NSG 330 Ch 37- Assessment & Management Allergic Disorders

The nurse observes diffuse swelling involving the deeper skin layers in a client who has experienced an allergic reaction. The nurse would correctly document this finding as

angioneurotic edema. 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.

A client visits the employee health department because of mild itching and a rash on both hands. What will the employee health nurse focus on during the assessment interview?

chemical and latex glove use Explanation: Because the itching and rash are localized, the employee health nurse will suspect an environmental cause in the workplace. With the advent of standard precautions, many nurses have experienced allergies to latex gloves. Allergies to medications, laundry detergents, or bath soaps and dermatologic reactions to stress usually elicit a more generalized or widespread rash.

The nurse is working in an allergy clinic with a client with tuberculosis. What other reaction is a type IV hypersensitivity disorder?

contact dermatitis Explanation: Tuberculosis and contact dermatitis are type IV hypersensitivity reactions. Anaphylaxis, allergic rhinitis, and atopic dermatitis are type I hypersensitivity reactions.

A nurse is providing care to a client with a history of atopic dermatitis who has numerous lesions on the arms, neck, and legs. The client states, "My skin is so ugly. I can't imagine what people must think when they look at me. I can't look at myself sometimes." What will the nurse include on the client's plan of care?

disturbed body image Explanation: The client's statements indicate a problem related to how the client views herself and how others view her, so there is a disturbed body image. The client does not state anything about feeling depressed. The client does not talk about pain. The client is seeking help for her atopic dermatitis, so deficient knowledge is not the issue.

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 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.

A nurse is teaching a client who is allergic to ragweed. What season does the nurse advise the client to expect an increase in symptoms?

early fall Explanation: Ragweed has a seasonal occurrence in early fall. Tree pollen and mold spore levels rise in the spring. Rose and grass pollen is prevalent in the summer.

A nurse is working in a dermatology clinic with clients who have allergies. What is the most important chemical mediator involved in the allergic response?

histamine Explanation: The pathophysiology of an allergic response involves a chain of events that includes responses from lymphocytes, IgE, mast cells, and basophils. All chemical mediators are participants in the response cycle, but histamine is the most important protein involved. Activated by a mast cell, it increases vessel permeability.

The nurse is teaching a client with allergic rhinitis about medications. What medication is a mast cell stabilizer used in the treatment of allergic rhinitis?

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

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?

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.

The nurse is teaching a client about histamine release during an anaphylactic reaction. What does histamine release in anaphylaxis cause?

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 is talking to a group of community volunteers about food allergies. What are the foods that cause the most severe allergic reactions and result in the highest client death rates?

peanut and tree nuts Explanation: Peanuts, cashews, and walnuts are responsible for the most severe allergic reactions. Some individuals are so sensitive that they can have a reaction just by being close enough to the food product to smell it or having the nut oil on their hands. While other foods like seafood, milk, chocolate, berries and seeds cause allergic responses, reactions to these foods do not lead to the highest death rates.

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

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.

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 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.

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

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.

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. 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 is educating a client about allergy management at home. What client statements indicate no further teaching is required? Select all that apply.

"I have pull shades on all of my windows." "I bought a wooden chair for my living room." Explanation: Using pull shades on windows and using steam for heating will help reduce environmental allergens such as dust. Rugs on floors will hold allergens in and floors need to be vacuumed every day. Dogs may bring allergens into the client's home, especially when in close proximity while sleeping.

When evaluating a client's knowledge about use of antihistamines, what statement indicates further education is required?

"If I am pregnant, I should take half the dose." 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 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 is a hyperimmune response to something in the environment that is usually harmless." Explanation: An allergic disorder is characterized by a hyperimmune response to weak antigens that usually are harmless. The antigens that can cause an allergic response are called allergens.

The nurse is teaching a client about a recent order for loratadine to help with seasonal allergies. What client statements indicate no further teaching is required? Select all that apply.

