Care of Patients with Hypersensitivity (Allergy) and Autoimmunity Ch 20 (Elsevier)

A patient has developed serum sickness. What is the most likely cause? 1 Antibiotic therapy 2 Antipyretic drugs 3 Antihistamine therapy 4 Corticosteroid therapy

1 Serum sickness is a group of symptoms that occurs after receiving serum or certain drugs. Serum sickness is often caused by penicillin or other antibiotics. Antipyretic drugs may be useful in treating the fever that accompanies serum sickness. Antihistamines and corticosteroids are also useful to treat symptoms.

Which hypersensitivity reaction is characterized by the antigen-antibody complex formation that gives rise to an inflammatory response? Select all that apply. 1 Anaphylaxis 2 Serum sickness 3 Rheumatoid arthritis 4 Immune hemolytic anemia 5 Hemolytic transfusion reactions

1, 2, 3, 4 Anaphylaxis, serum sickness, rheumatoid arthritis, and hemolytic anemia are hypersensitivity reactions that occur when excess antigens cause immune complexes to form in the blood, triggering inflammation that results in tissue or vessel damage. Hemolytic transfusion reactions occur when the body makes autoantibodies directed against self cells that have some form of foreign protein attached to them.

Which food items may cause anaphylaxis in some individuals? Select all that apply. 1 Nuts 2 Eggs 3 Peanuts 4 Shellfish 5 Potatoes

1, 2, 3, 4 Some food items may cause anaphylaxis in susceptible individuals. These include peanuts, shellfish, eggs, and nuts. Potatoes are not known to cause anaphylactic reactions.

A patient's serum contains a highly elevated level of immunoglobulin E (IgE) antibodies (140 IU/mL). What could be the possible effects of this elevated IgE? Select all that apply. 1 Capillary leak 2 Pruritus and inflammation 3 Activation of IgG antibodies 4 Activation of cytotoxic T-cells 5 Excessive release of histamine

1, 2, 5 A patient's blood with a type I hypersensitivity contains elevated levels of serum IgE. This antibody binds to the basophil, or mast cell, and stimulates the release of vasoactive agents (e.g., histamines) in response to the allergen. Histamine causes capillary leaks, pruritus, erythema, and inflammation. IgG antibodies and T-cells are involved in type II and type IV hypersensitivities, respectively. Their activation is not induced by IgE antibodies.

A patient is undergoing a skin test for allergies. Which symptoms are associated with an anaphylactic reaction? Select all that apply. 1 Red blotches 2 Itching and urticaria 3 High blood pressure 4 Diarrhea and vomiting 5 Erythema and angioedema

1, 2, 5 Red blotches, itching, urticaria, erythema, and angioedema are the common symptoms associated with anaphylactic reactions. During this reaction, vasodilation occurs and blood is lost from the vascular system; therefore, the patient becomes hypotensive, not hypertensive. Diarrhea and vomiting are not directly related to this reaction.

Epinephrine administration is essential during anaphylaxis. What is the mechanism of action of this drug? 1 Inhibits mast cells degranulation 2 Stimulates the alpha- and beta-adrenergic receptors 3 Blocks the effects of histamines on the gastrointestinal tract 4 Blocks the alpha-adrenergic receptors

2 Epinephrine stimulates the alpha- and beta-adrenergic receptors of the autonomic nervous system. This drug constricts the blood vessels and causes bronchodilation. Thus, it provides quick relief from the effects of anaphylaxis. The inhibition of mast cell degranulation is induced by corticosteroids and antihistamines. Antihistamines block the effects of histamines on the gastrointestinal tract or other systems. These drugs compete with histamine for H 1 receptors and prevent type I reactions. Alpha 1 blockers block the alpha-adrenergic receptors and the activity of epinephrine.

A patient who experienced an anaphylactic reaction is hypotensive and has a rapid, weak, and irregular pulse. What is the priority nursing intervention? 1 Elevate the legs and feet. 2 Administer metaproterenol. 3 Administer diphenhydramine. 4 Report the findings to the primary health care provider.

