CH:34 Clients with Immune-Mediated Disorders

A client is presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. What type of hypersensitivity did this client exhibit? 1) type II 2) type IV 3) type I 4) type III

type I Explanation: There are four types of hypersensitivity responses, three of which are immediate. This is an example of Type I, atopic or anaphylactic, which is mediated by immunoglobulin E (IgE) antibodies

A client with multiple food and environmental allergies expresses frustration and anger over having to be so watchful all the time and wonders if it is really worth it. Which response by the nurse would be best? 1) "Let's find a quiet spot, and I'll teach you a few coping strategies." 2) "I can only imagine how you feel. Would you like to talk about it?" 3) "Do you think that maybe you could be managing things more efficiently?" 4) "That's the same way that most clients who have a chronic illness feel."

"I can only imagine how you feel. Would you like to talk about it?" Explanation: To assist the client in adjusting to these modifications, the nurse must have an appreciation of the difficulties encountered by the client. The client is encouraged to verbalize feelings and concerns in a supportive environment and to identify strategies to deal with them effectively. The nurse should not suggest that the client has been mismanaging this health problem, and the nurse should not make comparisons with other patients. Further assessment should precede educational interventions.

A patient is admitted for the treatment of a primary immunodeficiency and intravenous immunoglobulin (IVIG) is ordered. What should the nurse monitor for as a potential adverse effect of IVIG administration? 1) Joint pain 2) Hypertension 3) Anaphylaxis 4) Hypothermia

Anaphylaxis Explanation: Potential adverse effects of an IVIG infusion include hypotension, flank pain, chills, and tightness in chest, terminating with a slightly elevated body temperature and anaphylactic reaction. Hypertension, hypothermia, and joint pain are not usual adverse effects of IVIG.

A junior nursing student is having an observation day in the operating room. Early in the day, the student reports eye swelling and dyspnea to the OR nurse. What should the nurse suspect 1) Anaphylaxis due to a latex allergy 2) Immune complex reaction due to contact with anesthetic gases 3) Cytotoxic reaction due to contact with the powder in the gloves 4) Delayed reaction due to exposure to cleaning products

Anaphylaxis due to a latex allergy Explanation: Immediate hypersensitivity to latex, a type I allergic reaction, is mediated by the IgE mast cell system. Symptoms can include rhinitis, conjunctivitis, asthma, and anaphylaxis. The term latex allergy is usually used to describe the type I reaction. The rapid onset is not consistent with a cytotoxic reaction, an immune complex reaction, or a delayed reaction.

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

Diphenhydramine Explanation: Certain medications are categorized by their action at these receptors. Diphenhydramine (Benadryl) is an example of an antihistamine, a medication that displays an affinity for H1 receptors. Cimetidine (Tagamet) and nizatidine (Axid) target H2 receptors to inhibit gastric secretions in peptic ulcer disease.

A home health nurse will soon begin administering IVIG to a new client on a regular basis. What teaching should the nurse provide to the client? 1) The need for a sterile home environment 2) Expected benefits and outcomes of the treatment 3) Technique for managing and monitoring daily fluid intake 4) Complementary alternatives to IVIG

Expected benefits and outcomes of the treatment Explanation: The client who is to receive IVIG at home will need information about the expected benefits and outcomes of the treatment as well as expected adverse reactions and their management. The home environment cannot be sterile, and complementary alternatives to IVIG have not been identified. Fluid management is not a central concern

The client presents to the emergency department with a suspected allergic reaction to the antibiotic they were given at the quick care clinic to treat their pneumonia. What are the priority actions the nurse should take? Select all that apply. 1) Insert an intravenous line. 2) Take vital signs. 3) Evaluate for hypertension. 4) Check for diplopia. 5) Place oxygen on the client. 6) Administer Vitamin K.

