ch 32 prepU

A client is in the clinic for seasonal allergic rhinitis. Loratadine (Claritin) is prescribed. Which statement will the nurse include when providing education concerning this drug?

"Determine if the drug is going to make you drowsy before you drive."

When the nurse is providing client education regarding food allergies, what statement made by the client would indicate a need for further education on the subject?

"Foods have an equal risk of causing an allergic response." Typically, food allergies are an immune response to the ingestion of a protein. Some food allergens such as shellfish, fish, corn, seeds, bananas, egg, milk, soy, peanut, and tree nuts have a higher inherent risk for triggering anaphylaxis than do others. However, many other foods have been identified as allergens, including certain fruits and vegetables. It is common for children with allergies to milk, eggs, wheat, or soy to outgrow their allergies.

A nurse is teaching a 55-year-old client about fexofenadine prescribed to treat allergic symptoms. Which client statement suggests an understanding of this teaching?

"I should avoid driving after taking this medication."

The nurse is providing instructions to a client who will be taking second-generation antihistamines at home. Which statement by the client indicates a need for further instruction?

"I will take this medication with apple juice." Fexofenadine and related drugs should not be taken with fruit juice

What statement made by a client suggests a need for further teaching on the risk factors associated with drug allergies?

"If you didn't have allergies as a child, you won't develop allergies later in life."

A nursing professor teaching junior-level students conducts a lecture regarding allergic contact dermatitis. Which of the following statements made by the students verifies the lecture was effective? Select all that apply.

"It is a type IV hypersensitivity reaction from direct contact with antigens." "Poison ivy is an example." "Skin lesions are usually blistered."

A nursing professor has just completed her lecture regarding hypersensitivity (allergic) responses, focused on Type I reactions. Which of the following statements made by her students will show that the students understood the material? Choose all that apply.

"It occurs within minutes of exposure to the antigen." "It is an immunoglobulin E (IgE)-induced response." "Anaphylaxis is a type I response."

When providing health education to a client prescribed diphenhydramine, what information should the nurse convey to the client?

"This drug is likely to make you feel drowsy."

When developing the teaching plan for a client receiving an antihistamine, which would the nurse include? (Select all that apply.)

Advising the client to avoid alcohol consumption Using sugarless candies or lozenges to combat dry mouth

A client reports a hacking cough. The client asks if taking an antihistamine would be helpful. The nurse's best response is:

Antihistamines are not recommended because they can dry lower respiratory secretions and worsen secretion retention and cough.

A client has been prescribed an antihistamine for the treatment of seasonal allergies. What dietary guidelines should the nurse provide to the client?

Avoid drinking alcohol while taking antihistamines

A male client presents to the health care provider's office with allergy-related symptoms that interfere with his job as a car salesman. What nasal spray does the nurse expect to be ordered?

Azelastine (Astelin)

Second-generation H1 antagonists (also called selective or nonsedating agents) were developed mainly to produce less sedation than the first-generation drugs. Which of the following are examples of these drugs? Choose all that apply.

Azelastine (Astelin) Cetirizine (Zyrtec) Fexofenadine (Allegra) Loratadine (Claritin)

Your client has a history of post-transfusion reactions. Her medical provider has ordered medication to prevent this. Which of the following medications would you anticipate being ordered for this client?

Benadryl

The nursing instructor is describing the four types of hypersensitivity reactions. What alternate name might the instructor use to identify type IV hypersensitivity?

Delayed hypersensitivity

A male client presents to the emergency department with symptoms of a gastrointestinal bleed. The health care provider orders a blood transfusion. The client has a history of anaphylaxis. The provider orders the administration of what drug before the blood transfusion?

Diphenhydramine

A female client is prescribed a first-generation antihistamine for her allergies. The nurse would expect her to experience what adverse effect?

Dry mouth

The pharmacology instructor is discussing the adverse effects of diphenhydramine. Which is not one of these effects?

Excessive salivation

Second-generation antihistamines were developed to remove the sedation of first generation drugs. Which of the following antihistamines is a second-generation drug?

Fexofenadine

Antihistamines are used frequently in the home care setting for the treatment of allergies. Which of the following is most likely to be a responsibility of the nurse caring for a patient who is taking antihistamines for this indication?

Helping the patient identify environmental allergens

Mr. Zee is prescribed an inhaled nasal steroid to relieve his symptoms associated with seasonal allergies. What is true about inhaled nasal steroids?

Inhaled nasal steroids are more effective than oral medications in treating the global symptoms associated with allergies.

Which statement accurately describes an aspect of serum sickness?

Is a delayed hypersensitivity reaction.

The nurse is caring for a client who needs education on the medication therapy for allergic rhinitis. The client is to take clemastine (Tavist) daily. In providing educational interventions regarding this medication, what is the most important instruction on the action of the medication?

It blocks the effects of histamine.

A clinic nurse is caring for a patient who has been prescribed fexofenadine for hay fever. When the nurse is assessing this patient's medication history, what drug would make the nurse question the order for fexofenadine?

Ketoconazole, Drug-drug interactions vary among the antihistamines. For example, anticholinergic effects may be prolonged if diphenhydramine is taken with a monoamine inhibitor and the interaction of fexofenadine with ketoconazole or erythromycin may raise fexofenadine concentrations to toxic levels.

A patient with vasomotor rhinitis has been prescribed an antihistamine. The patient is eager to know whether the prescribed antihistamine may cause excessive sedation. Which of the following antihistamines has very little sedative effect?

