Chapter 38 Nursing Management: Patients with Allergic Disorders
A camp nurse has been rushed to a playing field where a girl appears to be experiencing an anaphylactic reaction. The nurse has had the child rushed to the camp's infirmary. What action should the nurse prioritize in the immediate care of this child? A)Administer analgesics if available. B)Closely monitor the girl's heart rate. C)Position the girl in high Fowler's. D)Maintain the patency of the girl's airway.
D)Maintain the patency of the girl's airway.
A patient has sought care, stating that she developed hives overnight. The nurse's inspection confirms the presence of urticaria. What type of allergic hypersensitivity reaction has the patient developed? A) Type I B) Type II C) Type III D) Type IV
A) Type I Urticaria (hives) is a type I hypersensitive allergic reaction
A patient is brought to the emergency department (ED) in a state of anaphylaxis. What is the ED nurse's priority for care? A) Monitor the patient's level of consciousness. B) Protect the patient's airway. C) Provide psychosocial support. D) Administer medications as ordered.
B) Protect the patient's airway. Anaphylaxis severely theatens a patient's airway; the nurse's priority is preserving airway patency and breathing pattern. This is a higher priority than other valid aspects of care, including medication administration, psychosocial support, and assessment of LOC.
A nurse is providing information on food allergies to a group of teachers. What food items would the nurse inform the teachers are common allergens? A)Citrus fruit and rice B)Root vegetables and tomatoes C)Eggs and nuts D)Rye flour and cheese
C) Eggs and nuts
A child is undergoing testing for food allergies after experiencing unexplained signs and symptoms of hypersensitivity. What food items would the nurse inform the parents are common allergens? A) Citrus fruits and rice B) Root vegetables and tomatoes C) Eggs and wheat D) Hard cheeses and vegetable oils
C) Eggs and wheat The most common causes of food allergies are seafood (lobster, shrimp, crab, clams, fish), legumes (peanuts, peas, beans, licorice), seeds (sesame, cottonseed, caraway, mustard, flaxseed, sunflower seeds), tree nuts, berries, egg white, buckwheat, milk, and chocolate.
A 10-year-old boy has been brought to the emergency department (ED) by ambulance in apparent anaphylaxis after accidentally eating a snack bar that contained peanuts. The ED nurse should be aware that this patient's signs and symptoms are attributable to: - Dissolution of the basement membranes of epithelium - Rapid activation of the clotting cascade - A massive release of histamine - Activation of the sympathetic nervous system (SNS)
Correct response: A massive release of histamine Explanation: Anaphylaxis occurs when the body's immune system produces specific IgE antibodies toward a substance that is normally nontoxic (e.g., food such as a peanut). If the substance is ingested more than once, the body releases excess amounts of the protein histamine, resulting in anaphylaxis. The pathophysiology of anaphylaxis is not a consequence of the dissolution of the basement membrane, SNS activation, or inappropriate clotting.
A mother has come to the emergency department (ED) with her 2-year-old who appears to be having a hypersensitivity reaction. The ED nurse knows that a hypersensitivity reaction may be characterized by an immediate reaction beginning within minutes of exposure to an antigen. What condition is an example of such a reaction? - Anaphylactic reaction immediately following a bee sting - Skin reaction from tape adhesive - Hay fever - Rheumatoid arthritis
Correct response: Anaphylactic reaction immediately following a bee sting Explanation: Anaphylactic (type I) hypersensitivity is an immediate reaction mediated by IgE antibodies and requires previous exposure to the specific antigen. Type II reactions, or cytotoxic hypersensitivity, occur when the system mistakenly identifies a normal constituent of the body as foreign. Type III, or immune complex hypersensitivity, occurs as the result of two factors, the increased amount of circulating complexes and the presence of vasoactive amines. Type IV, or delayed-type hypersensitivity, occurs 24 to 72 hours after exposure to an allergen and is mediated by sensitized T-cells and macrophages.
A nurse is assessing a client who is experiencing an allergic reaction. What will the nurse identify as resulting from the release of histamine? Pruritus Vasodilation Hypotension Constipation
Correct response: Pruritus Explanation: 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 secretion of gastric and mucosal cells, resulting in diarrhea. Vasodilation and hypotension result from bradykinin release.
A patient in his 40s is considering immunotherapy as a treatment for his longstanding allergic rhinitis, a problem which term 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? a) Six to eight months b) One year to 18 months c) Two to three years d) Three to five years
Correct response: Three to five years Explanation: Unlike antiallergy medication, allergen immunotherapy has the potential to alter the allergic disease course after 3 to 5 years of therapy.
The nurse is conducting discharge teaching for a client who is being discharged from the emergency department after an anaphylactic reaction to peanuts. Which education should the nurse include in the teaching? Select all that apply. - Use of sedatives to treat reactions - Desensitization to allergen - Wearing a medical alert bracelet - Avoiding allergens
Correct response: Wearing a medical alert bracelet Avoiding allergens Explanation: People who have experienced food, medication, idiopathic, or exercise-induced anaphylactic reactions should make every attempt to strictly avoid the allergen. Additionally, they should wear a medical alert bracelet and carry an emergency kit containing epinephrine for injection to prevent the onset of the reaction on exposure. Sedatives are not used to treat anaphylactic reactions, and desensitization is not used for peanut allergies.
A patient with a family history of allergies has suffered an allergic response based on a genetic predisposition. This atopic response is usually mediated by what immunoglobulin? A) Immunoglobulin A B) Immunoglobulin M C) Immunoglobulin G D) Immunoglobulin E
D) Immunoglobulin E Atopy refers to allergic reactions characterized by the action of IgE antibodies and a genetic predisposition to allergic reactions.