Insert an intravenous line. Take vital signs. Place oxygen on the client. Explanation: Hypertension is seen in clients with cardiac and stroke. The nurse would see hypotension caused by dilation of blood vessels. Inserting an intravenous line should be done in case the client needs to be given medications or fluids. Vitamin K is administered to reverse the effects of Coumadin, not for an allergic reaction. Taking vital signs is important to determine if they are normal or require treatment. Placing oxygen on a client will help relieve dyspnea caused by constriction of airways, and swollen tongue and throat. Diplopia would be seen in clients with muscular disorders, neurological disorders, and migraines.

A client is learning about a new diagnosis of asthma with the asthma nurse. What medication will best prevent the onset of acute asthma exacerbations? 1) Epinephrine 2) Albuterol sulfate 3) Montelukast 4) Diphenhydramine

Montelukast Explanation: Many manifestations of inflammation can be attributed in part to leukotrienes. Medications categorized as leukotriene antagonists or modifiers such as montelukast block the synthesis or action of leukotrienes and prevent signs and symptoms associated with asthma. Diphenhydramine prevents histamine's effect on smooth muscle. Albuterol sulfate relaxes smooth muscle during an asthma attack. Epinephrine relaxes bronchial smooth muscle but is not used on a preventative basis.

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

Weekly Explanation: Typically, immunotherapy begins with very small amounts and gradually increases, usually at weekly intervals until a maximum tolerated dose is attained. Then maintenance booster injections are administered at 2- to 4-week intervals, frequently for a period of several years.

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) angioneurotic edema. 3) contact dermatitis. 4) pitting edema.

angioneurotic edema. Explanation: The area of skin demonstrating angioneurotic edema may appear normal, but often has a reddish hue and does not pit. Urticaria (hives) is characterized as edematous skin elevations that vary in size, shape, and itch, which cause local discomfort. Contact dermatitis refers to inflammation of the skin caused by contact with an allergenic substance such as poison ivy. Pitting edema, the result of increased interstitial fluid, is associated with disorders such as congestive heart failure.

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? 1) chemical and latex glove use 2) laundry detergent or bath soap changes 3) medication allergies 4) life stressors the nurse may be experiencing

chemical and latex glove use Explanation: Because the itching and rash are localized, the employee health nurse will suspect an environmental cause in the workplace. With the advent of standard precautions, many nurses have experienced allergies to latex gloves. Allergies to medications, laundry detergents, or bath soaps and dermatologic reactions to stress usually elicit a more generalized or widespread rash.

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."

"If possible, make sure that no one smokes tobacco in your home." Explanation: Avoidance strategies for allergic rhinitis include maintaining a smoke-free home, keeping windows closed during peak times, and using air conditioning whenever possible. Air drafts do not necessarily exacerbate allergies.

T-cell deficiency occurs when which gland fails to develop normally during embryogenesis? 1) Adrenal 2) Thymus 3) Thyroid 4) Pituitary

Thymus Explanation: T-cell deficiency occurs when the thymus gland fails to develop normally during embryogenesis.

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) Activation of the sympathetic nervous system (SNS) 3) Rapid activation of the clotting cascade 4) A massive release of histamine

A massive release of histamine Explanation: Anaphylaxis occurs when the body's immune system produces specific IgE antibodies toward a substance that is normally nontoxic (e.g., food such as a peanut). If the substance is ingested more than once, the body releases excess amounts of the protein histamine, resulting in anaphylaxis. The pathophysiology of anaphylaxis is not a consequence of the dissolution of the basement membrane, SNS activation, or inappropriate clotting.

A patient who has received a heart transplant is taking cyclosporine, an immunosuppressant. What should the nurse emphasize during health education about infection prevention? 1) Eat a high-calorie, high-protein diet. 2) Limit physical activity in order to conserve energy. 3) Take prophylactic antibiotics as ordered. 4) Perform frequent handwashing.

Perform frequent handwashing. Explanation: Hand hygiene is imperative in infection control. A well-balanced diet is important, but for most patients this is secondary to hygiene as an infection-control measure. Prophylactic antibiotics are not normally used. Limiting physical activity will not protect the patient from infection.

