Chapter 37: Assessment and Management of Patients With Allergic Disorders Prep-U

The nurse is caring for a client experiencing an anaphylactic reaction. The nurse prepares for the maximum intensity of histamine response to occur within which time frame? 5 to 10 minutes 15 to 20 minutes 30 to 35 minutes 40 to 45 minutes

5 to 10 minutes Explanation: Histamine's effects peak 5 to 10 minutes after antigen contact. The other time frames are inaccurate.

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

Hapten Explanation: 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.

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? Low white blood cell count Low eosinophil count High IgE concentration High neutrophil count

High IgE concentration Explanation: A high total IgE concentration and/or a high percentage of eosinophils may indicate an allergic disorder. However, normal IgE levels do not exclude the diagnosis of an allergic disorder. The amounts of neutrophils and white blood cells are not affected by allergic disorders.

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

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.

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 Subcutaneous Intravenous 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 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 Beef Eggs Chicken Shrimp

Milk Eggs Shrimp Explanation: Common food causes of anaphylaxis include peanuts, tree nuts, shellfish, fish, milk, eggs, soy, and wheat. Beef and chicken are not common causes.

Which allergic reaction is potentially life threatening? urticaria angioedema None of the listed allergic reactions is potentially life threatening. contact dermatitis

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

T-cell deficiency occurs when which gland fails to develop normally during embryogenesis? Thymus Adrenal Thyroid Pituitary

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

A patient received epinephrine in response to an anaphylactic reaction at 10:00 AM. The nurse knows to observe the patient for a "rebound" reaction that may occur as early as: 4:00 PM. 10:00 PM. 2:00 PM. 6:00 PM.

2:00 PM. Explanation: Rebound reactions can occur from 4 to 10 hours after an initial allergic reaction. Therefore the patient needs to be assessed from 2:00 PM to 8:00 PM.

When assessing the skin of a client with allergic contact dermatitis, the nurse would most likely expect to find irritation at which area? Plantar aspects of the feet Ankles Dorsal aspect of the hand Lower arms

Dorsal aspect of the hand Explanation: With allergic contact dermatitis, irritation is most common on the dorsal aspects of the hand. Irritant, phototoxic, and photoallergic types of contact dermatitis are commonly seen on the hands and lower arms.

A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder? So the client has strong drug therapy Because an autoimmune disease is a neoplastic disease For their immunosuppressant effects To decrease the body's risk of infection

For their immunosuppressant effects Explanation: Drug therapy using anti-inflammatory and immunosuppressive agents is the mainstay for alleviating symptoms. Some antineoplastic (cancer) drugs also are used for their immunosuppressant effects. Antineoplastic drugs do not decrease the body's risk of infection; an autoimmune disease is not a neoplastic disease. Drugs are not ordered just so the client has strong drug therapy.

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

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 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? Diarrhea Sedation Anorexia Palpitations

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 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? IgG antibodies allergic contact IgE-mediated hypersensitivity irritant contact

IgE-mediated hypersensitivity Explanation: 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.

The nurse is teaching a client about allergic rhinitis and its triggers. What is the most common trigger for the respiratory allergic response? mold spores plant pollen animal dander dust mites

plant pollen Explanation: 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.

The client asks the nurse how to determine a cause for rhinitis. What diagnostic test will the nurse explain to the client that will identify the cause of rhinitis? intradermal skin test radioallergosorbent test total serum IgE test peripheral blood count

total serum IgE test Explanation: Increased IgE levels are a positive indicator of allergic rhinitis. Skin and provocation tests can yield false-positive and false-negative results.

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

Which is a primary chemical mediator of hypersensitivity? Serotonin Histamine Heparin Bradykinin

Histamine Explanation: Histamine is a primary chemical mediator of hypersensitivity. Secondary mediators include serotonin, heparin, and bradykinin.

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

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

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

"If I am pregnant, I should take half the dose." Explanation: 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 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: Photosensitivity. Epigastric distress. Urinary retention. Seizures.