"Taking my medication on an empty stomach is a must." "Sucking on ice chips will help if my mouth is dry." "Being careful driving is important after taking the medication." "It is recommended that I buy a humidifier for my bedroom." Explanation: Client education includes instructing the client to take the medication on an empty stomach to prevent food from interfering with absorption. Avoid alcohol because the medication can cause increased drowsiness. A side effect is dry mouth, and sucking on ice chips will help. Being careful when driving is important because the medication can cause drowsiness. Using a humidifier will help decrease the negative symptoms associated with humidity.

A nurse is teaching a client how to use their EpiPen autoinjector. What client statement indicates the teaching is understood? Select all that apply.

"The EpiPen autoinjector needs to be pointed downward." "The needle needs to be at a 90-degree angle." "After I administer the injection, I will massage the area for 10 seconds." Explanation: The EpiPen autoinjector is pointed downward. The medication may not work as well if the injection is given in the buttocks. The preferred site is the thigh to avoid hitting bone, nerves, vessels or organs. The needle needs to be at a 90-degree angle. Massaging the area for 10 seconds after administering the injection increases the speed of absorption. Holding the EpiPen autoinjector against the thigh for 10 seconds gives the medication time to be fully administered.

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

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

A patient comes to the clinic with pruritus and nasal congestion after eating shrimp for lunch. The nurse is aware that the patient may be having an anaphylactic reaction to the shrimp. These symptoms typically occur within how many hours after exposure?

2 hours 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.

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

Which of the following individuals would be the most appropriate candidate for immunotherapy?

A patient with severe allergies to grass and tree pollen The benefit of immunotherapy has been fairly well established in instances of allergic rhinitis and bronchial asthma that are clearly due to sensitivity to one of the common pollens, molds, or household dust. Immunotherapy is not used to treat type I hypersensitivities. A positive tuberculin skin test is not an indication for immunotherapy.

A nurse knows of several patients who have achieved adequate control of their allergy symptoms using over-the-counter antihistamines. Antihistamines would be contraindicated in the care of which patient?

A pregnant woman at 30 weeks gestation Antihistamines are contraindicated during the third trimester of pregnancy. Previous tuberculosis, hormone therapy, and food allergies do not contraindicate the use of antihistamines.

A client presents to the emergency department in anaphylactic shock after a bee sting. What should the nurse do? Select all that apply.

Administer Diphenhydramine. Insert an intravenous line. Have respiratory therapy provide an albuterol treatment. Explanation: Administering diphenhydramine reverses the effect of histamine. Inserting an intravenous line will allow access to administer medications quickly. Metoprolol is a medication used to treat hypertension or chest pain. Administering an albuterol treatment reverses histamine-induced bronchospasm. The international normalized ratio (INR) level is monitored for warfarin treatment.

An office worker takes a cupcake that contains peanut butter. He begins wheezing, with an inspiratory stridor and air hunger and the occupational health nurse is called to the office. The nurse should recognize that the worker is likely suffering from which type of hypersensitivity?

Anaphylactic (type The most severe form of a hypersensitivity reaction is anaphylaxis. An unanticipated severe allergic reaction that is often explosive in onset, anaphylaxis is characterized by edema in many tissues, including the larynx, and is often accompanied by hypotension, bronchospasm, and cardiovascular collapse in severe cases. Type II, or cytotoxic, hypersensitivity occurs when the system mistakenly identifies a normal constituent of the body as foreign. Immune complex (type III) hypersensitivity involves immune complexes formed when antigens bind to antibodies. Type III is associated with systemic lupus erythematosus, rheumatoid arthritis, certain types of nephritis, and bacterial endocarditis. Delayed-type (type IV), also known as cellular hypersensitivity, occurs 24 to 72 hours after exposure to an allergen.

The nurse is providing care for a patient who has experienced a type I hypersensitivity reaction. What condition is an example of such a reaction?

Anaphylactic reaction after a bee sting Anaphylactic (type I) hypersensitivity is an immediate reaction mediated by IgE antibodies and requires previous exposure to the specific antigen. Skin reactions are more commonly type IV and myasthenia gravis is thought to be a type II reaction. Rheumatoid arthritis is not a type I hypersensitivity reaction.

A junior nursing student is having an observation day in the operating room. Early in the day, the student tells the OR nurse that her eyes are swelling and she is having trouble breathing. What should the nurse suspect?

