Allergic Conditions MCQs

A client seeks medical attention for the development of a rash on the hands. Which assessment findings indicate to the nurse that the client is experiencing irritant contact dermatitis? Select all that apply. A. Blisters B. Edema C. Burning D. Redness E. Crust formation

B,C,D Symptoms of irritant contact dermatitis include edema, burning, and redness. Blisters and crust formation is associated with allergic contact dermatitis.

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? A. Laryngeal edema B. Rhinitis C. Blistering D. Angioedema

C Latex related contact dermatitis vs latex allergy Manifestations associated with allergic contact dermatitis related to latex include blisters, pruritus, erythema, swelling, and crusting or other skin lesions. Laryngeal edema, rhinitis, and angioedema would be noted with a latex allergy.

The community health nurse is conducting a research study and is identifying clients in the community at risk for latex allergy. Which client population is at most risk for developing this type of allergy? 1. Hairdressers 2. The homeless 3. Children in day care centers 4. Individuals living in a group home

1. Hairdressers Rationale:Individuals most at risk for developing a latex allergy include health care workers, individuals who work in the rubber industry, or those who have had multiple surgeries, have spina bifida, wear gloves frequently, such as food handlers, hairdressers, and auto mechanics, or are allergic to kiwis, bananas, pineapples, tropical fruits, grapes, avocados, potatoes, hazelnuts, or water chestnuts.

The nurse is caring for a client who is experiencing a severe anaphylactic reaction caused by an allergy to peanuts. After administering subcutaneous epinephrine and beginning oxygen administration, what would be the next most important nursing action? 1. Administer analgesics to relieve the pain. 2. Start an intravenous (IV) line for fluid administration. 3. Insert a catheter to determine urinary output. 4. Obtain a history of possible reactions to penicillin.

2 Shock is a common problem in anaphylactic reactions; therefore, it is important to establish an IV for fluid and medication administration.

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? A. Intradermal B. Intramuscular C. Intravenous D. Subcutaneous

A The intradermal route is the correct route of administration for skin testing and therefore a safer route. Another safe route is epicutaneous.

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. A. Identify ways to manage allergy while dining out. B. Carry EpiPen autoinjector at all times. C. Food labels on baked items are the only labels that need to be read. D. Wear a medic alert bracelet. E. List symptoms of peanut allergy.

A,B,D,E -The EpiPen autoinjector should be carried at all times in case it needs to be administered because of an allergic reaction. Wearing a medic alert bracelet allows others to be alerted of the allergy. -Listing symptoms of the allergy makes the client aware of the allergic reaction if symptoms are being experienced. -Client should take caution when dining out and purchasing food (all food labels should be read).

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: A. 5 seconds. B. 10 seconds. C. 30 seconds. D. 60 seconds.

B Honan textbook describes older version of Epipen. The client should hold device firmly against the thigh for approximately 10 seconds. For newer ones, pt may hold for 3 seconds.

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: A. 6:00 PM. B. 4:00 PM. C. 2:00 PM. D. 10:00 PM.

C Rebound reactions can occur from 4 to 10 hours after an initial allergic reaction. Therefore the patient needs to be assessed from 2:00 PM to 8:00 PM.

When assessing the skin of a client with allergic contact dermatitis, the nurse would most likely expect to find irritation at which area? A. Plantar aspects of the feet B. Ankles C. Dorsal aspect of the hand D. Lower arms

C With allergic contact dermatitis, irritation is most common on the dorsal aspects of the hand.

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

D Patients who receive high-dose or long-term corticosteroid therapy must be cautioned not to stop taking the medication suddenly. Doses are tapered when discontinuing this medication to avoid adrenal insufficiency

The nurse is preparing a patient with a suspected latex allergy for the radioallergosorbent test (RAST). Which of the precautionary steps is most important for the nurse to follow? A. Scratch tests are performed after the RAST. B. Prick tests are performed after the RAST. C. Emergency equipment should be available. D. The test should be performed during bronchospasm.

C Allergy testing involves exposing patient to allergens, which might lead to allergic reactions that may have more systemic effects (ex. anaphylaxis) Thus, emergency equipments should be available. To minimize the risk of systemic reactions, tests involving skin (scratch and prick tests) should be done initially.

A client is having additional skin testing for allergies, which involves an intradermal injection of allergens, because the client did not test positive following scratch testing. Within a few minutes after the injection, the client becomes short of breath and reports feeling jittery and dizzy and the nurse notes redness and swelling at the injection site. What nursing action would be a priority? 1. Immediately administer D5W intravenously (IV). 2. Provide oxygen at 6 L/min via nasal cannula. 3. Administer 50 mg of diphenhydramine by mouth (po). 4. Administer 0.3 mg/mL of epinephrine (1:1000) intramuscularly (IM).

