Chapt 33 Immune (Prep U)

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

Painless chancres or ulcerated lesions are associated with which systemic disease?

Syphilis Explanation: Syphilis is manifested by a painless chancres or ulcerated lesions. Psoriasis is exhibited by plaques with scales. Kaposi sarcoma are cutaneous lesions that are blue-red or dark brown in color. Urticaria is wheals or hives due to infection or allergic reactions.

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.

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

A nurse is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention?

Foul-smelling discharge from the penis Explanation: Symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis and painful urination. Rashes on the palms of the hands and soles of the feet are symptoms of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus. Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes.

Which chemical mediators initiate and mediate the inflammatory response?

Leukotrienes Explanation: Leukotrienes are chemical mediators from constituents of cell membranes. Cytokines are nonantibody proteins that act as intercellular mediators, as in the generation of the immune response. Prostaglandins are lipid-soluble molecules synthesized from constituents of cell membranes. Complement is a plasma protein associated with immunologic reactions

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.

The six elements necessary for infection include a causative organism, a reservoir of available organisms, a portal or mode of exit from the reservoir, a mode of transmission from reservoir to host, a susceptible host, and

mode of entry into the host. Explanation: The six elements necessary for infection are a causative organism, a reservoir of available organisms, a portal or mode of exit from the reservoir, a mode of transmission from reservoir to host, a susceptible host, and a mode of entry into, not a mode of exit from, the host.

A client has been hospitalized for diagnostic testing. The client has just been diagnosed with multiple sclerosis, which the physician explains is an autoimmune disorder. How would the nurse explain an autoimmune disease to the client?

A disorder where killer T cells and autoantibodies attack or destroy natural cells—those cells that are "self." Explanation: Autoimmune disorders are those in which killer T cells and autoantibodies attack or destroy natural cells-those cells that are "self." Autoantibodies, antibodies against self-antigens, are immunoglobulins. They target histocompatible cells, cells whose antigens match the person's own genetic code. Autoimmune disorders are not caused by too many or too few immunoglobulins, and histocompatible cells do not attack immunoglobulins in an autoimmune disorder

The nurse is caring for a group of clients at a public health clinic. Which sexually transmitted disease would the nurse focus the client education on curative goals?

Chlamydia Explanation: Chlamydia is the most common and fast spreading bacteria. Because it is a bacteria, with proper treatment, chlamydia is able to be cured. Sexually transmitted diseases that are viruses, such as HIV, HPV, and herpes, can lay dormant in the body thus being difficult to treat

The nurse is preparing to administer a medication that has an affinity for H1 receptors. Which medication would the nurse administer?

Diphenhydramine Explanation: Certain medications are categorized by their action at these receptors. Diphenhydramine (Benadryl) is an example of an antihistamine, a medication that displays an affinity for H1 receptors. Cimetidine (Tagamet) and nizatidine (Axid) target H2 receptors to inhibit gastric secretions in peptic ulcer disease.

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

IgE Explanation: Immunoglobulin E (IgE) is involved with an allergic reaction. IgA combines with antigens and activates complement. IgB coats the surface of B lymphocytes. IgG is the principal immunoglobulin formed in response to most infectious agents.

A patient comes to the clinic with complaints of a painless sore on her lip 2 weeks after she had oral sex with her boyfriend. The nurse observes a chancre on the lips and the physician orders testing for syphilis. If results are positive, what is the likely stage the patient is in?

Primary Explanation: Primary syphilis occurs 2 to 3 weeks after initial inoculation with the organism. A painless lesion at the site of infection is called a chancre. These lesions usually resolve spontaneously within 3 to 12 weeks, with or without treatment (Porth & Matfin, 2009).

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.

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 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?

Correct response: 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.

A patient has a sensitivity to ragweed and tells the nurse that it comes at the same time every year. When does the patient typically notice the symptoms?

Early fall Explanation: Because allergic rhinitis is induced by airborne pollens or molds, it is characterized by the following seasonal occurrences: Early spring—tree pollen (oak, elm, poplar); early summer—rose pollen (rose fever) and grass pollen (Timothy, Redtop); and early fall—weed pollen (ragweed).

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 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 providing education to a client who has been diagnosed with chlamydia. The client will begin treatment with azithromycin today. Which teaching point should the nurse reinforce with this client?

"Abstain from any sexual activity for 1 week after the antibiotic is complete." Explanation: Client counseling includes abstinence for 1 week after treatment, in addition to the completion of the partner's treatment. Although handwashing is an important aspect of preventing the spread of infection, the nurse must emphasize prevention of chlamydia through the normal route of transmission of this infection, which is sexually. Coinfection with chlamydia often occurs in clients infected with gonorrhea. Chlamydia and gonorrhea are caused by bacteria that are transmitted during sexual relations. Both chlamydia and gonorrhea infections frequently do not cause symptoms in women and thus are often referred to as "silent" related to clinical presentation. It is important to retest women 3 months' posttreatment, due to the possibility of reinfection.

A client is experiencing severe anaphylactic shock. What actions should the nurse take first? Select all that apply.

Administer diphenhydramine. Ask the client if they are lightheaded. Give intravenous fluids. Prepare for insertion of an endotracheal tube. Explanation: Diphenhydramine would be administered because it reverses the effect of histamine. Lightheadedness is a symptom of anaphylactic shock. Intravenous fluids will be given to treat hypotension. Metoprolol is used to treat hypertension or chest pain. An endotracheal tube would be inserted if a respiratory arrest is imminent. Hematuria would be seen in urinary problems, such as bladder or kidney stones, enlarged prostate, kidney infection or urinary tract infection.

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 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.

A client is diagnosed with early latent syphilis of unknown duration. Which medication treatment will the nurse expect to be prescribed for this client?

Penicillin G benzathine, three intramuscular injections at 1-week intervals Explanation: Treatment of all stages of syphilis is the administration of antibiotic medications. Clients with late latent or latent syphilis of unknown duration should receive three injections of penicillin G benzathine at 1-week intervals. Penicillin G benzathine is the medication of choice for early syphilis or early latent syphilis of less than 1 year's duration. It is given by intramuscular injection at a single session. Clients who are allergic to penicillin are usually treated with doxycycline. Zithromax is not used to treat syphilis.

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