chapter 34

A patient with seasonal allergies has told the nurse that a colleague recommended pseudoephedrine hydrochloride (Sudafed) as a means of controlling signs and symptoms. The nurse should be aware that this drug provides relief for many patients but adverse effects include a risk of:

anxiety

Autoimmune disorders

are those in which killer T cells and autoantibodies attack or destroy natural cells—those cells that are self.

A patient with common variable immunodeficiency (CVID) is extremely fatigued and not feeling well. What lab test does the nurse anticipate the patient will have to detect a common development related to the disease?

b12 anemia

A nurse educator is explaining that patients with primary immunodeficiencies are living longer than in past decades because of advances in medical treatment. This increased longevity is associated with an increased risk of what?

cancer

histocompatible cells

cells whose antigens match the individuals own genetic code

Tilt table test

client lies horizontally on a table whose incline is elevated to approximately 70° for 45 minutes, may be done

A nurse should monitor clients most carefully when they are receiving:

computed tomography with contrast solution.

sublingual-swallow immunotherapy (SLIT)

has been used for desensitization against allergens that cause allergic rhinitis.

Urticaria

hives

Allergic disorders

hyperimmune response to weak antigens that are usually harmless

alloimmunity

immune response that is waged against transplanted organs and tissues that carry nonself antigens

remission

improvement or absence of signs of disease remission (asymptomatic periods

orthostatic intolerance

inability to maintain blood pressure while after standing for more than 10 minutes.

patch test

is used to identify the offending substance in allergic contact dermatitis

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 egg shrimp

Fibromyalgia

pain in the muscle fibers

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

parents carry epi pen

Mast cells

release histamine of connective tissue that contain granules of heparin, serotonin, bradykinin, and histamine (the most potent chemical of this group)

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:

routune exposure

Skin Tests

skin testing with extracts of various substances (antigens), such as pollens, animal dander, food, dust, and stinging insects.

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

Autoantibodies

, antibodies against self-antigens, are immunoglobulins.

induration

, the hard, raised area—not including the reddened area—is measured.

radioallergosorbent blood test (RAST)

, which measures IgE on a scale of 0 to 5, indicates a score of 2 or greater,

While monitoring the patient's eosinophil level, the nurse suspects a definite allergic disorder when seeing an eosinophil value of what percentage of the total leukocyte count?

15% to 40%

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

A pregnant woman at 30 weeks' gestation

antineoplastic

Cancer drugs

Injectants allergies

Drugs, bee venom Anaphylaxis, angioedema, acute urticaria

Ingestants allergies

Food (peanuts, milk, wheat, eggs, fish), drugs (aspirin, sulfonamides, antibiotics, especially penicillin) Gastroenteropathy, dermatitis, asthma, anaphylaxis, urticaria, angioedema, serum sickness

Antigens

Foreign material that invades the body

A nurse is caring for a patient with a phagocytic cell disorder. The patient states, "My specialist says that I will likely be cured after I get my treatment tomorrow." To what treatment is the patient most likely referring?

Hematopoietic stem cell transplantation

Inhalants allergies

House dust and mites, insect excrement, animal products (dander, saliva, urine), pollens, spores Allergic asthma, rhinitis, hypersensitivity pneumonitis

A patient's primary immunodeficiency disease is characterized by the inability of white blood cells to initiate an inflammatory response to infectious organisms. What is this patient's most likely diagnosis?

Hyperimmunoglobulinemia E syndrome

Anaphylaxis is a rapid and profound type

I hypersensitivity response.

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

Identifying the offending agent, if possible

immunoglobulin antibodies

IgG, IgA, IgM, IgD, IgE

The nurse is caring for a client with an immunodeficiency who has experienced sudden malaise. The nurse's colleague states, "I'm pretty sure that it's not an infection, because the most recent blood work looks fine." What principle should guide the nurse's response to the colleague?

Immunodeficient clients will usually exhibit subtle and atypical signs of infection.

A middle-aged man has presented for care to a nurse practitioner because his seasonal allergies are detracting from his quality of life. What should the nurse teach this patient about allergic rhinitis?

Immunotherapy may have the potential to provide long-term relief from symptoms.

A client 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 client will present with what alteration in laboratory values?

Increased eosinophils

A nurse is caring for a patient who has an immunodeficiency. What assessment finding should prompt the nurse to consider the possibility that the patient is developing an infection?

Persistent diarrhea

contactants allergy

Plant oils, topical medications, occupational chemicals, cosmetics, metals in jewelry and clothing fasteners, hair dyes, latex Contact dermatitis, urticaria, or anaphylaxis (rare)

A client with Wiskott-Aldrich syndrome is admitted to the medical unit. The nurse caring for the client should prioritize which of the following?

Protective isolation

The nurse teaches the client with allergies about anaphylaxis, including which statement?

The most common cause of anaphylaxis is penicillin.

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.

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.

The nurse is applying standard precautions in the care of a client who has an immunodeficiency. What are key elements of standard precautions? Select all that apply.

Using appropriate personal protective equipment Using safe injection practices Performing hand hygiene

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.

IVIG has been ordered for the treatment of a patient with an immunodeficiency. Which of the following actions should the nurse perform before administering this blood product?

Weigh the patient before administration to verify the correct dose.

angioneurotic edema

acute swelling of the face, neck, lips, larynx, hands, feet, genitals, and internal organs

The antigens that can cause an allergic response are called

allergens

Periods of acute flare-ups known as

exacerbations

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."

Which test indicates the quantity of allergen necessary to evoke an allergic reaction?

serum specific IgE test

intradermal injection test

which usually is performed only when results of a scratch test are negative for allergies, the tester injects a dilute solution of an antigen intradermally

The nurse is preparing to administer IVIG to a patient who has an immunodeficiency. What nursing guideline should the nurse apply?

Administer pretreatment medications as ordered 30 minutes prior to infusion.

Scratch or prick test

Involves scratching the skin and applying a small amount of the liquid test antigen to the scratch. Identifiable within 20 minutes when the appearance of a raised wheal with localized erythema appears

A nurse has included the nursing diagnosis of Risk for Latex Allergy Response in a client's plan of care. The presence of what chronic health problem would most likely prompt this diagnosis?

Spina bifida

chronic fatigue syndrome (CFS)

a disorder of unknown cause that affects many body systems

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