Seizures. Explanation: Atarax is the only OTC antihistamine that has the potential serious side effect of tremors and seizures.

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

dyspnea, bronchospasm, and/or laryngeal edema Explanation: 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 teaching a client about histamine release during an anaphylactic reaction. What does histamine release in anaphylaxis cause? feeling of impending doom urinary urgency stomach cramps nasal congestion

nasal congestion Explanation: Histamine release causes sweating, sneezing, shortness of breath, and nasal congestion. Feelings of impending doom are related to activation of IgE and subsequent release of chemical mediators. Urinary urgency and stomach cramps occur from smooth muscle contractions of intestines and bladder.

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

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.

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? oxymetazoline hydrochloride intranasal cromolyn sodium tetrahydrozoline hydrochloride pseudoephedrine hydrochloride

intranasal cromolyn sodium Explanation: Intranasal cromolyn sodium is a mast cell stabilizer. Tetrahydrozoline hydrochloride, oxymetazoline hydrochloride, and pseudoephedrine hydrochloride are adrenergic agents.

A patient was seen in the clinic for hypertension and received a prescription for a new antihypertensive medication. The patient arrived in the emergency department a few hours after taking the medication with severe angioedema. What medication prescribed may be responsible for the reaction? Vasodilator Angiotensin receptor blocker Beta blocker Angiotensin-converting enzyme (ACE) inhibitor

Angiotensin-converting enzyme (ACE) inhibitor Explanation: Several frequently prescribed medications, such as angiotensin-converting enzyme inhibitors and penicillin, may cause angioedema. The nurse needs to be aware of all medications the patient is taking and be alert to the potential of angioedema as a side effect.

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

Serum IgE level Explanation: Normally, serum IgE levels are below 1.0 mg/mL. The patient's level is significantly elevated suggesting allergic reaction. The other values are within normal parameters.

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 A cause-and-effect relationship An alloimmunity disorder Autoimmune

Autoimmune Explanation: Diseases are considered autoimmune disorders when they are characterized by unrelenting, progressive tissue damage without any verifiable etiology. The client did not have a previous disorder that has caused an exacerbation. An alloimmunity describes an immune response that is waged against transplanted organs and tissues that carry non self antigens. Because there is no identifiable cause, there can be no effect.

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

"The full benefit of the medication may take up to 2 weeks to be achieved." Explanation: Patients must be aware that full benefit of corticosteroid nasal sprays may not be achieved for several days to 2 weeks.

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 Explanation: 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.

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

What education should the nurse provide to the patient taking long-term corticosteroids? The patient should take the medication only as needed and not take it unnecessarily. 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. Corticosteroids are relatively safe drugs with very few side effects.

The patient should not stop taking the medication abruptly and should be weaned off of the medication. Explanation: 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.

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

photoallergic Explanation: 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.

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. Take the drug orally before, with, or after meals. Place the prescribed number of drops into the conjunctiva. Use ice chips to alleviate the symptoms of dry mouth.

Be aware that some nasal burning and itching may occur. Explanation: Triamcinolone is an inhaled corticosteroid administered by a metered-spray device. It may cause drying of the nasal mucosa and burning and itching sensations. The drug is not given orally and does not cause dry mouth. Adrenergic topical ophthalmic drops are used for symptomatic relief of eye irritations resulting from allergies.

A client has been seeing an allergist for 6 months for treatment of allergies. The client's allergies have been insufficiently controlled by symptomatic treatments and the physician has suggested desensitization. The anticipated outcome of desensitization is that repeated exposure to the: weak antigen promotes the production of IgG, an antibody that blocks IgE so it cannot stimulate mast cells. strong antigen promotes the production of IgE, an antibody that blocks IgG so it cannot stimulate mast cells. strong antigen promotes the production of IgG, an antibody that blocks IgE so it cannot stimulate basophils. weak antigen promotes the production of IgE, an antibody that blocks IgG so it cannot stimulate basophils.

weak antigen promotes the production of IgG, an antibody that blocks IgE so it cannot stimulate mast cells. Explanation: 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. Repeated exposure to the weak antigen promotes the production of IgG, an antibody that blocks IgE so it cannot stimulate mast cells.