A 44-year-old man has come to the clinic with an asthma exacerbation. He tells the nurse that his father and brother also suffer from asthma, as does his 15-year-old son. The nurse explains that this is an allergic response based on a genetic predisposition. The specific allergen initiated by this immunological mechanism is usually mediated by: Immunoglobulin A Immunoglobulin M Immunoglobulin G Immunoglobulin E
Correct response: Immunoglobulin E Explanation: Atopy refers to allergic reactions characterized by the action of IgE antibodies and a genetic predisposition to allergic reactions. IgG is the most common immunoglobulin and is found in intravascular and intercellular compartments. IgA and IgM are found in mucous secretions.
A patient has been brought to the emergency department by EMS after being found unresponsive. Rapid assessment reveals anaphylaxis as a potential cause of the patient's condition. The care team should attempt to assess for what potential causes of anaphylaxis? Select all that apply. A) Foods B) Medications C) Insect stings D) Autoimmunity E) Environmental pollutants
A) Foods B) Medications C) Insect stings Substances that most commonly cause anaphylaxis include foods, medications, insect stings, and latex. Pollutants do not commonly cause anaphylaxis and autoimmune processes are more closely associated with types II and III hypersensitivities.
A patient has been admitted to the emergency department with signs of anaphylaxis following a bee sting. The nurse knows that if this is a true allergic reaction the patient will present with what alteration in laboratory values? A) Increased eosinophils B) Increased neutrophils C) Increased serum albumin D) Decreased blood glucose
A) Increased eosinophils Higher percentages of eosinophils are considered moderate to severe eosinophilia. Moderate eosinophilia is defined as 15% to 40% eosinophils and is found in patients with allergic disorders. Hypersensitivity does not result in hypoglycemia or increased albumin and neutrophil counts.
A patient with severe environmental allergies is scheduled for an immunotherapy injection. What should be included in teaching the patient about this treatment? A) The patient will be given a low dose of epinephrine before the treatment. B) The patient will remain in the clinic to be monitored for 30 minutes following the injection. C) Therapeutic failure occurs if the symptoms to the allergen do not decrease after 3 months. D) The allergen will be administered by the peripheral intravenous route.
B) The patient will remain in the clinic to be monitored for 30 minutes following the injection. Although severe systemic reactions are rare, the risk of systemic and potentially fatal anaphylaxis exists. Because of this risk, the patient must remain in the office or clinic for at least 30 minutes after the injection and is observed for possible systemic symptoms. Therapeutic failure is evident when a patient does not experience a decrease in symptoms within 12 to 24 months. Epinephrine is not given prior to treatment and the IV route is not used.
An office worker takes a cupcake that contains peanut butter. He begins wheezing, with an inspiratory stridor and air hunger and the occupational health nurse is called to the office. The nurse should recognize that the worker is likely suffering from which type of hypersensitivity? A) Anaphylactic (type 1) B) Cytotoxic (type II) C) Immune complex (type III) D) Delayed-type (type IV)
A) Anaphylactic (type 1) The most severe form of a hypersensitivity reaction is anaphylaxis. An unanticipated severe allergic reaction that is often explosive in onset, anaphylaxis is characterized by edema in many tissues, including the larynx, and is often accompanied by hypotension, bronchospasm, and cardiovascular collapse in severe cases. Type II, or cytotoxic, hypersensitivity occurs when the system mistakenly identifies a normal constituent of the body as foreign. Immune complex (type III) hypersensitivity involves immune complexes formed when antigens bind to antibodies. Type III is associated with systemic lupus erythematosus, rheumatoid arthritis, certain types of nephritis, and bacterial endocarditis. Delayed-type (type IV), also known as cellular hypersensitivity, occurs 24 to 72 hours after exposure to an allergen.
The nurse is providing care for a patient who has experienced a type I hypersensitivity reaction. What condition is an example of such a reaction? A) Anaphylactic reaction after a bee sting B) Skin reaction resulting from adhesive tape C) Myasthenia gravis D) Rheumatoid arthritis
A) Anaphylactic reaction after a bee sting Anaphylactic (type I) hypersensitivity is an immediate reaction mediated by IgE antibodies and requires previous exposure to the specific antigen. Skin reactions are more commonly type IV and myasthenia gravis is thought to be a type II reaction. Rheumatoid arthritis is not a type I hypersensitivity reaction.
After the completion of testing, a child's allergies have been attributed to her family's cat. When introducing the family to the principles of avoidance therapy, the nurse should promote what action? A) Removing the cat from the family's home B) Administering OTC antihistamines to the child regularly C) Keeping the cat restricted from the child's bedroom D) Maximizing airflow in the house
A) Removing the cat from the family's home In avoidance therapy, every attempt is made to remove the allergens that act as precipitating factors. Fully removing the cat from the environment is preferable to just keeping the cat out of the child's bedroom. Avoidance therapy does not involve improving airflow or using antihistamines.
A nurse at an allergy clinic is providing education for a patient starting immunotherapy for the treatment of allergies. What education should the nurse prioritize? A) The importance of scheduling appointments for the same time each month B) The importance of keeping appointments for desensitization procedures C) The importance of avoiding antihistamines for the duration of treatment D) The importance of keeping a diary of reactions to the immunotherapy
B) The importance of keeping appointments for desensitization procedures The nurse informs and reminds the patient of the importance of keeping appointments for desensitization procedures, because dosages are usually adjusted on a weekly basis, and missed appointments may interfere with the dosage adjustment. Appointments are more frequent than monthly and antihistamines are not contraindicated. There is no need to keep a diary of reactions.
