M.8-2: Dynamic Study Module Hypersensitivity

The nurse is performing an admission assessment on a patient with suspected serum sickness. Which question by the nurse demonstrates an understanding of potential causes for this condition? ANSWER "Have you recently been diagnosed with an allergy to latex?" "Have you changed your laundry detergent the other day?" "Have you taken an antibiotic recently?" "Have you had a blood transfusion in the past 48 hours?"

"Have you taken an antibiotic recently?" WHAT YOU NEED TO KNOW Serum sickness is a type III hypersensitivity reaction that can occur in response to penicillin. A type III reaction results in immune complexes deposited in walls of small blood vessels, the kidneys, and the joints. Manifestations of serum sickness include fever, urticaria or rash, arthralgias, myalgias, and lymphadenopathy. A reaction to a blood transfusion is a type II reaction in which the blood cells are destroyed. A hypersensitivity to laundry detergent results in contact dermatitis, not a systemic reaction. A latex allergy can cause a type I reaction. previous

A patient states to the nurse, "My doctor ordered a prick test to see if I am allergic to pet dander. How will you perform the test?" Which response by the nurse will provide the patient with the correct information? ANSWER "I will be injecting the allergen extract intradermally." "I will give you a pill with the allergen to swallow." "I will be placing a patch with the allergen on the skin." "I will be puncturing the skin through the diluted allergenic extract."

"I will be puncturing the skin through the diluted allergenic extract."

The nurse is evaluating a patient's ability to manage an allergic anaphylactic reaction. Which patient statement indicates that further teaching is needed? ANSWER "I will seek medical attention if my EpiPen does not work." "I will make sure my EpiPen kit is immediately available." "I will carry a medical alert card in my wallet." "I will seek medical attention if I have to use my EpiPen."

"I will carry a medical alert card in my wallet." WHAT YOU NEED TO KNOW The patient should wear a medical alert bracelet or tag. In an emergency situation, a responder will not be searching through the patient's wallet and the patient may not have the wallet with him or herat all times. The other options are correct actions.

The nurse is teaching the parent of a young child with a peanut and dairy allergy. The parent says, "He is such a picky eater—what am I supposed to feed him?" Which response by the nurse provides the most beneficial solution? ANSWER "I will provide you a list of nutritious foods and have a dietician speak with you." "Let him eat the things he likes that do not contain nuts or dairy." "I will ask your healthcare provider to speak with you to provide further direction." "He can eat whatever he would like as long he is gaining weight and growing."

"I will provide you a list of nutritious foods and have a dietician speak with you."

The nurse is providing allergy treatment to a child who presents with a bee sting. The nurse provides teaching to the parent as to what to do if the child gets another bee sting. Which parent statement alerts the nurse of the need for further teaching? ANSWER "I will be attentive to my child's breathing pattern and use the epinephrine pen as directed." "I will keep in mind the severity and treatment of my child's first bee sting." "If my child gets stung by a bee again, I will remove the stinger and apply ice to reduce pain." "I will be sure that my child wears amedical alert bracelet."

"If my child gets stung by a bee again, I will remove the stinger and apply ice to reduce pain."

The nurse is caring for a child who presented with hives on the anterior and posterior trunk. Which statement by the child may be an indicator of an emergent hypersensitivity reaction? ANSWER "My skin is so itchy." "My stomach feels sick." "My tongue feels funny." "My head does not feel good."

"My tongue feels funny."

A patient is prescribed plasmapheresis for treatment of glomerulonephritis. The patient asks the nurse, "Why does my blood need to go through a machine?" Which response by the nurse is accurate? ANSWER "The machine replaces your red blood cells with new ones." "The machine will remove the antibodies from your blood." "The machine removes the antigens that are causing your illness from your blood." "The machine removes the harmful components in the plasma."

"The machine removes the harmful components in the plasma."

The nurse is teaching a patient prescribed a leukotriene modifier for treatment of asthma. Which information by the nurse describes the effects of leukotriene modifiers? ANSWER "The medication will dry up your nasal secretions." "This medication may make you feel drowsy." "The medication has a bronchodilator effect to help you breathe better." "The medication will reduce inflammation and nasal congestion."

"The medication will reduce inflammation and nasal congestion." Leukotriene modifiers block the action of inflammatory chemicals known as leukotrienes, released by the body in response to allergens. These medications reduce inflammation and nasal congestion associated with allergies. Epinephrine has a bronchodilating effect. Antihistamines can dry respiratory secretions through an anticholinergic effect. First-generation antihistamines can cause drowsiness.

