Chapter 33 Assessment and Management of Patients with Allergic Disorders

1. A client received a bee sting on the lip approximately 2 hours ago and has arrived at an

urgent/walk-in clinic for treatment because the swelling is now accompanied by nasal

congestion. On assessment, the client reports pruritus and a sensation of warmth at the

site. Which degree of anaphylaxis is the client experiencing?

A. No systemic reaction

B. Moderate systemic reaction

C. Severe systemic reaction

D. Mild systemic reaction

ANS: D

Rationale: Mild systemic reactions begin within the first 2 hours after the exposure, and

consist of cluster tingling and a sensation of warmth. Nasal congestion, periorbital

swelling, pruritus, sneezing, and tearing of the eyes is expected. While onset timing is the

same, moderate systemic reactions include bronchospasm, edema of the airways or

larynx with dyspnea, cough, and wheezing. Severe systemic reactions have an abrupt

onset with symptoms progressing rapidly to bronchospasm, laryngeal edema, severe

dyspnea, cyanosis, and hypotension. Severe systemic reaction should be considered as

an emergent situation. A systemic reaction occurred as a vector (the bee sting) and a

reaction (signs/symptoms) resulted.

A client with a family history of allergies has experienced an allergic response based on a genetic predisposition. This atopic response is usually mediated by which immunoglobulin (Ig)?

1) IgG

2) IgM

3) IgA

4) IgE

IgE

Explanation:

Atopy refers to allergic reactions characterized by the action of IgE antibodies and a genetic predisposition to allergic reactions. IgE (0.004% of total Ig) appears in serum; takes part in allergic and some hypersensitivity reactions; and combats parasitic infections. IgA (15% of total Ig) appears in body fluids (blood, saliva, tears, and breast milk, as well as pulmonary, gastrointestinal, prostatic, and vaginal secretions); protects against respiratory, gastrointestinal, and genitourinary infections; prevents absorption of antigens from food; and passes to neonate in breast milk for protection. IgM (10% of total Ig) appears mostly in intravascular serum; appears as the first Ig produced in response to bacterial and viral infections; and activates the complement system. IgG (75% of total Ig) appears in serum and tissues (interstitial fluid); assumes a major role in bloodborne and tissue infections; activates the complement system; enhances phagocytosis; and crosses the placenta.

3. An office worker eats a cookie that contains peanut butter. The worker 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

ANS: A

Rationale: 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

A client is learning about a new diagnosis of asthma with the asthma nurse. What medication will best prevent the onset of acute asthma exacerbations?

1) Epinephrine

2) Albuterol sulfate

3) Montelukast

4) Diphenhydramine

Montelukast

Explanation:

Many manifestations of inflammation can be attributed in part to leukotrienes. Medications categorized as leukotriene antagonists or modifiers such as montelukast block the synthesis or action of leukotrienes and prevent signs and symptoms associated with asthma. Diphenhydramine prevents histamine's effect on smooth muscle. Albuterol sulfate relaxes smooth muscle during an asthma attack. Epinephrine relaxes bronchial smooth muscle but is not used on a preventative basis.

A nurse is preparing a client for allergy skin testing. What precautionary step is most important for the nurse to follow?

1) The client must not have received an immunization within 7 days.

2) Prophylactic epinephrine should be given before the test.

3) The nurse should administer albuterol 30 to 45 minutes prior to the test.

4) Emergency equipment should be readily available.

Emergency equipment should be readily available.

Explanation:

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.

6. A client is scheduled for a skin test. The client informs the nurse that the client used a

corticosteroid earlier today to alleviate allergy symptoms. Which nursing intervention

should the nurse implement?

A. Note the corticosteroid use in the electronic health record and continue with the

test.

B. Modify the skin test to check for grass, mold, or dust allergies only.

C. Administer sodium valproate to reverse the effects of corticosteroid usage.

D. Cancel and reschedule the skin test when the client stops taking the

corticosteroid.

ANS: D

Rationale: Corticosteroids and antihistamines, including over-the-counter allergy

medications, suppress skin test reactivity and should be stopped 48 to 96 hours before

testing, depending on the duration of their activity. If the client takes one of these

medications within this time frame, the nurse should cancel the skin test and reschedule

for a time when the client is not taking it. The nurse should not continue with the test. The

nurse should not modify the test. Administration of sodium valproate is used to reverse

corticosteroid-induced mania, not to reverse it effects, in general.

7. A client has developed severe contact dermatitis with burning, itching, cracking, and

peeling of the skin on the client's hands. What should the nurse teach the client to do?