A nurse is teaching a client about allergic rhinitis. What client statements indicate teaching has been effective? Select all that apply. - "I can only have one alcoholic drink while I am taking my antihistamine." - "I should use my medication for allergy exacerbation only when my allergy is apparent." - "I will remove as much carpet from my house as I can." - "I need to reduce my exposure to people that have upper respiratory infections." - "I am allowed to miss only one desensitization appointment before my treatment is affected."
Correct response: "I should use my medication for allergy exacerbation only when my allergy is apparent." "I need to reduce my exposure to people that have upper respiratory infections." "I will remove as much carpet from my house as I can." Explanation: The client should only use their medication when allergy is apparent so they do not develop a tolerance, which can occur when the medication is used all the time. The client should reduce their exposure to people that have upper respiratory infections because they are more susceptible to getting sick. Removing as much carpet from the house as possible will help reduce allergens. The client cannot miss any desensitization appointments because it will interfere with dosage adjustments. While taking an antihistamine, alcohol cannot be consumed at all, as antihistamines can exaggerate the effects of alcohol.
A clinic nurse has been charged with the responsibility of teaching avoidance strategies to an adult patient who has allergic rhinitis. What measure should the nurse recommend to this patient? - "Make sure that there are never air drafts in your home." - "Avoid the use of air conditioning whenever possible." - "If possible, make sure that no one smokes tobacco in your home." - "Keep your windows open to ensure adequate air circulation."
Correct response: "If possible, make sure that no one smokes tobacco in your home." Explanation: Avoidance strategies for allergic rhinitis include maintaining a smoke-free home, keeping windows closed during peak times, and using air conditioning whenever possible. Air drafts do not necessarily exacerbate allergies.
The nurse is teaching a client about a recent order for loratadine to help with seasonal allergies. What client statements indicate no further teaching is required? Select all that apply. - "Taking my medication on an empty stomach is a must." - "It is recommended that I buy a humidifier for my bedroom." - "Being careful driving is important after taking the medication." - "Sucking on ice chips will help if my mouth is dry." - "Drinking two or three alcoholic drinks a week is okay."
Correct response: "Taking my medication on an empty stomach is a must." "Sucking on ice chips will help if my mouth is dry." "Being careful driving is important after taking the medication." "It is recommended that I buy a humidifier for my bedroom." Explanation: Client education includes instructing the client to take the medication on an empty stomach to prevent food from interfering with absorption. Avoid alcohol because the medication can cause increased drowsiness. A side effect is dry mouth, and sucking on ice chips will help. Being careful when driving is important because the medication can cause drowsiness. Using a humidifier will help decrease the negative symptoms associated with humidity.
A nurse is teaching a client how to use their EpiPen autoinjector. What client statement indicates the teaching is understood? Select all that apply. - "The EpiPen autoinjector needs to be pointed downward." - "I will jab the EpiPen autoinjector firmly into my right upper buttock." - "The needle needs to be at a 90-degree angle." - "After I administer the injection, I will massage the area for 10 seconds." - "The EpiPen autoinjector should be held against the injection site for 20 seconds."
Correct response: "The EpiPen autoinjector needs to be pointed downward." "The needle needs to be at a 90-degree angle." "After I administer the injection, I will massage the area for 10 seconds." Explanation: The EpiPen autoinjector is pointed downward. The medication may not work as well if the injection is given in the buttocks. The preferred site is the thigh to avoid hitting bone, nerves, vessels or organs. The needle needs to be at a 90-degree angle. Massaging the area for 10 seconds after administering the injection increases the speed of absorption. Holding the EpiPen autoinjector against the thigh for 10 seconds gives the medication time to be fully administered. Holding the injector against the thigh is not necessary.
The nurse is teaching a client how to self-administer epinephrine using an EpiPen autoinjector. What information should be included in the teaching? Select all that apply. a) Grasp the EpiPen autoinjector pointing upward. b) Jab the EpiPen autoinjector firmly into the outer thigh. c) The needle should be at a 30 degree angle. d) The buttocks can be used as an injection site. e) After administering the injection, massage the area for 10 seconds. f) Hold the EpiPen autoinjector against the thigh for 10 seconds.
Correct response: -Jab the EpiPen autoinjector firmly into the outer thigh. -After administering the injection, massage the area for 10 seconds. -Hold the EpiPen autoinjector against the thigh for 10 seconds. Explanation: The EpiPen autoinjector is administered pointing downward not upward. The EpiPen autoinjector is firmly jabbed into the outer thigh to ensure the needle pierces the skin. The needle needs to be at a 90-degree angle, not at a 30-degree angle. The medication may not work as well if the injection is given in the buttocks. The preferred site is the thigh to avoid hitting bone, nerves, vessels or organs. Massaging the area for 10 seconds after administering the injection increases the speed of absorption. Holding the EpiPen autoinjector against the thigh for 10 seconds gives the medication time to be fully administered.
A 17-year-old girl with spina bifida is helping her mother prepare for her younger brother's birthday party. After blowing up a balloon, the girl develops erythema and itching around her mouth. This is likely due to which of the following? A food allergy A latex allergy A developing cold sore Facial eczema
Correct response: A latex allergy Explanation: Health care workers and patients with exposure to latex, as in spina bifida, are at risk for developing a latex allergy. Symptoms of latex allergy can range from mild contact dermatitis and erythema to moderately severe symptoms of rhinitis and conjunctivitis, urticaria, and bronchospasm. Balloons, condoms, and catheters are some of the items that contain latex. The girl would not have a developing cold sore from blowing up balloons. Nor would she have a food allergy or facial eczema.
