Chapter 33: Assessment and Management of Patients with Allergic Disorders

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? A) Sublingual-swallow immunotherapy (SLIT) B) Desensitization C) Sublingual-topical immunotherapy (STIT) D) Resensitization

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.

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? A) allergic contact B) irritant contact C) IgG antibodies D) IgE-mediated hypersensitivity

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 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? A) Palpitations B) Anorexia C) Sedation D) Diarrhea

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 is experiencing an allergic reaction to a dose of penicillin. What should the nurse look for in the patient's initial assessment? A) The presence and location of pruritus B) Dyspnea, bronchospasm, and/or laryngeal edema. C) Hypotension and tachycardia D) The severity of cutaneous warmth and flushing

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 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? A) Eosinophil count B) White blood cell count C) Erythrocyte sedimentation rate D) Serum IgE level

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.

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? A) 3:00 PM B) 1:00 PM C) 11:00 AM D) 10:00 AM

10:00 AM Explanation: Mild and moderate reactions begin within 2 hours of exposure.

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? A) Meclizine hydrochloride B) Pentazocine C) Phenergan hydrochloride D) Epinephrine

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).

The nurse is evaluating a client's complete blood cell count and differential along with the serum immunoglobulin E (IgE) concentration. Which result might indicate that the client has an allergic disorder? A) Low white blood cell count B) High neutrophil count C) Low eosinophil count D) High IgE concentration

High IgE concentration Explanation: A high total IgE concentration and/or a high percentage of eosinophils may indicate an allergic disorder. However, normal IgE levels do not exclude the diagnosis of an allergic disorder. The amounts of neutrophils and white blood cells are not affected by allergic disorders.

When assessing the skin of a client with allergic contact dermatitis, the nurse would most likely expect to find irritation at which area? A) Plantar aspects of the feet B) Ankles C) Lower arms D) Dorsal aspect of the hand

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 client is presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. What type of hypersensitivity did this client exhibit? A) type II B) type IV C) type III D) type I

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.

Which allergic reaction is potentially life threatening? A) angioedema B) contact dermatitis C) urticaria D) None of the listed allergic reactions is potentially life threatening.

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

A client has begun sensitivity testing to determine the allergen which caused an anaphylactic reaction 3 weeks ago. In scratch testing, which part of the body is more sensitive to allergens? A) chest B) forearm C) back D) upper arm

back Explanation: The scratch or prick test involves scratching the skin and applying a small amount of the liquid test antigen to the scratch. The tester applies one allergen per scratch over the client's forearm, upper arm, or back. The back is more sensitive than the arms.

The nurse is reviewing various medications with a client that can be used to treat allergic disorders. What medication will the nurse identify as an intranasal corticosteroid? A) zileuton B) cromolyn sodium C) fexofenadine D) fluticasone

fluticasone Explanation: Fluticasone is an example of an intranasal corticosteroid. Cromolyn sodium is a mast cell stabilizer. Zileuton is a leukotriene-receptor inhibitor. Fexofenadine is a second-generation antihistamine.

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? A) Pushes down on the grey release cap to administer the medication B) Maintains pressure on the auto-injector for about 30 seconds after insertion C) Avoids massaging the injection site after administration D) Jabs the autoinjector into the outer thigh at a 90-degree angle

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 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"? A) Drink plenty of fluids. B) Only use the nasal spray for 3 to 4 days once every 12 hours. C) Use the medication every 4 hours to prevent congestion from recurring. D) Be sure to use the nasal spray for at least 10 days to ensure the stuffiness is gone.

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.

Client is presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. What action is of primary importance upon admission? A) encourage fluids to dilute allergen B) induce vomiting to rid body of allergen C) None of the options is correct. D) maintain airway

maintain airway Explanation: Anaphylaxis is a rapid, profound hypersensitivity response. A massive release of histamine causes vasodilation, increased capillary permeability, angioneurotic edema (acute swelling of the face, neck, lips, larynx, hands, feet, genitals, and internal organs), hypotension, and bronchoconstriction. In an emergency, the primary focus of care is maintaining the airway.