1 As the patient is hypotensive and has a rapid, weak, and irregular pulse, the priority nursing intervention in this situation is to elevate the legs and feet, leaving the head of the bed elevated to about 10 degrees. The nurse administers beta-adrenergic agonist metaproterenol to decrease mucus secretion if a patient has bronchospams. Diphenhydramine is an antihistamine agent administered if the patient has symptoms of angioedema and urticaria. The nurse should report the findings to the primary health care provider after elevating the legs and feet, as it is an emergency situation.

Which type of hypersensitivity may be associated with rhinorrhea? 1 Type I hypersensitivity 2 Type II hypersensitivity 3 Type III hypersensitivity 4 Type IV hypersensitivity

1 Rhinorrhea is manifested as stuffy nose and itchy, watery eyes. Patients may breathe through the mouth, and the nasal mucosa appears swollen and pink. It is a type I hypersensitivity reaction. Type II hypersensitivity, type III hypersensitivity, and type IV hypersensitivity are not associated with rhinorrhea.

The nurse is caring for a patient with a poison ivy skin rash. What type of hypersensitive reaction is the patient experiencing? 1 Delayed reaction 2 Cytotoxic reaction 3 Immediate reaction 4 Immune complex-mediated reaction

1 The patient is experiencing a delayed hypersensitivity reaction. This type IV reaction occurs hours to days after exposure. The reactive cell is the T-lymphocyte (T-cell). A type I reaction is an immediate hypersensitive reaction; hay fever, allergic asthma, and anaphylaxis are examples of type I reactions. A type III reaction is an immune complex-mediated hypersensitive reaction; serum sickness and vasculitis are examples of a type III reaction. In a type III reaction, excess antigens cause the formation of immune complexes in the blood. Cytotoxin reaction is a type II reaction in which the body makes special antibodies against self cells that have some form of foreign protein attached to them. Autoimmune hemolytic anemia and Goodpasture's syndrome are examples of type II reactions.

A patient presents with fever, arthralgia, rash, malaise, lymphadenopathy, nephritis, and polyarthritis. The patient has been admitted to the hospital several times in the past month and was last discharged one week ago. What does the nurse suspect this patient is experiencing? 1 Serum sickness 2 Rheumatoid arthritis 3 Systemic lupus erythematosus 4 Hemolytic transfusion reaction

1 The symptoms of fever, arthralgia, rash, malaise, lymphadenopathy, nephritis, and polyarthritis are classic signs and symptoms of serum sickness, which develops after receiving serum or certain drugs. The patient would have received these in previous hospital visits. Symptoms of rheumatoid arthritis include tender, warm, swollen joints; joint stiffness (especially in the morning and during periods of inactivity); fatigue; fever; and weight loss. Symptoms of systemic lupus erythematosus are swollen or painful joints, unexplained fever, and a red rash (most commonly on the nose and cheeks). Symptoms of a hemolytic transfusion reaction include back pain, bloody urine, chills, fainting or dizziness, fever, flank pain, and flushing of the skin.

Which type of hypersensitivity is anaphylaxis? 1 Rapid hypersensitivity 2 Delayed hypersensitivity 3 Cytotoxic hypersensitivity 4 Immune-complex mediated hypersensitivity

1 Type 1 hypersensitivity is also known as rapid hypersensitivity. Anaphylaxis is an example of type I hypersensitivity reaction, which occurs rapidly and systemically. Anaphylaxis is due to the reaction of immunoglobulin E (IgE) antibodies on mast cells with antigen, resulting in the release of mediators, especially histamine, which causes the allergic reaction. Anaphylaxis is not an example of delayed, cytotoxic, or immune-complex mediated hypersensitivity.

