NUR 211 Hypersensitivity

A client is prescribed prednisone for treatment of a type I reaction. The nurse plans to monitor the client for which adverse effects? Select all that apply. A. Fluid retention B. Gastric distress C. Hypotension D. Infection E. Osteoporosis

A B D E

The nurse is assessing a client with suspected serum sickness. Which symptoms will be consistent with serum sickness? Select all that apply. A. Arthralgia B. Blurred vision C. Lymphadenopathy D. Malaise E. Ptosis

A C D

When preparing the client for allergy testing, the nurse provides the client with which instruction? A. "Avoid taking your loratadine (Claritin) and triamcinolone (Azmacort) inhaler for 5 days before testing." B. "It is okay to use your fluticasone propionate (Flonase) nasal spray before testing." C. "Aspirin in a low dose is allowed to be taken before testing." D. "You can take antihistamine nasal sprays before testing."

A. "Avoid taking your loratadine (Claritin) and triamcinolone (Azmacort) inhaler for 5 days before testing."

Situation: The client with a history of asthma is admitted to the clinic for allergy testing. During skin testing, the client develops shortness of breath and stridor and becomes hypotensive. What is the most appropriate drug for the nurse to give in this situation? A. Epinephrine (Adrenalin) B. Fexofenadine (Allegra) C. Cromolyn sodium (Nasalcrom) D. Zileuton (Zyflo)

A. Epinephrine (Adrenalin)

The client recently admitted to the hospital is to receive an antibiotic intravenously for the first time for a urinary tract infection. Before checking the five R's prior to administration, what is the nurse's first action? A. Review the clinical records and ask the client about any known allergies. B. Check with the pharmacy for any known allergies for this client. C. Check the client's identification band for any allergies. D. Ask the nurse who previously cared for the client about any known allergies.

A. The clinical record should have all known hypersensitivities listed for the client. Also, ask the client about any known allergies.

The nursing instructor asks the student nurse to explain a type IV hypersensitivity reaction. Which statement by the student best describes type IV hypersensitivity? A. "It is a reaction of immune globulin (Ig)G with the host cell membrane or antigen." B. "The reaction of sensitized T-cells with antigen and release of lymphokines activate macrophages and induce inflammation." C. "It results in release of mediators, especially histamine, because of the reaction of IgE antibody on mast cells." D. "An immune complex of antigen and antibodies is formed and deposited in the walls of blood vessels."

B

A client's complete blood count (CBC) with differential has the following values. Which value indicates to the nurse that the client is having some type of allergic reaction? A. Total white blood cell (WBC) count 100% B. Eosinophils 11% C. Lymphocytes 38% D. Neutrophils 66%

B. Eosinophils have granules that contain enzymes to degrade histamine and other vasoactive amines and thereby limit allergic and inflammatory responses. Normally, eosinophils compose only 1% to 2% of the total white blood cell population. This value rises in response to an allergic reaction of any type. Reference: p. 386, Physiological Integrity

A client is admitted to the hospital with suspected Goodpasture's syndrome. Which findings will the nurse expect to observe? A. Bradycardia B. Hemoptysis C. Increased urine output D. Weight loss

B. Hemoptysis is a manifestation of Goodpasture's syndrome. Goodpasture's syndrome usually is not diagnosed until serious lung and kidney problems are present.

Which precaution is most important for the nurse to teach a client receiving long-term immunosuppressive therapy for an autoimmune disease? A. Avoid crowds and people who are ill. B. Call your health care provider at the first sign of an infection. C. Assess your response to this medication at least once per month. D. Be sure to tell your dentist you are taking this therapy before having any dental work.

