PrepU: Chapter 33: Assessment and Management of Patients with Allergic Disorders

The nurse tells the client that if exposure to an allergen occurs around 8:00 AM, then the client should expect a mild or moderate reaction by what time? A. 10 AM B. 11 AM C. 1 PM D. 3 PM

A. 10 AM Mild and moderate reactions begin within 2 hours of exposure.

The nurse is preparing to administer a medication that has an affinity for H1 receptors. Which medication would the nurse administer? A. Omeprazole B. Nizatidine C. Diphenhydramine D. Cimetidine

C. Diphenhydramine Certain medications are categorized by their action at these receptors. Diphenhydramine (Benadryl) is an example of an antihistamine, a medication that displays an affinity for H1 receptors. Cimetidine (Tagamet) and nizatidine (Axid) target H2 receptors to inhibit gastric secretions in peptic ulcer disease.

Which term refers to an incomplete antigen? A. antigen B. antibody C. hapten D. allergen

C. hapten A hapten is an incomplete antigen. An allergen is a substance that causes manifestations of allergy. An antigen is a substance that induces the production of antibodies. An antibody is a protein substance developed by the body in response to and interacting with a specific antigen.

A client with an allergic disorder is in treatment for their disorder. What might their treatment be? A. autoimmune therapy B. hypersensitive therapy C. resensitization therapy D. drug therapy

D. drug therapy Besides avoiding the allergen if possible, many clients experience symptomatic relief with drug therapy. Options A, B, and C are distractors for this question.

The nurse is evaluating a client's readiness for allergy skin testing. The nurse determines that the testing will need to be postponed when it is revealed that the client took which classification of medication the night before? A. anticoagulant B. antihistamine C. anti-inflammatory D. antidepressant

B. antihistamine Antihistamines and corticosteroids suppress skin test reactivity and should be stopped at least 48 hours before testing, some experts state 72 hours to 96 hours before testing. It is best to check with the primary care provider regarding the use of antihistamines and corticosteroids and false negatives can occur during the skin testing.

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? A. Sublingual-swallow immunotherapy (SLIT) B. desensitization C. Sublingual-topical immunotherapy (STIT) D. resensitization

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

The nurse is reviewing various medications with a client that can be used to treat allergic disorders. What medication will the nurse identify as an intranasal corticosteroid? A. zileuton B. fluticasone C. cromolyn sodium D. fexofenadine

B. fluticasone Fluticasone is an example of an intranasal corticosteroid. Cromolyn sodium is a mast cell stabilizer. Zileuton is a leukotriene-receptor inhibitor. Fexofenadine is a second-generation antihistamine.

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? A. diarrhea B. sedation C. palpatations D. anorexia

B. sedation Antihistamines are the major class of medications prescribed for the symptomatic relief of allergic rhinitis. The major side effect is sedation, although H1 antagonists are less sedating than earlier antihistamines.

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. Serum IgE level B. Erythrocyte sedimentation rate C. Eosinophil count D. WBC count

A. 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 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? A. High IgE concentration B. high neutrophil count C. low eosinophil count D. lower WBC count

A. High IgE concentration A high total IgE concentration and/or a high percentage of eosinophils may indicate an allergic disorder. However, normal IgE levels do not exclude the diagnosis of an allergic disorder. The amounts of neutrophils and white blood cells are not affected by allergic disorders.

The nurse is teaching a client about latex allergies. What route of exposure from latex products occurs from use of latex condoms? A. mucosal B. percutaneous C. parenteral D. cutaneous

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 nurse is caring for a client exposed to peanuts with a known allergy. What assessment is considered the most serious manifestation of angioneurotic edema? A. conjunctivitis B. urticaria C. laryngeal swelling D. abdominal pain

C. laryngeal swelling Diffuse swelling can affect many regions: lips, eyelids, cheeks, hands, feet, genitalia, tongue, larynx, bronchi, and the gastrointestinal canal. The most serious is the larynx because of the potential for compromised breathing. Abdominal pain, conjunctivitis and urticaria are not the most serious manifestations.

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? A. "It means you are very sensitive to something inside of yourself." B. "It is a harmless reaction to something in the environment." C. "It is a muted response to something in the environment." D. "It is a hyperimmune response to something in the environment that is usually harmless."

D. "It is a hyperimmune response to something in the environment that is usually harmless." An allergic disorder is characterized by a hyperimmune response to weak antigens that usually are harmless. The antigens that can cause an allergic response are called allergens.

When assessing the skin of a client with allergic contact dermatitis, the nurse would most likely expect to find irritation at which area? A. dorsal aspect of the hand B. lower arms C. plantar aspects of the feet D. ankles

A. dorsal aspect of the hand With allergic contact dermatitis, irritation is most common on the dorsal aspects of the hand. Irritant, phototoxic, and photoallergic types of contact dermatitis are commonly seen on the hands and lower arms.

