Med Surg I Prep U Chapter 37: Assessment and Management of Patients With Allergic Disorders

When evaluating a client's knowledge about use of antihistamines, which of the following statements made by the patient would indicate to the nurse a knowledge deficit?

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

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 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. Which of the following would 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 that he is allergic to animal dander. The nurse interprets this substance as which of the following?

Complete protein antigen

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 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

Which of the following aid in diagnosing the risk of anaphylaxis?

Intradermal testing

Which of the following is a mast cell stabilizer used in the treatment of allergic rhinitis?

Intranasal cromolyn sodium (NasalCrom)

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

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

Which type of contact dermatitis requires light exposure in addition to allergen contact?

Photoallergic

Preventive health education includes informing patients about the symptoms associated with allergic rhinitis. The nurse is aware that the most common trigger to this respiratory allergic response is:

Plant pollen.

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

Use a topical skin moisturizer daily.

Which of the following is a contraindication for immunotherapy?

Use of a beta-blocker

Client is presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. What action is of primary importance upon admission?

maintain airway

A client reports to a physician'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."

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."

A client with a history of allergic rhinitis comes to the clinic for an evaluation. The client is prescribed triamcinolone. Which of the following would 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. Which of the following would the nurse most likely exhibit?

Blistering

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

Cutaneous

T-cell deficiency occurs when which gland fails to develop normally during embryogenesis?

Thymus

A client is scheduled to begin immunotherapy. The nurse would explain that the client will receive injections initially at which interval

Weekly

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 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 of the following would the nurse prioritize as the most important action for the patient to take to prevent anaphylaxis?

Avoid potential allergens

A nurse is preparing a teaching plan about exposure control for a client with an allergic disorder. Which of the following would the nurse least likely include in the teaching plan?

Dusting the room at least weekly

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

IgE

Which chemical mediators initiate and mediate the inflammatory response?

Leukotrienes

Which route of exposure to latex products occurs from use of latex condoms?

Mucosal

What is the most common cause of anaphylaxis?

Penicillin

A nurse has developed irritant contact dermatitis from latex glove use. Which of the following would the nurse need to avoid?

Using oil-based hand lotion before donning gloves

A nurse is visiting the home of a client with atopic dermatitis. Which of the following suggestions for the client would be appropriate? Select all that apply.

• Keep the room temperature at approximately 70 degrees Farenheit. • Apply topical moisturizers to the skin. • Humidify the home when the heat is on during the winter.

A nurse is reviewing the dietary history of a client who has experienced anaphylaxis. Which of the following would the nurse identify as a common cause of anaplhylaxis? Select all that apply?

• Milk • Eggs • Shrimp

Patient teaching about mild allergic responses should include information about the onset of symptoms. The nurse tells the patient that if exposure to an allergen occurs around 8:00 AM, he should expect a mild or moderate reaction by what time?

10:00 AM

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%

The maximum intensity of histamine occurs within which time frame after contact with an antigen?

5 to 10 minutes

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?

5 to 10 minutes

Contact dermatitis is considered a type IV hypersensitivity reaction. The nurse is aware that this classification is characterized by which of the following?

A delayed-type hypersensitivity that is mediated by T cells

After receiving a dose of penicillin, a client develops dyspnea and hypotension. The nurse suspects the client is experiencing anaphylactic shock. What should the nurse do first?

Administer epinephrine, as ordered, and prepare to intubate the client, if necessary.

The nurse practitioner treating a patient with allergic rhinitis decides pharmacologic therapy would be helpful. Which of the following is she most likely to prescribe?

Allegra

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

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

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

Diphenhydramine (Benadryl)

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 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.

A health care provider prescribed Flonase, an intranasal corticosteroid, for a patient with a severe case of allergic rhinitis. The nurse told the patient that there is a delayed response to full benefits from the drug. The patient took his first dose on February 2. The patient should expect that the drug will be fully effective no later than:

February 15

Nursing students are reviewing various medications that can be used to treat allergic disorders. The students demonstrate understanding of the information when they identify which of the following 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

Which term refers to an incomplete antigen?

Hapten

A nurse practitioner working in a dermatology clinic explained to a group of nursing students that the pathophysiology of an allergic response involves a chain of events that includes responses from lymphocytes, IgE, mast cells, and basophils. The nurse mentioned that the most important chemical mediator involved in the response is:

Histamine

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

Histamine

When describing the immunoglobulin most likely involved with allergic reactions, which of the following would the nurse address?

IgE

There are several types of reactions to latex. The nurse knows to be most concerned about laryngeal edema with the following reaction:

IgE-mediated hypersensitivity.

Which of the following is considered the most serious manifestation of angioneurotic edema?

Laryngeal swelling

A client is prescribed montelukast as part of his treatment plan for an allergic disorder. The nurse understands that this drug belongs to which class?

Leukotriene-receptor antagonist

Histamine release in anaphylaxis causes which of the following?

Nasal congestion

A 6-year-old experienced an allergic reaction to shellfish. The nurse practitioner gave the mother a booklet that includes teaching points about food allergies. The nurse reminded the mother to be vigilant for mild systemic reactions such as:

Nasal congestion and sneezing.

A patient has had a "stuffy nose" and obtained Afrin nasal spray. What education should the nurse provide to the patient in order to prevent "rebound congestion"?

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

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

Prevention

A nurse is assessing a client who is experiencing an allergic reaction. Which of the following would the nurse identify as resulting from the release of histamine?

Pruritus

A client with Crohn's disease, an autoimmune disorder, informs the nurse that he has not had any symptoms of the disease in 8 months. What does the nurse understand this asymptomatic period is referred to?

Remission

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

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

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?

Serum IgE level

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.

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 the liquid test antigen to the scratch, usually on the back.

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 prescribed an oral corticosteroid for 2 weeks to relieve asthma symptoms. The nurse educates the client about side effects, which include

adrenal suppression

The best treatment for latex allergy is

avoidance of latex-based products.

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 nurse visits the employee health department because of mild itching and a rash on both hands. During the assessment interview, the employee health nurse should focus on:

chemical and latex glove use.

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 manifestatons generally correlate with:

route of exposure

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

In its attempt to suppress allergic responses, the body releases several chemicals which have a role in mediating physical reactions. Epinephrine, which interferes with vasoactive chemical release from mast cells, is instrumental in suppressing which type of hypersensitivity response?

type I

A patient with a history of anaphylactic reactions to insect stings has just been stung by a wasp. The patient is going to self-administer his EpiPen. Place the steps in the correct order that he would follow. Use all options.

• 1. Remove the gray safety-release cap • 2. Inject the black tip into the outer thigh • 3. Massage the injection area • 4. Call the emergency medical response number (911)

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.

• Wearing a medical alert bracelet • Avoiding allergens