Chapter 37: Assessment and Management of Patients With Allergic Disorders

When evaluating a client's knowledge about use of antihistamines, what statement indicates further education is required? "This medication may be taken with food." "If I am pregnant, I should take half the dose." "Hard candy will relieve my dry mouth." "I should be careful when driving."

"If I am pregnant, I should take half the dose." Explanation: Antihistamines are contraindicated during the third trimester of pregnancy, in nursing mothers and newborns, in children and elderly people, and in patients whose conditions may be aggravated by muscarinic blockade (e.g., asthma, urinary retention, open-angle glaucoma, hypertension, prostatic hyperplasia). The major side effect is sedation, although H1 antagonists are less sedating than earlier antihistamines. Additional side effects include nervousness, tremors, dizziness, dry mouth, palpitations, anorexia, nausea, and vomiting.

A client reports to a health care provider'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." "The test may be mildly uncomfortable." "I may experience itching and irritation at the site of the testing." "I'll go directly to the pharmacy with my EpiPen prescription."

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

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." "You need to come back to the clinic to get a different medication since this one is not working for you." "You may be immune to the effects of this medication and will need something else in its place." "I am sorry that you are feeling poorly but this is the only medication that will work for your problem."

"The full benefit of the medication may take up to 2 weeks to be achieved."

Which of the following is the most frequent route of exposure to a latex allergy? Inhalation Parenteral Mucosal Cutaneous

Cutaneous Explanation:Routes of exposure to latex products can be cutaneous, percutaneous, mucosal, parenteral, or aerosol. Allergic reactions are more likely with parenteral or mucous membrane exposure but can also occur with cutaneous contact or inhalation. The most frequent source of exposure is cutaneous, which usually involves the wearing of natural latex gloves.

Which term refers to an incomplete antigen? Hapten Antigen Antibody Allergen

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.

The nurse is evaluating a client's complete blood cell count and differential along with the serum immunoglobulin E (IgE) concentration. Which result might indicate that the client has an allergic disorder? High neutrophil count High IgE concentration Low white blood cell count Low eosinophil count

High IgE concentration

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

IgE

The nurse working in the emergency department is asked to explain allergy testing to a client who experienced an allergic reaction to an unknown allergen. Which test indicates the quantity of allergen necessary to evoke an allergic reaction? Scratch test Serum-specific IgE test Provocative testing Intradermal test

Serum-specific IgE test

Which allergic reaction is potentially life threatening? None of the listed allergic reactions is potentially life threatening. urticaria contact dermatitis angioedema

None of the listed allergic reactions is potentially life threatening.

Which intervention is the single most important aspect for the client at risk for anaphylaxis? Prevention Use of antihistamines Desensitization Wearing a medical alert bracelet

Prevention

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? White blood cell count Serum IgE level Erythrocyte sedimentation rate Eosinophil count

Serum IgE level

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 24 hours 6 hours 12 hours

2 hours

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? Sublingual-swallow immunotherapy (SLIT) Desensitization Sublingual-topical immunotherapy (STIT) Resensitization

Desensitization Explanation: Desensitization is another option. Desensitization is a form of immunotherapy in which a person receives weekly or twice-weekly injections of dilute but increasingly higher concentrations of an allergen without interruption. SLIT is a form of desensitization therapy. Options C and D are distractors for this question.

What type of immunoglobulin is most likely involved with allergic reactions? IgG IgA IgM IgE

IgE

A client has been having joint pain and swelling in the left foot and is diagnosed with rheumatoid arthritis. The symptoms began suddenly without any identifiable cause, and the client has significant joint destruction. What type of disease is this considered? Autoimmune An alloimmunity disorder An exacerbation of a previous disorder A cause-and-effect relationship

autoimmune

When assessing the skin of a client with allergic contact dermatitis, the nurse would most likley expect to find irritation at which area? Lower arms Dorsal aspect of the hand Ankles Plantar aspects of the feet

Dorsal aspect of the hand Explanation: 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.

A nurse is preparing a discharge teaching plan for a client with atopic dermatitis. Which instruction should the nurse include in the teaching plan? Wear only synthetic fabrics. Keep the thermostat above 75° F (23.9° C). Use a topical skin moisturizer daily. Bathe only three times per week.

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 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? Subcutaneous Intramuscular Intravenous Intradermal

Intradermal

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? Avoids massaging the injection site after administration Pushes down on the grey release cap to administer the medication Maintains pressure on the auto-injector for about 30 seconds after insertion Jabs the autoinjector into the outer thigh at a 90-degree angle

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.