A middle-aged woman suffers from debilitating seasonal allergies and has sought care because over-the-counter remedies do not adequately relieve her symptoms. The clinician's understanding of the patient's problem should include the fact that hypersensitivity is a result of what pathophysiological process? - An exaggerated, inappropriate response to an antigen - Deranged function of killer T cells and helper T cells - Lack of "self" and "non-self" differentiation by the immune system - A lack of antibodies against common pathogens
Correct response: An exaggerated, inappropriate response to an antigen Explanation: Hypersensitivity is an amplified or inappropriate response to an antigen (on second exposure), leading to inflammation and destruction of healthy tissue. It is not rooted in abnormal T-cell function or lack of antibodies. Autoimmune reactions occur when self-antigens are recognized by the body's normal defense mechanisms as foreign.
At an office birthday party, one of the executives ate a piece of cake that he was unaware had been made with peanut oil. He begins wheezing, with an inspiratory stridor and air hunger. The occupational health nurse is called to the office. The nurse recognizes he is suffering from which type of hypersensitivity? - Anaphylactic (type 1) - Immune Complex (type III) - Delayed type (type IV) - Cytotoxic (type II)
Correct response: Anaphylactic (type 1) Explanation: The most severe form of a hypersensitivity reaction is anaphylaxis. An unanticipated severe allergic reaction that is often explosive in onset, anaphylaxis is characterized by edema in many tissues, including the larynx, and is often accompanied by hypotension, bronchospasm, and cardiovascular collapse in severe cases. Type II, or cytotoxic, hypersensitivity occurs when the system mistakenly identifies a normal constituent of the body as foreign. Immune complex (type III) or immune complex hypersensitivity involves immune complexes formed when antigens bind to antibodies. Type III is associated with systemic lupus erythematosus, rheumatoid arthritis, certain types of nephritis, and bacterial endocarditis. Delayed type IV is also known as cellular hypersensitivity and occurs 24 to 72 hours after exposure to an allergen.
The nurse is creating a discharge teaching plan for a client with a latex allergy. Which information should be included? Select all that apply. - Radioallergosorbent testing (RAST) - Avoidance of latex-based products - Administration of antihistamines - Administration of emergency epinephrine
Correct response: Avoidance of latex-based products Administration of antihistamines Administration of emergency epinephrine Explanation: 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.
An occupational health nurse is assessing a woman who experienced an anaphylactic reaction to a dip that contained crab during an office celebration. Because the woman promptly self-administered epinephrine, her status has normalized and she is now resting in a colleague's office. What action should the nurse perform? - Liaise with the woman's family and arrange for her to return home. - Have the woman transported to a nearby emergency department. - Encourage the woman to limit her physical activity for the next 24 to 48 hours. - Provide reassurance to limit the woman's anxiety.
Correct response: Have the woman transported to a nearby emergency department. Explanation: Patients who have experienced anaphylactic reactions and received epinephrine should be transported to the local emergency department for observation and monitoring because of the risk for a "rebound" reaction 4 to 10 hours after the initial allergic reaction. This is a priority over anxiety reduction and activity limitation.
The nurse is conducting a medication reconciliation of a newly admitted hospital patient, during which the patient states that he has begun taking loratadine (Claritin) every day because of his longstanding allergies. What teaching point should the nurse consequently provide to this patient? - He should not take the drug every day because increased tolerance and reduced effectiveness will result. - The patient should take the drug consistently, regardless of the presence or absence of allergy symptoms. - The patient should take an increased dose during nonallergy seasons to increase serum levels of the drug when symptoms appear. - The drug will be ineffective if the patient's allergy triggers include environmental allergens.
Correct response: He should not take the drug every day because increased tolerance and reduced effectiveness will result. Explanation: Patients need to understand that medications for allergy control should be used only when the allergy is apparent. This is usually on a seasonal basis. Continued use of medications when not required can cause an increased tolerance to the medication, with the result that the medication will not be effective when needed. Antihistamines are effective against environmental allergens.
A middle-aged man has presented for care to a nurse practitioner because his seasonal allergies are detracting from his quality of life. What should the nurse teach this patient about allergic rhinitis? - Allergic rhinitis is a risk factor for chronic obstructive pulmonary disease (COPD). - A diagnosis is based on signs and symptoms because no objective diagnostic tests exist. - Allergic rhinitis develops as a result of prolonged exposure to unhygienic conditions. - Immunotherapy may have the potential to provide long-term relief from symptoms.
Correct response: Immunotherapy may have the potential to provide long-term relief from symptoms. Explanation: Immunotherapy can be an effective treatment for many patients with allergic rhinitis. Unhygienic conditions can exacerbate the problem, but these are not implicated in the etiology of allergic rhinitis. Diagnostic testing is widely available, and allergic rhinitis is not a risk factor for COPD.
A patient has developed severe contact dermatitis with burning, itching, cracking, and peeling of the skin on her hands. What should the patient be instructed to do? - Wear powdered latex gloves. - Wash her hands with antibacterial soap. - Maintain the room temperature at 80°F. - Keep her hands well moisturized.
Correct response: Keep her hands well moisturized. Explanation: Treatment of patients with atopic dermatitis must be individualized. Guidelines for treatment include decreasing itching and scratching by wearing cotton fabrics, washing with a mild detergent, humidifying dry heat in the winter, maintaining a moderate room temperature, using antihistamines such as diphenhydramine, and avoiding animals, dust, sprays, and perfumes. Keeping the skin moisturized with daily baths to hydrate the skin and topical skin moisturizers is encouraged.
A surgical nurse is careful to include an assessment question addressing latex allergies for each patient who is admitted to the surgical day care unit. This nurse should be aware that which of the following patients tend to have an increased risk of latex allergies? - Patients who have undergone multiple surgeries and medical procedures - Patients who have autoimmune diseases such as rheumatoid arthritis - Patients who have decreased neutrophil counts - Patients who have type 1 or type 2 diabetes mellitus
Correct response: Patients who have undergone multiple surgeries and medical procedures Explanation: All patients should be asked about latex allergy, although special attention should be given to those at particularly high risk (e.g., patients with spina bifida, patients who have undergone multiple surgical procedures). Autoimmune diseases, diabetes, and neutropenia are not associated with an increased risk of latex allergy.