What is the most common cause of anaphylaxis? A) Opioids B) Radiocontrast agent C) Penicillin D) NSAIDs

Penicillin Explanation: Penicillin is the most common cause of anaphylaxis, accounting 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.

The nurse is caring for a client exposed to peanuts with a known allergy. What assessment is considered the most serious manifestation of angioneurotic edema? A) laryngeal swelling B) urticaria C) abdominal pain D) conjunctivitis

laryngeal swelling Explanation: Diffuse swelling can affect many regions: lips, eyelids, cheeks, hands, feet, genitalia, tongue, larynx, bronchi, and the gastrointestinal canal. The most serious is the larynx because of the potential for compromised breathing. Abdominal pain, conjunctivitis and urticaria are not the most serious manifestations.

The nurse is teaching a client about the symptoms of anaphylaxis. Which client statements indicate no further teaching is needed? Select all that apply. A) "If I experience recurrent diarrhea after eating, I will need to call my doctor." B) "A feeling of fullness in my mouth is okay as long as it does not increase." C) "If I start having difficulty breathing, I need to get help right away." D) "Sneezing a lot can be a concern if it continues and does not let up." E) "Peripheral tingling is a symptom of anaphylaxis reaction."

C) "If I start having difficulty breathing, I need to get help right away." E) "Peripheral tingling is a symptom of anaphylaxis reaction." Explanation: Difficulty breathing is a life-threatening symptom of anaphylaxis and requires help right away. Peripheral tingling is a symptom of anaphylaxis reaction. Recurrent diarrhea is not a symptom of anaphylaxis. Sneezing is not a symptom of anaphylaxis reaction. A feeling of fullness in the mouth is a symptom of anaphylaxis reaction.

A client reports to a health care provider's office for intradermal allergy testing. Before testing, the nurse provides client teaching. Which client statement indicates a need for further education? A) "If I notice tingling in my lips or mouth, gargling may help the symptoms." B) "The test may be mildly uncomfortable." C) "I may experience itching and irritation at the site of the testing." D) "I'll go directly to the pharmacy with my EpiPen prescription."

"If I notice tingling in my lips or mouth, gargling may help the symptoms." Explanation: The client requires further teaching if the client states, "I will gargle to help alleviate tingling in the lips or mouth." Allergy testing introduces potentially irritating substances to the client. Tingling in the mouth, lips, or throat indicates the onset of a severe reaction and the need for immediate medical intervention. The testing may cause irritation and itching at the test site. The health care provider may order an epinephrine pen (EpiPen) for the client to self-administer epinephrine if the client experiences an allergic reaction away from the office setting.

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. A) Carry EpiPen autoinjector at all times. B) Identify ways to manage allergy while dining out. C) List symptoms of peanut allergy. D) Food labels on baked items are the only labels that need to be read. E) Wear a medic alert bracelet.

A) Carry EpiPen autoinjector at all times. B) Identify ways to manage allergy while dining out. C) List symptoms of peanut allergy. E) Wear a medic alert bracelet. 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.

When evaluating a client's knowledge about use of antihistamines, what statement indicates further education is required? A) "I should be careful when driving." B) "This medication may be taken with food." C) "If I am pregnant, I should take half the dose." D) "Hard candy will relieve my dry mouth."

"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.

The nurse is preparing a client for skin testing. The client has been taking an over-the-counter allergy medication. The nurse would instruct the client to stop taking the medication at which time before the test? A) 7 to 10 days B) 5 to 7 days C) 1 to 2 days D) 2 to 4 days

2 to 4 days Explanation: Corticosteroids and antihistamines, including over-the-counter allergy medications, should be stopped 48 to 96 hours before the test to prevent the drug from suppressing the test results.

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) a cross-reacting antibody that mistakes a normal constituent of the body as foreign B) a delayed-type hypersensitivity that is mediated by T cells C) the involvement of immune complexes formed when antigens bind to antibodies D) the immediate release of chemical mediators

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.

