermatitis

3

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. 1- Use of sedatives to treat reactions 2- Desensitization to allergen 3- Wearing a medical alert bracelet 4- Avoiding allergens

3,4

The parents of a 3-year-old boy have just been informed that allergy testing suggests their son has multiple food allergies. When providing health education for this family, what subject should the nurse prioritize? 1- Alternative nutritional delivery systems 2- Coping strategies for the lifestyle changes that their son's diagnosis necessitates 3- The appropriate use of antihistamines in pediatric patients 4- Possible sources of food allergens and strategies for avoiding offending foods

4

The nurse teaches the client with allergies about anaphylaxis, including which statement? 1- The most common cause of anaphylaxis is penicillin. 2- Anaphylactoid (anaphylaxis-like) reactions are commonly fatal. 3- The most common food item that causes anaphylaxis is chocolate. 4- Systemic reactions include urticaria and angioedema.

1

A patient has been diagnosed with an allergy to peanuts. What is a priority for this patient to carry at all times? 1- A medical alert bracelet 2- An H1 blocker 3- An EpiPen 4- An oral airway

3

A patient has developed severe contact dermatitis with burning, itching, cracking, and peeling of the skin on her hands. What should the patient be instructed to do? 1- Wear powdered latex gloves. 2- Wash her hands with antibacterial soap. 3- Maintain the room temperature at 80°F. 4- Keep her hands well moisturized.

4

When assessing the skin of a client with allergic contact dermatitis, the nurse would most likley expect to find irritation at which area? 1- Dorsal aspect of the hand 2- Lower arms 3- Ankles 4- Plantar aspects of the feet

1

A patient with severe environmental allergies is scheduled for the first in a planned series of immunotherapy injections. What should be included in teaching the patient about the injection? 1- The injection will cure the response to the allergen within 6 to 8 weeks. 2- The patient will remain in the clinic to be monitored for 30 minutes following the injection. 3- Therapeutic failure occurs if the symptoms to the allergen do not decrease after 3 months. 4- Injections are usually administered twice weekly.

2

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 1- Rhinitis medicamentosa 2- Tolerance to nose drops 3- Leukotriene modifier 4- Atopic dermatitis

1

A client is prescribed an oral corticosteroid for 2 weeks to relieve asthma symptoms. The nurse educates the client about side effects, which include 1- adrenal suppression. 2- diuresis. 3- hypoglycemia. 4- hypotension.

1

The nurse in an allergy clinic is assessing a new patient. The nurse is aware that histamine plays an important role in the immune response and that the effects of histamine can manifest in assessment findings. What response can occur as a result of histamine release? 1- Constriction of small venules 2- Contraction of bronchial smooth muscle 3- Dilation of large blood vessels 4- Decrease secretion of gastric and mucosal cells

2

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? 1- Immunoglobulin 2- Complete protein antigen 3- Chemical mediator 4- T-lymphocyte

2

A nurse is reading a journal article about medications used to treat allergic rhinitis. The nurse demonstrates understanding of the information when identifying which medication as being the most effective maintenance therapy for chronic allergic rhinitis? 1- Second-generation antihistamines 2- Mast cell stabilizers 3- Adrenergic agents 4- Intranasal corticosteroids

4

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. 1- Milk 2- Eggs 3- Shrimp 4- Beef 5- Chicken

1,2,3

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? 1- Report white patches in the mouth because the medication can cause a fungal infection. 2- Do not overuse the medication as rebound congestion can occur. 3- Taper the dose when discontinuing the medication. 4- Do not operate machinery or drive while using the medication.

2

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? 1- "It means you are very sensitive to something inside of yourself." 2- "It is a hyperimmune response to something in the environment that is usually harmless." 3- "It is a muted response to something in the environment." 4- "It is a harmless reaction to something in the environment."

2

A nurse is reviewing how to use an epinephrine auto-injector with a child and parents. The nurse determines that the teaching was successful when the child and parents state that after injection they will hold the pen in place for approximately: 1- 5 seconds. 2- 10 seconds. 3- 30 seconds. 4- 60 seconds.

2

A nurse is caring for a client with atopic dermatitis. Which suggestions for the client by the nurse would be appropriate? Select all that apply. 1 -Use a strong antibacterial detergent for the laundry. 2- Keep the room temperature at approximately 70 degrees Fahrenheit (21 degrees Celcius). 3- Apply topical moisturizers to the skin. 4- Wear clothing made from synthetic fabrics. 5- Humidify the home when the heat is on during the winter.

2,3,5

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? 1- Take the drug orally before, with, or after meals. 2- Use ice chips to alleviate the symptoms of dry mouth. 3- Be aware that some nasal burning and itching may occur. 4- Place the prescribed number of drops into the conjunctiva.

