Chapter 38 Patients w/ Allergic Disorders

A client has been taking a decongestant for allergic rhinitis. During a follow-up visit, which finding suggests that the decongestant has been effective? Increased salivation Increased tearing Reduced sneezing Headache

Reduced sneezing

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? Serum IgE level White blood cell count Eosinophil count Erythrocyte sedimentation rate

Serum IgE level

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. Symptoms can be eliminated by changing glove brands. Symptoms worsen when hand lotion is applied before donning latex gloves. Symptoms occur within minutes after exposure to latex.

Symptoms are localized to the area of exposure, usually the back of the hands.

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? cromolyn sodium fluticasone zileuton fexofenadine

fluticasone

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? . Avoids massaging the injection site after administration Jabs the autoinjector into the outer thigh at a 90-degree angle Pushes down on the grey release cap to administer the medication Maintains pressure on the auto-injector for about 30 seconds after insertion

Jabs the autoinjector into the outer thigh at a 90-degree angle

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

Do not overuse the medication as rebound congestion can occur.

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

IgE 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.

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? 10:00 AM 11:00 AM 1:00 PM 3:00 PM

10:00 AM Mild and moderate reactions begin within 2 hours of exposure.

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

avoidance of latex-based products.

The nurse is teaching a client about latex allergies. What route of exposure from latex products occurs from use of latex condoms? mucosal parenteral cutaneous percutaneous

mucosal

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

Client identifies methods for reducing exposure risk to allergens.

A client with allergic rhinitis is prescribed a mast cell stabilizer. Which would the nurse expect to be used? Zafirlukast Cromolyn sodium Cetirizine Diphenhydramine

Cromolyn sodium

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? Sublingual-swallow immunotherapy (SLIT) Desensitization Sublingual-topical immunotherapy (STIT) Resensitization

Desensitization Desensitization is another option. Desensitization is a form of immunotherapy in which a person receives weekly or twice-weekly injections of dilute but increasingly higher concentrations of an allergen without interruption. SLIT is a form of desensitization therapy. Options C and D are distractors for this question.

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. diuresis. hypoglycemia. hypotension.

adrenal suppression.

Client is presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. What action is of primary importance upon admission? maintain airway induce vomiting to rid body of allergen encourage fluids to dilute allergen None of the options is correct.

maintain airway

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: Dissolution of the basement membranes of epithelium Rapid activation of the clotting cascade A massive release of histamine Activation of the sympathetic nervous system (SNS)

A massive release of histamine

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 Lower arms Ankles Plantar aspects of the feet

Dorsal aspect of the hand

What is the most common cause of anaphylaxis? Opioids NSAIDs Penicillin Radiocontrast agent

Penicillin

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

Prevention

The nurse is planning the care of an 8-year-old boy who has been diagnosed with atopic dermatitis. In the boy's plan of nursing care, what nursing diagnosis should the nurse prioritize? Acute pain related to atopic dermatitis Risk for delayed development related to atopic dermatitis Risk for impaired skin integrity related to atopic dermatitis Chronic pain related to atopic dermatitis

Risk for impaired skin integrity related to atopic dermatitis

The nurse is teaching a client about contact dermatitis. What type of contact dermatitis requires light exposure in addition to allergen contact? photoallergic phototoxic irritant allergic

photoallergic Photoallergic contact dermatitis resembles allergic dermatitis, but it requires light exposure in addition to allergen contact to produce immunologic reactivity. Phototoxic contact dermatitis resembles the irritant type, but it requires sunlight in combination with the chemical to damage the epidermis. Allergic contact dermatitis results from contact of skin with a allergenic substance. Irritant contact dermatitis results from contact with a substance that chemically or physically damages the skin on a nonimmunologic basis.

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 animal dander dust mites mold spores

plant pollen Plant pollen (from trees, grass, and other plants) causes the most common form of allergic rhinitis, which is known as hay fever. Animal dander, dust mites, and mold spores can be triggers, but are not the most common causes.