A client has been transported to the emergency department after a severe allergic reaction. How should the nurse evaluate the client's respiratory status? Select all that apply 1) Monitor the client's respiratory pattern. 2) Measure the client's oxygen saturation by oximeter. 3) Assess breath sounds. 4) Assess the client's respiratory rate. 5) Facilitate lung function testing.

Assess breath sounds. Measure the client's oxygen saturation by oximeter. Monitor the client's respiratory pattern. Assess the client's respiratory rate. Explanation: The respiratory status is evaluated by monitoring the respiratory rate and pattern and by assessing for breathing difficulties, low oxygen saturation, or abnormal lung sounds such as wheezing. Lung function testing is a lengthy procedure that is not appropriate in an emergency context.

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? 1) Avoid potential allergens. 2) Carry an emergency kit. 3) Undergo desensitization treatment. 4) Wear a medical alert bracelet.

Avoid potential allergens. Explanation: Strict avoidance of potential allergens is the most important preventive measure for the patient at risk for anaphylaxis. People who have experienced food, medication, idiopathic, or exercise-induced anaphylactic reactions should always carry an emergency kit containing epinephrine for injection to prevent the onset of the reaction upon exposure, but avoiding potential allergens is more important. Desensitization, based on controlled anaphylaxis with a gradual release of mediators, is an effective treatment option, but it is more important to avoid allergic triggers. The medical alert bracelet will assist those rendering aid to the patient who has experienced an anaphylactic reaction, but it's better to avoid the reaction in the first place.

Atopic allergic disorders are characterized by 1) an IgA-mediated reaction. 2) a hereditary predisposition. 3) a response to physiologic allergens. 4) production of a systemic reaction.

a hereditary predisposition. Explanation: Atopic allergic disorders are characterized by a hereditary predisposition and production of a local reaction to IgE antibodies produced in response to common environmental allergens. Atopic and nonatopic allergic disorders are IgE-mediated allergic reactions.

The nurse is teaching the client about immune drug therapy before treatment begins in the home. What statement by the client indicates a need for further instruction? 1) "I will take my meds as prescribed and directed." 2) "I will set reminders on my phone for appointments." 3) "I will learn both brand and generic names of my meds." 4) "I won't contact my doctor unless I have blood in my stool."

"I won't contact my doctor unless I have blood in my stool." Explanation: The client needs further instruction regarding when to contact the provider. Diarrhea is a common GI adverse effect and colitis can develop. Waiting until blood is seen indicates that the client needs further education since even minor adverse reactions should be reported immediately so that intervention can be made. The client and family should be taught the generic and brand or trade names of these medications to avoid confusion. The client should take the drug only as directed on the prescription container and never increase, decrease, or omit a dose unless advised to do so by the provider. The client should set reminders such as on a calendar, cellphone alarm, or computer alert so that meds can be taken on schedule.

A nurse is preparing a client for allergy skin testing. What precautionary step is most important for the nurse to follow? 1) The client must not have received an immunization within 7 days. 2) Prophylactic epinephrine should be given before the test. 3) The nurse should administer albuterol 30 to 45 minutes prior to the test. 4) Emergency equipment should be readily available.

Emergency equipment should be readily available. Explanation: Emergency equipment must be readily available during testing to treat anaphylaxis. Immunizations do not contraindicate testing. Neither epinephrine nor albuterol is given prior to testing.

A nurse is preparing to discharge a patient with an immunodeficiency. When preparing the patient for self-infusion of IVIG in the home setting, what education should the nurse prioritize? 1) Signs and symptoms of adverse reactions 2) Formulas for calculating daily doses 3) Sterile technique for establishing a new IV site 4) Technique for adding medications to the IVIG

Signs and symptoms of adverse reactions Explanation: The patient who is to receive IVIG at home will need information about adverse reactions and their management. A patient would not start a new IV site independently and the patient does not calculate changes in dose independently. Medications are not added to IVIG.