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

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.

A nurse is assessing a client who is experiencing an allergic reaction. What will the nurse identify as resulting from the release of histamine? Vasodilation Hypotension Constipation Pruritus

Pruritus Explanation: Histamine causes erythema, localized edema in the form of wheals, pruritus, contraction of bronchial smooth muscle resulting in wheezing and bronchospasm, dilation of small venules and constriction of larger vessels, and increased secretion of gastric and mucosal cells, resulting in diarrhea. Vasodilation and hypotension result from bradykinin release.

Which acts as a potent vasoconstrictor and causes bronchial smooth muscle to contract? Serotonin Prostaglandin Platelet-activating factor Bradykinin

Serotonin Explanation: Serotonin acts as a potent vasoconstrictor and causes contraction of bronchial smooth muscle. Bradykinin is a polypeptide with the ability to cause increased vascular permeability, vasodilation, hypotension, and contraction of many types of smooth muscle, such as the bronchi. Prostaglandin is a polypeptide that stimulates nerve fibers and causes pain. Platelet-activating factor is responsible for initiating platelet aggregation and leukocytes, as well as vasodilation and increased capillary permeability.

A client is prescribed an oral corticosteroid for 2 weeks to relieve asthma symptoms. The nurse educates the client about side effects, which include: hypotension. adrenal suppression. hypoglycemia. diuresis.

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 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 contact dermatitis. pitting edema. angioneurotic edema. urticaria.

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 and shape, itch, and cause local discomfort. Contact dermatitis refers to inflammation of the skin caused by contact with an allergenic substance such as poison ivy. Pitting edema is the result of increased interstitial fluid and associated with disorders such as congestive heart failure.

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 Tolerance to nose drops Leukotriene modifier Rhinitis medicamentosa Atopic dermatitis

Rhinitis medicamentosa Explanation: Rhinitis medicamentosa is a rebound reaction from overuse of sympathomimetic nose drops or sprays that worsen the congestion, causing the client to use more of the medication, thereby leading to more nasal congestion. This differs from tolerance, when more medication is needed to achieve the desired effect. Leukotriene modifiers are a category of medications used to treat allergies. Atopic dermatitis is a type I hypersensitivity involving inflammation of the skin evidenced by itching, erythema, and skin lesions.

The nurse is working with a client with allergies. What will the nurse use to confirm allergies and decrease the risk of anaphylaxis? intradermal testing punch biopsy nasal smear peripheral blood smears

intradermal testing Explanation: The diagnosis of anaphylaxis risk is determined by prick and intradermal skin testing. Skin testing of patients who have clinical symptoms consistent with a type I, IgE-mediated reaction has been recommended. A nasal smear, punch biopsy, and peripheral blood smear would not be used for allergy testing.

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

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.

A client is upset about being diagnosed with allergies to peanuts and milk and does not want to avoid eating these items. Which treatment approach is best used to achieve desensitization of these food allergies in the client? Use of an epinephrine pen H1 blockers Corticosteroids Oral immunotherapy

Oral immunotherapy Explanation: A food allergy is an adverse reaction to certain foods due to immunologic mechanisms. Allergic reactions can range from cutaneous urticaria to anaphylaxis. Fish and shellfish as well as peanuts and tree nuts are the two food groups that cause the majority of adult food allergies. Other common foods causing allergy include cow's milk, eggs, soy, and wheat. Oral immunotherapy (OIT), or tolerance induction, is an increasingly used treatment. The client ingests very small amounts of the allergen in increasing dosages over several months. OIT is not a curative treatment. The goal of OIT is to increase the threshold that triggers a reaction. Peanut and milk OIT have been shown to desensitize approximately 60% to 80% of clients studied. OIT has not cured food allergy in these individuals; it has raised the client's tolerance of the offending food. H1 blockers and corticosteroids are used for clients who cannot avoid exposure to offending foods and for clients who have multiple food sensitivities that are not responsive to avoidance measures. All clients with food allergies, especially seafood and nuts, should have an auto-injectable epinephrine device prescribed; however, the client does not want to avoid eating these items.