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

Histamine

A 44-year-old man has come to the clinic with an asthma exacerbation. He tells the nurse that his father and brother also suffer from asthma, as does his 15-year-old son. The nurse explains that this is an allergic response based on a genetic predisposition. The specific allergen initiated by this immunological mechanism is usually mediated by: Immunoglobulin A Immunoglobulin M Immunoglobulin G Immunoglobulin E

Immunoglobulin E Atopy refers to allergic reactions characterized by the action of IgE antibodies and a genetic predisposition to allergic reactions. IgG is the most common immunoglobulin and is found in intravascular and intercellular compartments. IgA and IgM are found in mucous secretions.

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 Beef Chicken

Milk Eggs Shrimp

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. Undergo desensitization treatment. Carry an emergency kit. Wear a medical alert bracelet.

Avoid potential allergens.

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? irritant contact allergic contact IgE-mediated hypersensitivity IgG antibodies

IgE-mediated hypersensitivity A type I, IgE-mediated hypersensitivity can cause severe reaction symptoms such as laryngeal edema and bronchospasm. Irritant and allergic contact dermatitis result in more localized skin reactions. IgG antibodies are important in fighting viral and bacterial infections.

When evaluating a client's knowledge about use of antihistamines, what statement indicates further education is required? "This medication may be taken with food." "Hard candy will relieve my dry mouth." "If I am pregnant, I should take half the dose." "I should be careful when driving."

"If I am pregnant, I should take half the dose." Antihistamines are contraindicated during the third trimester of pregnancy, in nursing mothers and newborns, in children and elderly people, and in patients whose conditions may be aggravated by muscarinic blockade (e.g., asthma, urinary retention, open-angle glaucoma, hypertension, prostatic hyperplasia). The major side effect is sedation, although H1 antagonists are less sedating than earlier antihistamines. Additional side effects include nervousness, tremors, dizziness, dry mouth, palpitations, anorexia, nausea, and vomiting.

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

"If possible, make sure that no one smokes tobacco in your home." 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.

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? An exacerbation of a previous disorder Autoimmune An alloimmunity disorder A cause-and-effect relationship

Autoimmune

A patient has developed severe contact dermatitis with burning, itching, cracking, and peeling of the skin on her hands. What should the patient be instructed to do? Wear powdered latex gloves. Wash her hands with antibacterial soap. Maintain the room temperature at 80°F. Keep her hands well moisturized.

Keep her hands well moisturized. Treatment of patients with atopic dermatitis must be individualized. Guidelines for treatment include decreasing itching and scratching by wearing cotton fabrics, washing with a mild detergent, humidifying dry heat in the winter, maintaining a moderate room temperature, using antihistamines such as diphenhydramine, and avoiding animals, dust, sprays, and perfumes. Keeping the skin moisturized with daily baths to hydrate the skin and topical skin moisturizers is encouraged.

After receiving a dose of penicillin, a client develops dyspnea and hypotension and the nurse suspects the client is experiencing anaphylactic shock. What is the nurse's first action? Page an anesthesiologist immediately. Administer epinephrine, as ordered. Continue to monitor the client's vital signs. Insert an indwelling urinary catheter.

Administer epinephrine, as ordered. To reverse anaphylactic shock, the nurse first should administer epinephrine, a potent bronchodilator, as ordered. The health care provider is likely to order additional medications, such as antihistamines and corticosteroids; if the medications don't relieve the respiratory compromise associated with anaphylaxis. No antidote for penicillin exists; however, the nurse should continue to monitor the client's vital signs. A client who remains hypotensive may need fluid resuscitation and fluid intake and output monitoring with a Foley catheter; however, administering epinephrine is the first priority.

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? "You need to come back to the clinic to get a different medication since this one is not working for you." "You may be immune to the effects of this medication and will need something else in its place." "The full benefit of the medication may take up to 2 weeks to be achieved." "I am sorry that you are feeling poorly but this is the only medication that will work for your problem."

"The full benefit of the medication may take up to 2 weeks to be achieved."

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. The patient should take the medication only as needed and not take it unnecessarily. Corticosteroids are relatively safe drugs with very few side effects. The patient should discontinue using the drug immediately if weight gain is observed.

The patient should not stop taking the medication abruptly and should be weaned off of the medication. Patients who receive high-dose or long-term corticosteroid therapy must be cautioned not to stop taking the medication suddenly. Doses are tapered when discontinuing this medication to avoid adrenal insufficiency.