Anaphylaxis due to a latex allergy Immediate hypersensitivity to latex, a type I allergic reaction, is mediated by the IgE mast cell system. Symptoms can include rhinitis, conjunctivitis, asthma, and anaphylaxis. The term latex allergy is usually used to describe the type I reaction. The rapid onset is not consistent with a cytotoxic reaction, an immune complex reaction, or a delayed reaction.

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?

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.

The nurse is evaluating a client's readiness for allergy skin testing. The nurse determines that the testing will need to be postponed when it is revealed that the client took which classification of medication the night before?

Antihistamine Explanation: Antihistamines and corticosteroids suppress skin test reactivity and should be stopped at least 48 hours before testing, some experts state 72 hours to 96 hours before testing. It is best to check with the primary care provider regarding the use of antihistamines and corticosteroids and false negatives can occur during the skin testing.

A child has been transported to the emergency department (ED) after a severe allergic reaction. The ED nurse is evaluating the patients respiratory status. How should the nurse evaluate the patients respiratory status? Select all that apply.

Assess breath sounds Measure the childs oxygen saturation by oximeter Monitor the childs respiratory pattern Assess the childs respiratory rate The respiratory status is evaluated by monitoring the respiratory rate and pattern and by assessing for breathing difficulties, low oxygen saturation, or abnormal lung sounds such as wheezing. Lung function testing is a lengthy procedure that is not appropriate in an emergency context.

A school nurse is caring for a child who appears to be having an allergic response. What should be the initial action of the school nurse?

Assess for signs and symptoms of anaphylaxis. If a patient is experiencing an allergic response, the nurses initial action is to assess the patient for signs and symptoms of anaphylaxis. Erythema and urticaria may be present, but these are not the most significant or most common signs of anaphylaxis. Assessment must precede interventions, such as administering an antihistamine. Epinephrine is indicated in the treatment of anaphylaxis, not for every allergic reaction.

An adolescent patients history of skin hyperreactivity and inflammation has been attributed to atopic dermatitis. The nurse should recognize that this patient consequently faces an increased risk of what health problem?

Asthma Nurses should be aware that atopic dermatitis is often the first step in a process that leads to asthma and allergic rhinitis. It is not linked as closely to bronchitis, SLE, and RA.

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?

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.

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. Explanation: Strict avoidance of potential allergens is the most important preventive measure for the patient at risk for anaphylaxis. People who have experienced food, medication, idiopathic, or exercise-induced anaphylactic reactions should always carry an emergency kit containing epinephrine for injection to prevent the onset of the reaction upon exposure, but avoiding potential allergens is more important. Desensitization, based on controlled anaphylaxis with a gradual release of mediators, is an effective treatment option, but it is more important to avoid allergic triggers. The medical alert bracelet will assist those rendering aid to the patient who has experienced an anaphylactic reaction, but it's better to avoid the reaction in the first place.

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. 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 nurse comes to the employee health center for evaluation and is diagnosed with allergic contact dermatitis related to latex. What manifestation would the nurse most likely exhibit?

Blistering 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.

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 identifies methods for reducing exposure risk to allergens. Explanation: For the nursing diagnosis of deficient knowledge, the client's ability to identify methods for reducing the risk of allergen exposure indicates that the outcome has been met. The statement about coughing and deep breathing and an absence of symptoms would be appropriate for evaluating the nursing diagnosis of ineffective breathing pattern. Positive coping strategies would be an appropriate outcome for a nursing diagnosis of ineffective coping.

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?

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.

A nurse is aware of the need to assess patients risks for anaphylaxis. What health care procedure constitutes the highest risk for anaphylaxis?

Computed tomography with contrast solution Radiocontrast agents present a significant threat of anaphylaxis in the hospital setting. Vaccinations less often cause anaphylaxis. Bronchodilators and IV fluids are not implicated in hypersensitivity reactions.

The nurse in an allergy clinic is educating a new patient about the pathology of the patients health problem. What response should the nurse describe as a possible consequence of histamine release?

Contraction of bronchial smooth muscle Histamines effects during the immune response include contraction of bronchial smooth muscle, resulting in wheezing and bronchospasm, dilation of small venules, constriction of large blood vessels, and an increase in secretion of gastric and mucosal cells.