Which is an example of a type I hypersensitivity reaction? 1 Angioedema 2 Rheumatoid arthritis 3 Poison ivy skin rashes 4 Immune hemolytic anemia

1 Type I hypersensitivity reactions are caused by overactive immunity and result from increased production of immunoglobulin E. Examples of type I reactions include angioedema, anaphylaxis, and allergic asthma. Immune hemolytic anemia is a form of type II reaction (cytotoxic reaction), which occurs when the body makes autoantibodies directed against the body's own cells. In type III hypersensitivity reactions (immune complex reactions), excess antigens cause immune complexes to form in the blood, and these circulating complexes lodge themselves in the small blood vessels of the kidneys, skin and joints. This results in inflammation, tissue, and vessel damage. Rheumatoid arthritis is an example of a type III hypersensitivity reaction. In a Type IV reaction (delayed hypersensitivity reactions), sensitized T-cells from previous exposure respond to an antigen by releasing chemical mediators and triggering macrophages to destroy the antigen. The development of a poison ivy skin rash is an example of a type IV reaction.

A patient has developed a type IV hypersensitivity reaction. Which immune cells or components are involved in this type of reaction? 1 T-cells 2 Self cells 3 Antibodies 4 Complement

1 Type IV hypersensitivity is caused by T-cell mediated reactions. These cells release chemical mediators and activate macrophages to kill antigens. Antibodies and complement play no role in type IV hypersensitivity reactions but do in type III immune-complex-mediation reactions. Self cells are present in type II cytotoxic reactions when autoantibodies are produced against these cells. The self cell is then destroyed by phagocytosis.

The nurse is teaching a patient with a severe food allergy about using an automatic epinephrine injector. Which instruction is appropriate? 1 "Protect the injector from light and extreme temperatures." 2 "You only need to carry the injector with you when you go out to eat." 3 "Use the injector when two or more symptoms of anaphylaxis are present." 4 "Do not inject the drug through your pants; it must go directly into your skin."

1 When educating a patient about automatic epinephrine injectors, the nurse will tell the patient to protect it from light and extreme temperatures. The patient should keep the injector with him or her at all times, not just when going out to eat. The patient should use it as soon as one symptom of anaphylaxis is present. The patient can inject him or herself through pants; he or she should just avoid seams, pockets, and areas where the fabric is thicker.

The nurse is caring for a patient experiencing an anaphylactic reaction to an intravenous (IV) infusion. Which action would the nurse take immediately? 1 Apply oxygen using a high-flow non-rebreather mask. 2 Prepare to administer epinephrine 1:10,000 concentration. 3 Keep the head of the bed flat if the patient experiences hypotension. 4 Discontinue the IV immediately and start a new IV with normal saline.

1 Apply oxygen using a high-flow non-rebreather mask. The nurse should apply oxygen using a high flow, non-rebreather mask at 90% to 100%. This clinical action follows the Airway, Breathing, Circulation (ABC) management guidelines for an emergency event. Following that, the IV drug should be promptly discontinued and normal saline administered through the same IV after the tubing is changed. A new IV site is not necessary and may delay treatment. The nurse should prepare to administer epinephrine 1:1000 (not 1:10,000) concentration, 0.3 to 0.5 mL IV push; epinephrine constricts blood vessels, improves cardiac contraction, and dilates bronchioles. The head of the bed is kept at 10 degrees, not flat, if the patient experiences hypotension. Putting the patient completely supine will impair respiratory effort.

The nurse recognizes that which patient condition or disorder is an example of a type IV hypersensitivity reaction? Select all that apply. 1 Sarcoidosis 2 Serum sickness 3 Graves' disease 4 Myasthenia gravis 5 Poison ivy skin rashes

1, 5 Type IV hypersensitivity reactions are delayed hypersensitive reactions. Clinical examples of type IV hypersensitivity reactions include poison ivy and sarcoidosis. Serum sickness is a clinical example of type III hypersensitivity reactions. Grave's disease is a clinical example of type V hypersensitivity reactions. Myasthenia gravis is a clinical example of type V hypersensitivity reactions.