A nurse is working in a dermatology clinic with clients who have allergies. What is the most important chemical mediator involved in the allergic response? A. histamine B. prostaglandins C. serotonic D. leukotrienes

A. histamine The pathophysiology of an allergic response involves a chain of events that includes responses from lymphocytes, IgE, mast cells, and basophils. 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 client calls the clinic and asks the nurse if using oxymetazoline nasal spray would be all right to relieve the nasal congestion the client is experiencing due to seasonal allergies. What instructions should the nurse provide to the client to avoid complications? A. Report white patches in the mouth because the medication can cause a fungal infection B. Do not operate machinery or drive while using the medication C. Do not overuse the medication as rebound congestion can occur D. Taper the dose when discontinuing the medication

C. Do not overuse the medication as rebound congestion can occur Overusing oxymetazoline nasal spray can cause rebound congestion. The medication does not cause fungal infection. Corticosteroids should be tapered, but it is not necessary to taper oxymetazoline. Oxymetazoline does not cause sleepiness so the client can operate machinery or drive.

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? A. IM B. SC C. IV D. Intradermal

D. Intradermal The intradermal route is the correct route of administration for skin testing and therefore a safe route. Another safe route is epicutaneous. The type of skin testing being performed determines whether the nurse will administer the solution via the epicutaneous or intradermal route.

The nurse is administering intravenous vancomycin. What will the nurse initially assess the client for if an allergic reaction occurs? A. hypotension and tachycardia B. the presence and location of pruritus C. the severity of cutaneous warmth and flushing D. dyspnea, bronchospasm, and/or laryngeal edema

D. dyspnea, bronchospasm, and/or laryngeal edema Initial nursing assessment and intervention needs to be directed toward evaluating breathing and maintaining an open airway, so the initial assessment will be for dyspnea, bronchospasm, and laryngeal edema. Hypotension, pruritis, and flushing may occur, but the airway is most important.

The nurse knows the best strategy for latex allergy is A. avoidance of latex-based products B. corticosteroids C. epi from an emergency kit D. antihistamines

A. avoidance of latex-based products The best strategy available for latex allergy is to avoid latex-based products, but this is often difficult because of their widespread use. Antihistamines and an emergency kit containing epinephrine should be provided to these clients, along with instructions about emergency management of latex allergy.

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."

"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.

A client seeks medical attention for the development of a rash on the hands. Which assessment findings indicate to the nurse that the client is experiencing irritant contact dermatitis? Select all that apply. A. crust formation B. edema C. redness D. blisters E. burning

B. edema C. redness D. blisters Irritant contact dermatitis, a nonimmunologic response, may be caused by mechanical skin irritation or an alkaline pH associated with latex gloves. Symptoms of irritant contact dermatitis include edema, burning, and redness. Blisters and crust formation is associated with allergic contact dermatitis.

After receiving a dose of penicillin, a client develops dyspnea and hypotension and the nurse suspects the client is experiencing anaphylactic shock. What is the nurse's first action? A. insert an indwelling urinary catheter B. Continue to monitor V/S C. Administer epi, as ordered D. Page an anesthesiologist immediately

C. Administer epi, as ordered To reverse anaphylactic shock, the nurse first should administer epinephrine, a potent bronchodilator, as ordered. The health care provider is likely to order additional medications, such as antihistamines and corticosteroids; if the medications don't relieve the respiratory compromise associated with anaphylaxis. No antidote for penicillin exists; however, the nurse should continue to monitor the client's vital signs. A client who remains hypotensive may need fluid resuscitation and fluid intake and output monitoring with a Foley catheter; however, administering epinephrine is the first priority.

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? A. Bacterial endocarditis B. Lupus erythematosus C. Rh-hemolytic disease D. Rheumatoid arthritis

C. Rh-hemolytic disease A type II hypersensitivity, or cytotoxic, reaction, which involves binding either the IgG or IgM antibody to a cell-bound antigen, may lead to eventual cell and tissue damage. The reaction is the result of mistaken identity when the system identifies a normal constituent of the body as foreign and activates the complement cascade. Examples of type II reactions are myasthenia gravis, Goodpasture syndrome, pernicious anemia, hemolytic disease of the newborn, transfusion reaction, and thrombocytopenia.

A nurse is preparing a discharge teaching plan for a client with atopic dermatitis. Which instruction should the nurse include in the teaching plan? A. use a topical skin moisturizer daily B. bathe only three times per week C. keep the thermostat above 75 degrees D. wear only synthetic fabrics

A. 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 has had a "stuffy nose" and obtained an oxymetazoline nasal spray. What education should the nurse provide to the client in order to prevent "rebound congestion"? A. drink plenty of fluids B. Only use the nasal spray for 3 to 4 days once every 12 hours. C. Be sure to use the nasal spray for at least 10 days to ensure the stuffiness is gone. D. Use the medication every 4 hours to prevent congestion from recurring.

