Allergy/Anaphylaxis Practice

Which referral should the nurse implement for a client with severe multiple allergies? 1. Registered dietitian. 2. Occupational therapist. 3. Recreational therapist. 4. Social worker.

*1. A dietitian could help the client with any necessary dietary changes for food allergies and with ways to continue to meet nutritional needs. 2. An occupational therapist addresses the client's ability to perform activities of daily living. 3. A recreational therapist works in a psychiatric setting or rehabilitation setting and assists with the client's therapeutic recreational activities. 4. A social worker addresses the client's financial needs.

The client diagnosed with a bee sting allergy is being discharged from the emergency department. Which priority discharge instruction should be taught to the client? 1. Demonstrate how to use an EpiPen, an adrenergic agonist. 2. Teach the client to never go outdoors in the spring and summer. 3. Have the client buy diphenhydramine over the counter to use when stung. 4. Discuss wearing a Medic Alert bracelet when going outside.

*1. Clients who are allergic to bee sting venom should be taught to keep an EpiPen with them at all times and how to use the device. This could save their lives. 2. It is unrealistic to think the client will never go outdoors, but the client should be taught to avoid exposure to bees whenever possible. 3. Over-the-counter diphenhydramine (Benadryl) is a histamine-1 blocker, but it is oral and not useful in this situation. 4. The client should wear a Medic Alert bracelet, but it is not priority over ensuring the client knows how to treat a bee sting. Wearing the bracelet does not ensure correct treatment of the bee sting. TEST-TAKING HINT: Answer option "2" is an absolute and should be eliminated as a possible correct answer.

The client is highly allergic to insect venom and is prescribed venom immunotherapy. Which statement is the scientific rationale for this treatment? 1. Immunotherapy is effective in preventing anaphylaxis following a future sting. 2. Immunotherapy will prevent all future insect stings from harming the client. 3. This therapy will cure the client from having any allergic reactions in the future. 4. This therapy is experimental and should not be undertaken by the client.

*1. Immunotherapy does not cure the problem. However, if immunotherapy is done following a reaction, it provides passive immunity to the insect venom (similar to the way RhoGAM prevents a mother who is Rh negative from building antibodies to the blood of a baby who is Rh positive). This is the purpose for immunotherapy in clients who are allergic. 2. This is an untrue statement. 3. There is no cure for allergies to insect venom. 4. This therapy is standard procedure for clients who have severe allergies to insect venom. TEST-TAKING HINT: Answer options "2" and "3" contain forms of absolutes such as "all" and "cure." Rarely is anything absolute in health care. The test taker should be absolutely sure of the correct answer before choosing any answer containing an absolute descriptive word or passage. The stem asks for the rationale and option "4" is giving advice, so it can be eliminated.

The client in the emergency department begins to experience a severe anaphylactic reaction after an initial dose of IV penicillin, an antibiotic. Which interventions should the nurse implement? Select all that apply. 1. Prepare to administer Solu-Medrol, a glucocorticoid, IV. 2. Request and obtain a STAT chest x-ray. 3. Initiate the Rapid Response Team. 4. Administer epinephrine, an adrenergic blocker, SQ then IV continuous. 5. Assess for the client's pulse and respirations.

*1. Steroid medications decrease inflammation and therefore are one of the treatments for anaphylaxis. 2. A STAT chest x-ray is not indicated at this time. *3. The Rapid Response Team should be called because this client will be in respiratory and cardiac arrest very shortly. *4. Because of its ability to activate a combination of alpha and beta receptors, epinephrine is the treatment of choice for anaphylactic shock. *5. The first step in initiating cardiopulmonary resuscitation is to assess for a pulse and respirations. TEST-TAKING HINT: This is an alternative type-question. If the test taker did not read the sentence "Select all that apply," the fact there are five (5), not four (4), options should alert the test taker to go back and read the stem more closely. Each option must be decided on for itself. The test taker cannot eliminate one option based on the fact another option is correct.

The nurse is developing a care plan for a client diagnosed with allergic rhinitis. Which independent problem has priority? 1. Ineffective breathing pattern. 2. Knowledge deficit. 3. Anaphylaxis. 4. Ineffective coping.