3

A clinic nurse has been charged with the responsibility of teaching avoidance strategies to an adult patient who has allergic rhinitis. What measure should the nurse recommend to this patient? 1- "Make sure that there are never air drafts in your home." 2- "Avoid the use of air conditioning whenever possible." 3- "If possible, make sure that no one smokes tobacco in your home." 4- "Keep your windows open to ensure adequate air circulation."

3

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? 1- "You need to come back to the clinic to get a different medication since this one is not working for you." 2- "You may be immune to the effects of this medication and will need something else in its place." 3- "The full benefit of the medication may take up to 2 weeks to be achieved." 4- "I am sorry that you are feeling poorly but this is the only medication that will work for your problem."

3

A 44-year-old man has come to the clinic with an asthma exacerbation. He tells the nurse that his father and brother also suffer from asthma, as does his 15-year-old son. The nurse explains that this is an allergic response based on a genetic predisposition. The specific allergen initiated by this immunological mechanism is usually mediated by: 1- Immunoglobulin A 2- Immunoglobulin M 3- Immunoglobulin G 4- Immunoglobulin E

4

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? 1- Type I 2- Type II 3- Type III 4- Type IV

4

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? 1- Diarrhea 2- Anorexia 3- Palpitations 4- Sedation

4

A client with a history of anaphylactic reactions to insect stings has just been stung by a wasp. Place the steps in the correct order that the client will follow for self-administration of an EpiPen. Use all options.

Remove the gray safety-release cap Inject the black tip into the outer thigh Massage the injection area Call the emergency medical response number (911)

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? 1- Beta blocker 2- Angiotensin-converting enzyme (ACE) inhibitor 3- Angiotensin receptor blocker 4- Vasodilator

2

A mother has come to the emergency department (ED) with her 2-year-old who appears to be having a hypersensitivity reaction. The ED nurse knows that a hypersensitivity reaction may be characterized by an immediate reaction beginning within minutes of exposure to an antigen. What condition is an example of such a reaction? 1- Anaphylactic reaction immediately following a bee sting 2- Skin reaction from tape adhesive 3- Hay fever 4- Rheumatoid arthritis

1

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? 1- Serum IgE level 2- White blood cell count 3- Eosinophil count 4- Erythrocyte sedimentation rate

1

The best treatment for latex allergy is 1- corticosteroids. 2- avoidance of latex-based products. 3- antihistamines. 4- epinephrine from an emergency kit.

2

At an office birthday party, one of the executives ate a piece of cake that he was unaware had been made with peanut oil. He begins wheezing, with an inspiratory stridor and air hunger. The occupational health nurse is called to the office. The nurse recognizes he is suffering from which type of hypersensitivity? 1- Anaphylactic (type 1) 2- Cytotoxic (type II) 3- Immune Complex (type III) 4- Delayed type (type IV)

1

Which statement describes the clinical manifestations of a delayed hypersensitivity (type IV) allergic reaction to latex? 1- They are localized to the area of exposure, usually the back of the hands. 2- They can be eliminated by changing glove brands or using powder-free gloves. 3- They may worsen when hand lotion is applied before donning latex gloves. 4- They occur within minutes after exposure to latex.

1

A nurse is teaching a client how to use their EpiPen autoinjector. What client statements indicates no further teaching is required? Select all that apply. 1- "The EpiPen autoinjector needs to be pointed downward." 2- "I will jab the EpiPen autoinjector firmly into my right upper buttock." 3- "The needle needs to be at a 90-degree angle." 4- "After I administer the injection, I will massage the area for 10 seconds." 5- "The EpiPen autoinjector should be held against the injection site for 20 seconds."

1,3, 4

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? 1- Allergic contact dermatitis 2- Irritant contact dermatitis 3- Latex allergy 4- Latex hyperplasia

2

A 10-year-old boy has been brought to the emergency department (ED) by ambulance in apparent anaphylaxis after accidentally eating a snack bar that contained peanuts. The ED nurse should be aware that this patient's signs and symptoms are attributable to: 1- Dissolution of the basement membranes of epithelium 2- Rapid activation of the clotting cascade 3- A massive release of histamine 4- Activation of the sympathetic nervous system (SNS)

3

When evaluating a client's knowledge about use of antihistamines, what statement indicates further education is required? 1- "This medication may be taken with food." 2- "Hard candy will relieve my dry mouth." 3- "If I am pregnant, I should take half the dose." 4- "I should be careful when driving."

3

A client with seasonal allergic rhinitis comes to the clinic for a check-up. During the visit, the client tells the nurse that the symptoms primarily occur in the early fall. The nurse would suspect that the client has an allergy to which substance? 1- tree pollen 2- rose pollen 3- grass pollen 4- weed pollen

4