Chapter 37: Prep U Assessment and Management of Patients With Allergic Disorders
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?
IgE-mediated hypersensitivity
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.
Jab the EpiPen autoinjector firmly into the outer thigh. After administering the injection, massage the area for 10 seconds. Hold the EpiPen autoinjector against the thigh for 10 seconds.
The nurse is working with a colleague who has a delayed hypersensitivity (type IV) allergic reaction to latex. Which statement describes the clinical manifestations of this reaction?
Symptoms are localized to the area of exposure, usually the back of the hands.
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?
"If I notice tingling in my lips or mouth, gargling may help the symptoms."
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?
10 am
A patient comes to the clinic with pruritus and nasal congestion after eating shrimp for lunch. The nurse is aware that the patient may be having an anaphylactic reaction to the shrimp. These symptoms typically occur within how many hours after exposure?
2 hours
The maximum intensity of histamine occurs within which time frame after contact with an antigen?
5 to 10 minutes
A client has been hospitalized for diagnostic testing. The client has just been diagnosed with multiple sclerosis, which the physician explains is an autoimmune disorder. How would the nurse explain an autoimmune disease to the client?
A disorder where killer T cells and autoantibodies attack or destroy natural cells—those cells that are "self."
The nurse is educating a patient with allergic rhinitis about how the condition is induced. What should the nurse include in the education on this topic?
Airborne pollens or molds
The nurse is evaluating a client's readiness for allergy skin testing. The nurse determines that the testing will need to be postponed when it is revealed that the client took which classification of medication the night before?
Antihistamine
A client with an allergic disorder calls the nurse and asks what treatment is available for allergic disorders. The nurse explains to the client that there is more than one treatment available. What treatments would the nurse tell the client about?
Desensitization
The nurse is preparing to administer a medication that has an affinity for H1 receptors. Which medication would the nurse administer?
Diphenhydramine
When assessing the skin of a client with allergic contact dermatitis, the nurse would most likely expect to find irritation at which area?
Dorsal aspect of the hand
A patient is experiencing an allergic reaction to a dose of penicillin. What should the nurse look for in the patient's initial assessment?
Dyspnea, bronchospasm, and/or laryngeal edema.
A health care provider prescribed fluticasone for a client with a severe case of allergic rhinitis. The client took a first dose on February 2. What is the latest date by which the drug will be fully effective?
February 15
A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder?
For their immunosuppressant effects
Which term refers to an incomplete antigen?
Hapten
The nurse is evaluating a client's complete blood cell count and differential along with the serum immunoglobulin E (IgE) concentration. Which result might indicate that the client has an allergic disorder?
High IgE concentration
Which body substance causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle?
Histamine
When evaluating a client's knowledge about use of antihistamines, what statement indicates further education is required?
If I am pregnant, I should take half the dose.
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.
Remove the gray safety-release cap Inject the black tip into the outer thigh Massage the injection area Call the emergency medical response number (911)
An infant is born to a mother who had no prenatal care during her pregnancy. What type of hypersensitivity reaction does the nurse understand may have occurred?
Rh-hemolytic disease
The nurse is completing the intake assessment of a client new to the allergy clinic. The client states that he was taking nose drops six times a day to relieve his nasal congestion. The nasal congestion increased, causing him to increase his usage of the nasal spray to eight times a day. But again the congestion worsened. The nurse communicates to the health care provider that the client experienced
Rhinitis medicamentosa
What education should the nurse provide to the patient taking long-term corticosteroids?
The patient should not stop taking the medication abruptly and should be weaned off of the medication.
Which statement describes the clinical manifestations of a delayed hypersensitivity (type IV) allergic reaction to latex?
They are localized to the area of exposure, usually the back of the hands.
A nurse is preparing a discharge teaching plan for a client with atopic dermatitis. Which instruction should the nurse include in the teaching plan?
Use a topical skin moisturizer daily
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.
Wear a medic alert bracelet. List symptoms of peanut allergy. Identify ways to manage allergy while dining out. Carry EpiPen autoinjector at all times.
The nurse explains to a client that immunotherapy initially starts with injections at which interval?
Weekly
The parents of a child with contact dermatitis are asking questions about the reaction within the immune system. What description regarding contact dermatitis as a type IV hypersensitivity reaction is accurate?
a delayed-type hypersensitivity that is mediated by T cells
Atopic allergic disorders are characterized by
a hereditary predisposition.