Reproductive health education for women who are HIV-positive includes recommending which of the following contraceptives? 1) A diaphragm 2) Oral estrogen contraceptives 3) An intrauterine device (IUD) 4) The female condom

The female condom Explanation: The female condom, the first barrier method controlled by women, is the only proven, effective method to prevent the transmission of HIV and sexually transmitted infections (STI).

Which allergic reaction is potentially life threatening? 1) angioedema 2) None of the listed allergic reactions is potentially life threatening. 3) urticaria 4) contact dermatitis

angioedema Explanation: Angioedema is potentially life threatening. Medical management would include intubation, subcutaneous epinephrine, and aminophylline in severe reactions.

The healthcare provider has informed the client about the client's need to have immunotherapy treatments. The client asks the nurse, "Will I need to be in the hospital for these treatments?" What should be the nurse's response? 1) "The treatment environment depends on the extent of the disease and the complexity of the treatment." 2) "Your first four treatments will likely be inpatient and the rest outpatient." 3) "We have a new chemotherapy center that will do your treatments as an outpatient." 4) "Let me call your healthcare provider and let them know you have questions."

"The treatment environment depends on the extent of the disease and the complexity of the treatment." Explanation: A client may be treated as an outpatient in the ambulatory setting or as an inpatient in a hospital. Administration environment is dependent upon the extent of disease, comorbidity, or the complexity of this or other therapies. Clients have a right to choose treatment options; a new center does not necessarily mean that is where the client may want to go.

An experienced medical nurse has provided care for patients who have immunodeficiencies that are primary, as well as for patients who have secondary immunodeficiencies. Which of the following individuals is most clearly exhibiting secondary immunodeficiency? 1) A child who had an allergic reaction to a scheduled immunization 2) A woman whose diagnosis of sepsis is attributable to her recent chemotherapy 3) An elderly resident of a long-term care facility who has been diagnosed with the Norwalk virus 4) A man who developed deep vein thrombosis (DVT) after being immobilized during recovery from orthopedic surgery

A woman whose diagnosis of sepsis is attributable to her recent chemotherapy Explanation: Secondary immunodeficiencies affect the normal immune system of the patient, resulting in increased susceptibility to infection and certain types of cancer. Chemotherapy is an example of a factor that can precipitate this susceptibility. Development of postoperative DVT and allergic reactions are not example of secondary immunodeficiency. Infection often results from a secondary immunodeficiency, but not every infection is attributable to this factor.

A nurse is providing health education regarding self-care to a patient with an immunodeficiency. What teaching point should the nurse emphasize? 1) The need to keep fingernails and toenails closely trimmed 2) The need for thorough oral hygiene 3) The importance of aggressive treatment of acne 4) The importance of avoiding alcohol-based cleansers

The need for thorough oral hygiene Explanation: Many patients develop oral manifestations and need education about promoting good dental hygiene to diminish the oral discomfort and complications that frequently result in inadequate nutritional intake. Alcohol cleansers do not necessarily need to be avoided and nail care is not a central concern. Acne care is not a main focus of education, since it is not relevant to many patients.

A client with a family history of allergies has experienced an allergic response based on a genetic predisposition. This atopic response is usually mediated by which immunoglobulin (Ig)? 1) IgG 2) IgM 3) IgA 4) IgE

IgE Explanation: Atopy refers to allergic reactions characterized by the action of IgE antibodies and a genetic predisposition to allergic reactions. IgE (0.004% of total Ig) appears in serum; takes part in allergic and some hypersensitivity reactions; and combats parasitic infections. IgA (15% of total Ig) appears in body fluids (blood, saliva, tears, and breast milk, as well as pulmonary, gastrointestinal, prostatic, and vaginal secretions); protects against respiratory, gastrointestinal, and genitourinary infections; prevents absorption of antigens from food; and passes to neonate in breast milk for protection. IgM (10% of total Ig) appears mostly in intravascular serum; appears as the first Ig produced in response to bacterial and viral infections; and activates the complement system. IgG (75% of total Ig) appears in serum and tissues (interstitial fluid); assumes a major role in bloodborne and tissue infections; activates the complement system; enhances phagocytosis; and crosses the placenta.