The nurse is teaching a client about allergic rhinitis and its triggers. What is the most common trigger for the respiratory allergic response? A) dust mites B) plant pollen C) animal dander D) mold spores

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 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. A) Milk B) Shrimp C) Beef D) Eggs E) Chicken

A) Milk B) Shrimp D) Eggs Explanation: Common food causes of anaphylaxis include peanuts, tree nuts, shellfish, fish, milk, eggs, soy, and wheat. Beef and chicken are not common causes.

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? A) Avoid potential allergens. B) Wear a medical alert bracelet. C) Carry an emergency kit. D) Undergo desensitization treatment.

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 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? A) Taper the dose when discontinuing the medication. B) Do not overuse the medication as rebound congestion can occur. C) Do not operate machinery or drive while using the medication. D) Report white patches in the mouth because the medication can cause a fungal infection.

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.

Which statement describes the clinical manifestations of a delayed hypersensitivity (type IV) allergic reaction to latex? A) They occur within minutes after exposure to latex. B) hey can be eliminated by changing glove brands or using powder-free gloves. C) They may worsen when hand lotion is applied before donning latex gloves. D) They are localized to the area of exposure, usually the back of the hands.

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.

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: A) pitting edema. B) angioneurotic edema. C) contact dermatitis. D) urticaria.

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.

The nurse plans care for a client who is diagnosed with atopic dermatitis. For each teaching point, click to specify if the instruction addresses skin hydration or itchy skin. Each teaching point may address more than 1 condition (Itchy Skin or Skin Hydration) Wear cotton fabric. Use an emollient containing glycerol on the skin after bathing. Take short showers using a mild soap for cleansing. Wash clothes using a mild detergent. Take an antihistamine before bed.

Itchy Skin Use an emollient containing glycerol on the skin after bathing. Wear cotton fabric. Wash clothes using a mild detergent. Take an antihistamine before bed. Skin Hydration Use an emollient containing glycerol on the skin after bathing. Take short showers using a mild soap for cleansing.

An infant is born to a mother who had no prenatal care during her pregnancy. What type of hypersensitivity reaction does the nurse understand may have occurred? A) Bacterial endocarditis B) Rh-hemolytic disease C) Rheumatoid arthritis D) Lupus erythematosus

Rh-hemolytic disease Explanation: A type II hypersensitivity, or cytotoxic, reaction, which involves binding either the IgG or IgM antibody to a cell-bound antigen, may lead to eventual cell and tissue damage. The reaction is the result of mistaken identity when the system identifies a normal constituent of the body as foreign and activates the complement cascade. Examples of type II reactions are myasthenia gravis, Goodpasture syndrome, pernicious anemia, hemolytic disease of the newborn, transfusion reaction, and thrombocytopenia.

Which acts as a potent vasoconstrictor and causes bronchial smooth muscle to contract? A) Platelet-activating factor B) Bradykinin C) Prostaglandin D) Serotonin

Serotonin Explanation: Serotonin acts as a potent vasoconstrictor and causes contraction of bronchial smooth muscle. Bradykinin is a polypeptide with the ability to cause increased vascular permeability, vasodilation, hypotension, and contraction of many types of smooth muscle, such as the bronchi. Prostaglandin is a polypeptide that stimulates nerve fibers and causes pain. Platelet-activating factor is responsible for initiating platelet aggregation and leukocytes, as well as vasodilation and increased capillary permeability.

What education should the nurse provide to the patient taking long-term corticosteroids? A) The patient should discontinue using the drug immediately if weight gain is observed. B) The patient should not stop taking the medication abruptly and should be weaned off of the medication. C) The patient should take the medication only as needed and not take it unnecessarily. D) Corticosteroids are relatively safe drugs with very few side effects.

