RNSG 1343 Complex Concepts of Adult Health Ch 20 Evolve

The nurse is teaching a patient with a severe food allergy about using an automatic epinephrine injector. Which instruction is appropriate?

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

What type of hypersensitivity occurs when a patient receives the wrong blood type during a transfusion, leading to a hemolytic transfusion reaction?

Cytotoxic reactions (When a patient receives the wrong blood type during transfusion, the red blood cells given in the transfusion are destroyed by the patient's immune system in a cytotoxic reaction. Immune complex reactions, rapid hypersensitivity reactions, and delayed hypersensitivity reactions are not related to hemolytic transfusion reactions.)

A patient is experiencing a severe type I hypersensitivity reaction resulting in angioedema. What is the nurse's priority action?

Finding out what medications the patient is taking (It is most important to find out what medications the patient is taking. While other information might be helpful to the assessment, time is important since laryngeal edema can result in loss of the airway. The patient with angioedema will most likely feel frightened and anxious, and it will improve as the angioedema resolves. Hereditary angioedema will result in recurring angioedema not associated with a specific drug, but asking about recurrence and family history is a secondary consideration after asking about medications.)

A patient is diagnosed with a type I hypersensitivity. Which antibody level increases during this type of allergy?

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

A patient is scheduled to undergo desensitization therapy during which a very dilute solution of allergen (1:100,000) is injected. This process induces the formation of antibodies against the allergen. Which antibody is produced during this process?

IgG (A very small amount of allergen is sufficient to induce IgG antibody production against the allergen. IgG antibodies do not stimulate an allergic response. These antibodies clear the allergens by precipitation reactions. IgE antibodies are not triggered by very small amount of allergens. IgM or IgA antibody production is usually not stimulated by allergens.)

The nurse is assessing a patient with allergic rhinitis. What assessment finding does the nurse anticipate?

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

The nurse recognizes that which patient condition or disorder is an example of a type IV hypersensitivity reaction? Select all that apply.

Sarcoidosis. Poison ivy skin rashes. (Type IV hypersensitivity reactions are delayed hypersensitive reactions. Clinical examples of type IV hypersensitivity reactions include poison ivy and sarcoidosis. Serum sickness is a clinical example of type III hypersensitivity reactions. Grave's disease is a clinical example of type V hypersensitivity reactions. Myasthenia gravis is a clinical example of type V hypersensitivity reactions.)

Which diseases can be categorized as autoimmune diseases? Select all that apply.

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

A patient has developed a type IV hypersensitivity reaction. Which immune cells or components are involved in this type of reaction?

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

A patient is suffering with type I hypersensitivity. Which questions does the nurse ask during the assessment? Select all that apply.

"Do you have any food or drug allergies?" "Do you have any family members with a type I allergy?" "When did this problem begin and how long does each episode last?" (In order to identify the causative allergen, the nurse asks if the patient has any allergy to some foods, drugs, or other chemical compounds. The exposure to such compounds can result in mild to severe type I reactions. This type of hypersensitivity can be a hereditary problem; therefore, asking about family history of the disease will be useful. In order to understand the severity of the disease, information about onset and duration can be beneficial. Rather than asking about favorite foods or beverages, the nurse should inquire about any allergies to food items or beverages. Transplantation-related problems are associated with autoimmunity, not with type I hypersensitivity.)

The nurse is reviewing discharge teaching with a patient who suffered an anaphylactic reaction to a bee sting. Which statement by the patient indicates the need for further teaching?

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

What should be the immediate nursing action for a patient having an allergic reaction to penicillin who has symptoms of swollen lips and tongue, soft palate, and widespread hives with pruritus?

Administering intravenous epinephrine (The patient is experiencing a penicillin-induced anaphylactic reaction, which requires immediate medical treatment. The nurse should administer epinephrine, which helps in suppressing the anaphylactic reaction. Administering oral serratiopeptidase, inhaling salbutamol, or administering intramuscular theophylline does not help in the immediate treatment of anaphylaxis.)

The nurse plans to assess a patient with type I hypersensitivity for which clinical manifestation?