An immunocompromised client is being treated in the hospital. The nurse's assessment reveals that the client's submandibular lymph nodes are swollen, a finding that represents a change from the previous day. What is the nurse's most appropriate action? 1) Inform the client's primary care provider of this finding. 2) Administer a PRN dose of acetaminophen as ordered. 3) Monitor the client's vital signs q2h for the next 24 hours. 4) Implement standard precautions in the client's care.

Inform the client's primary care provider of this finding. Explanation: Swollen lymph nodes are suggestive of infection and warrant prompt medical assessment and treatment. Acetaminophen is an ineffective response. The nurse should monitor the client's vital signs closely, but the physician should also be informed. Standard precautions should be in place regardless of the client's status.

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) Intradermal 2) Intravenous 3) Subcutaneous 4) Intramuscular

Intradermal Explanation: The intradermal route is the correct route of administration for skin testing and therefore a safe route. Another safe route is epicutaneous. The type of skin testing being performed determines whether the nurse will administer the solution via the epicutaneous or intradermal route.

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? 1) chest 2) forearm 3) back 4) upper arm

back Explanation: The scratch or prick test involves scratching the skin and applying a small amount of the liquid test antigen to the scratch. The tester applies one allergen per scratch over the client's forearm, upper arm, or back. The back is more sensitive than the arms.

Fibromyalgia is a common condition that involves 1) generalized muscle aching, mood swings, and loss of balance. 2) pain, viral infection, and tremors. 3) diminished vision, chronic fatigue, and reduced appetite. 4) chronic fatigue, generalized muscle aching, and stiffness.

chronic fatigue, generalized muscle aching, and stiffness. Explanation: Fibromyalgia is a common condition that involves chronic fatigue, generalized muscle aching, and stiffness. The cause is unknown, and no pathological characteristics specific for the condition have been identified. Treatment consists of attention to the specific symptoms reported by the client. NSAIDs may be used to treat the diffuse muscle aching and stiffness. Tricyclic antidepressants are used to improve or restore normal sleep patterns, and individualized programs of exercise are used to decrease muscle weakness and discomfort and to improve the general deconditioning that occurs in these individuals.

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) Palpitations 3) Anorexia 4) Sedation

Sedation Explanation: Antihistamines are the major class of medications prescribed for the symptomatic relief of allergic rhinitis. The major side effect is sedation, although H1 antagonists are less sedating than earlier antihistamines.

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

Wearing a medical alert bracelet Avoiding allergens Explanation: People who have experienced food, medication, idiopathic, or exercise-induced anaphylactic reactions should make every attempt to strictly avoid the allergen. Additionally, they should wear a medical alert bracelet and carry an emergency kit containing epinephrine for injection to prevent the onset of the reaction on exposure. Sedatives are not used to treat anaphylactic reactions, and desensitization is not used for peanut allergies.

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) hypotension. 2) adrenal suppression. 3) diuresis. 4) hypoglycemia.

adrenal suppression Explanation: The nurse should instruct the client that side effects of oral corticosteroid therapy include adrenal suppression, fluid retention, weight gain, glucose intolerance, hypertension, and gastric irritation.

The nurse knows the best strategy for latex allergy is 1) epinephrine from an emergency kit. 2) antihistamines. 3) corticosteroids. 4) avoidance of latex-based products.

avoidance of latex-based products. Explanation: 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 treatment option does the nurse anticipate for the patient with severe combined immunodeficiency disease (SCID)? 1) Radiation therapy 2) Antibiotics 3) Removal of the thymus gland 4) Bone marrow transplantation

Bone marrow transplantation Explanation: Treatment options for SCID include stem cell and bone marrow transplantation.