B. Only use the nasal spray for 3 to 4 days once every 12 hours. Adrenergic agents, which are vasoconstrictors of mucosal vessels, are used topically in nasal (oxymetazoline [Afrin]) and ophthalmic (brimonidine [Alphagan P]) formulations in addition to the oral route (pseudoephedrine [Sudafed]). The topical route (drops and sprays) causes fewer side effects than oral administration; however, the use of drops and sprays should be limited to a few days to avoid rebound congestion.

Which type of hypersensitivity reaction involves immune complexes forming when antigens bind to antibodies? A. Type I B. Type II C. Type III D. Type IV

C. Type III Type III hypersensitivity is associated with systemic lupus erythematosus, rheumatoid arthritis, serum sickness, certain types of nephritis, and some types of bacterial endocarditis. Type I, or anaphylactic hypersensitivity, is an immediate reaction, beginning within minutes of exposure to an antigen. Type II, or cytotoxic, hypersensitivity occurs when the system mistakenly identifies a normal constituent of the body as foreign. Type IV, or delayed-type, hypersensitivity occurs 24 to 72 hours after exposure to an allergen.

What education should the nurse provide to the patient taking long-term corticosteroids? A. The patient should not stop taking the medication abruptly and should be weaned off of the medication. B. The patient should discontinue using the drug immediately if weight gain is observed. C. The patient should take the medication only as needed and not take it unnecessarily. D. Corticosteroids are relatively safe drugs with very few side effects.

A. The patient should not stop taking the medication abruptly and should be weaned off of the medication. Patients who receive high-dose or long-term corticosteroid therapy must be cautioned not to stop taking the medication suddenly. Doses are tapered when discontinuing this medication to avoid adrenal insufficiency.

The nurse is teaching a client after a medication allergic reaction has occurred. What is the most important action for the nurse to teach the client to take to prevent anaphylaxis? A. carry an emergency kit B. avoid potential allergens C. undergo desensitization treatment D. wear a medical alert bracelet

B. avoid potential allergens Strict avoidance of potential allergens is the most important preventive measure for the patient at risk for anaphylaxis. People who have experienced food, medication, idiopathic, or exercise-induced anaphylactic reactions should always carry an emergency kit containing epinephrine for injection to prevent the onset of the reaction upon exposure, but avoiding potential allergens is more important. Desensitization, based on controlled anaphylaxis with a gradual release of mediators, is an effective treatment option, but it is more important to avoid allergic triggers. The medical alert bracelet will assist those rendering aid to the patient who has experienced an anaphylactic reaction, but it's better to avoid the reaction in the first place.

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

B. autoimmune Diseases are considered autoimmune disorders when they are characterized by unrelenting, progressive tissue damage without any verifiable etiology. The client did not have a previous disorder that has caused an exacerbation. An alloimmunity describes an immune response that is waged against transplanted organs and tissues that carry non self antigens. Because there is no identifiable cause, there can be no effect.

what is the most common cause of anaphylaxis? A. NSAIDS B. radiocontrast agents C. opioids D. penicillin

D. penicillin Penicillin is the most common pharmacological cause of anaphylaxis and accounts for about 75% of fatal anaphylactic reactions in the United States each year. Opioids, NSAIDs, and radiocontrast agents are some of the medications that are frequently reported as causing anaphylaxis.

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

D. angioedema Angioedema is potentially life threatening. Medical management would include intubation, subcutaneous epinephrine, and aminophylline in severe reactions.

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

C. "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 (e.g., asthma, urinary retention, open-angle glaucoma, hypertension, prostatic hyperplasia). The major side effect is sedation, although H1 antagonists are less sedating than earlier antihistamines. Additional side effects include nervousness, tremors, dizziness, dry mouth, palpitations, anorexia, nausea, and vomiting.

Which intervention is the single most important aspect for the client at risk for anaphylaxis? A. wearing a medical alert bracelet B. desensitization C. prevention D. use of antihistamines

C. prevention Prevention involves strict avoidance of potential allergens for the individual at risk for anaphylaxis. If avoidance of or exposure to allergens is impossible then the individual should be prepared with an emergency kit containing epinephrine for injection to prevent the onset of the reaction upon exposure. While helpful, there must be no lapses in desensitization therapy because this may lead to the reappearance of an allergic reaction when the medication is reinstituted. A medical alert bracelet will assist those rendering aid to a client who has experienced an anaphylactic reaction. antihistamines may not be effective in preventing anaphylaxis.