CH 33: Assessment and Management of Patients with Allergic Disorders
What education should the nurse provide to the patient taking long-term corticosteroids? A) The patient should discontinue using the drug immediately if weight gain is observed. B) The patient should not stop taking the medication abruptly and should be weaned off of the medication. C) The patient should take the medication only as needed and not take it unnecessarily. D) Corticosteroids are relatively safe drugs with very few side effects.
B
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? A) Rh-hemolytic disease B) Bacterial endocarditis C) Lupus erythematosus D) Rheumatoid arthritis
A
The nurse is reviewing various medications with a client that can be used to treat allergic disorders. What medication will the nurse identify as an intranasal corticosteroid? A) fluticasone B) fexofenadine C) cromolyn sodium D) zileuton
A
The nurse is teaching a client about allergic rhinitis and its triggers. What is the most common trigger for the respiratory allergic response? A) plant pollen B) animal dander C) dust mites D) mold spores
A
When evaluating a client's knowledge about use of antihistamines, what statement indicates further education is required? A) "If I am pregnant, I should take half the dose." B) "Hard candy will relieve my dry mouth." C) "This medication may be taken with food." D) "I should be careful when driving."
A
Which term refers to an incomplete antigen? A) Hapten B) Allergen C) Antigen D) Antibody
A
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? A) Complete protein antigen B) T-lymphocyte C) Immunoglobulin D) Chemical mediator
A
A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated? A) IgG B) IgE C) IgB D) IgA
B
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? A) forearm B) back C) upper arm D) chest
B
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"? A) Use the medication every 4 hours to prevent congestion from recurring. B) Only use the nasal spray for 3 to 4 days once every 12 hours. C) Be sure to use the nasal spray for at least 10 days to ensure the stuffiness is gone. D) Drink plenty of fluids.
B
A client is prescribed an oral corticosteroid for 2 weeks to relieve asthma symptoms. The nurse educates the client about side effects, which include A) hypotension. B) adrenal suppression. C) hypoglycemia. D) diuresis.
B
The nurse explains to a client that immunotherapy initially starts with injections at which interval? A) Bi-monthly B) Weekly C) Daily D) Monthly
B
When assessing the skin of a client with allergic contact dermatitis, the nurse would most likely expect to find irritation at which area? A) Ankles B) Dorsal aspect of the hand C) Lower arms D) Plantar aspects of the feet
B
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. A) Beef B) Milk C) Shrimp D) Eggs E) Chicken
B, C, and D
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) Angioedema B) Rhinitis C) Blistering D) Laryngeal edema
C
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? A) Low eosinophil count B) Low white blood cell count C) High IgE concentration D) High neutrophil count
C
The nurse knows the best strategy for latex allergy is A) corticosteroids. B) epinephrine from an emergency kit. C) antihistamines. D) avoidance of latex-based products.
D
Which allergic reaction is potentially life threatening? A) None of the listed allergic reactions is potentially life threatening. B) contact dermatitis C) urticaria D) angioedema
D
The nurse is teaching a client about contact dermatitis. What type of contact dermatitis requires light exposure in addition to allergen contact? A) allergic B) photoallergic C) phototoxic D) irritant
B
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? A) allergic contact B) IgG antibodies C) irritant contact D) IgE-mediated hypersensitivity
D
A client with allergic rhinitis is prescribed a mast cell stabilizer. Which would the nurse expect to be used? A) Cromolyn sodium B) Cetirizine C) Zafirlukast D) Diphenhydramine
A
The nurse is talking with a client who was stung by a bee and began having difficulty breathing. What serious complication from injected venom should the nurse discuss with the client? A) Airway obstruction B) Hives C) Diarrhea D) Itching
A
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) 2:00 PM. B) 4:00 PM. C) 6:00 PM. D) 10:00 PM.
A
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) Carry EpiPen autoinjector at all times. B) Food labels on baked items are the only labels that need to be read. C) List symptoms of peanut allergy. D) Wear a medic alert bracelet. E) Identify ways to manage allergy while dining out.
