Chapter 38: Allergies
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? a) Angiotensin-converting enzyme (ACE) inhibitor b) Vasodilator c) Beta blocker d) Angiotensin receptor blocker
a) 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 is a group of mediators that initiate the inflammatory response? a) Prostaglandins b) Leukotrienes c) Lymphokines d) Mast cells
b) Leukotrienes Leukotrienes are a group of chemical mediators that initiate the inflammatory response. Lymphokines are substances released by sensitized lymphocytes when they contact specific organs. Mast cells are connective tissue that contains heparin and histamine in their granules. Prostaglandins are unsaturated fatty acids that have a wide assortment of biologic activity.
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? a) Seafood b) Peanut and tree nuts c) Milk and chocolate d) Berries and seeds
b) Peanut and tree nuts Peanuts, cashews, and walnuts are responsible for the most severe allergic reactions. Some individuals are so sensitive that they can have a reaction just by being close enough to the food product to smell it or to have the nut oil on their hands.
A client is scheduled to begin immunotherapy. The nurse would explain that the client will receive injections initially at which interval a) Monthly b) Weekly c) Daily d) Bi-monthly
b) 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.
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? a) "You need to come back to the clinic to get a different medication since this one is not working for you." b) "I am sorry that you are feeling poorly but this is the only medication that will work for your problem." c) "The full benefit of the medication may take up to 2 weeks to be achieved." d) "You may be immune to the effects of this medication and will need something else in its place."
c) "The full benefit of the medication may take up to 2 weeks to be achieved." Patients must be aware that full benefit of corticosteroid nasal sprays may not be achieved for several days to 2 weeks.
Which of the following aid in diagnosing the risk of anaphylaxis? a) Nasal smear b) Punch biopsy c) Intradermal testing d) Peripheral blood smears
c) Intradermal testing The diagnosis of anaphylaxis risk is determined by prick and intradermal skin testing. Skin testing of patients who have clinical symptoms consistent with a type I, IgE-mediated reaction has been recommended. A nasal smear, punch biopsy, and peripheral blood smear would not be used.
A nurse is preparing a teaching plan about exposure control for a client with an allergic disorder. Which of the following would the nurse least likely include in the teaching plan? a) Using cotton pillows that can be washed b) Wearing a mask when the lawn is cut c) Replacing rugs with wood flooring d) Dusting the room at least weekly
d) Dusting the room at least weekly Environmental control measures include dusting and vacuuming the room every day, using pillows made of cotton and that can be washed, removing and replacing rugs with wood flooring or linoleum, and wearing a mask when cleaning or at times of increased exposure, such as when the lawn is being cut.
The nurse working in the ED is asked to explain allergy testing to a patient who experienced an allergic reaction to an unknown allergen. Which test indicates the quantity of allergen necessary to evoke an allergic reaction? a) Intradermal test b) Provocative testing c) Scratch test d) Radioallergosorbent testing (RAST)
d) Radioallergosorbent testing (RAST) RAST is a radioimmunoassay that measures allergen-specific IgE. The RAST indicates the quantity of allergen necessary to evoke an allergic reaction. Provocative testing involves the direct administration of the suspected allergen to the sensitive tissue, such as the conjunctiva. The scratch test does not indicate the quantity of allergen.
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? a) Eosinophil count b) Erythrocyte sedimentation rate c) White blood cell count d) Serum IgE level
d) Serum IgE level 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.
The nurse is conducting an initial assessment of a hospitalized patient who states that he has a latex allergy. The nurse notes that the skin of the patient's hands is dry, thick, and cracked. The nurse documents the patient's reaction to latex as which of the following factors? a) Latex allergy b) Allergic contact dermatitis c) Irritant contact dermatitis d) Latex hyperplasia
c) Irritant contact dermatitis Dry, thickened, and cracked skin is a symptom of a chronic irritant dermatitis reaction to latex. Symptoms of allergic contact dermatitis reaction to latex include pruritus, swelling, crusting thickened skin, blisters, and other lesions. Symptoms of latex allergy include rhinitis, flushing, urticarial, laryngeal edema, bronchospasms, asthma, and cardiovascular collapse.
The maximum intensity of histamine following antigen contact, occurs within which timeframe? a) 5 minutes b) 45 minutes c) 30 minutes d) 15 minutes
d) 15 minutes Maximum intensity is reached within about 15 minutes after antigen contact. The other timeframes are inaccurate.
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 several large raised areas. b) Rash is pale in color. c) Rash has developed gradually. d) Rash is localized to a body area.
a) Rash has several large raised areas. 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.