The nurse is planning care for a client with atopic dermatitis. Which information will the nurse include when teaching the client self-care for the condition? Select all that apply. Apply a skin cream that contains glycerol. Take antihistamines early in the day. Crusting of lesions is a sign of healing. Use a mild soap when bathing. Wear clothing made of cotton.

Use a mild soap when bathing. Wear clothing made of cotton. Apply a skin cream that contains glycerol. Explanation: Atopic dermatitis is a type I immediate hypersensitivity disorder involving IgE antibodies that causes dry, pruritic, hypersensitive skin. It often begins with small, red, pruritic papules that stimulate intense itching, leaving erythematous, excoriated areas of skin. This often triggers an "itch-scratch cycle" where rubbing or scratching the skin causes further irritation, redness, and skin breakdown. Treatment of clients with atopic dermatitis involves avoidance of irritative agents, use of anti-inflammatory topical agents, and moisturization of the skin. The client should be advised to use mild soap when bathing and to wear clothing made of cotton. Thick cream moisturizers and emollients that contain glycerol should be used as these will keep the skin hydrated. Antihistamines may be used however should be taken at bedtime because they are sedating. The presence of purulence or honey-colored crusts suggests S. aureus infection and antibiotics are needed to eradicate infection.

A pediatric client is recovering from an anaphylactic reaction to an allergen which brought him to the ED. The client's mother is quite concerned with the potential reoccurrence of her child's reaction. In attempting to narrow down the possible allergen, it is important to consider that clinical manifestations generally correlate with: route of exposure. skin reactions. respiratory symptoms. systemic effects.

route of exposure. Explanation: Clinical manifestations generally correlate with the manner in which the allergen enters the body. For example, inhaled allergens usually cause respiratory symptoms, including nasal congestion, runny nose, sneezing, coughing, dyspnea, and wheezing. Inhaled allergens often trigger asthma.

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 II type I type IV type III

type I Explanation: Epinephrine interferes with the release of vasoactive chemicals from mast cells which cause vasodilation during anaphylaxis, also known as a Type I response.

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? "I'll go directly to the pharmacy with my EpiPen prescription." "The test may be mildly uncomfortable." "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."

"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 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? 24 hours 2 hours 6 hours 12 hours

2 hours Explanation: Mild systemic, anaphylactic reactions consist of peripheral tingling and a sensation of warmth, possibly accompanied by a sensation of fullness in the mouth and throat. Nasal congestion, periorbital swelling, pruritus, sneezing, and tearing of the eyes can also be expected. Onset of symptoms begins within the first 2 hours after exposure.

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? Angioedema Blistering Rhinitis Laryngeal edema

Blistering Explanation: Manifestations associated with allergic contact dermatitis related to latex include blisters, pruritus, erythema, swelling, and crusting or other skin lesions. Laryngeal edema, rhinitis, and angioedema would be noted with a latex allergy.

While interviewing a client with an allergic disorder, the client tells the nurse about an allergy to animal dander. The nurse knows that animal dander is what type of substance? T-lymphocyte Chemical mediator Immunoglobulin Complete protein antigen

Complete protein antigen Explanation: Animal dander is considered a complete protein antigen. Immunoglobulins are antibodies formed by lymphocytes and plasma cells. Chemical mediators are substances released by the mast cells upon stimulation by an antigen. T-lymphocytes assist the B cells in producing antibodies.

