NUR 302: Ch 38 Assessment and management of patients with allergic disorders

Which of the following is a contraindication for immunotherapy?

Use of a beta-blocker

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?

"If I am pregnant, I should take half the dose."

A client presents at the clinic with an allergic disorder. The client asks the nurse what an "allergic disorder" means. What would be the nurse's best response?

"It is a hyperimmune response to something in the environment that is usually harmless."

A patient was seen in the clinic 3 days previously for allergic rhinitis and was given a prescription for a corticosteroid nasal spray. The patient calls the clinic and tells the nurse that the nasal spray is not working. What is the best response by the nurse?

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

A client with a history of allergic rhinitis comes to the clinic for an evaluation. The client is prescribed triamcinolone. Which of the following would the nurse include when teaching the client about this drug?

Be aware that some nasal burning and itching may occur.

The nurse is evaluating the plan of care for a client with an allergic disorder who has a nursing diagnosis of deficient knowledge related to measures for allergy control. Which of the following would indicate to the nurse that the outcome has been met?

Client identifies methods for reducing exposure risk to allergens.

Students are reviewing information about hypersensitivity disorders in preparation for class discussion the next day. The students demonstrate understanding of the material when they identify which of the following as a type IV hypersensitivity disorder?

Contact dermatitis

Which of the following is the most frequent route of exposure to a latex allergy?

Cutaneous

A client with an allergic disorder calls the nurse and asks what treatment is available for allergic disorders. The nurse explains to the client that there is more than one treatment available. What treatments would the nurse tell the client about?

Desensitization

The nurse is preparing to administer a medication that has an affinity for H1 receptors. Which medication would the nurse administer?

Diphenhydramine (Benadryl)

When assessing the skin of a client with allergic contact dermatitis, the nurse would most likley expect to find irritation at which area?

Dorsal aspect of the hand

Which term refers to an incomplete antigen?

Hapten

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

High IgE concentration

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:

Histamine.

When describing the immunoglobulin most likely involved with allergic reactions, which of the following would the nurse address?

IgE

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?

Jabs the autoinjector into the outer thigh at a 90-degree angle

Which of the following is considered the most serious manifestation of angioneurotic edema?

Laryngeal swelling

A patient has had a "stuffy nose" and obtained Afrin nasal spray. What education should the nurse provide to the patient in order to prevent "rebound congestion"?

Only use the Afrin for 3 to 4 days once every 12 hours.

Which type of contact dermatitis requires light exposure in addition to allergen contact?

Photoallergic

Preventive health education includes informing patients about the symptoms associated with allergic rhinitis. The nurse is aware that the most common trigger to this respiratory allergic response is

Plant pollen.

Preventive health education includes informing patients about the symptoms associated with allergic rhinitis. The nurse is aware that the most common trigger to this respiratory allergic response is:

Plant pollen.

Which intervention is the single most important aspect for the client at risk for anaphylaxis?

Prevention

An infant is born to a mother who had no prenatal care during her pregnancy. What type of hypersensitivity reaction does the nurse understand may have occurred?

Rh-hemolytic disease

A patient asks the nurse if it would be all right to take an over-the-counter antihistamine for the treatment of a rash. What should the nurse educate the patient is a major side effect of antihistamines?

Sedation

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:

Seizures.

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?

Serum IgE level

The nurse teaches the client with allergies about anaphylaxis, including which statement?

The most common cause of anaphylaxis is penicillin.

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 need for the child to carry an EpiPen

The nurse is caring for a teenage girl who has had an anaphylactic reaction after being stung by a wasp. 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?

Thigh

A nurse is preparing a discharge teaching plan for a client with atopic dermatitis. Which instruction should the nurse include in her teaching plan?

Use a topical skin moisturizer daily.

A nurse has developed irritant contact dermatitis from latex glove use. Which of the following would the nurse need to avoid?

Using oil-based hand lotion before donning gloves

A client is scheduled to begin immunotherapy. The nurse would explain that the client will receive injections initially at which interva

Weekly

A client is prescribed an oral corticosteroid for 2 weeks to relieve asthma symptoms. The nurse educates the client about side effects, which include

adrenal suppression.

The best treatment for latex allergy is

avoidance of latex-based products.

A nurse visits the employee health department because of mild itching and a rash on both hands. During the assessment interview, the employee health nurse should focus on:

chemical and latex glove use.

