Ch. 38 Assessment and Management of Patients With Allergic Disorders
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? A. Page an anesthesiologist immediately and prepare to intubate the client. B. Administer epinephrine, as ordered, and prepare to intubate the client, if necessary. C.Administer the antidote for penicillin, as ordered, and continue to monitor the client's vital signs. D. Insert an indwelling urinary catheter and begin to infuse I.V. fluids, as ordered.
Correct response: Administer epinephrine, as ordered, and prepare to intubate the client, if necessary. Explanation: To reverse anaphylactic shock, the nurse first should administer epinephrine, a potent bronchodilator, as ordered. The physician is likely to order additional medications, such as antihistamines and corticosteroids; if these medications don't relieve the respiratory compromise associated with anaphylaxis, the nurse should prepare to intubate the client. No antidote for penicillin exists; however, the nurse should continue to monitor the client's vital signs. A client who remains hypotensive may need fluid resuscitation and fluid intake and output monitoring; however, administering epinephrine is the first priority.
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? A. Sudafed B. Afrin C. Allegra D. Rhinocort
Correct response: Allegra Explanation: Allegra is the only antihistamine choice. Sudafed and Afrin are over-the-counter, and Rhinocort is a corticosteroid.
The nurse is preparing to administer a medication that has an affinity for H1 receptors. Which medication would the nurse administer? A. Diphenhydramine (Benadryl) B. Omeprazole (Prilosec) C. Cimetidine (Tagamet) D. Ranitidine (Zantac)
Correct response: Diphenhydramine (Benadryl) 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 ranitidine (Zantac) target H2 receptors to inhibit gastric secretions in peptic ulcer disease.
A nurse practitioner working in an allergy clinic is treating a patient who is allergic to ragweed. She advises the patient to expect an increase in symptoms during which of the following seasons?
Correct response: Early fall Explanation: Ragweed has a seasonal occurrence in early fall. Tree pollen and mold spores occur in the spring. Rose and grass pollen occur in the summer.
Which of the following terms refers to an incomplete antigen?
Correct response: Hapten Explanation: A hapten is an incomplete antigen. An allergen is a substance that causes manifestations of allergy. An antigen is a substance that induces the production of antibodies. An antibody is a protein substance developed by the body in response to and interacting with a specific antigen.
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?
Correct response: 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 (injectiing 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 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?
Correct response: 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.
Which of the following is a contraindication for immunotherapy? A.Use of a beta-blocker B.Allergic rhinitis C.Conjunctivitis D.Allergic asthma
Correct response: Use of a beta-blocker Explanation: A contraindication of immunotherapy is the use of a beta-blocker or angiotensin-converting inhibitor therapy, which may mask early signs of anaphylaxis. Indications for immunotherapy are allergic rhinitis, conjunctivitis, or allergic rhinitis.
Rhinitis medicamentosa
Rhinitis medicamentosa is a rebound reaction from overuse of sympathomimetic nose drops or sprays that worsen the congestion, causing the patient to use more of the medication and thus leading to more nasal congestion. This differs from tolerance where 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.
Histamine release in anaphylaxis causes which of the following? A.Nasal congestion B.Feeling of impending doom C.Urinary urgency D.Stomach cramps
Correct response: Nasal congestion Explanation: Histamine release causes sweating, sneezing, shortness of breath, and nasal congestion. Feelings of impending doom are related to activation of IgE and subsequent release of chemical mediators. Urinary urgency and stomach cramps occur from smooth muscle contractions of intestines and bladder.
What is the most common cause of anaphylaxis? A. Opioids B. NSAIDs C. Penicillin D. Radiocontrast agent
Correct response: 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.
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?
Correct response: 15% to 40% Explanation: Eosinophils, which are granular leukocytes, normally make up 0% to 3% of the total number of WBCs (Fischbach & Dunning, 2009). A level between 5% and 15% is nonspecific but does suggest allergic reaction. Higher percentages of eosinophils are considered to represent moderate to severe eosinophilia. Moderate eosinophilia is defined as 15% to 40% eosinophils and may be found in patients with allergic disorders.
Contact dermatitis is considered a type IV hypersensitivity reaction. The nurse is aware that this classification is characterized by which of the following? A. The immediate release of chemical mediators B. A cross-reacting antibody that mistakes a normal constituent of the body as foreign C. A delayed-type hypersensitivity that is mediated by T cells D. The involvement of immune complexes formed when antigens bind to antibodies
Correct response: 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.
When describing the immunoglobulin most likely involved with allergic reactions, which of the following would the nurse address?
Correct response: IgE Explanation: Immunoglobulins of the IgE class are involved in allergic reactions, with two or more IgE molecules binding together to an allergen and triggering mast cells or basophils to release chemical mediators. IgA protects against respiratory, gastrointestinal, and genitourinary infections. IgG activates the complement system, IgM appears as the first immunoglobulin produced in response to bacterial and viral infections and also activates the complement system
There are several types of reactions to latex. The nurse knows to be most concerned about laryngeal edema with the following reaction A.Irritant contact. B.Allergic contact. C.IgE-mediated hypersensitivity. D.IgG antibodies.
Correct response: 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 nurse is preparing a discharge teaching plan for a client with atopic dermatitis. Which instruction should the nurse include in her teaching plan? A. Wear only synthetic fabrics. B. Use a topical skin moisturizer daily. C. Bathe only three times per week. D. Keep the thermostat above 75° F (23.9° C).
Use a topical skin moisturizer daily. Explanation: The nurse should instruct the client to use a topical skin moisturizer daily to help keep the skin hydrated. Likewise, the client should be encouraged to bathe daily. To minimize irritation, the client should wear only cotton fabrics. The client should maintain a room temperature between 68° F (20° C) and 72° F (22.2° C).
The nurse observes diffuse swelling involving the deeper skin layers in the patient who has experienced an allergic reaction. The nurse would correctly document this finding as which of the following?
Correct response: 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 and shape, itch, and cause local discomfort. Contact dermatitis refers to inflammation of the skin caused by contact with an allergenic substance, such as poison ivy. Pitting edema is the result of increased interstitial fluid and associated with disorders such as congestive heart failure.
Which of the following body substances causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle?
Correct response: Histamine Explanation: When cells are damaged, histamine is released. Bradykinin is a polypeptide that stimulates nerve fibers and causes pain. Serotonin is a chemical mediator that acts as a potent vasoconstrictor and bronchoconstrictor. Prostaglandins are unsaturated fatty acids that have a wide assortment of biologic activity. Histamine is a primary chemical mediator of hypersensitivity. Secondary mediators include serotonin, heparin, and bradykinin.
A client comes to the clinic with a rash. While inspecting the client's skin, the nurse determines that the rash is medication-related based on which of the following? A. Rash has developed gradually. B. Rash is pale in color. C. Rash has several large raised areas. D. Rash is localized to a body area.
Correct response: Rash has several large raised areas. Explanation: In general, drug reactions appear suddenly, have a particularly vivid color, and manifest with characteristics more intense than the somewhat similar eruptions of infectious origin. Therefore, the appearance of several large raised areas would suggest a drug reaction.
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. Lupus erythematosus D. Rheumatoid arthritis
Correct response: 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.