B. The client should be taught all of these precautions. However, because anyone who is immunosuppressed is unable to adequately defend against an infection, even a minor infection has the potential to lead to life-threatening sepsis. No infection, no matter how minor, should be ignored in a client who is immunosuppressed. Reference: p. 394, Health Promotion and Maintenance

The nurse plans to assess the client with type I hypersensitivity for which clinical manifestation? A. Poison ivy B. Autoimmune hemolytic anemia C. Allergic asthma D. Rheumatoid arthritis

C. Allergic asthma

A client who is receiving an intravenous antibiotic begins to cough and states, "My throat feels like it is swelling." Which action will the nurse take next?

C. Because the antibiotic is the most likely cause of the client's anaphylactic reaction, the nurse's first action should be to discontinue the antibiotic.

Assessment findings reveal that the client admitted to the hospital has a contact type I hypersensitivity to latex. Which preventive nursing intervention is best in planning care for this client? A. Report the need for desensitization therapy. B. Convey the need for pharmacologic therapy to the health care provider. C. Communicate the need for avoidance therapy to the health care team. D. Discuss symptomatic therapy with the health care provider.

C. Contact hypersensitivities can occur with latex, pollens, foods, and environmental proteins. Avoidance therapy is the recommended nursing intervention.

The client is being discharged from the hospital after an allergic reaction to environmental airborne allergens. Which instruction is most important for the nurse to include in this client's discharge teaching plan? A. Wash fruits and vegetables with mild soap and water before eating. B. Intermittent exposure to known allergens will produce immunity. C. Remove cloth drapes, carpeting, and upholstered furniture. D. Be cautious when eating unprocessed honey.

C. Remove cloth drapes, carpeting, and upholstered furniture.

The nurse is reviewing discharge teaching with the client who suffered an anaphylactic reaction to a bee sting. Which statement by the client indicates the need for further teaching? A. "I must wear a medical alert bracelet stating that I am allergic to bee stings." B. "I need to carry epinephrine with me." C. "My spouse must learn how to give me an injection." D. "I am immune to bee stings now that I have had a reaction."

D. "I am immune to bee stings now that I have had a reaction."

The middle-aged client, who is alert, is admitted to the emergency department (ED) with wheezing, difficulty breathing, angioedema, blood pressure (BP) of 70/52, and apical pulse of 122 and irregular. The nurse makes an immediate assessment using the ABCs for any client experiencing anaphylaxis. What nursing intervention is the immediate priority? A. Raise the lower extremities. B. Start intravenous (IV) administration of normal saline. C. Reassure the client that appropriate interventions are being instituted. D. Apply oxygen using a high-flow non-rebreather mask at 40% to 60%.

D. Apply oxygen using a high-flow non-rebreather mask at 40% to 60%.

The nurse prepares to administer zafirlukast (Accolate) to a client with allergic rhinitis. The nurse understands that zafirlukast works by which mechanism? A. Blocking histamine from binding to receptors B. Preventing synthesis of mediators C. Preventing mast cell membranes from opening D. Blocking the leukotriene receptor

D. Blocking the leukotriene receptor

The nurse is reviewing the medical record of a client who is prescribed a decongestant. The nurse plans to contact the client's health care provider if the client has which condition? A. Cataracts B. Crohn's disease C. Diabetes mellitus D. Hypertension

D. Decongestants have actions similar to adrenergic drugs, causing vasoconstriction, which can increase blood pressure.

A client in the allergy clinic develops all of these clinical manifestations after receiving an intradermal injection of an allergen. Which symptom requires the most immediate action by the nurse? A. Anxiousness B. Urticaria C. Pruritus D. Stridor

D. Stridor indicates airway involvement and warrants immediate intervention such as use of oxygen and administration of epinephrine. Maintaining the client's airway is the high-test priority.

Situation: The client with a history of asthma is prescribed a leukotriene receptor antagonist to prevent allergic rhinitis. The nurse anticipates that which drug will be prescribed? A. Cromolyn sodium (Nasalcrom) B. Desloratadine (Clarinex) C. Fexofenadine (Allegra) D. Zafirlukast (Accolate)

D. Zafirlukast (Accolate)