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

Jabs the autoinjector into the outer thigh at a 90-degree angle Explanation: To self-administer epinephrine, the client should remove the autoinjector from its carrying tube, grasp the unit with the black tip (injecting end) pointed downward, form a fist around the device, and remove the gray safety release cap. Then the client should hold the black tip near the outer thigh and swing and jab firmly into the outer thigh at a 90-degree angle until a click is heard. Next, the client should hold the device firmly in place for about 10 seconds, remove the device, and massage the site for about 10 seconds.

A nurse is caring for a client with atopic dermatitis. Which suggestions for the client by the nurse would be appropriate? Select all that apply. Wear clothing made from synthetic fabrics. Use a strong antibacterial detergent for the laundry. Keep the room temperature at approximately 70 degrees Fahrenheit (21 degrees Celsius). Humidify the home when the heat is on during the winter. Apply topical moisturizers to the skin.

Keep the room temperature at approximately 70 degrees Fahrenheit (21 degrees Celsius). Apply topical moisturizers to the skin. Humidify the home when the heat is on during the winter. Explanation: The nurse would suggest that the client use a mild detergent for laundry and keep the room temperature between 68 to 72 degrees Fahrenheit (20 to 22 degrees Celsius) to decrease itching and scratching. Other suggestions include applying topical moisturizers to the skin, wearing clothes made from cotton fabrics, and humidifying the home when dry home heating is used during the winter.

A client is prescribed montelukast as part of a treatment plan for an allergic disorder. The nurse understands that this drug belongs to which class? Mast cell stabilizer Nonsedating antihistamine Corticosteroid Leukotriene-receptor antagonist

Leukotriene-receptor antagonist Explanation: Montelukast is classified as a leukotriene-receptor antagonist. Cromolyn sodium is a mast cell stabilizer. Cetirizine, loratadine, and fexofenadine are nonsedating antihistamines. Beclomethasone, budesonide, dexamethasone, flunisolide, fluticasone, and triamcinolone are corticosteroids.

Which statement describes the clinical manifestations of a delayed hypersensitivity (type IV) allergic reaction to latex? They occur within minutes after exposure to latex. They can be eliminated by changing glove brands or using powder-free gloves. They may worsen when hand lotion is applied before donning latex gloves. They are localized to the area of exposure, usually the back of the hands.

They are localized to the area of exposure, usually the back of the hands. Explanation: Clinical manifestations of a delayed hypersensitivity reaction are localized to the area of exposure. Clinical manifestations of an irritant contact dermatitis can be eliminated by changing glove brands or using powder-free gloves. With an irritant contact dermatitis, avoid use of hand lotion before donning gloves; this may worsen symptoms, as lotions may leach latex proteins from the gloves. Described as a latex allergy, when clinical manifestations occur within minutes after exposure to latex, an immediate hypersensitivity (type I) allergic reaction has occurred.

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. Carry EpiPen autoinjector at all times. List symptoms of peanut allergy. Wear a medic alert bracelet. Food labels on baked items are the only labels that need to be read. Identify ways to manage allergy while dining out.

Wear a medic alert bracelet. List symptoms of peanut allergy. Identify ways to manage allergy while dining out. Carry EpiPen autoinjector at all times. Explanation: Wearing a medic alert bracelet allows others to be alerted of the allergy. Listing symptoms of the allergy makes the client aware of the allergic reaction if symptoms are being experienced. Identifying ways to manage allergies while dining out allows the client to be safe from a potential reaction. All food labels should be read not only baked items. The EpiPen autoinjector should be carried at all times in case it needs to be administered because of an allergic reaction.

A client comes to the emergency department complaining of difficulty breathing and feeling strange after eating a shrimp cocktail. The client is leaning forward with a respiratory rate of 36 breaths per minute. The nurse suspects anaphylaxis. What is the nurse's priority action? providing pain relief measures encouraging activity decreasing anxiety maintaining an open airway

maintaining an open airway Explanation: The priority action at this time is maintaining an open airway because the client is experiencing a severe allergic reaction that is compromising the airway and ability to inhale. There is no indication that the client's difficulty breathing is causing pain. Anxiety and activity are important, but the priority is the client's airway.