A. Wear powdered latex gloves when in public.

B. Wash her hands with antibacterial soap every few hours.

C. Maintain room temperature at 75 to 80°F (24° to 27°C) whenever possible.

D. Keep the hands well moisturized at all times

ANS: D

Rationale: Powdered latex gloves can cause contact dermatitis. Skin should be kept well

hydrated and should be washed with mild soap. Maintaining room temperature at 75 to

80°F (24° to 27°C) is excessively warm.

8. A client with severe environmental allergies is scheduled for an immunotherapy

injection. What should be included in teaching the client about this treatment?

A. The client will be given a low dose of epinephrine before the treatment.

B. The client 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 given by the peripheral intravenous (IV) route.

ANS: B

Rationale: Although severe systemic reactions are rare, the risk of systemic and

potentially fatal anaphylaxis exists. Because of this risk, the client 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 client 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.

9. The nurse in an allergy clinic is educating a new client about the pathology of the

client'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

ANS: B

Rationale: 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.

10. The nurse is providing care for a client who has experienced a type I hypersensitivity

reaction. Which client would have this type of reaction?

A. A client with an anaphylactic reaction after a bee sting

B. A client with a skin reaction resulting from adhesive tape

C. A client with a diagnosis of myasthenia gravis

D. A client with rheumatoid arthritis

ANS: A

Rationale: Anaphylactic (type I) hypersensitivity is an immediate reaction mediated by

immunoglobulin E 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.

11. A nurse is caring for a client who has had an anaphylactic reaction after a bee sting.

The nurse is providing client teaching prior to the client's discharge. In the event of an

anaphylactic reaction, the nurse explains that the client should self-administer

epinephrine at which site?

A. Forearm

B. Thigh

C. Deltoid muscle

D. Abdomen

ANS: B

Rationale: The client 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 automatically inject a

premeasured dose of epinephrine into the subcutaneous tissue. The muscle of the lateral

thigh is the best site to administer epinephrine because it is one of the largest muscles in

the body and has significant blood flow, which allows more rapid absorption of the

medication than in the smaller muscles in the forearm or shoulder (deltoid) or

subcutaneously in the abdomen.

12. A nurse has included the nursing diagnosis of Risk for Latex Allergy Response in a

client's plan of care. The presence of which chronic health problem would most likely

prompt this diagnosis?

A. Herpes simplex

B. Human immunodeficiency virus (HIV)

C. Spina bifida

D. Hypogammaglobulinemia

C

Rationale: Clients with spina bifida are at a particularly high risk for developing a latex

allergy. Clients with spina bifida are at high risk because they have had multiple

surgeries, multiple urinary catheterization procedures, and other treatments involving

use of latex products, and latex allergy develops as a result of repeated exposure to the

proteins and polypeptides in natural rubber latex. Clients with herpes simplex, HIV, or

hypogammaglobulinemia (decreased level of gamma immunoglobulins) are less likely

than clients with spina bifida to have as many surgeries or other treatments that would

expose them to latex.

13. A client has been diagnosed with Stevens-Johnson syndrome. Which factors are

common triggers of this condition? Select all that apply.

A. Tamoxifen and vemurafenib

B. Exposure to cold objects, cold fluids, or cold air

C. Allopurinol and nevirapine

D. Wearing clothing washed in a detergent

E. Radiation in combination with phenytoin

ANS: A, C, E

Rationale: Stevens-Johnson syndrome is a severe reaction commonly triggered by

medication. The syndrome can evolve into extensive epidermal necrosis and become

life-threatening. Among the many medications that trigger this condition are tamoxifen,

vemurafenib, allopurinol and nevirapine. The combination of radiation and antiepileptic

drugs such as phenytoin can also trigger this condition. Exposure to cold objects, cold

fluids, or cold air can trigger cold urticaria, resulting in wheals (hives) or angioedema, but

would not trigger Steven-Johnson syndrome. Wearing clothing washed in a detergent can

trigger contact dermatitis but would not trigger Steven-Johnson syndrome

14. A client is undergoing testing for food allergies after experiencing unexplained signs

and symptoms of hypersensitivity. Which food items would the nurse inform the client

are common allergens?

A. Citrus fruits and rice

B. Root vegetables and tomatoes

C. Eggs and wheat

D. Hard cheeses and vegetable oils

ANS: C

Rationale: The most common food allergens are seafood (lobster, shrimp, crab, clams,

fin fish), peanuts, tree nuts, eggs, wheat, milk, and soy. Citrus fruits, rice, root

vegetables, tomatoes, hard cheeses, and vegetable oils are not common allergens.

15. A client 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 client will

present with what alteration in laboratory values?