4 Intradermal testing increases the risk for an adverse reaction with skin testing, including anaphylaxis. Early signs of anaphylaxis include feelings of uneasiness, apprehension, and weakness followed by the histamine response and other biochemicals causing bronchoconstriction, mucosal edema, and excess mucus production. Respiratory symptoms include congestion, rhinorrhea, dyspnea, and increasing respiratory distress with audible wheezing. Epinephrine (1:1000) 0.3 to 0.5 mg/mL, the first-line drug for the treatment of anaphylaxis, is administered IM or IV when symptoms of anaphylaxis appear; in this case it would be given IM, as there is not time to start an IV.

A client has severe contact dermatitis of her hands and arms because of contact with poison ivy. She complains to the nurse, "The itching is awful. I just cannot keep from scratching." Which interventions would be appropriate to include in the teaching plan for this client? Select all that apply. 1. Take cool or tepid baths daily to decrease pruritus. 2. Use cool, wet cloths or dressings as often as needed to reduce itching. 3. Use a topical corticosteroid to soothe irritated skin. 4. Expose affected skin areas to the sun or ultraviolet (UV) light to promote healing of the lesions. 5. Use a soft towel and rub the body dry after bathing to prevent secondary skin infection.

1,2,3 The nurse should teach the importance of taking cool or tepid baths, applying cool dressings, and applying topical corticosteroids to help reduce pruritus and scratching. Sun exposure leads to vasodilation and may increase itching. The nurse should teach the client to use the towel to pat—not rub—the skin dry after bathing.

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? A. The patient will remain in the clinic to be monitored for 30 minutes following the injection. B. The injection will cure the response to the allergen within 6 to 8 weeks. C. Injections are usually administered twice weekly. D. Therapeutic failure occurs if the symptoms to the allergen do not decrease after 3 months.

A Although severe systemic reactions are rare, the risk of systemic and potentially fatal anaphylaxis exists. It tends to occur most frequently at the induction or "up-dosing" phase. Therefore, the patient must be monitored after administration of immunotherapy. Because of the risk of anaphylaxis, injections should not be administered by a lay person or by the patient. The patient must remain in the office or clinic for at least 30 minutes after the injection, and is observed for possible systemic symptoms. Therapeutic failure is evident when a patient does not experience a decrease in symptoms within 12 to 24 months. Maintenance booster injections are administered at 2- to 4-week intervals, frequently for a period of several years, before maximum benefit is achieved.

Which body substance secreted during an immune reaction causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle? A. Histamine B. Bradykinin C. Serotonin D. Prostaglandin

A When cells are damaged, histamine is released. The latter two S/Sx can lead to serious reactions during anaphylaxis. Some antihistmaines, such as cimetidine, reduce gastric acid by blocking H2 receptors in the stomach.

Which nonpharmacologic treatments should the nurse suggest for the client who is experiencing seasonal allergic rhinitis due to the pollen in the air? (select all that apply) A. Remain indoors during the day B. Maintain a clean, dust-free environment C. Use special filters on the air conditioners D. Shower before exiting the house E. Keep doors and windows closed

A,B,C,E In avoidance therapy, every attempt is made to remove the allergens that act as precipitating factors. Examples include using air cleaners/purifiers, humidifiers, and dehumidifiers; keeping windows closed during periods of high pollen counts and windy conditions; using air conditioning as much as possible in the warmer months; sleeping with windows closed; removing dust-catching furnishings

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

D Plant pollen (from trees, grass, and other plants) causes the most common form of allergic rhinitis, which is known as hay fever. The rest of the options can be triggers, but are not the most common causes.

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? A. Risk for impaired skin integrity related to atopic dermatitis B. Chronic pain related to atopic dermatitis C. Acute pain related to atopic dermatitis D. Risk for delayed development related to atopic dermatitis

A Impaired skin integrity is central to the clinical presentation of atopic dermatitis and should be a priority in the planning and provision of care.

A 17-year-old girl with spina bifida is helping her mother prepare for her younger brother's birthday party. After blowing up a balloon, the girl develops erythema and itching around her mouth. This is likely due to which of the following? A. Facial eczema B. Food allergy C. Latex allergy D. Developing cold sore

C Health care workers and patients with exposure to latex, as in spina bifida, are at risk for developing a latex allergy. Symptoms of latex allergy can range from mild contact dermatitis and erythema to moderately severe symptoms of rhinitis and conjunctivitis, urticaria, and bronchospasm.

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? A. Provide reassurance to limit the woman's anxiety. B. Liaise with the woman's family and arrange for her to return home. C. Have the woman transported to a nearby emergency department. D. Encourage the woman to limit her physical activity for the next 24 to 48 hours.