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

Cutaneous Explanation: Routes of exposure to latex products can be cutaneous, percutaneous, mucosal, parenteral, or aerosol. Allergic reactions are more likely with parenteral or mucous membrane exposure but can also occur with cutaneous contact or inhalation. The most frequent source of exposure is cutaneous, which usually involves the wearing of natural latex gloves.

A nurse is teaching a client about allergic rhinitis. What client statements indicate teaching has been effective? Select all that apply. 1) "I will remove as much carpet from my house as I can." 2) "I need to reduce my exposure to people that have upper respiratory infections." 3) "I can only have one alcoholic drink while I am taking my antihistamine." 4) "I am allowed to miss only one desensitization appointment before my treatment is affected." 5) "I should use my medication for allergy exacerbation only when my allergy is apparent."

"I should use my medication for allergy exacerbation only when my allergy is apparent." "I need to reduce my exposure to people that have upper respiratory infections." "I will remove as much carpet from my house as I can." Explanation: The client should only use their medication when allergy is apparent so they do not develop a tolerance, which can occur when the medication is used all the time. The client should reduce their exposure to people that have upper respiratory infections because they are more susceptible to getting sick. Removing as much carpet from the house as possible will help reduce allergens. The client cannot miss any desensitization appointments because it will interfere with dosage adjustments. While taking an antihistamine, alcohol cannot be consumed at all, as antihistamines can exaggerate the effects of alcohol.

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? 1) "The test may be mildly uncomfortable." 2) "I'll go directly to the pharmacy with my EpiPen prescription." 3) "If I notice tingling in my lips or mouth, gargling may help the symptoms." 4) "I may experience itching and irritation at the site of the testing."

"If I notice tingling in my lips or mouth, gargling may help the symptoms." Explanation: The client requires further teaching if the client states, "I will gargle to help alleviate tingling in the lips or mouth." Allergy testing introduces potentially irritating substances to the client. Tingling in the mouth, lips, or throat indicates the onset of a severe reaction and the need for immediate medical intervention. The testing may cause irritation and itching at the test site. The health care provider may order an epinephrine pen (EpiPen) for the client to self-administer epinephrine if the client experiences an allergic reaction away from the office setting.

A home health nurse is reinforcing health education with a patient who is immunosuppressed and his family. What statement best suggests that the patient has understood the nurse's teaching? 1) "My family needs to understand that I'll probably need lifelong treatment." 2) "I need to know how to treat my infections in a home setting." 3) "I need to understand how to give my platelet transfusions." 4) "My family needs to understand when I can go get the seasonal flu shot."

"My family needs to understand that I'll probably need lifelong treatment." Explanation: The patient must be made aware that all health-related instructions are lifelong. Immunizations may be contraindicated and infection usually requires inpatient treatment. Platelet transfusions are not indicated for most patients who have immunodeficiencies.

The nurse is teaching a client how to self-administer epinephrine using an EpiPen autoinjector. What information should be included in the teaching? Select all that apply. 1) The buttocks can be used as an injection site. 2) After administering the injection, massage the area for 10 seconds. 3) Grasp the EpiPen autoinjector pointing upward. 4) Jab the EpiPen autoinjector firmly into the outer thigh. 4) The needle should be at a 30 degree angle. 5) Hold the EpiPen autoinjector against the thigh for 10 seconds.

After administering the injection, massage the area for 10 seconds. Hold the EpiPen autoinjector against the thigh for 10 seconds. Jab the EpiPen autoinjector firmly into the outer thigh. Explanation: The EpiPen autoinjector is administered pointing downward not upward. The EpiPen autoinjector is firmly jabbed into the outer thigh to ensure the needle pierces the skin. The needle needs to be at a 90-degree angle, not at a 30-degree angle. The medication may not work as well if the injection is given in the buttocks. The preferred site is the thigh to avoid hitting bone, nerves, vessels or organs. Massaging the area for 10 seconds after administering the injection increases the speed of absorption. Holding the EpiPen autoinjector against the thigh for 10 seconds gives the medication time to be fully administered.