A. Increased eosinophils

B. Increased neutrophils

C. Increased serum albumin

D. Decreased blood glucose

Rationale: Higher percentages of eosinophils are considered moderate to severe

eosinophilia. Moderate eosinophilia is defined as 15% to 40% eosinophils and is found in

clients with allergic disorders. Hypersensitivity does not result in hypoglycemia or

increased albumin and neutrophil counts

16. A nurse should prioritize and closely monitor a client for a potentially severe

anaphylactic reaction after the client has received which medical intervention?

A. Measles-mumps-rubella vaccine

B. Rapid administration of intravenous fluids

C. Computed tomography with contrast solution

D. Nebulized bronchodilator

ANS: C

Rationale: The most severe anaphylaxis, sometimes referred to as anaphylactic shock, is

caused by antibiotics and radiocontrast agents. The computed tomography scan with

contrast dye uses these agents. Vaccines can produce an anaphylactic reaction but are

usually localized and not severe. Intravenous fluid and bronchodilators may be used to

manage anaphylaxis in clients with symptoms of bronchospasm or hypotension, but they

are not typically associated with triggering anaphylactic shock themselves.

A patient who has received a heart transplant is taking cyclosporine, an immunosuppressant. What should the nurse emphasize during health education about infection prevention?

1) Eat a high-calorie, high-protein diet.

2) Limit physical activity in order to conserve energy.

3) Take prophylactic antibiotics as ordered.

4) Perform frequent handwashing.

ANS: A

18. The nurse is providing health education to the parents of a 3-year-old who has been

diagnosed with food allergies. Which statement should the nurse make when teaching

this family about the child's health problem?

A. "Food allergies are a lifelong condition, but most families adjust well to the

necessary lifestyle changes."

B. "Consistent use of over-the-counter antihistamines can often help a child

overcome food allergies."

C. "Make sure that you carry a steroid inhaler with you at all times, especially when

you eat in restaurants."

D. "Many children outgrow their food allergies in a few years if they avoid the

offending foods."

ANS: D

Rationale: Many food allergies disappear with time, particularly in children. About one

third of proven allergies disappear in 1 to 2 years if the client carefully avoids the

offending food. Antihistamines do not cure allergies, and an EpiPen is carried for clients

with food allergies, not a steroid inhaler.

19. A 5-year-old has been diagnosed with a severe walnut allergy after experiencing an

anaphylactic reaction. Which topic is the nurse's priority when providing health

education to the family?

A. Beginning immunotherapy

B. Carrying an epinephrine pen

C. Maintaining the child's immunization status

D. Avoiding all foods that have a high potential for allergies

ANS: B

Rationale: All clients 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.

20. A client's history of skin hyperreactivity and inflammation has been attributed to

atopic dermatitis. The nurse should recognize that this client consequently faces an

increased risk of which health problem?

A. Bronchitis

B. Systemic lupus erythematosus (SLE)

C. Rheumatoid arthritis (RA)

D. Asthma

ANS: D

Rationale: Nurses should be aware that atopic dermatitis is often the first step in a

process, known as atopic march, that leads to asthma and allergic rhinitis. It is not linked

as closely to bronchitis, SLE, or RA

21. The nurse is planning the care of a client who has a diagnosis of atopic dermatitis,

which commonly affects both of her hands and forearms. What risk nursing diagnosis

should the nurse include in the client's care plan?

A. Risk for disturbed body image related to skin lesions

B. Risk for disuse syndrome related to dermatitis

C. Risk for ineffective role performance related to dermatitis

D. Risk for self-care deficit related to skin lesions

ANS: A

Rationale: The highly visible skin lesions associated with atopic dermatitis constitute a

risk for disturbed body image. This may culminate in ineffective role performance, but

this is not likely the case for the majority of clients.

22. A client has been brought to the emergency department after being found

unresponsive, and anaphylaxis is suspected. The care team should attempt to assess for

which potential causes of anaphylaxis? Select all that apply.

A. Foods

B. Medications

C. Insect stings

D. Autoimmunity

E. Environmental pollutants

ANS: A, B, C

Rationale: 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.

23. A school nurse is caring for a 10-year-old who appears to be having an allergic

response. Which intervention 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 over-the-counter (OTC) antihistamine.

D. Administer epinephrine

ANS: A

Rationale: If a client is experiencing an allergic response, the nurse's initial action is to

assess the client 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.

24. A client is receiving a transfusion of packed red blood cells. Shortly after initiation of

the transfusion, the client begins to exhibit signs and symptoms of a transfusion reaction.

The client is suffering from which type of hypersensitivity?