C Patients who have experienced anaphylactic reactions and received epinephrine should be transported to the local emergency department for observation and monitoring because of the risk for a "rebound" reaction 4 to 10 hours after the initial allergic reaction.

The nurse is assessing the skin of an adult with atopic dermatitis. Where would the nurse expect to find lesions? 1. Face and scalp 2. Antecubital and popliteal surfaces 3. Soles of the feet 4. Buttocks

2 Adults tend to have reddened & itchy areas on the antecubital and popliteal surfaces (flexural folds). Infants typically have affected areas on the cheeks, scalp, arms, and legs.

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. 1. Massage the injection area 2. Remove the blue safety-release cap (gray for older ones) 3. Inject the orange tip into the outer thigh (black for older ones) 4. Call the emergency number (911)

2-3-1-4

For skin conditions involving pruritus, such as atopic dermatitis, what is considered a priority in a teaching plan? 1. Use of medications to decrease level of anxiety 2. Measures to keep the client from scratching 3. Teaching warning signs and symptoms of infection 4. Obtaining daily skin assessments

3 Recognition of the signs and symptoms of infection are the highest priority. Pruritus creates an increased risk for infection because skin integrity may be compromised. Measures to decrease anxiety and to keep the client from scratching are important for the comfort and well-being of the client, but are not as important as preventing infection. Daily assessment of the skin is vital to identification of infection, but prevention is the priority.

A patient with eczematous dermatitis calls the nurse to report pain and itching from the eczema. Which of the following non-pharmacologic comfort measures does the nurse instruct the patient to implement at home? (Select all that apply.) A. Moist, cool compresses B. Heating pad C. Tepid bath D. Back rub using baby oil

A,C Eczematous dermatitis, or atopic dermatitis, is a red rash that evolves rapidly and is blistered and swollen, progressing to hardened, dry flaking skin on the face, upper chest, antecubital fossa, and popliteal fossa. The comfort measure goal is decreasing inflammation and debridement of crusts and scales. Moist, cool compresses and a tepid bath can all relieve pain/pruritis associated with eczematous dermatitis.

A patient is experiencing an allergic reaction to a dose of penicillin. What should the nurse look for in the patient's initial assessment? A. The presence and location of pruritus B. Dyspnea, bronchospasm, and/or laryngeal edema. C. The severity of cutaneous warmth and flushing D. Hypotension and tachycardia

B Sx of anaphylaxis can quickly progress into airway obstruction issues (dyspnea, bronchospasm, and/or laryngeal edema). Using ABC framework, assessment of respiratory status should be the priority.

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

B The best strategy available for latex allergy is to avoid latex-based products, but this is often difficult because of their widespread use. Antihistamines and an emergency kit containing epinephrine should be provided to these clients, along with instructions about emergency management of latex allergy.

What is the BEST position for a patient in anaphylactic shock? A. Lateral recumbent B. Supine with legs elevated C. High Fowler's D. Semi-Fowler's

B This position will increase venous return to the heart, which will help increase cardiac output and blood pressure.

The nurse is creating a discharge teaching plan for a client with a latex allergy. Which information should be included? Select all that apply. A. Radioallergosorbent testing (RAST) B. Avoidance of latex-based products C. Administration of antihistamines D. Administration of emergency epinephrine

B,C,D The nurse should include in the discharge teaching plan avoidance of latex-based products, correctly using emergency epinephrine, and administration of antihistamines. RAST testing would not be indicated; it is a diagnostic test for allergies, and the client's latex allergy is already diagnosed.

You're providing education to a patient, who has a severe peanut allergy, on how to recognize the signs and symptoms of anaphylactic shock. Select all the signs and symptoms associated with anaphylactic shock: A. Hyperglycemia B. Difficulty speaking C. Feeling dizzy D. Hypertension E. Dyspnea F. Itchy G. Vomiting and Nausea H. Fever I. Slow heart rate

B,C,E,F,G Respiratory: dyspnea and wheezing (bronchoconstriction), swelling of upper airways due to edema "tightness"...can't speak, coughing, stuffy nose, watery eyes Cardiac: tachycardia, hypotension (vasodilation)...loss of consciousness, dizzy, GI: vomiting, nausea, pain, Skin: vasodilation...red, swollen, itchy, hives

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? A. "Keep your windows open to ensure adequate air circulation." B. "Make sure that there are never air drafts in your home." C. "If possible, make sure that no one smokes tobacco in your home." D. "Avoid the use of air conditioning whenever possible."

C Avoidance strategies for allergic rhinitis include maintaining a smoke-free home, keeping windows closed during peak times, and using air conditioning whenever possible.

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

D Overusing adrenergic agents (agonists), such as oxymetazoline nasal spray can cause rebound congestion. Using these should be limited to few days.