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

A patient has developed serum sickness. What is the most likely cause?

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

A patient has developed a type II hypersensitivity reaction. Which condition is associated with this type of hypersensitivity?

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

A patient with a type I allergy is treated with antihistamines and corticosteroids. What other measure can help the patient to prevent future recurrence of allergies?

Avoidance therapy (The best way to prevent future recurrence of a type I allergy is to avoid known causative allergens whenever possible. Exposure to these agents may lead to an IgE-mediated immune response. Epinephrine injections are administered only when needed; excessive use can cause serious side effects. Antihistamines may cause dryness and drowsiness; increasing fluid intake may help prevent dryness, and increasing rest periods may provide comfort. However, these measures do not prevent the recurrence of allergies.)

A patient presents with severe angioedema of the lips, face, and tongue. Which medication is most likely to have caused this hypersensitivity reaction?

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

The nurse is caring for a patient with a poison ivy skin rash. What type of hypersensitive reaction is the patient experiencing?

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

A patient who experienced an anaphylactic reaction is hypotensive and has a rapid, weak, and irregular pulse. What is the priority nursing intervention?

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

The nurse recalls that which event occurs in a type II hypersensitivity reaction?

IgG antibody reacts with host cell membrane. (Type II hypersensitivity reactions are also called cytotoxic reactions. The mechanisms involved in type II hypersensitivity reactions include the reaction of the IgG antibody with the host cell membrane or antigen being adsorbed by the host cell membrane. The reaction of the IgE antibody on mast cells with antigen results in the release of mediators, especially histamine. This mechanism is involved in type I hypersensitivity reactions. The reaction of autoantibodies with normal cell-surface receptors stimulates a continual overreaction of the target cell. This mechanism is involved in type V hypersensitivity reactions. The reaction of sensitized T-cells with antigen and the release of lymphokines activate macrophages and induce inflammation. This is the mechanism involved in type IV hypersensitivity reactions.)

The nurse is assessing a patient with suspected serum sickness. Which symptoms are consistent with serum sickness? Select all that apply.

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

Which food items may cause anaphylaxis in some individuals? Select all that apply.

Nuts. Eggs. Peanuts. Shellfish. (Some food items may cause anaphylaxis in susceptible individuals. These include peanuts, shellfish, eggs, and nuts. Potatoes are not known to cause anaphylactic reactions.)

A patient has developed a type II hypersensitivity. Which mechanism is involved in this type of allergic reaction?

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

What are the most common triggers for allergic rhinitis? Select all that apply.

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

What is the role of decongestants in the treatment of a type I hypersensitivity?

Reduce edema (Decongestants usually contain ephedrine, phenylephrine, or pseudoephedrine. These drugs cause vasoconstriction in the inflamed area and reduce edema. Antihistamines clear the allergens and inhibit the release of vasoactive amines. Corticosteroids inhibit the synthesis of vasoactive agents.)

A patient presents with fever, arthralgia, rash, malaise, lymphadenopathy, nephritis, and polyarthritis. The patient has been admitted to the hospital several times in the past month and was last discharged one week ago. What does the nurse suspect this patient is experiencing?

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

Epinephrine administration is essential during anaphylaxis. What is the mechanism of action of this drug?

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

A patient in the allergy clinic develops all of these clinical manifestations after receiving an intradermal injection of an allergen. Which symptom requires the most immediate action by the nurse?

Stridor (Stridor indicates airway involvement and warrants immediate intervention such as use of oxygen and administration of epinephrine. Maintaining the patient's airway is the highest priority. Anxiousness, urticaria, and pruritus may be symptoms of a reaction but are not the nurse's highest priority when the patient is in respiratory distress.)

A patient is ordered desensitization therapy for allergy. What does the nurse tell the patient about desensitization therapy?

The allergen is administered in increasing doses. (Desensitization therapy involves the administration of an allergen in increasing doses. The course is generally recommended for 5 years. Small amounts of allergen are injected subcutaneously. The side effects of decongestants, not desensitization therapy, include dry mouth and increased blood pressure.)

Which type of hypersensitivity may be associated with rhinorrhea?

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