*1. This can be an independent or collaborative nursing problem. It is an airway problem and has priority. 2. Knowledge deficit is not a priority over the client with breathing problems. 3. Anaphylaxis is a collaborative problem. The nurse will need to start IVs, administer medications, and possibly place the client on a ventilator if the client is to survive. 4. Ineffective coping is a psychosocial problem; it does not have priority over breathing. TEST-TAKING HINT: The test taker must apply some problem-solving/decisionmaking standard. In this case Maslow's hierarchy of needs is a good option. Airway has priority.

The client diagnosed with an anaphylactic reaction is admitted to the emergency room. Which assessment data indicate the client is not responding to the treatment? 1. The client has a urinary output of 120 mL in two (2) hours. 2. The client has an AP of 110 and a BP of 90/60. 3. The client has clear breath sounds and an RR of 26. 4. The client has hyperactive bowel sounds.

1. A urinary output of greater than 30 mL/hr is within normal limits and indicates the client is responding to treatment. *2. These vital signs indicate shock, which is a medical emergency and requires immediate intervention. 3. Clear breath sounds indicate response to treatment, and although the RR is increased, this could be the result of anxiety or fear. 4. The client's bowel sounds are not significant data to determine the client's response to treatment.

The nurse in the holding area of the operating room is assessing the client prior to surgery. Which information warrants immediate intervention by the nurse? 1. The client is able to mark the correct site for the surgery. 2. The client can only tell the nurse about the surgery in lay terms. 3. The client is allergic to iodine and does not have an allergy bracelet. 4. The client has signed a consent form for surgery and anesthesia.

1. By the Joint Commission standards, clients must mark any surgical site to make sure the operation is not done on the incorrect site, such as the right arm instead of the left arm. 2. The client should understand the surgery in his or her own terms. *3. Iodine is the basic ingredient in Betadine (povidone-iodine), which is a common skin prep used for surgeries. Therefore, the nurse should notify the surgeon if the client has an allergy to iodine. 4. The client should have a signed consent for the surgery and the anesthesia prior to surgery. TEST-TAKING HINT: The options involve basic concepts for surgical preparation, and allergies must be identified on the client as well as in the client's chart.

The client has had an anaphylactic reaction to insect venom, a bee sting. Which discharge instruction should the nurse discuss with the client? 1. Take a corticosteroid dose pack when stung by a bee. 2. Take antihistamines prior to outdoor activities. 3. Use a cromolyn sodium (Intal) inhaler prophylactically. 4. Carry a bee sting kit, especially when going outside.

1. Corticosteroids may be used in both systemic and topical forms for many types of hypersensitivity responses, but must be ordered by a health-care provider and are not automatically taken after a bee sting. 2. Antihistamines are the major class of drugs used to treat hypersensitivity responses, but they are not taken prophylactically. They are used when a reaction occurs. 3. This drug treats allergic rhinitis and asthma prophylactically. It does not help bee stings or insect bites. *4. The kit usually includes a prefilled syringe of epinephrine and an epinephrine nebulizer, which allows prompt self-treatment for any future exposures to insect venom or other potential allergen exposure.

Which is the highest priority nursing intervention for the client who is having an anaphylactic reaction? 1. Administer parenteral epinephrine, an adrenergic agonist. 2. Prepare for immediate endotracheal intubation. 3. Provide a calm assurance when caring for the client. 4. Establish and maintain a patent airway.

1. Epinephrine is the drug of choice for an anaphylactic reaction. It is a potent vasoconstrictor and bronchodilator counteracting the effects of histamine, but this is not the priority intervention. 2. This is an important intervention, but it is not the priority intervention. 3. Decreasing the client's anxiety is important, but it is not the priority intervention. *4. Establishing a patent airway is priority because facial angioedema, bronchospasm, and laryngeal edema occur with an anaphylactic reaction. Inserting a nasopharyngeal or oropharyngeal airway maintains a patent airway.

Which assessment data should make the nurse suspect the client has chronic allergies? 1. Jaundiced sclera and jaundiced palms of hands. 2. Pale, boggy, edematous nasal mucosa. 3. Lacy white plaques on the oral mucosa. 4. Purple or blue patches on the face.

1. This may indicate a hemolytic reaction. *2. Pale, boggy, edematous nasal mucosa indicates chronic allergies. 3. This may indicate hemolysis or immune deficiency. 4. This may indicate Kaposi's sarcoma.