A, C, D, and E
What are expected client outcomes the nurse would include in a plan of care for a client with allergic rhinitis? Select all that apply. A) The client controls outdoor precipitating factors B) The client develops cachexia C) The client reports no symptoms of peripheral tingling D) The client's lungs will have occasional crackles or rhonchi E) The client will wear a dampened mask if dust is a problem
A, C, and E
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? A) 3:00 PM B) 11:00 AM C) 10:00 AM D) 1:00 PM
C
A client visits the employee health department because of mild itching and a rash on both hands. What will the employee health nurse focus on during the assessment interview? A) laundry detergent or bath soap changes B) medication allergies C) life stressors the nurse may be experiencing D) chemical and latex glove use
D
The nurse is caring for a client with myasthenia gravis. The nurse generates a plan of care for the client based on which type of hypersensitivity reaction? A) Cytotoxic B) Delayed C) Anaphylactic D) Immune complex
D
The nurse is teaching a client about histamine release during an anaphylactic reaction. What does histamine release in anaphylaxis cause? A) feeling of impending doom B) stomach cramps C) urinary urgency D) nasal congestion
D
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? A) Undergo desensitization treatment. B) Carry an emergency kit. C) Wear a medical alert bracelet. D) Avoid potential allergens.
D
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? A) IgE-mediated hypersensitivity B) allergic contact C) irritant contact D) IgG antibodies
A
Which intervention is the single most important aspect for the client at risk for anaphylaxis? A) Wearing a medical alert bracelet B) Prevention C) Use of antihistamines D) Desensitization
B
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? A) 5 to 10 minutes B) 15 to 20 minutes C) 30 to 35 minutes D) 40 to 45 minutes
A
A client presents with itching, swelling, redness, and wheals of superficial skin layers. What is the most likely type of allergy this client is displaying? A) dermatitis medicamentosa B) urticaria C) angioedema D) contact dermatitis
B
Which body substance causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle? A) Bradykinin B) Histamine C) Serotonin D) Prostaglandin
B
The nurse is administering intravenous vancomycin. What will the nurse initially assess the client for if an allergic reaction occurs? A) the presence and location of pruritus B) hypotension and tachycardia C) dyspnea, bronchospasm, and/or laryngeal edema D) the severity of cutaneous warmth and flushing
C
Which cells present the antigen to T cells and initiate the immune response? A) B cells B) Hapten C) Macrophages D) Antigens
C
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) Do not operate machinery or drive while using the medication. C) Report white patches in the mouth because the medication can cause a fungal infection. D) Do not overuse the medication as rebound congestion can occur.
D
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? A) Be aware that some nasal burning and itching may occur. B) Use ice chips to alleviate the symptoms of dry mouth. C) Place the prescribed number of drops into the conjunctiva. D) Take the drug orally before, with, or after meals.
A
A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder? A) For their immunosuppressant effects B) Because an autoimmune disease is a neoplastic disease C) So the client has strong drug therapy D) To decrease the body's risk of infection
A
A nurse is preparing a discharge teaching plan for a client with atopic dermatitis. Which instruction should the nurse include in the teaching plan? A) Use a topical skin moisturizer daily. B) Wear only synthetic fabrics. C) Bathe only three times per week. D) Keep the thermostat above 75° F (23.9° C).
A
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? A) Jabs the autoinjector into the outer thigh at a 90-degree angle B) Avoids massaging the injection site after administration C) Maintains pressure on the auto-injector for about 30 seconds after insertion D) Pushes down on the grey release cap to administer the medication
A
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? A) Eosinophil count B) Erythrocyte sedimentation rate C) White blood cell count D) Serum IgE level
D
A patient has been diagnosed with an allergy to peanuts. What is a priority for this patient to carry at all times? A) An H1 blocker B) An EpiPen C) A medical alert bracelet D) An oral airway
B
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 A) Rhinitis medicamentosa B) Tolerance to nose drops C) Atopic dermatitis D) Leukotriene modifier
A
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? A) "I am sorry that you are feeling poorly but this is the only medication that will work for your problem." B) "The full benefit of the medication may take up to 2 weeks to be achieved." C) "You may be immune to the effects of this medication and will need something else in its place." D) "You need to come back to the clinic to get a different medication since this one is not working for you."
B
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. What client statement will indicate to the nurse that the outcome has been met? A) Client demonstrates appropriate coping strategies for dealing with a chronic disorder. B) Client identifies methods for reducing exposure risk to allergens. C) Client reports an absence of symptoms associated with the allergy. D) Client states the need for coughing and deep breathing.
B
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 A) urticaria. B) contact dermatitis. C) pitting edema. D) angioneurotic edema.
D
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? A) Sublingual-swallow immunotherapy (SLIT) B) Desensitization C) Sublingual-topical immunotherapy (STIT) D) Resensitization
B
A client presents to the emergency department in anaphylactic shock after a bee sting. What should the nurse do? Select all that apply. A) Have respiratory therapy provide an albuterol treatment. B) Monitor international normalized ratio (INR) level. C) Insert an intravenous line. D) Give metoprolol. E) Administer Diphenhydramine.
