NCLEX Style Questions: Hypersensitivity

A client is noted to have a type I (IgE-mediated) hypersensitivity reaction with a systemic response. Which clinical manifestation should the nurse anticipate? (Select all that apply)

A. Allergic rhinitis

B. Stridor

C. Wheezing

D. Urticaria

E. Hypotension

B. Stridor

C. Wheezing

D. Urticaria

E. Hypotension

Which hypersensitivity reaction releases enzymes that increase tissue damage?

A. Type III

B. Type IV

C. Type I

D. Type II

Type III

Which is the nurse's PRIORITY action when managing a client experiencing a type I hypersensitivity?

A. Management of arthralgia

B. Airway management

C. Stopping the blood transfusion

D. Decreasing a fever

B. airway management

How are the systemic type I IgE-mediated responses initiated?

A. With contact of the allergen and IgE in the conjunctival tissues.

B. by contact of the allergen with IgE in the bronchial tree

C. the allergen makes contact with the IgE in the circulatory system

D. Allergens are absorbed in the GI mucosa

D. Allergens are absorbed in the GI mucosa

The nurse is providing teaching for a client on dietary intake and anaphylaxis. Which food should the nurse identify that trigger anaphylaxis in a sensitized individual (Select all that apply)

A. Fish

B. Coconut oil

C. Milk

D. Chocolate

E. Grains

D. Chocolate

E. Grains

The nurse is teaching a group of clients with allergies to foods and a history of asthma about the risk factors for the development of anaphylaxis. The nurse identifies which age group as having the highest risk for the development and severity of anaphylaxis?

A. Adolescent

B. Older adult

C. Adult

D. Child

B. Older adult

The nurse is providing discharge teaching for a teenager who has experienced anaphylaxis related to a food allergy. Which statement by the nurse addresses the most common risk factor for an allergic reaction in a teenager?

A. "eat nutritional meals and drink plenty of fluids."

B. "Monitor what you are eating outside the home."

C. Seek emergency medical help if you feel you have experiencing anaphylaxis."

D. "limit your exposure to the food that caused the reaction."

B. "Monitor what you are eating outside the home."

The nurse is caring for a client who requires a course of oral steroids more than once a year for the treatment of asthma related to allergens. Which alternative therapy should the nurse anticipate being prescribe for the client to avoid the frequent use of steroids?

A. Immunotherapy

B. Omalizumab

C. Plasmapheresis

D. Antihistamines

A. Immunotherapy

For which allergy will the nurse teach the parents that a child with spinal bifida is at increased risk?

A. Drug allergy

B. Contact dermatitis

C. Latex allergy

D. Food allergy

C. Latex allergy

A nurse is reviewing the chart of a newborn treated for hemolytic disease. Which statement shows the nurse's understanding of the cause of the disease?

A. "Neutrophils attempt to phagocytize the RBCs."

B. "antibodies bound with an antigen activate the cascade destroying the RBCs."

C. "Complement activation causes the release of inflammatory chemical mediators resulting in RBC destruction."

D. "Endogenous antigens stimulate a type II reaction resulting in lysis of the RBC."

B. "Antibodies bound with an antigen activate a cascade destroying the RBCs."

to determine the causes of hypersensitivity reaction, a prick test may be used. Which statement is the most accurate to describe this procedure and results? (select all that apply)

A. The client must avoid contact with the allergen for 48 hours after the skin test.

B. A positive response may include pruritus, erythema, and development of a wheal.

C. The allergen is diluted only if a severe systemic reaction is anticipated.

D. A positive response can be determined within 15-20 minutes.

E. The diluted allergen extract is intradermally injected in the forearm area.

B. A positive response may include pruritus, erythema, and development of a wheal.

D. A positive response can be determined within 15-20 minutes

A client is starting treatment for a hypersensitivity reaction. Which pharmacologic therapy should the nurse anticipate will be initiated to develop IgG antibodies to the allergen?

A. Nonsteroidal anti-inflammatory medications

B. Corticosteroids

C. Immunotherapy

D. Antihistamines

C. Immunotherapy

The nurse is caring for a client newly diagnosed with seasonal allergic rhinitis. The client is experiencing rhinorrhea, water eyes, and itchy throat. Which prescribed initial treatment does the nurse anticipate?

A. Inhaled corticosteroids

B. Antihistamine

C. Antibiotic

D. Oral steroids

B. Antihistamine

Which nonpharmacologic treatments should the nurse suggest for the client who is experiencing seasonal allergic rhinitis due to the pollen in the air? (select all that apply)

A. Remain indoors during the day

B. Maintain a clean, dust-free environment

C. Use special filters on the air conditioners

D. Shower before exiting the house

E. Keep doors and windows closed

A. Remain indoors during the day

B. Maintain a clean, dust-free environment

C. Use special filters on the air conditioners

D. Keep doors and windows closed

A client presents to the clinic with erythema and vesicles on the trunk and bilateral upper and lower extremities. Which type of skin testing should the nurse anticipate being prescribed for the client to determine the cause of hypersensitivity reaction?

A. Food allergy test

B. Intradermal test

C. Epicutaneous test

D. Patch test

C. Epicutaneous Test

In performing a physical assessment on a client who is experiencing a hypersensitivity reaction, which findings should the nurse anticipate? (select all that apply)

A. altered respiratory rate

B. eyes with tearing and redness

C. cold, moist skin

D. Skin lesions or rashes

E. Adventitious breath sounds

A. Altered respiratory rate

B. eyes with tearing and redness

D. Skin lesions or rashes

E. Adventitious breath sounds

Which nursing interventions address the immediate priority of care for a client experiencing a severe hypersensitivity reaction? (select all that apply)

A. Assess respiratory status continuously

B. Administer subcutaneous epinephrine as prescribed

C. Monitor urine output

D. Teach the client when and how to use an anaphylactic kit

E. Administer oxygen via nasal cannula at the prescribed rate

A. Assess respiratory status continuously

B. Administer subcutaneous epinephrine as prescribed

E. Administer oxygen via nasal cannula at the prescribed rate

When planning care for a client admitted with a hypersensitivity reaction, the nurse addresses the potential problem of airway clearance. Which intervention will assistantships in addressing this potential problem? (Select all that apply)

A. Assessing level of consciousness

B. Administering oxygen

C. Auscultating lung sounds

D. Placing the client in a supine position

e. Administering epinephrine

A. Assessing level of consciousness

B. administering oxygen

C. Auscultating lung sounds

E. Administering epinephrine

When planning care for a client admitted with a hypersensitivity reaction, the nurse addresses the potential problem of impaired tissue perfusion. Which intervention will assist in addressing this potential problem?

A. Monitoring urine output

B. Providing calm reassurance

C. Assessing for pain

D. Elevating the head of the bed

A. monitoring urine output

The nurse is caring for a client with a history of anaphylaxis related to a known latex allergy. Which is a priority goal when planning a nursing intervention for the client?

A. the client will avoid the known allergen

B. The client will teach family members about the life-threatening condition

C. The client will verbalize an understanding of the goal

D. The client will avoid the foods linked to the latex allergy.

A. the client will avoid the known allergen