What are expected client outcomes the nurse would include in a plan of care for a client with allergic rhinitis? Select all that apply. a) The client's lungs will have occasional crackles or rhonchi b) The client will wear a dampened mask if dust is a problem c) The client reports no symptoms of peripheral tingling d) The client controls outdoor precipitating factors e) The client develops cachexia
Correct response: The client will wear a dampened mask if dust is a problem The client reports no symptoms of peripheral tingling The client controls outdoor precipitating factors Explanation: Wearing a dampened mask if there is a dust problem, reporting no symptoms of peripheral tingling, and controlling outdoor precipitating factors are all expected client outcomes that would be included in a plan of care. Lungs should be absent of crackles or rhonchi. Cachexia is seen in clients with a chronic illness, such as AIDS, chronic obstructive pulmonary disease, or heart failure.
Allergy testing has revealed that an elementary school-aged child has a severe hypersensitivity to insect stings. When conducting health education with the child's parents, the nurse should address which of the following subjects? - The importance of limiting the child's activity level when outdoors - The importance of keeping a metered-dose inhaler of albuterol with the child - The need for the child to carry an EpiPen - The need to provide antihistamine tablets to the child's teacher and caregivers
Correct response: The need for the child to carry an EpiPen Explanation: People who are sensitive to insect bites and stings, those who have experienced food or medication reactions, and those who have experienced idiopathic or exercise-induced anaphylactic reactions should always carry an emergency kit that contains epinephrine. This is a priority intervention over the administration of bronchodilators. Oral antihistamines are not used in the emergency treatment of anaphylaxis, and there is no need for activity limitation.
A patient with severe environmental allergies is scheduled for the first in a planned series of immunotherapy injections. What should be included in teaching the patient about the injection? - The injection will cure the response to the allergen within 6 to 8 weeks. - The patient will remain in the clinic to be monitored for 30 minutes following the injection. - Therapeutic failure occurs if the symptoms to the allergen do not decrease after 3 months. - Injections are usually administered twice weekly.
Correct response: The patient will remain in the clinic to be monitored for 30 minutes following the injection. Explanation: Although severe systemic reactions are rare, the risk of systemic and potentially fatal anaphylaxis exists. It tends to occur most frequently at the induction or "up-dosing" phase. Therefore, the patient must be monitored after administration of immunotherapy. Because of the risk of anaphylaxis, injections should not be administered by a lay person or by the patient. The patient must remain in the office or clinic for at least 30 minutes after the injection, and is observed for possible systemic symptoms. Therapeutic failure is evident when a patient does not experience a decrease in symptoms within 12 to 24 months. Maintenance booster injections are administered at 2- to 4-week intervals, frequently for a period of several years, before maximum benefit is achieved.
A nurse who works on a busy medical unit has been experiencing dry, itchy, reddened hands that she believes are a result of the frequent hand-washing that her job requires. What should the nurse's colleague recommend for the relief of this problem? Use of a different type of soap Over-the-counter antihistamines Topical corticosteroids Handwashing with water alone
Correct response: Use of a different type of soap Explanation: Irritant dermatitis requires identification and removal of source of irritation, which in this case is almost certainly the soap or hand-washing product that is in use on the unit. The nurse should obtain an alternative product because hand-washing with water alone is a violation of infection control. Antihistamines and corticosteroids are unlikely to produce relief.
The nurse is teaching a client about contact dermatitis. What type of contact dermatitis requires light exposure in addition to allergen contact? photoallergic phototoxic irritant allergic
Correct response: photoallergic Explanation: 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.
A client has been seeing an allergist for 6 months for treatment of allergies. The client's allergies have been insufficiently controlled by symptomatic treatments and the physician has suggested desensitization. The anticipated outcome of desensitization is that repeated exposure to the: - weak antigen promotes the production of IgG, an antibody that blocks IgE so it cannot stimulate mast cells. - strong antigen promotes the production of IgE, an antibody that blocks IgG so it cannot stimulate mast cells. - weak antigen promotes the production of IgE, an antibody that blocks IgG so it cannot stimulate basophils. - strong antigen promotes the production of IgG, an antibody that blocks IgE so it cannot stimulate basophils.
Correct response: weak antigen promotes the production of IgG, an antibody that blocks IgE so it cannot stimulate mast cells. Explanation: 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. Repeated exposure to the weak antigen promotes the production of IgG, an antibody that blocks IgE so it cannot stimulate mast cells.
A patient with seasonal allergies has told the nurse that a colleague recommended pseudoephedrine hydrochloride (Sudafed) as a means of controlling signs and symptoms. The nurse should be aware that this drug provides relief for many patients but adverse effects include a risk of: Gastritis Depression Anxiety Decreased urine output
Correct response: Anxiety Explanation: Although considered safe if used as directed, some patients will complain of mild shakiness, heart palpitations, and anxiety shortly after ingestion of pseudoephedrine hydrochloride. This drug is not associated with gastritis, decreased urine output, or depression.
A nurse is aware of the need to assess patients' risks for anaphylaxis. What health care procedure constitutes the highest risk for anaphylaxis? A) Administration of the measles-mumps-rubella (MMR) vaccine B) Rapid administration of intravenous fluids C) Computed tomography with contrast solution D) Administration of nebulized bronchodilators
C) Computed tomography with contrast solution Radiocontrast agents present a significant threat of anaphylaxis in the hospital setting. Vaccinations less often cause anaphylaxis. Bronchodilators and IV fluids are not implicated in hypersensitivity reactions.