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

Cromolyn sodium Explanation: Cromolyn sodium is a mast cell stabilizer. Zafirlukast is a leukotriene-receptor antagonist. Cetirizine is a second-generation antihistamine. Diphenhydramine is a first-generation antihistamine.

A patient is receiving a transfusion of packed red blood cells. Shortly after initiation of the transfusion, the patient begins to exhibit signs and symptoms of a transfusion reaction. The patient is suffering from which type of hypersensitivity?

Cytotoxic (type A type II hypersensitivity reaction resulting in red blood cell destruction is associated with blood transfusions. This type of reaction does not result from types I, III, or IV reactions.

A client with an allergic disorder calls the nurse and asks what treatment is available for allergic disorders. The nurse explains to the client that there is more than one treatment available. What treatments would the nurse tell the client about?

Desensitization 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.

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?

Do not overuse the medication as rebound congestion can occur. Explanation: Overusing oxymetazoline nasal spray can cause rebound congestion. The medication does not cause fungal infection. Corticosteroids should be tapered, but it is not necessary to taper oxymetazoline. Oxymetazoline does not cause sleepiness so the client can operate machinery or drive.

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 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 patient is experiencing an allergic reaction to a dose of penicillin. What should the nurse look for in the patient's initial assessment?

Dyspnea, bronchospasm, and/or laryngeal edema. Explanation: Severe systemic, anaphylactic reactions have an abrupt onset with the same signs and symptoms described previously. These symptoms progress rapidly to bronchospasm, laryngeal edema, severe dyspnea, cyanosis, and hypotension. Dysphagia (difficulty swallowing), abdominal cramping, vomiting, diarrhea, and seizures can also occur. Cardiac arrest and coma may follow.

A child is undergoing testing for food allergies after experiencing unexplained signs and symptoms of hypersensitivity. What food items would the nurse inform the parents are common allergens?

Eggs and wheat The most common causes of food allergies are seafood (lobster, shrimp, crab, clams, fish), legumes (peanuts, peas, beans, licorice), seeds (sesame, cottonseed, caraway, mustard, flaxseed, sunflower seeds), tree nuts, berries, egg white, buckwheat, milk, and chocolate

A nurse is preparing a patient for allergy skin testing. Which of the following precautionary steps is most important for the nurse to follow?

Emergency equipment should be readily available. Emergency equipment must be readily available during testing to treat anaphylaxis. Immunizations do not contraindicate testing. Neither epinephrine nor albuterol is given prior to testing.

The nurse is administering injected allergens for "hyposensitization," which may produce harmful systemic reactions. Prior to administering these allergens, what medication should the nurse have at the bedside?

Epinephrine Explanation: Because the injection of an allergen may induce systemic reactions, such injections are administered only in a setting where epinephrine is immediately available (i.e., primary provider's office, clinic).

A patient has been brought to the emergency department by EMS after being found unresponsive. Rapid assessment reveals anaphylaxis as a potential cause of the patients condition. The care team should attempt to assess for what potential causes of anaphylaxis? Select all that apply.

Foods Medications Insect stings Substances that most commonly cause anaphylaxis include foods, medications, insect stings, and latex. Pollutants do not commonly cause anaphylaxis and autoimmune processes are more closely associated with types II and III hypersensitivities.

A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder?

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 term refers to an incomplete antigen?

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.

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

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.

A patient with multiple food and environmental allergies tells the nurse that he is frustrated and angry about having to be so watchful all the time and wonders if it is really worth it. What would be the nurses best response?

I can only imagine how you feel. Would you like to talk about it? To assist the patient in adjusting to these modifications, the nurse must have an appreciation of the difficulties encountered by the patient. The patient is encouraged to verbalize feelings and concerns in a supportive environment and to identify strategies to deal with them effectively. The nurse should not suggest that the patient has been mismanaging his health problem and the nurse should not make comparisons with other patients. Further assessment should precede educational interventions.

A patient has presented with signs and symptoms that are consistent with contact dermatitis. What aspect of care should the nurse prioritize when working with this patient?