A. Anaphylactic (type 1)

B. Cytotoxic (type II)

C. Immune complex (type III)

D. Delayed type (type IV)

ANS: B

Rationale: A type II hypersensitivity reaction resulting in red blood cell destruction is

associated with blood transfusions. This type of reaction does not result from types I, III,

or IV reactions.

25. Which of the following individuals would be the most appropriate candidate for

immunotherapy?

A. A client who had an anaphylactic reaction to an insect sting

B. A child with allergies to eggs and dairy

C. A client who has had a positive tuberculin skin test

D. A client with severe allergies to grass and tree pollen

ANS: D

Rationale: 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.

26. A nurse has asked the nurse educator if there is any way to predict the severity of a

client's anaphylactic reaction. Which response by the nurse educator would be best?

A. "The faster the onset of symptoms, the more severe the reaction."

B. "The reaction will be about one-third more severe than the client's last reaction

to the same antigen."

C. "There is no way to gauge the severity of a client's anaphylaxis, even if it has

occurred repeatedly in the past."

D. "The reaction will generally be slightly less severe than the last reaction to the

same antigen."

A

Rationale: The time from exposure to the antigen to onset of symptoms is a good

indicator of the severity of the reaction: the faster the onset, the more severe the

reaction. None of the other statements is an accurate description of the course of

anaphylactic reactions.

27. A nurse knows of several clients who have achieved adequate control of their allergy

symptoms using over-the-counter antihistamines. Antihistamines would be

contraindicated in the care of which client?

A. A client who has previously been treated for tuberculosis

B. A client who is at 30 weeks' gestation

C. A client who is on estrogen-replacement therapy

D. A client with a severe allergy to eggs

B

Rationale: Antihistamines are contraindicated during the third trimester of pregnancy

28. A client has been living with seasonal allergies for many years, but does not take

antihistamines, stating, "When I was young, I used to take antihistamines, but they

always put me to sleep." How should the nurse best respond?

A. "Newer antihistamines are combined with a stimulant that offsets drowsiness."

B. "Most people find that they develop a tolerance to sedation after a few months."

C. "The newer antihistamines are different than in years past, and cause less

sedation."

D. "Have you considered taking them at bedtime instead of in the morning?"

ANS: C

Rationale: Unlike first-generation H1 receptor antagonists, newer antihistamines bind to

peripheral rather than central nervous system H1 receptors, causing less sedation, if any

at all. Tolerance to sedation did not usually occur with first-generation drugs, and newer

antihistamines are not combined with a stimulant. Although taking an antihistamine at

bedtime may be a suitable option for the client, it is not the nurse's best response

because it does not inform the client of the newer antihistamines, which cause little or no

sedation and thus could be taken any time of day.

29. A client has been transported to the emergency department after a severe allergic

reaction. How should the nurse evaluate the client's respiratory status? Select all that

apply.

A. Facilitate lung function testing.

B. Assess breath sounds.

C. Measure the client's oxygen saturation by oximeter.

D. Monitor the client's respiratory pattern.

E. Assess the client's respiratory rate

ANS: B, C, D, E

30. A client with multiple food and environmental allergies expresses frustration and

anger over having to be so watchful all the time and wonders if it is really worth it. Which

response by the nurse would be best?

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 clients who have a chronic illness feel."

D. "Do you think that maybe you could be managing things more efficiently?"

ANS: A

Rationale: To assist the client in adjusting to these modifications, the nurse must have an

appreciation of the difficulties encountered by the client. The client 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 client has been

mismanaging this health problem, and the nurse should not make comparisons with

other clients. Further assessment should precede educational interventions.

31. A nurse at an allergy clinic is providing education for a client starting immunotherapy

for the treatment of allergies. Which education should the nurse prioritize?

A. Scheduling appointments for the same time each month

B. Keeping appointments for desensitization procedures

C. Avoiding antihistamines for the duration of treatment

D. Keeping a diary of reactions to the immunotherapy

ANS: B

Rationale: The nurse informs and reminds the client 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.

32. A client has presented with signs and symptoms that are consistent with contact

dermatitis. Which aspect of care should the nurse prioritize when working with this client?

A. Promoting adequate perfusion in affected regions

B. Promoting safe use of topical antihistamines

C. Identifying the offending agent, if possible

D. Teaching the client to safely use an EpiPen

ANS: C

Rationale: Identifying the offending agent is a priority in the care of a client with

dermatitis. This provides a cure via removal of the offending agent, rather than being

limited to treating the symptoms. Topical antihistamines can provide some relief from

itching, especially with allergic dermatitis, but identifying and removing the offending

agent takes is a higher priority, as it would allow the client to not need to use a topical

antihistamine.