The nurse is reviewing the medical record of a patient who is prescribed a decongestant. The nurse plans to contact the patient's health care provider if the patient has which condition? 1 Cataracts 2 Hypertension 3 Crohn's disease 4 Diabetes mellitus

2 Decongestants have actions similar to adrenergic drugs, causing vasoconstriction, which can increase blood pressure. Decongestants are not contraindicated in patients with cataracts, Crohn's disease, or diabetes mellitus.

The nurse plans to assess a patient with type I hypersensitivity for which clinical manifestation? 1 Poison ivy 2 Allergic asthma 3 Rheumatoid arthritis 4 Autoimmune hemolytic anemia

2 Allergic asthma is a manifestation of type I hypersensitivity. Poison ivy is a type IV delayed mechanism of hypersensitivity. Autoimmune hemolytic anemia is a type II cytotoxic mechanism of hypersensitivity. Rheumatoid arthritis is a type III immune complex-mediated mechanism of hypersensitivity.

A patient has developed a type II hypersensitivity. Which mechanism is involved in this type of allergic reaction? 1 Activation of T-cells 2 Phagocytosis of self cells 3 Stimulation of thyroid cells 4 Secretion of histamines from mast cells

2 In type II reactions, an autoantibody is produced against the self cell that contains an antigen or foreign protein on its surface. The self cells are then destroyed by phagocytosis or lysis. Activation of T-cells takes place in delayed hypersensitivity. Stimulation of thyroid cells and secretion of histamines are the mechanisms of type V and type I hypersensitivities, respectively.

Which patient condition would necessitate the nurse to wear latex-free gloves when providing care? 1 A patient with cleft palate 2 A patient with spina bifida 3 A patient with galactosemia 4 A patient with Tay-Sachs disease

2 Latex allergy is a type I hypersensitivity reaction in which the specific allergen is a processed natural latex rubber protein. Spina bifida is a birth defect in which there is incomplete closing of the backbone and membranes around the spinal cord. Allergen risk increases due to high exposure to latex, such as in patients with spina bifida, so the nurse must wear latex-free gloves. Cleft palate, galactosemia, and Tay-Sachs disease are also birth defects but are not associated with latex allergy.

The nurse is assessing a patient with suspected serum sickness. Which symptoms are consistent with serum sickness? Select all that apply. 1 Ptosis 2 Malaise 3 Arthralgia 4 Blurred vision 5 Lymphadenopathy

2, 3, 5 Serum sickness is a group of symptoms that occurs after receiving serum or certain drugs; symptoms include arthralgia (achy joints), lymphadenopathy (enlarged lymph nodes), fever, rash, malaise, and possibly polyarthritis and nephritis. Blurred vision and ptosis are not symptoms of serum sickness.

A patient with a history of asthma develops shortness of breath and stridor and becomes hypotensive during allergy skin testing. Which medication would the nurse expect to administer in this situation? 1 Zileuton 2 Epinephrine 3 Fexofenadine 4 Cromolyn sodium

2 The patient is experiencing an anaphylactic reaction, and epinephrine is a first-line sympathomimetic used to treat anaphylaxis. Fexofenadine is a nonsedating antihistamine and is not a first-line drug to treat anaphylaxis. Cromolyn sodium is a mast cell-stabilizing drug; it is used to prevent symptoms of allergic rhinitis but is not useful during an acute episode. Zileuton is a leukotriene antagonist; it is also used to prevent symptoms of allergic rhinitis but is likewise not useful during an acute episode.

The nursing instructor asks the student nurse to explain a type IV hypersensitivity reaction. Which statement by the student best describes type IV hypersensitivity? 1 "It is a reaction of immunoglobulin G (IgG) with the host cell membrane or antigen." 2 "The reaction of sensitized T-cells with antigen and release of lymphokines activate macrophages and induce inflammation." 3 "It results in release of mediators, especially histamine, because of the reaction of IgE antibody on mast cells." 4 "An immune complex of antigen and antibodies is formed and deposited in the walls of blood vessels."