A nurse is caring for a teenage girl who has had an anaphylactic reaction after a bee sting. The nurse is providing patient teaching prior to the patient's discharge. In the event of an anaphylactic reaction, the nurse informs the patient that she should self-administer epinephrine in what site? A) Forearm B) Thigh C) Deltoid muscle D) Abdomen
B) Thigh The patient is taught to position the device at the middle portion of the thigh and push the device into the thigh as far as possible. The device will autoinject a premeasured dose of epinephrine into the subcutaneous tissue.
A junior nursing student is having an observation day in the operating room. Early in the day, the student tells the OR nurse that her eyes are swelling and she is having trouble breathing. What should the nurse suspect? A) Cytotoxic reaction due to contact with the powder in the gloves B) Immune complex reaction due to contact with anesthetic gases C) Anaphylaxis due to a latex allergy D) Delayed reaction due to exposure to cleaning products
C) Anaphylaxis due to a latex allergy Immediate hypersensitivity to latex, a type I allergic reaction, is mediated by the IgE mast cell system. Symptoms can include rhinitis, conjunctivitis, asthma, and anaphylaxis. The term latex allergy is usually used to describe the type I reaction. The rapid onset is not consistent with a cytotoxic reaction, an immune complex reaction, or a delayed reaction.
The nurse is educating a client about allergy management at home. What client statements indicate no further teaching is required? Select all that apply. - "I picked out a new tufted bedspread for my bed." - "I only let my dog sleep with me every other day." - "I have pull shades on all of my windows." - "I bought a wooden chair for my living room." - "I will vacuum my floors once a week."
Correct response: "I have pull shades on all of my windows." "I bought a wooden chair for my living room." Explanation: Using pull shades on windows and using steam for heating will help reduce environmental allergens such as dust. Rugs on floors will hold allergens in and floors need to be vacuumed every day. Dogs may bring allergens into the client's home, especially when in close proximity while sleeping.
The parents of a 3-year-old boy have just been informed that allergy testing suggests their son has multiple food allergies. When providing health education for this family, what subject should the nurse prioritize? - Alternative nutritional delivery systems - Coping strategies for the lifestyle changes that their son's diagnosis necessitates - The appropriate use of antihistamines in pediatric patients - Possible sources of food allergens and strategies for avoiding offending foods
Correct response: Possible sources of food allergens and strategies for avoiding offending foods Explanation: A teaching priority for individuals with food allergies surrounds the accurate identification and avoidance of possible allergens. Coping strategies are also likely relevant but avoiding allergens is a priority. Antihistamine use is secondary, and alternative nutritional delivery systems are almost never indicated.
The nurse is planning the care of an 8-year-old boy who has been diagnosed with atopic dermatitis. In the boy's plan of nursing care, what nursing diagnosis should the nurse prioritize? - Acute pain related to atopic dermatitis - Risk for delayed development related to atopic dermatitis - Risk for impaired skin integrity related to atopic dermatitis - Chronic pain related to atopic dermatitis
Correct response: Risk for impaired skin integrity related to atopic dermatitis Explanation: Impaired skin integrity is central to the clinical presentation of atopic dermatitis and should be a priority in the planning and provision of care. Atopic dermatitis is unpleasant but does not normally result in acute or chronic pain. The problem will have an effect on the child's routines and quality of life but is not likely to have an appreciable effect on his overall growth and development.
The nurse is preparing a patient with a suspected latex allergy for the radioallergosorbent test (RAST). Which of the precautionary steps is most important for the nurse to follow? a) The test should be performed during bronchospasm. b) Scratch tests are performed after the RAST. c) Prick tests are performed after the RAST. d) Emergency equipment should be available.
Correct response: Emergency equipment should be available. Explanation: In cases of doubt about the validity of the skin test, a RAST or provocative challenge test may be performed. If a skin test is indicated, there is a reasonable suspicion that a specific allergen is producing symptoms in an allergic patient. However, several precautionary steps must be observed before skin testing with allergens: Testing is not performed during periods of bronchospasm, Epicutaneous tests (scratch and prick tests) are performed before other testing methods in an effort to minimize the risk of systemic reaction. Emergency equipment must be readily available to treat anaphylaxis.
A client comes to the clinic for evaluation, stating "I think I have seasonal allergies." The nurse suspects that the client may have allergic rhinitis based on which assessment finding? Select all that apply. - gray-black discoloration under the eyes - conjunctival erythema - rhinorrhea - rash on the neck - nonpalpable cervical lymph nodes
Correct response: gray-black discoloration under the eyes rhinorrhea conjunctival erythema Explanation: A client suffering with allergic rhinitis may appear fatigued (the client may report not feeling well-rested after a full night's sleep). The client may present with any of the following conditions: clear or cloudy fluid surrounding the tympanic membranes; nasal congestion or rhinorrhea; marked erythema of palpebral conjunctivae associated with increased tearing; enlarged nasal turbinates that are a pale-bluish color and boggy in texture; enlarged anterior cervical lymph nodes; cobblestoned appearance on the posterior pharynx (due to chronic postnasal drip and nasal congestion); sinus tenderness on palpation; allergic "shiners" (gray-black discoloration below lower eyelids sometimes referred to as "raccoon eyes"); and puffy eyes.
Which of the following individuals would be the most appropriate candidate for immunotherapy? A) A patient who had an anaphylactic reaction to an insect sting B) A child with allergies to eggs and dairy C) A patient who has had a positive tuberculin skin test D) A patient with severe allergies to grass and tree pollen
D) A patient with severe allergies to grass and tree pollen The benefit of immunotherapy has been fairly well established in instances of allergic rhinitis and bronchial asthma that are clearly due to sensitivity to one of the common pollens, molds, or household dust. Immunotherapy is not used to treat type I hypersensitivities. A positive tuberculin skin test is not an indication for immunotherapy.