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 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? A) laundry detergent or bath soap changes B) chemical and latex glove use C) life stressors the nurse may be experiencing D) medication allergies

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 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: A) Tolerance to nose drops B) Atopic dermatitis C) Leukotriene modifier D) Rhinitis medicamentosa

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 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? A) An exacerbation of a previous disorder B) An alloimmunity disorder C) A cause-and-effect relationship D) Autoimmune

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 administering intravenous vancomycin. What will the nurse initially assess the client for if an allergic reaction occurs? A) the severity of cutaneous warmth and flushing B) hypotension and tachycardia C) the presence and location of pruritus D) dyspnea, bronchospasm, and/or laryngeal edema

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 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? A) 2 hours B) 12 hours C) 24 hours D) 6 hours

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 talking with a client who was stung by a bee and began having difficulty breathing. What serious complication from injected venom should the nurse discuss with the client? A) Itching B) Diarrhea C) Hives D) Airway obstruction

Airway obstruction Explanation: Injectants, such as bee venom, and some other allergens can produce systemic and potentially fatal effects, including shock and airway obstruction caused by laryngeal swelling. Although all other answers can occur with an allergen, they are not the most serious complication.

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? A) Laryngeal edema B) Angioedema C) Blistering D) Rhinitis

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.

Which of the following is the most frequent route of exposure to a latex allergy? A) Cutaneous B) Inhalation C) Mucosal D) Parenteral

Cutaneous Explanation: Routes of exposure to latex products can be cutaneous, percutaneous, mucosal, parenteral, or aerosol. Allergic reactions are more likely with parenteral or mucous membrane exposure but can also occur with cutaneous contact or inhalation. The most frequent source of exposure is cutaneous, which usually involves the wearing of natural latex gloves.

The nurse working in an allergy clinic is preparing to administer skin testing to a client. Which route is the safest for the nurse to use to administer the solution? A) Intramuscular B) Subcutaneous C) Intradermal D) Intravenous

Intradermal Explanation: The intradermal route is the correct route of administration for skin testing and therefore a safe route. Another safe route is epicutaneous. The type of skin testing being performed determines whether the nurse will administer the solution via the epicutaneous or intradermal route.

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? A) Symptoms can be eliminated by changing glove brands. B) Symptoms worsen when hand lotion is applied before donning latex gloves. C) Symptoms occur within minutes after exposure to latex. D) Symptoms are localized to the area of exposure, usually the back of the hands.

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 client is prescribed an oral corticosteroid for 2 weeks to relieve asthma symptoms. The nurse educates the client about side effects, which include: A) adrenal suppression. B) hypoglycemia. C) hypotension. D) diuresis.

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.

The nurse is teaching a client about contact dermatitis. What type of contact dermatitis requires light exposure in addition to allergen contact? A) photoallergic B) phototoxic C) allergic D) irritant

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.

A client reports to a health care provider's office for intradermal allergy testing. Before testing, the nurse provides client teaching. Which client statement indicates a need for further education? A) "I may experience itching and irritation at the site of the testing." B) "I'll go directly to the pharmacy with my EpiPen prescription." C) "The test may be mildly uncomfortable." D) "If I notice tingling in my lips or mouth, gargling may help the symptoms."

"If I notice tingling in my lips or mouth, gargling may help the symptoms." Explanation: The client requires further teaching if the client states, "I will gargle to help alleviate tingling in the lips or mouth." Allergy testing introduces potentially irritating substances to the client. Tingling in the mouth, lips, or throat indicates the onset of a severe reaction and the need for immediate medical intervention. The testing may cause irritation and itching at the test site. The health care provider may order an epinephrine pen (EpiPen) for the client to self-administer epinephrine if the client experiences an allergic reaction away from the office setting.

The nurse explains to a client that immunotherapy initially starts with injections at which interval? A) Weekly B) Monthly C) Bi-monthly D) Daily

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.

Which intervention is the single most important aspect for the client at risk for anaphylaxis? A) Use of antihistamines B) Desensitization C) Wearing a medical alert bracelet D) Prevention

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 nurse is working in a dermatology clinic with clients who have allergies. What is the most important chemical mediator involved in the allergic response? A) serotonin B) histamine C) prostaglandins D) leukotrienes

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.

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: A) route of exposure. B) skin reactions. C) respiratory symptoms. D) systemic effects.

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.

A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder? A) For their immunosuppressant effects B) To decrease the body's risk of infection C) Because an autoimmune disease is a neoplastic disease D) So the client has strong drug therapy

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.