2 The reaction of sensitized T-cells with antigen and release of lymphokines is a delayed hypersensitivity reaction, as is seen with poison ivy (type IV hypersensitivity). A reaction of IgG with the host cell membrane or antigen describes a type II hypersensitivity. A release of mediators, especially histamine, because of the reaction of IgE antibody on mast cells describes a type I hypersensitivity reaction. An immune complex of antigen and antibodies deposited in the walls of blood vessels describes a type III hypersensitivity reaction.

Which type of hypersensitivity is a cell-mediated immunity with T-lymphocyte as the reactive cell? 1 Rapid hypersensitivity 2 Delayed hypersensitivity 3 Cytotoxic hypersensitivity 4 Immune complex-mediated hypersensitivity

2 Type IV hypersensitivity is a type of cell-mediated response that is often called delayed type hypersensitivity since the reaction takes 2 to 3 days to develop. In a type IV reaction, the reactive cell is the T-lymphocyte (T-cell). Rapid hypersensitivity, cytotoxic hypersensitivity, and immune complex-mediated hypersensitivity are antibody-mediated hypersensitivity reactions.

A woman who is breastfeeding is diagnosed with rheumatoid arthritis. She does not want to stop breastfeeding. Which medication is safest for her to take? 1 Anakinra (Kineret) 2 Abatacept (Orencia) 3 Adalibumab (Humira) 4 Tocilizumab (Actemra)

3 Adalibumab (Humira) is a monoclonal antibodies to tumor necrosis factor. Because it is large with high molecular weight, it is unlikely to enter the breast milk. Anakinra (Kineret) is monoclonal antibodies to interleukin-1. Abatacept (Orencia) is a CTLA4 agonist. Toclizumab (Actemra) is monoclonal antibodies to interleukin-6. There is not enough sufficient evidence for any of these drugs to know how they affect breastfeeding outcomes so use is not recommended.

While assessing a patient, the nurse notes that the patient's vagina and buccal and nasal mucous membranes are dry. The laboratory reports indicate the presence of elevated levels of IgM rheumatoid factor. The nurse suspects what syndrome? 1 Sicca syndrome 2 Reiter's syndrome 3 Sjögren's syndrome 4 Goodpasture's syndrome

3 Dry eyes, dry nasal and buccal membranes, and vaginal dryness are the symptoms associated with Sjögren's syndrome. The presence of elevated levels of IgM rheumatoid factor in the laboratory reports indicates that the patient with this syndrome has accompanied rheumatoid arthritis. Dry buccal and nasal membranes and vaginal dryness are not associated with sicca syndrome, Reiter's syndrome, or Goodpasture's syndrome. Sicca syndrome is associated with dry eyes. Reiter's syndrome is characterized by arthritis, urethritis, and conjunctivitis. Goodpasture's syndrome is an autoimmune disorder in which autoantibodies are produced against the glomerular basement membrane and neutrophils.

The nurse is reviewing discharge teaching with a patient who suffered an anaphylactic reaction to a bee sting. Which statement by the patient indicates the need for further teaching? 1 "I need to carry epinephrine with me." 2 "My spouse must learn how to give me an injection." 3 "I am immune to bee stings now that I have had a reaction." 4 "I must wear a medical alert bracelet stating that I am allergic to bee stings."

3 No immunity develops after an anaphylactic reaction. In fact, the next reaction could be more severe. The patient should carry epinephrine at all times and always wear a medical alert bracelet that states all allergies. Someone (spouse, neighbor, or family member) must learn how to give the patient injections in case the patient is unable self-administer the injection.

During the physical examination, the patient reports a history of latex allergy. Which item may cause this reaction? 1 Pollens 2 Milk products 3 Surgical gloves 4 Legumes and nuts

3 Surgical gloves may be made of natural latex proteins and can cause an allergy that has symptoms related to type I and type IV hypersensitivity reactions. Pollens, milk products, and legumes and nuts are not responsible for latex allergy because they do not contain latex.