A child has been transported to the emergency department (ED) after a severe allergic reaction. The ED nurse is evaluating the patient's respiratory status. How should the nurse evaluate the patient's respiratory status? Select all that apply. A) Facilitate lung function testing. B) Assess breath sounds. C) Measure the child's oxygen saturation by oximeter. D) Monitor the child's respiratory pattern. E) Assess the child's respiratory rate.
B) Assess breath sounds. C) Measure the child's oxygen saturation by oximeter. D) Monitor the child's respiratory pattern. E) Assess the child's respiratory rate. The respiratory status is evaluated by monitoring the respiratory rate and pattern and by assessing for breathing difficulties, low oxygen saturation, or abnormal lung sounds such as wheezing. Lung function testing is a lengthy procedure that is not appropriate in an emergency context.
The nurse in an allergy clinic is educating a new patient about the pathology of the patient's health problem. What response should the nurse describe as a possible consequence of histamine release? A) Constriction of small venules B) Contraction of bronchial smooth muscle C) Dilation of large blood vessels D) Decreased secretions from gastric and mucosal cells
B) Contraction of bronchial smooth muscle Histamine's effects during the immune response include contraction of bronchial smooth muscle, resulting in wheezing and bronchospasm, dilation of small venules, constriction of large blood vessels, and an increase in secretion of gastric and mucosal cells.
A patient has presented with signs and symptoms that are consistent with contact dermatitis. What aspect of care should the nurse prioritize when working with this patient? A) Promoting adequate perfusion in affected regions B) Promoting safe use of topical antihistamines C) Identifying the offending agent, if possible D) Teaching the patient to safely use an EpiPen
C) Identifying the offending agent, if possible Identifying the offending agent is a priority in the care of a patient with dermatitis. Antihistamines are not administered topically and epinephrine is not used to treat dermatitis. Inadequate perfusion occurs with PAD or vasoconstriction.
An adult patient's primary care provider prescribed fluticasone (Flonase) by metered-dose inhaler, which the patient states that she administers whenever she senses the onset of her allergy symptoms. How should the nurse respond to this patient's statement? a) "You need to combine a dose of this drug with an over-the-counter antihistamine to bring about allergy relief." b) "This drug has a long-term effect and won't provide immediate relief of your symptoms." c) "It's better if you can anticipate situations and places that will trigger your allergies and take a dose before you feel symptoms." d) "It sounds like you understand this drug and the best way to use it to treat your allergies."term-14
Correct response: "This drug has a long-term effect and won't provide immediate relief of your symptoms." Explanation: Corticosteroids provide full benefit in several days to 2 weeks. Consequently, they are not used for short-term allergy relief. They do not require potentiation by antihistamines.
A client comes to the clinic for a follow up visit. The client tells the nurse, "I think I was having a mild allergic reaction yesterday to some shrimp that I ate." After further assessment, which manifestations would the nurse expect the client to report that would support a mild reaction? Select all that apply. - itching - tingling of the hands - swelling around the eyes - flushing - sneezing
Correct response: tingling of the hands swelling around the eyes sneezing Explanation: 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 also can be expected. Moderate systemic reactions may include flushing, warmth, anxiety, and itching in addition to any of the milder symptoms.
The nurse is administering a sympathomimetic drug to a patient. What areas of concern does the nurse have when administering this drug? (Select all that apply.) Constricts integumentary smooth muscle Causes laryngospasm Causes bronchodilation Causes bronchoconstriction Dilates the muscular vasculature
Correct response: Causes bronchodilation Constricts integumentary smooth muscle Dilates the muscular vasculature Explanation: The patient must be aware of the effects caused by overuse of the sympathomimetic agents in nose drops or sprays, because a condition referred to as rhinitis medicamentosa may result. After topical application of the medication, a rebound period occurs in which the nasal mucous membranes become more edematous and congested than they were before the medication was used.
A nurse is caring for a client with atopic dermatitis. Which suggestions for the client by the nurse would be appropriate? Select all that apply. - Use a strong antibacterial detergent for the laundry. - Keep the room temperature at approximately 70 degrees Fahrenheit (21 degrees Celsius). - Apply topical moisturizers to the skin. - Wear clothing made from synthetic fabrics. - Humidify the home when the heat is on during the winter.
Correct response: Keep the room temperature at approximately 70 degrees Fahrenheit (21 degrees Celsius). Apply topical moisturizers to the skin. Humidify the home when the heat is on during the winter. Explanation: The nurse would suggest that the client use a mild detergent for laundry and keep the room temperature between 68 to 72 degrees Fahrenheit (20 to 22 degrees Celsius) 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.
A patient with multiple food and environmental allergies tells the nurse that he is frustrated and angry about having to be so watchful all the time and wonders if it is really worth it. What would be the nurse's best response? A) "I can only imagine how you feel. Would you like to talk about it?" B) "Let's find a quiet spot and I'll teach you a few coping strategies." C) "That's the same way that most patients who have a chronic illness feel." D) "Do you think that maybe you could be managing things more efficiently?"
A) "I can only imagine how you feel. Would you like to talk about it?" To assist the patient in adjusting to these modifications, the nurse must have an appreciation of the difficulties encountered by the patient. The patient is encouraged to verbalize feelings and concerns in a supportive environment and to identify strategies to deal with them effectively. The nurse should not suggest that the patient has been mismanaging his health problem and the nurse should not make comparisons with other patients. Further assessment should precede educational interventions.
A school nurse is caring for a child who appears to be having an allergic response. What should be the initial action of the school nurse? A) Assess for signs and symptoms of anaphylaxis. B) Assess for erythema and urticaria. C) Administer an OTC antihistamine. D) Administer epinephrine.