The nurse in the emergency department is allergic to latex. Which intervention should the nurse implement regarding the use of nonsterile gloves? 1. Use only sterile, nonlatex gloves for any procedure requiring gloves. 2. Do not use gloves when starting an IV or performing a procedure. 3. Keep a pair of nonsterile, nonlatex gloves in the pocket of the uniform. 4. Wear white cotton gloves at all times to protect the hands.

1. The nurse should use nonlatex gloves because of the latex allergy, but the gloves do not have to be sterile. 2. The nurse must use gloves during procedures and starting an IV. Not using gloves is a violation of Occupational Safety and Health Administration standards and places the nurse at risk for developing illnesses. *3. The nurse should be prepared to care for a client at all times and should not place himself or herself at risk because the facility does not keep nonlatex gloves available in the rooms. The nurse should carry the needed equipment (nonlatex gloves) with him or her. 4. White cotton gloves are made of cloth and do not provide the barrier against wet substances. TEST-TAKING HINT: The test taker must be aware of adjectives such as "sterile" in option "1." Basic concepts such as Standard Precautions should cause the test taker to eliminate option "2." Option "4" has the word "all" in it and could be eliminated as an answer because this is an absolute.

The client in the HCP's office is complaining of allergic rhinitis. Which assessment question is important for the nurse to ask the client? 1. "What time of year do the symptoms occur?" 2. "Which over-the-counter medications have you tried?" 3. "Do other members of your family have allergies to animals?" 4. "Why do you think you have allergies?"

1. The symptoms are occurring at this time, so asking what time of the year the symptoms occur is not an appropriate question. *2. There are many over-the-counter remedies available. Therefore, the nurse should assess which medications the client has tried and what medications the client is currently taking. 3. The client being allergic to animals was not in the stem. Many clients diagnosed with allergic rhinitis are allergic to seasonal environmental allergens such as pollen and mold. 4. The client probably does not have any explanation for developing allergies. TEST-TAKING HINT: The test taker should not read into a question. Because animals were not mentioned in the stem, option "3" can be eliminated. Many over-the-counter medications and herbal remedies are available to clients, and it is important for the nurse to determine what the client has been taking.

The nurse on a medical unit has received the morning shift report. Which client should the nurse assess first? 1. The client who has a 0730 sliding-scale insulin order. 2. The client who received an initial dose of IV antibiotic at 0645. 3. The client who is having back pain at a "4" on a 1-to-10 scale. 4. The client who has dysphagia and needs to be fed.

1. This client should be seen but not before assessing for a possible anaphylactic reaction. *2. This client has received an initial dose of antibiotic IV and should be assessed for tolerance to the medication within 30 minutes. 3. Pain is a priority but not over a potential life-threatening emergency. 4. This client can be seen last. A delayed meal is not life threatening. TEST-TAKING HINT: The test taker should determine which client has the most pressing need and rank the options in order. Life-threatening situations have priority.

The client comes to the emergency department complaining of dyspnea and wheezing after eating at a seafood restaurant. The client cannot speak and has a bluish color around the mouth. Which intervention should the nurse implement first? 1. Initiate an IV with normal saline. 2. Prepare to intubate the client. 3. Administer oxygen at 100%. 4. Ask the client about an iodine allergy.

1. This intervention should be implemented, but it is not the first action. 2. This does address oxygenation but will take time to accomplish, so this intervention is not the first action. *3. The client is cyanotic with dyspnea and wheezing. The nurse should administer oxygen first. 4. The client may be allergic to iodine, a component of many shellfish, but the first need of the client is oxygenation. TEST-TAKING HINT: The test taker must apply some decision-making standard to determining what to do first. Maslow's hierarchy of needs ranks oxygen as first. Of the two (2) options addressing oxygen, option "3" immediately attempts to provide oxygen to the client.

The client is prescribed a prick epicutaneous test to determine the cause of hypersensitivity reactions. Which result indicates the client is hypersensitive to the allergen? 1. The client complains of shortness of breath. 2. The skin is dry, intact, and without redness. 3. The pricked blood tests positive for allergens. 4. A pruritic wheal and erythema occur.