A patient presents with severe angioedema of the lips, face, and tongue. Which medication is most likely to have caused this hypersensitivity reaction? 1 Acarbose (Precose) 2 Asenapine (Saphris) 3 Benanzepril (Lotensin) 4 Gabapentin (Neurontin)

3 The drugs most commonly associated with angioedema are angiotensin-converting enzyme inhibitors, such as benanzepril (Lotensin). Acarbose (Precose) is a diabetic medication. Asenapine (Saphris) is an atypical antipsychotic. Gabapentin (Neurontin) is an anticonvulsant.

A patient has been ordered by the health care provider to carry a "bee sting kit" at all times. What does the nurse teach the patient about the care and use of the device? 1 Carry a drug-filled device at all times. 2 Inject the drug into the forearm when required. 3 Obtain a replacement device if the drug is discolored. 4 Go to the nearest hospital for a 2-hour observation after using the device.

3 The patient should obtain a replacement device if the drug is discolored; the drug must be clear, with sufficient time left before the expiration date. The patient must keep at least two drug-filled devices on hand in case more than one dose is needed. The drug is injected into the thigh muscle, not the forearm. The patient must go to the nearest hospital for observation for at least 4 to 6 hours after the device is used.

A patient is diagnosed with a type I hypersensitivity. Which antibody level increases during this type of allergy? 1 IgM 2 IgD 3 IgE 4 Immunoglobulin G (IgG)

3 IgE increases - Type I In a patient exposed to an allergen, elevated levels of IgE antibodies are produced. The elevated level of antibodies causes inflammation, erythema, or edema in the affected region. *IgG antibodies play a crucial role in type II allergies.* IgM antibodies act at the first stage of an infection caused by viruses, microorganisms, or toxins. The role of IgD antibodies is not clearly known, but they activate B-cells during infection.

What are the most common triggers for allergic rhinitis? Select all that apply. 1 Hay fever 2 Latex gloves 3 Plant pollens 4 Animal dander 5 Dust and molds

3, 4, 5 Allergic rhinitis, or hay fever, is triggered by immunity and inflammation reactions to airborne allergens, especially plant pollens, molds, dust, animal dander, wool, food, and air pollutants. Latex products are not associated with allergic rhinitis.

Which diseases can be categorized as autoimmune diseases? Select all that apply. 1 Pyelonephritis 2 Cholecystitis 3 Scleroderma 4 Rheumatic fever 5 Goodpasture's syndrome

3, 4, 5 Autoimmunity is a process in which an individual becomes oversensitive and starts producing antibodies against self cells or proteins. Scleroderma, rheumatic fever, and Goodpasture's syndrome are autoimmune diseases that occur when immune cells start destroying self cells. Pyelonephritis is an infection of the kidneys and does not have an autoimmune cause. Cholecystitis is inflammation of the gallbladder; it is not caused by autoimmunity.

A patient has developed a type II hypersensitivity reaction. Which condition is associated with this type of hypersensitivity? 1 Hay fever 2 Sarcoidosis 3 Serum sickness 4 Autoimmune hemolytic anemia

4 Hemolytic anemia is a type II hypersensitivity. In this reaction, the body makes special autoantibodies to kill the self cells (or blood cells), causing anemia due to loss of blood cells. Hay fever, serum sickness, and sarcoidosis are type I, type III, and type IV hypersensitivities respectively.

The nurse is assessing a patient with allergic rhinitis. What assessment finding does the nurse anticipate? 1 The presence of fever 2 Glowing skin over the sinuses 3 Yellow drainage from the nose 4 Runny nose with itchy, watery eyes

4 The patient with allergic rhinitis has a runny nose and itchy, watery eyes. The drainage from the nose is usually clear or white. When a penlight is placed on the skin over the sinuses, there is a reduced glow. The patient with allergic rhinitis does not have fever unless there is an infection present.