Which of the following is a contraindication for immunotherapy? a) Use of a beta-blocker b) Conjunctivitis c) Allergic asthma d) Allergic rhinitis
a) Use of a beta-blocker 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.
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: a) Serotonin. b) Histamine. c) Prostaglandins. d) Leukotrienes.
b) Histamine. All chemical mediators are participants in the response cycle, but histamine is the most important protein involved. Activated by a mast cell, it increases vessel permeability.
A nurse is assessing a client who is experiencing an allergic reaction. Which of the following would the nurse identify as resulting from the release of histamine? a) Constipation b) Hypotension c) Pruritus d) Vasodilation
c) Pruritus Histamine causes erythema, localized edema in the form of wheals, pruritus, contraction of bronchial smooth muscle resulting in wheezing and bronchospasm, dilation of small venules and constriction of larger vessels, and increased secreation of gastric and mucosal cells, resulting in diarrhea. Vasodilation and hypotension result from bradykinin release.
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? a) 2 hours b) 6 hours c) 12 hours d) 24 hours
a) 2 hours Mild systemic, anaphylactic reactions consist of peripheral tingling and a sensation of warmth, possibly accompanied by a sensation of fullness in the mouth and throat. Nasal congestion, periorbital swelling, pruritus, sneezing, and tearing of the eyes can also be expected. Onset of symptoms begins within the first 2 hours after exposure.
A nurse is visiting the home of a client with atopic dermatitis. Which of the following suggestions for the client would be appropriate? Select all that apply. a) Keep the room temperature at approximately 70 degrees Farenheit. b) Humidify the home when the heat is on during the winter. c) Apply topical moisturizers to the skin. d) Wear clothing made from synthetic fabrics. e) Use a strong antibacterial detergent for the laundry.
a) Keep the room temperature at approximately 70 degrees Farenheit. b) Humidify the home when the heat is on during the winter. c) Apply topical moisturizers to the skin. The nurse would suggest that the client use a mild detergent for laundry and keep the room temperature between 68 to 72 degrees Farenheit to decrease itching and scratching. Other suggestions include applying topical moisturizers to the skin, wearing clothes made from cotton fabrics, and humidifying the home when dry home heating is used during the winter.
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? a) "I should be careful when driving." b) "If I am pregnant, I should take half the dose." c) "Hard candy will relieve my dry mouth." d) "This medication may be taken with food."
b) "If I am pregnant, I should take half the dose." 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 (eg, 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.
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? a) Urticaria b) Angioneurotic edema c) Contact dermatitis d) Pitting edema
b) 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.
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? a) 1:00 PM b) 3:00 PM c) 10:00 AM d) 11:00 AM
c) 10:00 AM Mild and moderate reactions begin within 2 hours of exposure.
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? a) Maintains pressure on the auto-injector for about 30 seconds after insertion b) Avoids massaging the injection site after administration c) Jabs the autoinjector into the outer thigh at a 90-degree angle d) Pushes down on the grey release cap to administer the medication
c) 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 (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.
Which of the following is a mild systemic reaction to anaphylaxis? a) Itching b) Flushing c) Peripheral tingling d) Anxiety
c) Peripheral tingling Mild systemic reactions consist of peripheral tingling and a sensation of warmth, possibly accompanied by a sensation of fullness in the mouth and throat. Nasal congestion, periorbital swelling, pruritus, sneezing, and tearing of the eyes can also be expected. The other answers are examples of moderate systemic reactions.
A nurse knows to advise a patient who is taking Atarax, an over-the-counter (OTC) antihistamine, to be aware of the serious potential side effect of: a) Urinary retention. b) Photosensitivity. c) Seizures. d) Epigastric distress.
c) Seizures. Atarax is the only OTC antihistamine that has the potential serious side effect of tremors and seizures.
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) Bathe only three times per week. b) Wear only synthetic fabrics. c) Keep the thermostat above 75° F (23.9° C). d) Use a topical skin moisturizer daily.
d) Use a topical skin moisturizer daily. 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).
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? a) "If I notice tingling in my lips or mouth, gargling may help the symptoms." b) "I may experience itching and irritation at the site of the testing." c) "The test may be mildly uncomfortable." d) "I'll go directly to the pharmacy with my EpiPen prescription."
a) "If I notice tingling in my lips or mouth, gargling may help the symptoms." The client requires further teaching if he states he will gargle to help alleviate tingling in the lips or mouth. Allergy testing introduces potentially irritating substances to the client. Tingling in the mouth, lips, or throat indicates the onset of a severe reaction and the need for immediate medical intervention. The testing may cause irritation and itching at the test site. The physician may order an epinephrine pen (EpiPen) for the client to self-administer epinephrine if he experiences an allergic reaction away from the office setting.