Identifying the offending agent, if possible Identifying the offending agent is a priority in the care of a patient with dermatitis. Antihistamines are not administered topically and epinephrine is not used to treat dermatitis. Inadequate perfusion occurs with PAD or vasoconstriction

The nurse is teaching a group of health care workers about latex allergies. What reaction will the nurse teach the workers to be most concerned about with laryngeal edema?

IgE-mediated hypersensitivity 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.

A patient with a family history of allergies has suffered an allergic response based on a genetic predisposition. This atopic response is usually mediated by what immunoglobulin?

Immunoglobulin E Atopy refers to allergic reactions characterized by the action of IgE antibodies and a genetic predisposition to allergic reactions.

The nurse is creating a care plan for a patient suffering from allergic rhinitis. Which of the following outcomes should the nurse identify?

Improved coping with lifestyle modifications The goals for the patient with allergies may include restoration of normal breathing pattern, increased knowledge about the causes and control of allergic symptoms, improved coping with alterations and modifications, and absence of complications. Antibiotics are not used to treat allergies and corticosteroids, if needed, are not administered parenterally. Allergies do not normally threaten skin integrity.

A patient has been admitted to the emergency department with signs of anaphylaxis following a bee sting. The nurse knows that if this is a true allergic reaction the patient will present with what alteration in laboratory values?

Increased eosinophils Higher percentages of eosinophils are considered moderate to severe eosinophilia. Moderate eosinophilia is defined as 15% to 40% eosinophils and is found in patients with allergic disorders. Hypersensitivity does not result in hypoglycemia or increased albumin and neutrophil counts.

A patient has a documented history of allergies presents to the clinic. She states that she is frustrated by her chronic nasal congestion, anosmia (inability to smell) and inability to concentrate. The nurse should identify which of the following nursing diagnoses?

Ineffective Individual Coping with Chronicity of Condition and Need for Environmental Modification The most appropriate nursing diagnosis is Ineffective Individual Coping with Chronicity of Condition and Need for Environmental Modification. This nursing diagnosis is all encompassing of the subjective and objective data. Altered body image and acute confusion are not evidenced by the data. The patients condition is not necessary attributable to a knowledge deficit.

After teaching a client how to self-administer epinephrine, the nurse determines that the teaching plan has been successful when the client demonstrates which action?

Jabs the autoinjector into the outer thigh at a 90-degree angle 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 patient has developed severe contact dermatitis with burning, itching, cracking, and peeling of the skin on her hands. What should the nurse teach the patient to do?

Keep her hands well-moisturized at all times. Powdered latex gloves can cause contact dermatitis. Skin should be kept well-hydrated and should be washed with mild soap. Maintaining roomtemperature at 75F to 80F is not necessary

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?

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 group of mediators initiates the inflammatory response?

Leukotrienes Explanation: Leukotrienes are a group of chemical mediators that initiate the inflammatory response. Lymphokines are substances released by sensitized lymphocytes when they contact specific organs. Mast cells are connective tissue that contains heparin and histamine in their granules. Prostaglandins are unsaturated fatty acids that have a wide assortment of biologic activity.

The nurse is providing health education to the parents of a toddler who has been diagnosed with food allergies. What should the nurse teach this family about the childs health problem?

Many children outgrow their food allergies in a few years if they avoid the offending foods Many food allergies disappear with time, particularly in children. About one-third of proven allergies disappear in 1 to 2 years if the patient carefully avoids the offending food. Antihistamines do not cure allergies and an EpiPen is carried, not a steroid inhaler.

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

A nurse is caring for a patient who has allergic rhinitis. What intervention would be most likely to help the patient meet the goal of improved breathing pattern?

Modify the environment to reduce the severity of allergic symptoms. The patient is instructed and assisted to modify the environment to reduce the severity of allergic symptoms or to prevent their occurrence. Deep breathing and coughing are not indicated unless an infection is present. Anaphylaxis requires prompt medical attention, but a minority of allergic reactions are anaphylaxis. Overuse of antihistamines reduces their effectiveness.

A patient is learning about his new diagnosis of asthma with the asthma nurse. What medication has the ability to prevent the onset of acute asthma exacerbations?