33. A client was prescribed an oral antibiotic for the treatment of sinusitis. The client has

now stopped, reporting the development of a rash shortly after taking the first dose of the

drug. Which response by the nurse would be most appropriate?

A. Encourage the client to continue with the medication while monitoring the skin

condition closely.

B. Refer the client to a primary care provider to have the medication changed.

C. Arrange for the client to go to the nearest emergency department.

D. Encourage the client to take an over-the-counter antihistamine with each dose

of the antibiotic.

ANS: B

Rationale: On discovery of a medication allergy, clients are warned that they have a

hypersensitivity to a particular medication and are advised not to take it again. As a

result, the client would need to liaise with the primary provider. There is no need for

emergency care unless symptoms worsen to involve respiratory function. An

antihistamine would not be an adequate or appropriate recommendation from the nurse

34. A client has sought care, stating that the client developed hives overnight. The

nurse's inspection confirms the presence of urticaria. What type of allergic

hypersensitivity reaction has the client developed?

A. Type I

B. Type II

C. Type III

D. Type IV

ANS: A

Rationale: Type I hypersensitivity reactions are unanticipated severe allergic reactions

that are rapid in onset, characterized by edema in many tissues, including the larynx, and

often accompanied by hypotension, bronchospasm, and cardiovascular collapse in severe

cases. Urticaria (hives) is a type I hypersensitive allergic reaction of the skin that is

characterized by the sudden appearance of intensely pruritic pink or red discrete papules

that progress to wheals of variable size. Type II, or cytotoxic, hypersensitivity reactions

occur when antibodies are directed against antigens on cells or basement membranes of

tissues. Examples of type II reactions are myasthenia gravis, Goodpasture syndrome,

pernicious anemia, hemolytic disease of the newborn, transfusion reaction, and

thrombocytopenia. Type III, or immune complex, hypersensitivity reactions are

damaging inflammatory reactions caused by the insoluble immune complexes formed by

antigens that bind to antibodies. Examples of type III reactions include systemic lupus

erythematosus, serum sickness, nephritis, and rheumatoid arthritis. Type IV, or delayed,

hypersensitivity reactions are T cell-mediated immune reactions that typically occur 24

to 48 hours after exposure to an antigen. Examples of type IV reactions include contact

dermatitis, graft-versus-host disease, Hashimoto's thyroiditis, and sarcoidosis.

35. The nurse is providing care for a client who has a diagnosis of hereditary angioedema.

When planning this client'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

ANS: D

Rationale: Edema of the respiratory tract can compromise the airway in clients with

hereditary angioedema. As such, this is a priority nursing diagnosis over pain and

possible infection. Skin integrity is not threatened by angioedema.

36. A junior nursing student is having an observation day in the operating room. Early in

the day, the student reports eye swelling and dyspnea to the OR nurse. 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

ANS: C

Rationale: 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

37. A nurse is caring for a client who has allergic rhinitis. What intervention would be

most likely to help the client meet the goal of improved breathing pattern?

A. Teach the client to take deep breaths and cough frequently.

B. Use antihistamines daily throughout the year.

C. Teach the client to seek medical attention at the first sign of an allergic reaction.

D. Modify the environment to reduce the severity of allergic symptoms.

ANS: D

Rationale: The client 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 is anaphylaxis. Overuse of

antihistamines reduces their effectiveness.

38. The nurse is creating a care plan for a client suffering from allergic rhinitis. What

outcome should the nurse identify?

A. Appropriate use of prophylactic antibiotics

B. Safe injection of corticosteroids

C. Improved skin integrity

D. Improved coping with lifestyle modifications

ANS: D

Rationale: The goals for the client with allergies may include restoration of normal

breathing pattern, increased knowledge about the causes and control of allergic

symptoms, improved coping with alterations and modifications, and absence of

complications. Antibiotics are not used to treat allergies and corticosteroids, if needed,

are not given parenterally. Allergies do not normally threaten skin integrity.

39. A 5-year-old client has been diagnosed with a severe food allergy. Which instruction

should the nurse include when educating the parents about this client's allergy and care?

A. Wear a medical identification bracelet.

B. Know how to use the antihistamine pen.

C. Know how to give injections of lidocaine.

D. Avoid live attenuated vaccinations.

ANS: A

Rationale: The nurse also advises the parents to have the client wear a medical

identification bracelet and to be able to identify symptoms of food allergy. Clients and

their families do not carry antihistamine pens, they carry epinephrine pens. Lidocaine is

not self-administered to treat allergies. The client may safely be vaccinated.