ch38: allergies
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? Carry an emergency kit. Wear a medical alert bracelet. Avoid potential allergens. Undergo desensitization treatment.
Avoid potential allergens. 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 with a history of allergic rhinitis comes to the clinic for an evaluation. The client is prescribed triamcinolone. What will the nurse include when teaching the client about this drug? Place the prescribed number of drops into the conjunctiva. Take the drug orally before, with, or after meals. Use ice chips to alleviate the symptoms of dry mouth. Be aware that some nasal burning and itching may occur.
Be aware that some nasal burning and itching may occur. Triamcinolone is an inhaled corticosteroid administered by a metered-spray device. It may cause drying of the nasal mucosa and burning and itching sensations. The drug is not given orally and does not cause dry mouth. Adrenergic topical ophthalmic drops are used for symptomatic relief of eye irritations resulting from allergies.
A nurse is reviewing how to use an epinephrine auto-injector with a child and parents. The nurse determines that the teaching was successful when the child and parents state that after injection they will hold the pen in place for approximately: 10 seconds. 60 seconds. 5 seconds. 30 seconds.
10 seconds. Once the device is inserted, the client should hold device firmly against the thigh for approximately 10 seconds.
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? 10:00 AM 11:00 AM 1:00 PM 3:00 PM
10:00 AM Mild and moderate reactions begin within 2 hours of exposure.
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 15 to 20 minutes 30 to 35 minutes 40 to 45 minutes
5 to 10 minutes Histamine's effects peak 5 to 10 minutes after antigen contact. The other time frames are inaccurate.
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. Milk Eggs Beef Shrimp Chicken
Milk Eggs Shrimp Common food causes of anaphylaxis include peanuts, tree nuts, shellfish, fish, milk, eggs, soy, and wheat. Beef and chicken are not common causes.
What is the most common cause of anaphylaxis? Opioids Radiocontrast agent Penicillin NSAIDs
Penicillin 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 client experiencing an anaphylactic reaction may experience which of the following signs and symptoms? (Select all that apply.) Pruritus Pallor Bronchospasm Laryngeal edema Dyspnea
Pruritus Bronchospasm Laryngeal edema Dyspnea Mild systemic reactions consist of peripheral tingling, warmth, a sensation of fullness in the mouth and throat, nasal congestion, periorbital swelling, pruritus, sneezing, and tearing of the eyes. Moderate systemic reactions may include flushing and anxiety in addition to any of the milder symptoms. More serious reactions include 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.
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? Systemic reactions include urticaria and angioedema. Anaphylactoid (anaphylaxis-like) reactions are commonly fatal. The most common food item that causes anaphylaxis is chocolate. The most common cause of anaphylaxis is penicillin.
The most common cause of anaphylaxis is penicillin. The most common cause of anaphylaxis is penicillin, accounting for about 75% of fatal anaphylactic reactions in the United States. Although possibly severe, anaphylactoid reactions are rarely fatal. Food items that are common causes of anaphylaxis include peanuts, tree nuts, shellfish, fish, milk, eggs, soy, and wheat. Local reactions usually involve urticaria and angioedema at the site of the antigen exposure. Systemic reactions, which occur within about 30 minutes of exposure, involve cardiovascular, respiratory, gastrointestinal, and integumentary organ systems.
A patient in his 40s is considering immunotherapy as a treatment for his longstanding allergic rhinitis, a problem which is taking an increasing toll on his quality of life. The nurse at the allergy clinic should ensure that the patient knows that allergy control by this method usually requires treatment for how long? Three to five years Six to eight months One year to 18 months Two to three years
Three to five years Unlike antiallergy medication, allergen immunotherapy has the potential to alter the allergic disease course after 3 to 5 years of therapy.
The nurse explains to a client that immunotherapy initially starts with injections at which interval? Monthly Daily Weekly Bi-monthly
Weekly 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.
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? the involvement of immune complexes formed when antigens bind to antibodies a cross-reacting antibody that mistakes a normal constituent of the body as foreign a delayed-type hypersensitivity that is mediated by T cells the immediate release of chemical mediators
a delayed-type hypersensitivity that is mediated by T cells 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 histamine release during an anaphylactic reaction. What does histamine release in anaphylaxis cause? nasal congestion feeling of impending doom urinary urgency stomach cramps
nasal congestion 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.