Montelukast (Singulair) Many manifestations of inflammation can be attributed in part to leukotrienes. Medications categorized as leukotriene antagonists or modifiers such as montelukast (Singulair) block the synthesis or action of leukotrienes and prevent signs and symptoms associated with asthma. Diphenhydramine prevents histamines effect on smooth muscle. Albuterol sulfate relaxes smooth muscle during an asthma attack. Epinephrine relaxes bronchial smooth muscle but is not used on a preventative basis.

A client has had a "stuffy nose" and obtained an oxymetazoline nasal spray. What education should the nurse provide to the client in order to prevent "rebound congestion"?

Only use the nasal spray for 3 to 4 days once every 12 hours. Explanation: Adrenergic agents, which are vasoconstrictors of mucosal vessels, are used topically in nasal (oxymetazoline [Afrin]) and ophthalmic (brimonidine [Alphagan P]) formulations in addition to the oral route (pseudoephedrine [Sudafed]). The topical route (drops and sprays) causes fewer side effects than oral administration; however, the use of drops and sprays should be limited to a few days to avoid rebound congestion.

What is the most common cause of anaphylaxis?

Penicillin Explanation: Penicillin is the most common pharmacological cause of anaphylaxis and accounts for about 75% of fatal anaphylactic reactions in the United States each year. Opioids, NSAIDs, and radiocontrast agents are some of the medications that are frequently reported as causing anaphylaxis.

Which intervention is the single most important aspect for the client at risk for anaphylaxis?

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 is brought to the emergency department (ED) in a state of anaphylaxis. What is the ED nurses priority for care?

Protect the patients airway. Anaphylaxis severely threatens a patients airway; the nurses priority is preserving airway patency and breathing pattern. This is a higher priority than other valid aspects of care, including medication administration, psychosocial support, and assessment of LOC.

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

Reduced sneezing Explanation: Decongestants relieve congestion and sneezing and reduce labored respirations. When effective, decongestants dry the mucous membranes; therefore, the client shouldn't experience increased salivation or tearing. Because decongestants alleviate congestion, they also relieve headaches, which may be caused by congestion.

A patient was prescribed an oral antibiotic for the treatment of sinusitis. The patient has now stopped, stating she developed a rash shortly after taking the first dose of the drug. What is the nurses most appropriate response?

Refer the woman to her primary care provider to have the medication changed. On discovery of a medication allergy, patients are warned that they have a hypersensitivity to a particular medication and are advised not to take it again. As a result, the patient would need to liaise with the primary care provider. There is no need for emergency care unless symptoms worsen to involve respiratory function. An antihistamine would not be an adequate or appropriate recommendation from the nurse.

A client with a history of anaphylactic reactions to insect stings has just been stung by a wasp. Place the steps in the correct order that the client will follow for self-administration of an EpiPen. Use all options.

Remove the gray safety-release cap Inject the black tip into the outer thigh Massage the injection area Call the emergency medical response number (911) Explanation: When using an EpiPen, the client removes it from the carrying tube, grasps the unit with the black tip pointed downward, forms a fist around the unit, and removes the gray safety-release cap. Then the client holds the black tip near the outer thigh and swings and injects it firmly into the outer thigh until hearing a click with the device perpendicular to the thigh. Next, the client holds the device firmly against the thigh for about 10 seconds, then removes it and massages the area for 10 seconds. Lastly, the client or another person calls 911 and seeks emergency medical attention.

After the completion of testing, a childs allergies have been attributed to her familys cat. When introducing the family to the principles of avoidance therapy, the nurse should promote what action?

Removing the cat from the familys home In avoidance therapy, every attempt is made to remove the allergens that act as precipitating factors. Fully removing the cat from the environment is preferable to just keeping the cat out of the childs bedroom. Avoidance therapy does not involve improving airflow or using antihistamines.

The nurse is completing the intake assessment of a client new to the allergy clinic. The client states that he was taking nose drops six times a day to relieve his nasal congestion. The nasal congestion increased, causing him to increase his usage of the nasal spray to eight times a day. But again the congestion worsened. The nurse communicates to the health care provider that the client experienced

Rhinitis medicamentosa 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 planning the care of a patient who has a diagnosis of atopic dermatitis, which commonly affects both of her hands and forearms. What risk nursing diagnosis should the nurse include in the patients care plan?