The nurse is educating a client about the risks of stroke related to the new prescription for a COX-2 inhibitor and what symptoms to report. Which COX-2 inhibitor is the nurse educating the client about? 1) Celecoxib 2) Tolmetin sodium 3) Piroxicam 4) Ibuprofen

Celecoxib Explanation: The COX-2 inhibitor celecoxib (Celebrex) is associated with an increased risk of cardiovascular events, including myocardial infarction and stroke.

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? 1) Client identifies methods for reducing exposure risk to allergens. 2) Client demonstrates appropriate coping strategies for dealing with a chronic disorder. 3) Client reports an absence of symptoms associated with the allergy. 4) Client states the need for coughing and deep breathing.

Client identifies methods for reducing exposure risk to allergens. Explanation: For the nursing diagnosis of deficient knowledge, the client's ability to identify methods for reducing the risk of allergen exposure indicates that the outcome has been met. The statement about coughing and deep breathing and an absence of symptoms would be appropriate for evaluating the nursing diagnosis of ineffective breathing pattern. Positive coping strategies would be an appropriate outcome for a nursing diagnosis of ineffective coping.

A home health nurse is caring for a client who has an immunodeficiency. What is the nurse's priority action to help ensure successful outcomes and a favorable prognosis? 1) Encourage the client and family to manage the client's activity level and activities of daily living effectively. 2) Encourage the client and family to be active partners in the management of the immunodeficiency. 3) Make sure that the client and family understand the importance of monitoring fluid balance. 4) Make sure that the client and family know how to adjust dosages of the medications used in treatment.

Encourage the client and family to be active partners in the management of the immunodeficiency. Explanation: Encouraging the client and family to be active partners in the management of the immunodeficiency is the key to successful outcomes and a favorable prognosis. This transcends the client's activity and functional status. Medications should not be adjusted without consultation from the primary provider. Fluid balance is not normally a central concern.

The client on immunotherapy is experiencing loose stools. Which meal would the nurse recommend as being best for this client? 1) Fried fish with potato salad and lemonade 2) Chef's salad with kale, wheat bran crackers, and tea 3) Grilled chicken with steamed vegetables and water 4) Cabbage with sausage, green beans, and coffee

Grilled chicken with steamed vegetables and water Explanation: The best meal or this client would be the grilled chicken, steamed vegetables, and water. Diarrhea may be a GI adverse reaction to immunotherapy. Instruct the client to avoid foods like caffeine, alcohol, and high roughage. Encourage foods with bulk such as apples, oatmeal, bananas, white rice, and cooked vegetables. Be sure the client drinks fluid to replace the loss from diarrhea. The meal with the chef salad and kale may be very high in roughage, and tea has caffiene which will make diarrhea worse. The fried fish meal with potato salad may be irritating due to the frying of the fish or battering the fish before frying. The sausage/cabbage meal with coffee would be avoided due to the caffeine in the coffee and cabbage may cause abdominal discomfort due to flatus.

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

Histamine Explanation: When cells are damaged, histamine is released. Bradykinin is a polypeptide that stimulates nerve fibers and causes pain. Serotonin is a chemical mediator that acts as a potent vasoconstrictor and bronchoconstrictor. Prostaglandins are unsaturated fatty acids that have a wide assortment of biologic activities.

A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated? 1) IgB 2) IgG 3) IgA 4) IgE

IgE Explanation: Immunoglobulin E (IgE) is involved with an allergic reaction. IgA combines with antigens and activates complement. IgB coats the surface of B lymphocytes. IgG is the principal immunoglobulin formed in response to most infectious agents.