Which of the following are chemical mediators that initiate and mediate the inflammatory response? a) Leukotrienes b) Complement c) Prostaglandins d) Cytokines
a) Leukotrienes Leukotrienes are chemical mediators from constituents of cell membranes. Cytokines are nonantibody proteins that act as intercellular mediators, as in the generation of the immune response. Prostaglandins are lipid-soluble molecules synthesized form constituents from cell membranes. Complement is a plasma protein associated with immunologic reactions.
Which of the following statements describes the clinical manifestations of a delayed hypersensitivity (type IV) allergic reaction to latex? a) They are localized to the area of exposure, usually the back of the hands. b) They occur within minutes after exposure to latex. c) They may worsen when hand lotion is applied before donning latex gloves. d) They can be eliminated by changing glove brands or using powder-free gloves.
a) They are localized to the area of exposure, usually the back of the hands. Clinical manifestations of a delayed hypersensitivity reaction are localized to the area of exposure. Clinical manifestations of an irritant contact dermatitis can be eliminated by changing glove brands or using powder-free gloves. With an irritant contact dermatitis, avoid use of hand lotion before donning gloves as this may worsen symptoms as lotions may leach latex proteins from the gloves. Described as a latex allergy, when clinical manifestations occur within minutes after exposure to latex, an immediate hypersensitivity (type I) allergic reaction has occurred.
A patient has a sensitivity to ragweed and tells the nurse that it comes at the same time every year. When does the patient typically notice the symptoms? a) Early spring b) Early fall c) Midwinter d) Summer
b) Early fall Because allergic rhinitis is induced by airborne pollens or molds, it is characterized by the following seasonal occurrences: Early spring—tree pollen (oak, elm, poplar); early summer—rose pollen (rose fever) and grass pollen (Timothy, Redtop); and early fall—weed pollen (ragweed).
Diagnostic testing is an essential part of assessment to determine a cause for rhinitis. Which of the following is the most conclusive test for this condition? a) Peripheral blood count b) Total serum IgE test c) Radioallergosorbent test d) Intradermal skin test
b) Total serum IgE test Increased IgE levels are a positive indicator of allergic rhinitis. Skin and provocation tests can yield false-positive and false-negative results.
Which statement would would alert the nurse to suspect a client is experiencing a mild anaphylactic reaction? a) "I'm having difficulty swallowing." b) "I feel like my face is so flushed." c) "My throat feels like it's full." d) "I'm having tightness in my chest."
c) "My throat feels like it's full." Manifestations of a mild anaphylactic reaction include peripheral tingling and a sensation of warmth, a sensation of fullness in the mouth and throat, nasal congestion, periorbital swelling, pruritus, sneezing, and tearing of the eyes. Flushing, warmth, anxiety, and itching in addition to the mild symptoms indicate a moderate reaction. A severe systemic reaction begins abruptly with the mild and moderate symptoms rapidly progressing to bronchospasm, laryngeal edema, severe dyspnea, cyanosis, and hypotension as well as dysphagia, abdominal cramping, vomiting, diarrhea, and possibly seizures.
Which route of exposure to latex products occurs from use of latex condoms? a) Mucosal b) Percutaneous c) Cutaneous d) Parenteral
a) Mucosal Mucosal exposure can occur from the use of latex condoms, catheters, airways, and nipples. Parenteral exposure can occur from IV lines or hemodialysis equipment. Cutaneous exposure involves the wearing of latex gloves.
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) Eczema. b) Rhinitis. c) A latex allergy. d) Asthma.
c) A latex allergy. A latex allergy does not have the genetic component and organ specificity as do the other choices. It is classified as nonatopic.
A client being treated for an allergy has been prescribed antihistamines. The Kardex of this client reads as follows: Age: 32; Profession: Carpenter; Lifestyle & diet: Lives alone, average smoker, nonalcoholic, no food preferences, practices yoga; Medical history: Suffers from hay fever, recent urinary tract infection that has been treated successfully. What information from the Kardex is likely to have the greatest implication in educating the client about antihistamine administration? a) The client's smoking habit b) The client's medical history c) The client's age d) The client's profession
d) The client's profession Most antihistamines cause drowsiness, so the nurse should advise the client not to operate machinery or perform tasks that require alertness when taking antihistamines. Since the client is not an older adult, his age has no implications on the therapy. The recent urinary tract infection will have no implications either. Antihistamines are not administered to clients with disorders of the lower respiratory tract. In addition, smoking does not affect the effectiveness of the antihistamine therapy.