1. This is a sign of an anaphylactic reaction to an allergen and will not happen during this test because of the small amount of allergen used. 2. This indicates a negative test and the client is not sensitive to the allergen. 3. The skin reaction, not the blood pricked, indicates a positive or negative test. *4. During this test, a drop of diluted allergenic extract is placed on the skin and then the skin is punctured through the drop. A positive test causes a localized pruritic wheal and erythema, which occurs in five (5) to 20 minutes.

The client in the HCP's office has a red, raised rash covering the forearms, neck, and face and is experiencing extreme itching which is diagnosed as an allergic reaction to poison ivy. Which discharge instructions should the nurse teach? 1. Tell the client never to scratch the rash. 2. Instruct the client in administering IM Benadryl. 3. Explain how to take a steroid dose pack. 4. Have the client wear shirts with long sleeves and high necks.

1. This is an unrealistic expectation for a client diagnosed with poison ivy. The pruritus is intense. 2. The client should be instructed on how to use the EpiPen, not IM Benadryl. *3. Clients with poison ivy are frequently prescribed a steroid dose pack. The dose pack has the steroid provided in descending doses to help prevent adrenal insufficiency. 4. This may cause the client to be warm, which increases the likelihood of itching. TEST-TAKING HINT: Option "1" has the word "never," which is an absolute word and can be eliminated on this basis. Very few conditions require the nurse to teach the client to take intramuscular (IM) injections; therefore, option "2" could be eliminated as a possible answer.

The charge nurse observes the primary nurse interacting with a client. Which action by the primary nurse warrants immediate intervention by the charge nurse? 1. The nurse explains the IVP diuretic will make the client urinate. 2. The nurse dons nonsterile gloves to remove the client's dressing. 3. The nurse administers a medication without checking for allergies. 4. The nurse asks the UAP for help moving a client up in bed.

1. This is appropriate anytime the nurse is administering a diuretic medication. 2. A nurse uses nonsterile gloves to remove old dressings, then washes the hands and sets up the sterile field before donning sterile gloves to reapply the dressing. *3. Checking for allergies is one (1) of the five (5) rights of medication. Is it the right drug? Even if the drug is the one the HCP ordered, it is not the right drug if the client is allergic to it. The nurse should always assess a client's allergies prior to administering any medication. 4. The nurse should ask for assistance in moving a client in bed to prevent on-thejob injuries. TEST-TAKING HINT: The stem asks the test taker to determine which is an incorrect action. This is an "except" question. Three (3) answers are actions the nurse should take.

The client asks the nurse, "Which time of the year is allergic rhinitis least likely to occur?" Which statement is the nurse's best response? 1. "It is least likely to occur during the springtime." 2. "Allergic rhinitis is not likely to occur during the summer." 3. "It is least likely to occur in the early fall." 4. "Allergic rhinitis is least likely to occur in early winter."

1. Tree pollen is abundant in early spring. 2. Rose and grass pollen are prevalent in early summer. 3. Ragweed and other pollens are prevalent in early fall. *4. Early winter is the beginning of deciduous plants becoming dormant. Therefore, allergic rhinitis is least prevalent during this time of year. TEST-TAKING HINT: The test taker could eliminate the three (3) options based on the plant growing season if the test taker realized allergic rhinitis can be caused by environmental plant pollens and molds.

The client is experiencing an anaphylactic reaction to bee venom. Which interventions should the nurse implement? List in order of priority. 1. Establish a patent airway. 2. Administer epinephrine, an adrenergic agonist, IVP. 3. Start an IV with 0.9% saline. 4. Teach the client to carry an EpiPen when outside. 5. Administer diphenhydramine (Benadryl), an antihistamine, IVP.

In order of priority: 1, 3, 2, 5, 4. 1. Airway is always the first priority for any process in which the airway might be compromised. 3. The nurse should start an IV so medications can be administered to treat the anaphylactic reaction. 2. Epinephrine is the drug of choice for the treatment of anaphylaxis. The medication is administered every 10 to 15 minutes until the reaction has subsided. Epinephrine is given for its vasoconstrictive action. 5. Benadryl, an antihistamine, is given to block histamine release, reducing capillary permeability. 4. Teaching is important to prevent or treat further reactions, but this will be done after the crisis is over.