Prep U for Brunner and Suddarth's Textbook of Medical Surgical Nursing, 13th Edition Chapter 38: Assessment and Management of Patients With Allergic Disorders

A patient is experiencing an allergic reaction to a dose of penicillin. What should the nurse look for in the patient's initial assessment?

Dyspnea, bronchospasm, and/or laryngeal edema. pg. 1037

What nursing intervention helps reduce itchiness or prevent the client from scratching the skin would you institute with a client who has an allergic reaction and tends to itch due to histamine release?

Advise the client to use distracting techniques. pg.

What is the most common cause of anaphylaxis?

Penicillin pg. 1036

When evaluating a client's knowledge about use of antihistamines, which of the following statements made by the patient would indicate to the nurse a knowledge deficit?

"If I am pregnant, I should take half the dose." pg. 1040

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." pg. 1043

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." pg. 1030

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." pg. 1041

Patient teaching about mild allergic responses should include information about the onset of symptoms. The nurse tells the patient that if exposure to an allergen occurs around 8:00 AM, he should expect a mild or moderate reaction by what time?

10:00 AM pg. 1037

The nurse is caring for a client experiencing an anaphylactic reaction. The nurse prepares for the maximum intensity of histamine response to occur within which time frame?

5 to 10 minutes pg. 1030

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 pg. 1046

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. pg. 1037

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

Antihistamine pg. 1036

Your client is about to have a skin test for an allergic disorder. What critical instruction should the nurse give this client?

Avoid antihistamines and cold preparations for 48 to 72 hours before the test.

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. pg. 1040

A client with allergic rhinitis is prescribed a mast cell stabilizer. Which of the following would the nurse expect to be used?

Cromolyn sodium pg. 1040

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 pg. 1042

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 pg. 1046

Injected allergens are used for "hyposensitization" and may produce systemic reactions that can be harmful. Which of the following medications should be on hand in case of an adverse reaction?

Epinephrine pg. 1043

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 pg. 1041

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 pp. 1040-1041.

Which term refers to an incomplete antigen?

Hapten pg. p. 1029-1030.

A nurse practitioner working in a dermatology clinic explained to a group of nursing students that the pathophysiology of an allergic response involves a chain of events that includes responses from lymphocytes, IgE, mast cells, and basophils. The nurse mentioned that the most important chemical mediator involved in the response is:

Histamine. pg. 1030

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

IgE pg. 1030

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?

Intradermal pg. 1033

Which of the following is considered the most serious manifestation of angioneurotic edema?

Laryngeal swelling pg. 1047

Histamine release in anaphylaxis causes which of the following?

Nasal congestion pg. 1030

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. pg. 1040

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

Photoallergic pg. 1046

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. pg. 1038

A client comes to the clinic reporting nasal congestion and states, "I've been using an over-the-counter nasal spray that seemed to help at first, but then I got even more congested than before I started the medication. I continued the nasal spray, but it seems to be worse." The nurse suspects which of the following?

Rhinitis medicamentosa pg. 1044

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?

Symptoms are localized to the area of exposure, usually the back of the hands. pg. 1050

The nurse is conducting a community education program on allergies and anaphylactic reactions. The nurse determines that the participants understand the education when they make which statement about anaphylaxis?

The most common cause of anaphylaxis is penicillin. pg. 1036

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. pg. 1042

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

Weekly pg. 1043

The best treatment for latex allergy is

avoidance of latex-based products. pg. 1051

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 pg. 1037

A 10-year-old boy has been brought to the emergency department (ED) by ambulance in apparent anaphylaxis after accidentally eating a snack bar that contained peanuts. The ED nurse should be aware that this patient's signs and symptoms are attributable to:

A massive release of histamine

When a patient experiences an allergic reaction, the nurse should initially assess for:

Dyspnea, bronchospasm, and/or laryngeal edema. pg. 1038

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

Avoid potential allergens pg. 1037

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

IgE pg. 1030

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. pg. 1049

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 pg. 1040

Allergy testing has revealed that an elementary school-aged child has a severe hypersensitivity to insect stings. When conducting health education with the child's parents, the nurse should address which of the following subjects?

The need for the child to carry an EpiPen

Which type of hypersensitivity reaction involves immune complexes forming when antigens bind to antibodies?

Type III pg. p. 1032-1033.

Which of the following is a contraindication for immunotherapy?

Use of a beta-blocker pg. 1042

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 pg. 1051

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. pg. 1043

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 pg. 1033

A nurse is preparing a discharge teaching plan for a client with atopic dermatitis. Which instruction should the nurse include in her teaching plan?

Use a topical skin moisturizer daily. pg. 1047

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

Histamine pg. p. 1029-1030

The patient presents to the health care provider's office with an allergic reaction. The doctor documents the patient's condition as a nonatopic, IgE-mediated response. The nurse knows that the reaction is:

A latex allergy. pg. 1036

The nurse is creating a discharge teaching plan for a client with a latex allergy. Which information should be included? Select all that apply.

Avoidance of latex-based products Administration of antihistamines Administration of emergency epinephrine pg. 1051

Students are reviewing information about hypersensitivity disorders in preparation for class discussion the next day. The students demonstrate understanding of the material when they identify which of the following as a type IV hypersensitivity disorder?

Contact dermatitis pg. 1046

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 pg. 1039

Which cells present the antigen to T cells and initiate the immune response?

Macrophages pg. 1030

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 and Shrimp pg. 1037

Health teaching about food allergies includes advising patients about the food products that cause the most severe reactions and result in the highest patient death rates. Which of the following foods fit that category?

Peanut and tree nuts pg. 1048

Which intervention is the single most important aspect for the client at risk for anaphylaxis?

Prevention pg. 1037

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 pg. 1032