Risk for Disturbed Body Image Related to Skin Lesions The highly visible skin lesions associated with atopic dermatitis constitute a risk for disturbed body image. This may culminate in ineffective role performance, but this is not likely the case for the majority of patients. Dermatitis is unlikely to cause a disuse syndrome or self-care deficit.

The nurse is providing care for a patient who has a diagnosis of hereditary angioedema. When planning this patients care, what nursing diagnosis should be prioritized?

Risk for Impaired Gas Exchange Related to Airway Obstruction Edema of the respiratory tract can compromise the airway in patients with hereditary angioedema. As such, this is a priority nursing diagnosis over pain and possible infection. Skin integrity is not threatened by angioedema.

A patient asks the nurse if it would be all right to take an over-the-counter antihistamine for the treatment of a rash. What should the nurse educate the patient is a major side effect of antihistamines?

Sedation 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.

A patient with a history of allergies comes to the clinic for an evaluation. The following laboratory test findings are recorded in a patient's medical record: Total serum IgE levels: 2.8 mg/mL White blood cell count: 5,100/cu mm Eosinophil count: 4% Erythrocyte sedimentation rate: 20 mm/h The nurse identifies which result as suggesting an allergic reaction?

Serum IgE level 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 nurse has included the nursing diagnosis of Risk for Latex Allergy Response in a patients plan of care. The presence of what chronic health problem would most likely prompt this diagnosis?

Spina bifida Patients with spina bifida are at a particularly high risk for developing a latex allergy. This is not true of patients with herpes simplex, HIV, or hypogammaglobulinemia

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. 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. When clinical manifestations occur within minutes after exposure to latex, which is described as a latex allergy, an immediate hypersensitivity (type I) allergic reaction has occurred.

A nurse has asked the nurse educator if there is any way to predict the severity of a patients anaphylactic reaction. What would be the nurses best response?

The faster the onset of symptoms, the more severe the reaction. The time from exposure to the antigen to onset of symptoms is a good indicator of the severity of the reaction: the faster the onset, the more severe the reaction. None of the other statements is an accurate description of the course of anaphylactic reactions.

A nurse at an allergy clinic is providing education for a patient starting immunotherapy for the treatment of allergies. What education should the nurse prioritize?

The importance of keeping appointments for desensitization procedures The nurse informs and reminds the patient of the importance of keeping appointments for desensitization procedures, because dosages are usually adjusted on a weekly basis, and missed appointments may interfere with the dosage adjustment. Appointments are more frequent than monthly and antihistamines are not contraindicated. There is no need to keep a diary of reactions.

The nurse is conducting a community education program on allergies and anaphylactic reactions. The nurse determines that the participants understand the education when they make which statement about anaphylaxis?

The most common cause of anaphylaxis is penicillin. Explanation: The most common cause of anaphylaxis is penicillin, accounting for about 75% of fatal anaphylactic reactions in the United States. 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, which occur within about 30 minutes of exposure, involve cardiovascular, respiratory, gastrointestinal, and integumentary organ systems.

A child has been diagnosed with a severe walnut allergy after suffering an anaphylactic reaction. What is a priority for health education?

The need for the parents to carry an epinephrine pen All patients with food allergies, especially seafood and nuts, should have an EpiPen device prescribed. The child does not necessarily need to avoid all common food allergens. Immunotherapy is not indicated in the treatment of childhood food allergies. Immunizations are important, but do not address food allergies.

A patient has been living with seasonal allergies for many years, but does not take antihistamines, stating, When I was young I used to take antihistamines, but they always put me to sleep. How should the nurse best respond?

The newer antihistamines are different than in years past, and cause less sedation. Unlike first-generation H1 receptor antagonists, newer antihistamines bind to peripheral rather than central nervous system H1 receptors, causing less sedation, if at all. Tolerance to sedation did not usually occur with first-generation drugs and newer antihistamines are not combined with a stimulant.

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. 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.

A patient with severe environmental allergies is scheduled for an immunotherapy injection. What should be included in teaching the patient about this treatment?