Loratadine

A group of students are reviewing information about antihistamines. The students demonstrate understanding of the information when they identify which agent as a second generation antihistamine?

Loratadine.

The health care provider has ordered promethazine (Phenergan) for a client who is having a severe allergic reaction. The nurse is aware that this medication is also used to treat what condition?

Nausea and vomiting

Pseudoephedrine (Sudafed) is prescribed for a client suffering from nasal and sinus congestion. What is the most important assessment the nurse should complete before the client leaves the clinic to purchase the medication?

Obtain the client's blood pressure. Sudafed is a decongestant. Decongestants are used cautiously in clients with a history of hypertension because of the vasoconstrictive effects of the drug. Swelling of nasal passages is a symptom of congestion

Some antihistamines can produce significant sedation. Which drug is most likely to cause this adverse effect?

Promethazine

The nurse is teaching a group of clients with allergic rhinitis about the use of their medications. What would be the most essential information to give these clients about preventing possible drug interactions?

Read drug labels before taking OTC medications.

Combining first-generation antihistamines with sedating agents can can result in what adverse effect?

Respiratory depression

What type of antihistamine is typically preferred for older adults?

Second-generation

When caring for a patient with an allergic reaction following a blood transfusion, which of the following conditions should the nurse consider as a contraindication for antihistamine therapy?

Stenosing peptic ulcer

A 62-year-old client has been prescribed an antihistamine to alleviate vasomotor rhinitis. The client reports gastric irritation after taking the tablet. Which instructions should the nurse provide to help alleviate the client's condition?

Take the tablet with food.

Second-generation H1 antagonists cause less CNS depression because they are selective for peripheral H1 receptors and because of which other property?

They do not cross the blood-brain barrier.

What is one of the benefits related to second generation antihistamine administration in older adults?

They do not impair thinking.

What causes the inflammation of nasal mucosa that is seen in allergic rhinitis?

Type I hypersensitivity reaction to Inhaled allergens

A client's report of nasal congestion, itching, sneezing, and watery drainage, including itching of the throat, eyes, and ears are consistent with what situation?

allergic rhinitis

What medication should be prescribed to minimize the risk associated with a blood transfusion for a client with a history of a previous transfusion reaction?

diphenhydramine

A 20-year-old woman calls the clinic at 5 PM and reports to the nurse that she forgot to take her morning dose of fexofenadine (Allegra). She usually takes her evening dose at 8 PM. She wants to know what she should do. The nurse will instruct her to

forget about the morning dose and take the evening dose.

The substances released from mast cells are responsible for what physiological response? Select all that apply.

inflammation bronchoconstriction

The nursing instructor is explaining the four types of allergic reaction to the nursing students. The instructor explains that allergic rhinitis is a

type I hypersensitivity reaction.

Which client is most likely to benefit from the administration of a nasal steroid.

A client who has chronic allergic rhinitis

A nursing professor has just completed her lecture regarding hypersensitivity (allergic) responses. Her lecture focused on Type III reactions. Which of the following statements made by her students will show that the students understood the material? Choose all that apply.

"It is an IgG- or IgM-mediated reaction that forms antigen-antibody complexes that kicks in inflammation in the tissue." "Serum sickness is the prototype of these reactions."

A nursing professor teaching sophomore students conducts a lecture regarding allergic food reactions. Which of the following statements made by the students verifies the lecture was effective? Select all that apply.

"They usually are an immune response to the ingestion of a protein." "Shellfish and eggs are examples of allergens that may have a high risk for anaphylaxis."

A 76-year-old client has been prescribed an oral antihistamine. What adverse effect presents a priority safety concern for older adult clients?

Drowsiness

When describing the effects of second-generation antihistamines, which would the nurse address as being decreased?

Sedation. The adverse effects most often seen with antihistamine use are drowsiness and sedation. However, second-generation antihistamines are less sedating in many people. The anticholinergic effects associated with both generations include drying of the respiratory and gastrointestinal mucous membranes, gastrointestinal upset and nausea, arrhythmias, dysuria, urinary hesitancy, and skin eruption and itching associated with dryness.

A professor teaching pharmacology conducts a lecture regarding allergic drug reactions. Which of the following statements made by students verifies the lecture was effective? Select all that apply.

"Virtually any drug may induce an immunologic response." "Allergic drug reactions are complex and diverse and may include any of the types of hypersensitivity."

A nurse is describing the action of a prescribed antihistamine to a client. The nurse is describing which medication, by explaining that the drug elicits its antihistamine effects by nonselectively binding to central and peripheral H1 receptors?

Diphenhydramine

A 15-year-old patient is prescribed an antihistamine for allergic rhinitis. However, antihistamines used to treat allergic reactions may themselves cause allergy. The nurse needs to educate the patient to be aware of symptoms suggesting allergy. Which of the following is an allergic reaction to antihistamines?

Skin rash and urticaria

Hypersensitivity reactions are grouped into four types according to the mechanisms by which they are produced. Which type of hypersensitivity reaction is occurring in the attached graphic?

Type I, Type I (also called immediate hypersensitivity because it occurs within minutes of exposure to the antigen) is an IgE-induced response triggered by the interaction of antigen with antigen-specific IgE bound on mast cells, causing mast cell activation. Histamine and other mediators are released immediately, and cytokines, chemokines, and leukotrienes are synthesized after activation.