Which action by the nurse is the most appropriate for treating a patient experiencing severe anaphylactic reaction while in the acute care setting? ANSWER Administer epinephrine subcutaneously Give oral diphenhydramine (Benadryl) Administer epinephrine intravenously Apply epinephrine directly to the site of entry

Administer epinephrine intravenously WHAT YOU NEED TO KNOW Anaphylaxis is an acute systemic type I response that may result in shock and death and is considered a medical emergency. The nurse should administer epinephrine intravenously when treating a severe anaphylactic reaction. Due to the severity of the situation, oral diphenhydramine, subcutaneous epinephrine, and epinephrine applied directly to the site of entry cannot provide the emergent treatment necessary for an acute systemic type I response.

A patient states, "I am having trouble breathing and I feel like there is a ton of pressure on my chest. I don't know what brought this on, I was just down in the basement, cleaning." The patient has no medical history and the vital signs are T 99°F, R 24 breaths/min, BP 92/48 mmHg, P 102 beats/min, O2 saturation 93%. Based on the information obtained, which hypersensitivity should the nurse suspect the patient is experiencing? ANSWER Pneumonia Allergic asthma Bronchitis Allergic rhinitis

Allergic asthma

The nurse is reviewing the chart of a patient diagnosed with poison ivy. Which hypersensitivity reaction should the nurse anticipate finding upon assessment of the exposed area? ANSWER Contact dermatitis Erythema multiforme Hives Atopic dermatitis

Contact dermatitis

The nurse is teaching a patient with latex allergy the importance of when to seek medical attention after exposure. Which situation should the nurse include? ANSWER If the patient develops hives If the patient experiences flu-like symptoms If the patient comes in contact with latex If the patient develops a runny nose

If the patient develops hives The patient should seek medical attention if they develop hives after coming in contact with latex. It is not necessary to seek medical attention if the patient accidently comes in contact with latex. Seeking medical attention is reserved for symptoms that occur after contact. Flu-like symptoms do not indicate the patient is having a latex allergy. However, if the patient comes into contact with latex and experiences nasal congestion, coughing, or wheezing, then it is important that the patient seek medical attention immediately.

Which potential problem is the priority for the nurse to address while charting a plan of care for a patient with a hypersensitivity reaction? ANSWER Altered nutrition Impaired skin integrity Acute pain Ineffective airway clearance

Ineffective airway clearance WHAT YOU NEED TO KNOW Ineffective airway clearance is the priority for the nurse to address when planning care for a patient with a hypersensitivity reaction. Acute pain, altered nutrition, and impaired skin integrity are not priority potential problems for the nurse to address when planning care for a patient with a hypersensitivity reaction.

The nurse is caring for a patient who has recently received a stem cell transplant. The patient presents to the clinic with clinical symptoms of graft-versus-host disease. Which finding should the nurse anticipate during the assessment of the patient? ANSWER Splenomegaly Bronchoconstriction Proteinuria Jaundice

Jaundice WHAT YOU NEED TO KNOW A clinical assessment finding for graft-versus-host disease includes jaundice, skin rash, and nausea and vomiting. Graft-versus-host disease results as an immune response to organ, bonemarrow, or stem cell transplants. Proteinuria and splenomegaly are assessment findings in a patient with serum sickness. Bronchoconstriction occurs in a patient with allergic asthma.

The nurse is reviewing the medical record of a patient diagnosed with severe, persistent asthma exacerbated by seasonal allergies. Which medication should the nurse expect on the patient's medication record? ANSWER Antihistamine Epinephrine pen Leukotriene modifier Calcium channel blocker

Leukotriene modifier WHAT YOU NEED TO KNOW Leukotriene modifiers block the action of inflammatory compounds known as leukotrienes, involved with the mechanism of asthma. An epinephrine pen is used in emergencies after exposure to allergens known to place patients at risk for anaphylaxis. Antihistamines are used to inhibit histamine release and not effective in relieving asthmatic responses to allergens. Calcium channel blockers do not have a role in the management of asthma or allergies.

Which collaborative laboratory test should the nurse anticipate the for a patient to determine food allergies? ANSWER Type and screen WBC count and differential Complement assay Radioallergosorbent test (RAST)

Radioallergosorbent test (RAST)

The nurse is caring for an older patient who reports joint pain. Assessment reveals a diffuse rash, arthralgia, and lymphadenopathy. The patient is receiving penicillin for acute glomerulonephritis. Based on the nurse's assessment findings, which hypersensitivity should the nurse suspect? ANSWER Serum sickness Graft-versus-host disease Anaphylactic reaction Contact dermatitis

Serum sickness

Which clinical manifestation of a hypersensitivity reaction should the nurse monitor for in a patient receiving a blood transfusion? ANSWER Respirations 22 breaths/min Blood pressure156/80 mmHg Pulse 92 beats/min Temperature 101.6ºF