The patient will remain in the clinic to be monitored for 30 minutes following the injection. Although severe systemic reactions are rare, the risk of systemic and potentially fatal anaphylaxis exists. Because of this risk, the patient must remain in the office or clinic for at least 30 minutes after the injection and is observed for possible systemic symptoms. Therapeutic failure is evident when a patient does not experience a decrease in symptoms within 12 to 24 months. Epinephrine is not given prior to treatment and the IV route is not used.

A patients decline in respiratory and renal function has been attributed to Goodpasture syndrome, which is a type II hypersensitivity reaction. What pathologic process underlies the patients health problem?

The patients body has mistakenly identified a normal constituent of the body as foreign. Type II reactions, or cytotoxic hypersensitivity, occur when the system mistakenly identifies a normal constituent of the body as foreign. An example of this type of reaction is Goodpasture syndrome. Type III, or immune complex, hypersensitivity involves immune complexes that are formed when antigens bind to antibodies. Type IV hypersensitivity is mediated by sensitized T cells that cause cell and tissue damage. Histamine does not directly cause cell lysis.

A patient who is scheduled for a skin test informs the nurse that he has been taking corticosteroids to help control his allergy symptoms. What nursing intervention should the nurse implement?

The patients test should be cancelled until he is off his corticosteroids. Corticosteroids and antihistamines, including over-the-counter allergy medications, suppress skin test reactivity and should be stopped 48 to 96 hours before testing, depending on the duration of their activity. Emergency equipment must be at hand during allergy testing, but the test would be postponed.

Which statement describes the clinical manifestations of a delayed hypersensitivity (type IV) allergic reaction to latex?

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

A nurse is caring for a teenage girl who has had an anaphylactic reaction after a bee sting. The nurse is providing patient teaching prior to the patients discharge. In the event of an anaphylactic reaction, the nurse informs the patient that she should self-administer epinephrine in what site?

Thigh The patient is taught to position the device at the middle portion of the thigh and push the device into the thigh as far as possible. The device will autoinject a premeasured dose of epinephrine into the subcutaneous tissue.

T-cell deficiency occurs when which gland fails to develop normally during embryogenesis?

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

A patient has sought care, stating that she developed hives overnight. The nurses inspection confirms the presence of urticaria. What type of allergic hypersensitivity reaction has the patient developed?

Type I Urticaria (hives) is a type I hypersensitive allergic reaction

The nurse is teaching a client newly diagnosed with a peanut allergy about how to manage the allergy. What information should be included in the teaching? Select all that apply.

Wear a medic alert bracelet. List symptoms of peanut allergy. Identify ways to manage allergy while dining out. Carry EpiPen autoinjector at all times. 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 5-year-old boy has been diagnosed with a severe food allergy. What is an important parameter to address when educating the parents of this child about his allergy and care?

Wear a medical identification bracelet The nurse also advises the patient to wear a medical identification bracelet or to carry emergency equipment at all times. Patients and their families do not carry antihistamine pens, they carry epinephrine pens. Lidocaine is not self-administered to treat allergies. The patient may safely be vaccinated.

The nurse is conducting discharge teaching for a client who is being discharged from the emergency department after an anaphylactic reaction to peanuts. Which education should the nurse include in the teaching? Select all that apply.

Wearing a medical alert bracelet Avoiding allergens Explanation: People who have experienced food, medication, idiopathic, or exercise-induced anaphylactic reactions should make every attempt to strictly avoid the allergen. Additionally, they should wear a medical alert bracelet and carry an emergency kit containing epinephrine for injection to prevent the onset of the reaction on exposure. Sedatives are not used to treat anaphylactic reactions, and desensitization is not used for peanut allergies.

The nurse explains to a client that immunotherapy initially starts with injections at which interval?

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.

The parents of a child with contact dermatitis are asking questions about the reaction within the immune system. What description regarding contact dermatitis as a type IV hypersensitivity reaction is accurate?

a delayed-type hypersensitivity that is mediated by T cells Explanation: Contact dermatitis is a delayed-type hypersensitivity response that can occur 24 to 72 hours after exposure to an allergen.

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. 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.

Which allergic reaction is potentially life threatening?

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