A nurse at an allergy clinic is providing education for a client starting immunotherapy for the treatment of allergies. Which education should the nurse prioritize? 1) Keeping appointments for desensitization procedures 2) Scheduling appointments for the same time each month 3) Keeping a diary of reactions to the immunotherapy 4) Avoiding antihistamines for the duration of treatment

Keeping appointments for desensitization procedures Explanation: The nurse informs and reminds the client of the importance of keeping appointments for desensitization procedures, because dosages are usually adjusted on a weekly basis, and missed appointments may interfere with the dosage adjustment. Appointments are more frequent than monthly and antihistamines are not contraindicated. There is no need to keep a diary of reactions.

A teenager is diagnosed with cellulitis of the right knee and fails to respond to oral antibiotics. He then develops osteomyelitis of the right knee, prompting a detailed diagnostic workup that reveals a phagocytic disorder. This patient faces an increased risk of what complication? 1) Thrombocytopenia 2) Neutropenia 3) HIV/AIDS 4) Hemophilia

Neutropenia Explanation: Patients with phagocytic cell disorders may develop severe neutropenia. None of the other listed health problems is a common complication of phagocytic disorders.

What severe complication does the nurse monitor for in a patient with ataxia-telangiectasia? 1) Neurologic dysfunction 2) Chronic lung disease 3) Acute kidney injury 4) Overwhelming infection

Overwhelming infection Explanation: Ataxia-telangiectasia is an autosomal recessive neurodegenerative disorder characterized by cerebellar ataxia (loss of muscle coordination), telangiectasia (vascular lesions caused by dilated blood vessels), and immune deficiency. The immunologic defects reflect abnormalities of the thymus. The disorder is characterized by some degree of T-cell deficiency, which becomes more severe with advancing age. Immunodeficiency is manifested by recurrent and chronic sinus and pulmonary infections, leading to bronchiectasis.

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

Prevention Explanation: Prevention involves strict avoidance of potential allergens for the individual at risk for anaphylaxis. If avoidance of or exposure to allergens is impossible then the individual should be prepared with an emergency kit containing epinephrine for injection to prevent the onset of the reaction upon exposure. While helpful, there must be no lapses in desensitization therapy because this may lead to the reappearance of an allergic reaction when the medication is reinstituted. A medical alert bracelet will assist those rendering aid to a client who has experienced an anaphylactic reaction. antihistamines may not be effective in preventing anaphylaxis.

A young couple visits the nurse practitioner stating that they want to start a family. The husband states that his brother died of a severe infection at age 6 months. He says he never knew what was wrong but his mother had him undergo "blood testing" as a child. Based on these statements, what health problem should the nurse practitioner suspect? 1) Severe neutropenia 2) Aplastic anemia 3) X-linked agammaglobulinemia 4) Drug-induced thrombocytopenia

X-linked agammaglobulinemia Explanation: There is no evidence of drug-induced thrombocytopenia or aplastic anemia. The child would have only suffered from severe neutropenia if there was evidence of bacterial or fungal infections. The fact the mother of this individual had him tested for gamma-globulin as a child would indicate that his sibling had X-linked agammaglobulinemia. More than 10% of patients with X-linked agammaglobulinemia are hospitalized for infection at less than 6 months of age. Since the condition is X-linked it is important for the couple to undergo genetic testing

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

The most common cause of anaphylaxis is penicillin. Explanation: The most common cause of anaphylaxis, accounting for about 75% of fatal anaphylactic reactions in the United States, is penicillin. Although possibly severe, anaphylactoid reactions are rarely fatal. Food items that are common causes of anaphylaxis include peanuts, tree nuts, shellfish, fish, milk, eggs, soy, and wheat. Local reactions usually involve urticaria and angioedema at the site of the antigen exposure. Systemic reactions occur within about 30 minutes of exposure involving cardiovascular, respiratory, gastrointestinal, and integumentary organ systems.