Temperature 101.6ºF

A patient presents with signs of severe anaphylaxis including difficulty breathing and urticaria. The nurse notes there is no history of asthma, drug use, or any prescribed medications. Based on this data, which diagnosis should the nurse anticipate for this patient? ANSWER Type II (cytotoxic) hypersensitivity Type I (IgE-mediated) hypersensitivity Type IV (delayed) hypersensitivity Allergic reaction

Type I (IgE-mediated) hypersensitivity WHAT YOU NEED TO KNOW The patient is having a type I (IgE-mediated) reaction that was likely triggered by conditions in the factory which was first encountered on that day that included signs of severe anaphylaxis, difficulty breathing, and urticaria. This event is too recent to be attributed to a type IV (delayed) hypersensitivity reaction. The patient has not been exposed to any donor tissues or drugs to account for a type II (cytotoxic) reaction. An allergic reaction is a mild, not severe, form of a type I reaction.

A patient is experiencing a hypersensitivity response triggered by hayfever. Which type of hypersensitivity response should the nurse anticipate? ANSWER Sure incorrect Type IV response Type I response Type III response Type II response

Type I response A type I response is triggered when an allergen interacts with IgE. This response causes the release of histamine and other chemical mediators, complement, acetylcholine, kinins, and chemotactic factors. A type II reaction occurs when IgG or IgM type antibodies are formed to a cell-bound antigen such as the ABO or Rh antigens in blood. A type III reaction is caused by the formation of IgG or IgM antibody-antigen immune complexes in the circulation. A type IV reaction is cell mediated and involves the T cells of the immune system. Type II, III, and IV reactions are not triggered when an allergen interacts with IgE.

The nurse is providing teaching to a patient who has experienced an anaphylactic reaction after eating shrimp. Which statement by the nurse provides the patient with the most accurate information? ANSWER "You only need to avoid eating shellfish, such as clams and oysters." "Avoid eating all crustaceans, such as shrimp, lobster, and crab." "You should avoid eating all seafood, until allergy skin testing is done." "You can consume finned ocean fish."

"You should avoid eating all seafood, until allergy skin testing is done."

The nurse is caring for a child with a severe peanut allergy who is enrolled in a clinical trial for epicutaneous immunotherapy. The parent asks, "How will this be done?" How should the nurse respond? ANSWER "Your child will be exposed to peanuts and receive an injection that reduces the amount of histamine that is released." "Your child will be given an oral peanut protein formulation." "Your child will be exposed to the allergen with a subcutaneous injection." "A patch with the allergen will be placed on the skin daily."

"A patch with the allergen will be placed on the skin daily."

A pregnant woman with a latex allergy is admitted to the hospital for delivery. Which latex precaution should the nurse implement? ANSWER Cover IV fluid bags so they do not come in contact with the patient There are no interventions necessary; hospital products are latex free Place a latex allergy sign outside the patient's door Avoid using gloves as much as possible

Place a latex allergy sign outside the patient's door

The nurse is caring for a patient who presents with symptoms of urticaria on both hands. Which disease in the patient's history is considered as a risk factor related to this hypersensitivity reaction? ANSWER Acute kidney injury Atrial fibrillation Hepatitis A Asthma

Asthma WHAT YOU NEED TO KNOW Patients with respiratory disease, such as asthma, have an increased risk for a type I hypersensitivity. Renal, cardiac, and liver disease are not identified risk factors for type I hypersensitivity.

The nurse is teaching a patient with a latex allergy. Which latex-containing product at home should the nurse encourage the patient to avoid? ANSWER Chewing gum Toothbrush bristles Plastic food wrap Trash can liners

Chewing gum WHAT YOU NEED TO KNOW A product found at home that may have latex in it is chewing gum. Any number of products used in both the hospital and home environments may contain natural rubber latex (NRL). A type IV hypersensitivity (contact dermatitis) resulting from exposure to NRL can progress to a type I systemic allergic reaction without previous symptoms signaling an escalation. Plastic food wrap, trash can liners, and toothbrush bristles do not contain latex.

Which information is important for the nurse to consider when caring for children with allergic reactions? ANSWER Food allergies are rare in children. Children quickly outgrow peanut allergies. Breastfeeding is a risk factor in the development of food allergies. Children are at higher risk for respiratory distress.

Children are at higher risk for respiratory distress.

A patient is admitted to the emergency department with red, itchy patches on both legs that appeared 24 hours after returning from an overnight camping trip. Which type of hypersensitivity response does the nurse expect the patient to be experiencing? ANSWER Type II Type IV Type III Type I

Type IV