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? a) 1% to 3% b) 5% to 10% c) 15% to 40% d) 3% to 4%
c) 15% to 40% 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.
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) Rhinocort c) Allegra d) Afrin
c) Allegra Allegra is the only antihistamine choice. Sudafed and Afrin are over-the-counter, and Rhinocort is a corticosteroid.
The nurse is completing the intake assessment of a patient new to the allergy clinic. The patient states that he was taking nose drops six times a day to relieve his nasal congestion. The nasal congestion increased, causing him to increase his usage of the nasal spray to eight times a day. But again the congestion worsened. The nurse communicates to the health care provider that the patient experienced which of the following? a) Atopic dermatitis b) Leukotriene modifier c) Tolerance to nose drops d) Rhinitis medicamentosa
d) 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.
A client is receiving immunotherapy as part of the treatment plan for an allergic disorder. After administering the therapy, the client states, "I guess I can go home now." Which response by the nurse would be most appropriate? a) "You need to stay about another half-hour so we can make sure you don't have a reaction." b) "It's okay to leave but make sure to call us if you start to feel strange after an hour or so." c) "We need to schedule your next appointment first and then you can leave." d) "You must stay here so that you can get another injection of a different substance to which you're allergic."
a) "You need to stay about another half-hour so we can make sure you don't have a reaction." Although severe systemic reactions are rare, the risk of serious and potentially fatal anaphylaxis exists. Therefore, the client needs to remain in the office or clinic for at least 30 minutes after the injection to be observed for possible systemic symptoms. The client should not be allowed to leave until 30 minutes pass. If more than one allergen is being used, the injections typically occur at the same time.
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 anaphylaxis? Select all that apply? a) Milk b) Beef c) Shrimp d) Eggs e) Chicken
a) Milk c) Shrimp d) Eggs Common food causes of anaphylaxis include peanuts, tree nuts, shelfish, fish, milk, eggs, soy, and wheat. Beef and chicken are not common causes.
The nurse is creating a discharge teaching plan for a patient with a latex allergy. Which of the following should be included? Select all that apply. a) Administration of emergency epinephrine b) Radioallergosorbent testing (RAST) c) Avoidance of latex-based products d) Administration of antihistamines
a) Administration of emergency epinephrine c) Avoidance of latex-based products d) Administration of antihistamines 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 patient's latex allergy is already diagnosed.
Which of the following is a mast cell stabilizer used in the treatment of allergic rhinitis? a) Intranasal cromolyn sodium (NasalCrom) b) Oxymetazoline hydrochloride (Afrin) c) Tetrahydrozoline hydrochloride (Visine) d) Pseudoephedrine hydrochloride (Sudafed)
a) Intranasal cromolyn sodium (NasalCrom) Intranasal cromolyn sodium (NasalCrom) is a mast cell stabilizer. Visine, Afrin, and Sudafed are adrenergic agents.
Histamine release in anaphylaxis causes which of the following? a) Nasal congestion b) Stomach cramps c) Urinary urgency d) Feeling of impending doom
a) 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.
A client has had skin testing and the results are inconclusive. The nurse would expect to prepare the client for which type of testing? a) Radioallergosorbent test b) Eosinophil count c) Complete blood count with differential d) Serum immunoglobulin E levels
a) Radioallergosorbent test If there is doubt about the results of skin tests, a radioallergosorbent test (RAST) or provocative challenge test would be done. Serum immunoglobulin E levels, eosinophil count, and complete blood count with differential would most likely be done prior to skin testing to provide supportive data to suggest an allergic disorder.
A nurse has developed irritant contact dermatitis from latex glove use. Which of the following would the nurse need to avoid? a) Using powder-free gloves whenever possible b) Using oil-based hand lotion before donning gloves c) Applying silicone agents to the skin d) Changing the brand of gloves used
b) Using oil-based hand lotion before donning gloves With irritant contact dermatitis, the nurse should avoid using oil-based hand lotions before donning gloves because these lotions may leak latex proteins from the gloves, increasing skin exposure and the risk of developing true allergic reactions. Appropriate actions would include changing the brand of gloves used, using powder-free gloves, and applying water- or silicone-based moisturizing creams, lotions, or topical barrier agents.
