Chapter 38: Assessment and Management of Patients With Allergic Disorders

A patient received epinephrine in response to an anaphylactic reaction at 10:00 AM. The nurse knows to observe the patient for a "rebound" reaction that may occur as early as:

2:00 PM. Explanation: Rebound reactions can occur from 4 to 10 hours after an initial allergic reaction. Therefore the patient needs to be assessed from 2:00 PM to 8:00 PM.

A health care provider prescribed Flonase, an intranasal corticosteroid, for a patient with a severe case of allergic rhinitis. The nurse told the patient that there is a delayed response to full benefits from the drug. The patient took his first dose on February 2. The patient should expect that the drug will be fully effective no later than:

February 15.

The nurse is obtaining a medication history from a patient with allergic rhinitis. The patient states, "I've been on numerous medications over the years and nothing seems to work. Plus I get so tired and sleepy from them." The nurse documents the medications used in the patient's medical record: Diphenhydramine 50 mg orally twice a day Hydroxyzine 25 mg orally three times a day Chlorpheniramine 4 mg orally every 6 hours Fexofenadine 60 mg orally twice a day When reviewing the list, which medication would the nurse identify as causing the least sedation?

Fexofenadine

Nursing students are reviewing various medications that can be used to treat allergic disorders. The students demonstrate understanding of the information when they identify which of the following as an intranasal corticosteroid?

Fluticasone

The nurse practitioner treating a patient with allergic rhinitis decides pharmacologic therapy would be helpful. Which of the following is she most likely to prescribe?

Allegra

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

Angioneurotic edema

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."

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

Blistering

While interviewing a client with an allergic disorder, the client tells the nurse that he is allergic to animal dander. The nurse interprets this substance as which of the following?

Complete protein antigen

Which of the following is the most frequent route of exposure to a latex allergy?

Cutaneous

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

IgE

When describing the immunoglobulin most likely involved with allergic reactions, which of the following would the nurse address?

IgE

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

Jabs the autoinjector into the outer thigh at a 90-degree angle

Histamine release in anaphylaxis causes which of the following?

Nasal congestion

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

Only use the Afrin for 3 to 4 days once every 12 hours.

Which of the following is a mild systemic reaction to anaphylaxis?

Peripheral tingling

Which type of contact dermatitis requires light exposure in addition to allergen contact?

Photoallergic

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

RAST

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?

Rh-hemolytic disease

Which of the following acts as a potent vasoconstrictor and causes contraction of bronchial smooth muscle?

Serotonin

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

The nurse is working with a colleague who has a delayed hypersensitivity (type IV) allergic reaction to latex. Which of the following statements describes the clinical manifestations of this reaction?

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

The nurse is evaluating a patient's complete blood cell count and differential (CBC and diff) along with the serum immunoglobulin E (IgE) level. Which of the following results might indicate that the patient has an allergic disorder?

High IgE level

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

Histamine

A nurse is reviewing the dietary history of a client who has experienced anaphylaxis. Which of the following would the nurse identify as a common cause of anaplhylaxis? Select all that apply?

Milk Eggs Shrimp

A 6-year-old experienced an allergic reaction to shellfish. The nurse practitioner gave the mother a booklet that includes teaching points about food allergies. The nurse reminded the mother to be vigilant for mild systemic reactions such as:

Nasal congestion and sneezing.

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

A patient with a history of anaphylactic reactions to insect stings has just been stung by a wasp. The patient is going to self-administer his EpiPen. Place the steps in the correct order that he would follow. Use all options.

- Remove the gray safety-release cap - Jab the black tip into the outer thigh - Massage the injection area - Call the emergency medical response number (911)

The nurse is educating a patient with allergic rhinitis about how the condition is induced. What should the nurse include in the education on this topic?

Airborne pollens or molds

A patient is prescribed an oral corticosteroid for 2 weeks for relief of asthma symptoms. The nurse instructs the patient that side effects include which of the following?

Adrenal suppression

After teaching a client with allergic rhinitis about loratadine, the nurse determines that the client needs additional instruction when he states which of the following?

"I have to be careful because this drug will make me fairly sleepy."

A client reports to a physician's office for intradermal allergy testing. Before testing, the nurse provides client teaching. Which client statement indicates a need for further education?

"If I notice tingling in my lips or mouth, gargling may help the symptoms."

A client is receiving immunotherapy as part of the treatment plan for an allergic disorder. After administering the therapy, the client states, "I guess I can go home now." Which response by the nurse would be most appropriate?

"You need to stay about another half-hour so we can make sure you don't have a reaction."

According to nursing research by Campbell et al., about 65% of patients identified with anaphylaxis who were seen in the emergency department were discharged to home. Of those 65%, one-third were prescribed self-injectable epinephrine. Patient teaching for use of an EpiPen must be included with discharge instructions. Select all the teaching points that apply.

- Grasp the EpiPen with the black tip pointing downward. - Form a fist around the unit. - Hold black tip near outer thigh.

The maximum intensity of histamine following antigen contact, occurs within which timeframe?

15 minutes

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 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

Contact dermatitis is considered a type IV hypersensitivity reaction. The nurse is aware that this classification is characterized by which of the following?

A delayed-type hypersensitivity that is mediated by T cells

After receiving a dose of penicillin, a client develops dyspnea and hypotension. The nurse suspects the client is experiencing anaphylactic shock. What should the nurse do first?

Administer epinephrine, as ordered, and prepare to intubate the client, if necessary.

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

Antihistamine

Which of the following would the nurse prioritize as the most important action for the patient to take to prevent anaphylaxis?

Avoid potential allergens

The best treatment for latex allergy includes which of the following?

Avoidance of latex-based products

A client with a history of allergic rhinitis comes to the clinic for an evaluation. The client is prescribed triamcinolone. Which of the following would the nurse include when teaching the client about this drug?

Be aware that some nasal burning and itching may occur.

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. Which of the following would indicate to the nurse that the outcome has been met?

Client identifies methods for reducing exposure risk to allergens.

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

Diphenhydramine (Benadryl)

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

When assessing the skin of a client with allergic contact dermatitis, the nurse would most likley expect to find irritation at which area?

Dorsal aspect of the hand

A nurse is preparing a teaching plan about exposure control for a client with an allergic disorder. Which of the following would the nurse least likely include in the teaching plan?

Dusting the room at least weekly

There are several types of reactions to latex. The nurse knows to be most concerned about laryngeal edema with the following reaction:

IgE-mediated hypersensitivity.

The nurse working in an allergy clinic is preparing to administer skin testing to a patient. Which of the following routes is the safest for the nurse to use to administer the solution?

Intradermal

Which of the following is a group of mediators that initiate the inflammatory response?

Leukotrienes

Preventive health education includes informing patients about the symptoms associated with allergic rhinitis. The nurse is aware that the most common trigger to this respiratory allergic response is:

Plant pollen.

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

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.

A client is scheduled to begin immunotherapy. The nurse would explain that the client will receive injections initially at which interval

Weekly

Which of the following is a contraindication for immunotherapy?

Use of a beta-blocker

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."

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

Which of the following interventions is the single most important aspect for the patient at risk for anaphylaxis?

Prevention

The nurse is completing the intake assessment of a patient new to the allergy clinic. The patient 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 patient experienced which of the following?

Rhinitis medicamentosa