A client is prescribed an oral corticosteroid for 2 weeks to relieve asthma symptoms. The nurse educates the client about side effects, which include
adrenal suppression.
Which allergic reaction is potentially life threatening? -contact dermatitis -None of the listed allergic reactions is potentially life threatening. -angioedema -urticaria
angioedema
The nurse observes diffuse swelling involving the deeper skin layers in a client who has experienced an allergic reaction. The nurse would correctly document this finding as
angioneurotic edema.
The nurse knows the best strategy for latex allergy is
avoidance of latex-based products
A client has begun sensitivity testing to determine the allergen which caused an anaphylactic reaction 3 weeks ago. In scratch testing, which part of the body is more sensitive to allergens?
back
A 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?
chemical and latex glove use
The nurse is working in an allergy clinic with a client with tuberculosis. What other reaction is a type IV hypersensitivity disorder?
contact dermatitis
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?
fluticasone
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?
histamine
The nurse is teaching a client with allergic rhinitis about medications. What medication is a mast cell stabilizer used in the treatment of allergic rhinitis?
intranasal cromolyn sodium
The nurse is teaching a client about histamine release during an anaphylactic reaction. What does histamine release in anaphylaxis cause?
nasal congestion
The nurse is teaching a client about contact dermatitis. What type of contact dermatitis requires light exposure in addition to allergen contact?
photoallergic
The nurse is teaching a client about allergic rhinitis and its triggers. What is the most common trigger for the respiratory allergic response?
plant pollen
A client is presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. What type of hypersensitivity did this client exhibit?
type I
In its attempt to suppress allergic responses, the body releases several chemicals which have a role in mediating physical reactions. Epinephrine, which interferes with vasoactive chemical release from mast cells, is instrumental in suppressing which type of hypersensitivity response?
type I
A client presents with itching, swelling, redness, and wheals of superficial skin layers. What is the most likely type of allergy this client is displaying?
urticaria
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?
Jabs the autoinjector into the outer thigh at a 90-degree angle
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.
Milk Eggs Shrimp
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?
Be aware that some nasal burning and itching may occur.
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?
Avoid potential allergens.
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?
Blistering
A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated?
IgE
A patient asks the nurse if it would be all right to take an over-the-counter antihistamine for the treatment of a rash. What should the nurse educate the patient is a major side effect of antihistamines?
Sedation
A 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:
Seizures.
The nurse working in an allergy clinic is preparing to administer skin testing to a client. Which route is the safest for the nurse to use to administer the solution?
Intradermal
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"?
Only use the nasal spray for 3 to 4 days once every 12 hours.
A client is experiencing an acute hemolytic reaction. What actions should the nurse take? Select all that apply.
Check for low back pain. Assess for anxiety and mental status changes. Notify the health care provider.
A patient with a history of allergies comes to the clinic for an evaluation. The following laboratory test findings are recorded in a patient's medical record: Total serum IgE levels: 2.8 mg/mL White blood cell count: 5,100/cu mm Eosinophil count: 4% Erythrocyte sedimentation rate: 20 mm/h The nurse identifies which result as suggesting an allergic reaction?
Serum IgE level
What are expected client outcomes the nurse would include in a plan of care for a client with allergic rhinitis? Select all that apply.
The client will wear a dampened mask if dust is a problem The client reports no symptoms of peripheral tingling The client controls outdoor precipitating factors
A patient was seen in the clinic 3 days previously for allergic rhinitis and was given a prescription for a corticosteroid nasal spray. The patient calls the clinic and tells the nurse that the nasal spray is not working. What is the best response by the nurse?
The full benefit of the medication may take up to 2 weeks to be achieved
The nurse teaches the client with allergies about anaphylaxis, including which statement?
The most common cause of anaphylaxis is penicillin.
A client being treated for an allergy has been prescribed antihistamines. The Kardex of this client reads as follows: Age: 32; Profession: Carpenter; Lifestyle & diet: Lives alone, average smoker, nonalcoholic, no food preferences, practices yoga; Medical history: Suffers from hay fever, recent urinary tract infection that has been treated successfully. What information from the Kardex is likely to have the greatest implication in educating the client about antihistamine administration?
The client's profession