A client comes to the clinic complaining of a rash on the arms, chest and upper thighs. Inspection reveals pink, raised lesions of varying sizes and shapes. The client reports that the lesions are "quite itchy and uncomfortable." The client's medication history is unremarkable. The nurse would document these lesions as: urticaria dermatitis medicamentosa serum sickness Angioneurotic edema

urticaria Urticaria (hives) is a type I hypersensitive allergic reaction of the skin characterized by the sudden appearance of pinkish, edematous elevations that vary in size and shape. These elevations itch and cause local discomfort. Dermatitis medicamentosa, a type I hypersensitivity disorder, is the term applied to skin rashes associated with certain medications. Angioneurotic edema involves the deeper layers of the skin, resulting in more diffuse swelling, rather than the discrete lesions characteristic of hives. On occasion, this reaction covers the entire back. The skin over the reaction may appear normal but often has a reddish hue. The skin does not pit on pressure, as ordinary edema does. Serum sickness is an immune-complex type III hypersensitivity. If these type III complexes are deposited in tissues or vascular endothelium, there is an increase in vascular permeability and tissue injury, resulting in a vasculitis (inflammation of blood vessels).

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? Intramuscular Intradermal Subcutaneous Intravenous

Intradermal

A client presents at the clinic with an allergic disorder. The client asks the nurse what an "allergic disorder" means. What would be the nurse's best response? "It means you are very sensitive to something inside of yourself." "It is a hyperimmune response to something in the environment that is usually harmless." "It is a muted response to something in the environment." "It is a harmless reaction to something in the environment."

"It is a hyperimmune response to something in the environment that is usually harmless."

Which term refers to an incomplete antigen? Hapten Allergen Antigen Antibody

Hapten A hapten is an incomplete antigen. An allergen is a substance that causes manifestations of allergy. An antigen is a substance that induces the production of antibodies. An antibody is a protein substance developed by the body in response to and interacting with a specific antigen.

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"? Be sure to use the nasal spray for at least 10 days to ensure the stuffiness is gone. Use the medication every 4 hours to prevent congestion from recurring. Drink plenty of fluids. Only use the nasal spray for 3 to 4 days once every 12 hours.

Only use the nasal spray for 3 to 4 days once every 12 hours.

Which test indicates the quantity of allergen necessary to evoke an allergic reaction? Serum-specific IgE test Provocative testing Scratch test Intradermal test

Serum-specific IgE test The serum-specific IgE test, formerly known as RAST, is a radioimmunoassay that measures allergen-specific IgE. It indicates the quantity of allergen necessary to evoke an allergic reaction. Provocative testing involves the direct administration of the suspected allergen to the sensitive tissue such as the conjunctiva. The scratch test does not indicate the quantity of allergen.

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

Weekly 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 is administering intravenous vancomycin. What will the nurse initially assess the client for if an allergic reaction occurs? dyspnea, bronchospasm, and/or laryngeal edema hypotension and tachycardia the presence and location of pruritus the severity of cutaneous warmth and flushing

dyspnea, bronchospasm, and/or laryngeal edema Initial nursing assessment and intervention needs to be directed toward evaluating breathing and maintaining an open airway, so the initial assessment will be for dyspnea, bronchospasm, and laryngeal edema. Hypotension, pruritis, and flushing may occur, but the airway is most important

The nurse is determining if a client is experiencing an immune response. Which of the following is not one of the four Rs of the immune response? 1. Recognize 2. Remember 3. Remove 4. Respond

3. Remove

An occupational health nurse is assessing a woman who experienced an anaphylactic reaction to a dip that contained crab during an office celebration. Because the woman promptly self-administered epinephrine, her status has normalized and she is now resting in a colleague's office. What action should the nurse perform? Liaise with the woman's family and arrange for her to return home. Have the woman transported to a nearby emergency department. Encourage the woman to limit her physical activity for the next 24 to 48 hours. Provide reassurance to limit the woman's anxiety.

Have the woman transported to a nearby emergency department. Patients who have experienced anaphylactic reactions and received epinephrine should be transported to the local emergency department for observation and monitoring because of the risk for a "rebound" reaction 4 to 10 hours after the initial allergic reaction. This is a priority over anxiety reduction and activity limitation.