The nurse is creating a discharge teaching plan for a client with a latex allergy. Which information should be included? Select all that apply. Administration of antihistamines Radioallergosorbent testing (RAST) Avoidance of latex-based products Administration of emergency epinephrine
Administration of antihistamines Avoidance of latex-based products Administration of emergency epinephrine The nurse should include in the discharge teaching plan avoidance of latex-based products. Additionally, the nurse should include administration of antihistamines and an emergency epinephrine. RAST testing would not be indicated; it is a diagnostic test for allergies, and the client's latex allergy is already diagnosed.
A client has been diagnosed with Stevens-Johnson syndrome. Which factors are common triggers of this condition? Select all that apply. Allopurinol and nevirapine Radiation in combination with phenytoin Exposure to cold objects, cold fluids, or cold air Tamoxifen and vemurafenib Wearing clothing washed in a detergent
Allopurinol and nevirapine Radiation in combination with phenytoin Tamoxifen and vemurafenib Stevens-Johnson syndrome is a severe reaction commonly triggered by medication. The syndrome can evolve into extensive epidermal necrosis and become life-threatening. Among the many medications that trigger this condition are tamoxifen, vemurafenib, allopurinol and nevirapine. The combination of radiation and antiepileptic drugs such as phenytoin can also trigger this condition. Exposure to cold objects, cold fluids, or cold air can trigger cold urticaria, resulting in wheals (hives) or angioedema, but would not trigger Steven-Johnson syndrome. Wearing clothing washed in a detergent can trigger contact dermatitis but would not trigger Steven-Johnson syndrome.
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 receptor blocker Beta blocker Vasodilator Angiotensin-converting enzyme (ACE) inhibitor
Angiotensin-converting enzyme (ACE) inhibitor Several frequently prescribed medications, such as angiotensin-converting enzyme inhibitors and penicillin, may cause angioedema. The nurse needs to be aware of all medications the patient is taking and be alert to the potential of angioedema as a side effect.
Which of the following agents are responsible for causing the most serious anaphylactic reactions? (Select all that apply.) Insect venom Latex items Antibiotic medications Radiocontrast agents Peanuts Shellfish Dairy products
Antibiotic medications Radiocontrast agents Antibiotics and radiocontrast agents have the most serious significant reactions. All of the answer choices are common causes of anaphylaxis. Penicillin is the most common medication to cause anaphylaxis, and antibiotics and radiocontrast agents cause the most serious anaphylactic reactions.
When assessing the skin of a client with allergic contact dermatitis, the nurse would most likely expect to find irritation at which area? Ankles Dorsal aspect of the hand Plantar aspects of the feet Lower arms
Dorsal aspect of the hand 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.
The nurse is planning care for a client with atopic dermatitis. Which information will the nurse include when teaching the client self-care for the condition? Select all that apply. Crusting of lesions is a sign of healing. Apply a skin cream that contains glycerol. Wear clothing made of cotton. Take antihistamines early in the day. Use a mild soap when bathing.
Apply a skin cream that contains glycerol. Wear clothing made of cotton. Use a mild soap when bathing. Atopic dermatitis is a type I immediate hypersensitivity disorder involving IgE antibodies that causes dry, pruritic, hypersensitive skin. It often begins with small, red, pruritic papules that stimulate intense itching, leaving erythematous, excoriated areas of skin. This often triggers an "itch-scratch cycle" where rubbing or scratching the skin causes further irritation, redness, and skin breakdown. Treatment of clients with atopic dermatitis involves avoidance of irritative agents, use of anti-inflammatory topical agents, and moisturization of the skin. The client should be advised to use mild soap when bathing and to wear clothing made of cotton. Thick cream moisturizers and emollients that contain glycerol should be used as these will keep the skin hydrated. Antihistamines may be used however should be taken at bedtime because they are sedating. The presence of purulence or honey-colored crusts suggests S. aureus infection and antibiotics are needed to eradicate infection.
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 contact dermatitis. angioneurotic edema. pitting edema. urticaria.
angioneurotic edema. 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.
The nurse is teaching a client about contact dermatitis. What type of contact dermatitis requires light exposure in addition to allergen contact? allergic irritant phototoxic photoallergic
photoallergic 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.
The nurse is teaching a client about allergic rhinitis and its triggers. What is the most common trigger for the respiratory allergic response? plant pollen dust mites mold spores animal dander
plant pollen 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.
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? Pushes down on the grey release cap to administer the medication Avoids massaging the injection site after administration Jabs the autoinjector into the outer thigh at a 90-degree angle Maintains pressure on the auto-injector for about 30 seconds after insertion
Jabs the autoinjector into the outer thigh at a 90-degree angle 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.