The nurse practitioner treating a patient with allergic rhinitis decides pharmacologic therapy would be helpful. Which of the following is she most likely to prescrib

Allegra

Which of the following would the nurse prioritize as the most important action for the patient to take to prevent anaphylaxis?

Avoid potential allergens

When a patient experiences an allergic reaction, the nurse should initially assess for:

Dyspnea, bronchospasm, and/or laryngeal edema.

Which body substance causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle?

Histamine

There are several types of reactions to latex. The nurse knows to be most concerned about laryngeal edema with the following reaction:

IgE-mediated hypersensitivity.

A client comes to the emergency department complaining of difficulty breathing. He states, "It feels like my throat is closing up. We were out to dinner and then I started feeling strange after we ate our shrimp cocktail." The client is leaning forward with a respiratory rate of 36 breaths per minute. His skin is pale. The nurse suspects anaphylaxis. Which nursing diagnosis would be the priority?

Ineffective airway clearance related to bronchospasm and laryngeal edema

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.

Keep the room temperature at approximately 70 degrees Farenheit. Apply topical moisturizers to the skin. Humidify the home when the heat is on during the winter.

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 anaplhylaxis? Select all that apply?

Milk Eggs Shrimp

The nurse is completing the intake assessment of a client new to the allergy clinic. The client 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 client experienced

Rhinitis medicamentosa

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?

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

A patient comes to the clinic with pruritus and nasal congestion after eating shrimp for lunch. The nurse is aware that the patient may be having an anaphylactic reaction to the shrimp. These symptoms typically occur within how many hours after exposure?

2 hours

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?

10:00 AM

Contact dermatitis is considered a type IV hypersensitivity reaction. The nurse is aware that this classification is characterized by which of the following?

A delayed-type hypersensitivity that is mediated by T cells

After receiving a dose of penicillin, a client develops dyspnea and hypotension. The nurse suspects the client is experiencing anaphylactic shock. What should the nurse do first?

Administer epinephrine, as ordered, and prepare to intubate the client, if necessary.

A nurse comes to the employee health center for evaluation and is diagnosed with allergic contact dermatitis related to latex. Which of the following would the nurse most likely exhibit?

Blistering

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?

Immunotherapy may have the potential to provide long-term relief from symptoms.

The nurse working in an allergy clinic is preparing to administer skin testing to a client. Which route is the safest for the nurse to use to administer the solution?

Intradermal

Which of the following aid in diagnosing the risk of anaphylaxis?

Intradermal testing

Which test indicates the quantity of allergen necessary to evoke an allergic reaction?

Serum-specific IgE test

What education should the nurse provide to the patient taking long-term corticosteroids?

The patient should not stop taking the medication abruptly and should be weaned off of the medication.

Which chemical mediators initiate and mediate the inflammatory response?

Leukotrienes

A patient is experiencing an allergic reaction to a dose of penicillin. What should the nurse look for in the patient's initial assessment?

Dyspnea, bronchospasm, and/or laryngeal edema.

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?

Eggs and nuts

What is the most common cause of anaphylaxis?

Penicillin

Which route of exposure to latex products occurs from use of latex condoms?

Mucosal

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?

15% to 40%

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:

A massive release of histamine

A health care provider prescribed Flonase, an intranasal corticosteroid, for a patient with a severe case of allergic rhinitis. The nurse told the patient that there is a delayed response to full benefits from the drug. The patient took his first dose on February 2. The patient should expect that the drug will be fully effective no later than:

February 15.

Nursing students are reviewing various medications that can be used to treat allergic disorders. The students demonstrate understanding of the information when they identify which of the following as an intranasal corticosteroid?

Fluticasone

Histamine release in anaphylaxis causes which of the following?

Nasal congestion

A nurse is preparing a presentation to a local commununity group about allergic disorders. Which medication would the nurse include as the most common cause of anaphylaxis?

Penicillin

A patient with a history of anaphylactic reactions to insect stings has just been stung by a wasp. The patient is going to self-administer his EpiPen. Place the steps in the correct order that he would follow. Use all options.

Remove the gray safety-release cap Inject the black tip into the outer thigh Massage the injection area Call the emergency medical response number (911)

The nurse is working with a colleague who has a delayed hypersensitivity (type IV) allergic reaction to latex. Which statement describes the clinical manifestations of this reaction?

Symptoms are localized to the area of exposure, usually the back of the hands.