A) Assess for signs and symptoms of anaphylaxis. If a patient is experiencing an allergic response, the nurse's initial action is to assess the patient for signs and symptoms of anaphylaxis. Erythema and urticaria may be present, but these are not the most significant or most common signs of anaphylaxis. Assessment must precede interventions, such as administering an antihistamine. Epinephrine is indicated in the treatment of anaphylaxis, not for every allergic reaction.
A nurse is preparing a patient for allergy skin testing. Which of the following precautionary steps is most important for the nurse to follow? A) The patient must not have received an immunization within 7 days. B) The nurse should administer albuterol 30 to 45 minutes prior to the test. C) Prophylactic epinephrine should be administered before the test .D) Emergency equipment should be readily available.
D) Emergency equipment should be readily available. Emergency equipment must be readily available during testing to treat anaphylaxis. Immunizations do not contraindicate testing. Neither epinephrine nor albuterol is given prior to testing.
The nurse is teaching a client newly diagnosed with a peanut allergy about how to manage the allergy. What information should be included in the teaching? Select all that apply. - Wear a medic alert bracelet. - List symptoms of peanut allergy. - Identify ways to manage allergy while dining out. - Food labels on baked items are the only labels that need to be read. - Carry EpiPen autoinjector at all times.
Correct response: Wear a medic alert bracelet. List symptoms of peanut allergy. Identify ways to manage allergy while dining out. Carry EpiPen autoinjector at all times. Explanation: Wearing a medic alert bracelet allows others to be alerted of the allergy. Listing symptoms of the allergy makes the client aware of the allergic reaction if symptoms are being experienced. Identifying ways to manage allergies while dining out allows the client to be safe from a potential reaction. All food labels should be read not only baked items. The EpiPen autoinjector should be carried at all times in case it needs to be administered because of an allergic reaction.
A nurse is caring for a patient who has allergic rhinitis. What intervention would be most likely to help the patient meet the goal of improved breathing pattern? A) Teach the patient to take deep breaths and cough frequently. B) Use antihistamines daily throughout the year. C) Teach the patient to seek medical attention at the first sign of an allergic reaction. D) Modify the environment to reduce the severity of allergic symptoms.
D) Modify the environment to reduce the severity of allergic symptoms. The patient is instructed and assisted to modify the environment to reduce the severity of allergic symptoms or to prevent their occurrence. Deep breathing and coughing are not indicated unless an infection is present. Anaphylaxis requires prompt medical attention, but a minority of allergic reactions are anaphylaxis. Overuse of antihistamines reduces their effectiveness.
The nurse is providing care for a patient who has a diagnosis of hereditary angioedema. When planning this patient's care, what nursing diagnosis should be prioritized? A) Risk for Infection Related to Skin Sloughing B) Risk for Acute Pain Related to Loss of Skin Integrity C) Risk for Impaired Skin Integrity Related to Cutaneous Lesions D) Risk for Impaired Gas Exchange Related to Airway Obstruction
D) Risk for Impaired Gas Exchange Related to Airway Obstruction Edema of the respiratory tract can compromise the airway in patients with hereditary angioedema. As such, this is a priority nursing diagnosis over pain and possible infection. Skin integrity is not threatened by angioedema.
A child has been diagnosed with a severe walnut allergy after suffering an anaphylactic reaction. What is a priority for health education? A) The need to begin immunotherapy as soon as possible B) The need for the parents to carry an epinephrine pen C) The need to vigilantly maintain the child's immunization status D) The need for the child to avoid all foods that have a high potential for allergies
B) The need for the parents to carry an epinephrine pen All patients with food allergies, especially seafood and nuts, should have an EpiPen device prescribed. The child does not necessarily need to avoid all common food allergens. Immunotherapy is not indicated in the treatment of childhood food allergies. Immunizations are important, but do not address food allergies.
The client presents to the health care provider's office with an allergic reaction. The health care provider documents the client's condition as a nonatopic, IgE-mediated response. What allergic reaction is this client experiencing? Eczema Rhinitis A latex allergy Asthma
Correct response: A latex allergy Explanation: A latex allergy does not have the genetic component and organ specificity as do the other choices. It is classified as nonatopic.
The nurse is teaching a client about the symptoms of anaphylaxis. Which client statements indicate no further teaching is needed? Select all that apply. - "If I experience recurrent diarrhea after eating, I will need to call my doctor." - "If I start having difficulty breathing, I need to get help right away." - "A feeling of fullness in my mouth is okay as long as it does not increase." - "Sneezing a lot can be a concern if it continues and does not let up." - "Peripheral tingling is a symptom of anaphylaxis reaction."
Correct response: "If I start having difficulty breathing, I need to get help right away." "Peripheral tingling is a symptom of anaphylaxis reaction." Explanation: Difficulty breathing is a life-threatening symptom of anaphylaxis and requires help right away. Peripheral tingling is a symptom of anaphylaxis reaction. Recurrent diarrhea is not a symptom of anaphylaxis. Sneezing is not a symptom of anaphylaxis reaction. A feeling of fullness in the mouth is a symptom of anaphylaxis reaction.
The nurse is conducting an assessment on a client that has acute irritant contact dermatitis. What signs and symptoms would the nurse expect to see upon assessment? Select all that apply. - rhinitis - blisters - redness - cracked skin - edema
Correct response: edema redness Explanation: Edema is an acute symptom of irritant contact dermatitis. Cracked skin is a chronic symptom of irritant contact dermatitis. Blisters are symptoms of allergic contact dermatitis. Redness is an acute symptom of irritant contact dermatitis. Rhinitis is a symptom of latex allergy.