A, C, and E
A nurse is working in a dermatology clinic with clients who have allergies. What is the most important chemical mediator involved in the allergic response? A) leukotrienes B) prostaglandins C) serotonin D) histamine
D
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? A) type II B) type III C) type I D) type IV
D
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? A) Symptoms occur within minutes after exposure to latex. B) Symptoms are localized to the area of exposure, usually the back of the hands. C) Symptoms worsen when hand lotion is applied before donning latex gloves. D) Symptoms can be eliminated by changing glove brands.
B
A nurse knows to advise a patient who is taking Atarax, an over-the-counter (OTC) antihistamine, to be aware of the serious potential side effect of: A) Seizures. B) Epigastric distress. C) Photosensitivity. D) Urinary retention.
A
A nurse is teaching a client how to use their EpiPen autoinjector. What client statement indicates the teaching is understood? Select all that apply. A) "The EpiPen autoinjector needs to be pointed downward." B) "I will jab the EpiPen autoinjector firmly into my right upper buttock." C) "The needle needs to be at a 90-degree angle." D) "The EpiPen autoinjector should be held against the injection site for 20 seconds." E) "After I administer the injection, I will massage the area for 10 seconds."
A, C, and E
A client reports to a health care provider's office for intradermal allergy testing. Before testing, the nurse provides client teaching. Which client statement indicates a need for further education? A) "I may experience itching and irritation at the site of the testing." B) "The test may be mildly uncomfortable." C) "I'll go directly to the pharmacy with my EpiPen prescription." D) "If I notice tingling in my lips or mouth, gargling may help the symptoms."
D
A client is experiencing an acute hemolytic reaction. What actions should the nurse take? Select all that apply. A) Check for low back pain. B) Assess for anxiety and mental status changes. C) Dispose of the blood container and tubing. D) Discontinue the intravenous line the blood was transfusing through. E) Notify the health care provider.
A, B, and E
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? A) A cause-and-effect relationship B) Autoimmune C) An alloimmunity disorder D) An exacerbation of a previous disorder
B
A patient has a sensitivity to ragweed and tells the nurse that it comes at the same time every year. When does the patient typically notice the symptoms? A) Early fall B) Midwinter C) Early spring D) Summer
A
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? A) The most common cause of anaphylaxis is penicillin. B) The most common food item that causes anaphylaxis is chocolate. C) Anaphylactoid (anaphylaxis-like) reactions are commonly fatal. D) Systemic reactions include urticaria and angioedema.
A
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 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. A) Avoiding allergens B) Wearing a medical alert bracelet C) Use of sedatives to treat reactions D) Desensitization to allergen
A and B
A client with severe environmental allergies is scheduled for an immunotherapy injection. What should be included in teaching the client about this treatment? A) The allergen will be given by the peripheral intravenous route. B) The client will remain in the clinic to be monitored for 30 minutes following the injection. C) Therapeutic failure occurs if the symptoms to the allergen do not decrease after 3 months. D) The client will be given a low dose of epinephrine before the treatment.
B
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? A) Anorexia B) Sedation C) Diarrhea D) Palpitations
B
The client asks the nurse how to determine a cause for rhinitis. What diagnostic test will the nurse explain to the client that will identify the cause of rhinitis? A) peripheral blood count B) total serum IgE test C) radioallergosorbent test D) intradermal skin test
B
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? A) Latex allergy B) Irritant contact dermatitis C) Latex hyperplasia D) Allergic contact dermatitis
B
Which statement describes the clinical manifestations of a delayed hypersensitivity (type IV) allergic reaction to latex? A) They may worsen when hand lotion is applied before donning latex gloves. B) They are localized to the area of exposure, usually the back of the hands. C) They can be eliminated by changing glove brands or using powder-free gloves. D) They occur within minutes after exposure to latex.
B
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? A) 24 hours B) 12 hours C) 2 hours D) 6 hours
C
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) Hypotension and tachycardia C) Dyspnea, bronchospasm, and/or laryngeal edema. D) The severity of cutaneous warmth and flushing
C
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. A) Inject the black tip into the outer thigh B) Massage the injection area C) Remove the gray safety-release cap D) Call the emergency medical response number (911)
C, A, B, then D
A client is presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. What type of hypersensitivity did this client exhibit? A) type IV B) type II C) type III D) type I
D
A client with an allergic disorder is in treatment for their disorder. What might their treatment be? A) Autoimmune therapy B) Hypersensitive therapy C) Resensitization therapy D) Drug therapy
D