Deck 37: Assessment and Management of Patients With Allergic Disorders

Question 1

A patient with a family history of allergies has suffered an allergic response based on a genetic predisposition. This atopic response is usually mediated by what immunoglobulin?

A) Immunoglobulin A
B) Immunoglobulin M
C) Immunoglobulin G
D) Immunoglobulin $\mathrm{E}$

Answer 1

Immunoglobulin $\mathrm{E}$

Question 2

An office worker takes a cupcake that contains peanut butter. He 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)

Answer 2

Anaphylactic (type 1)

Question 3

A patient is learning about his new diagnosis of asthma with the asthma nurse. What medication has the ability to prevent the onset of acute asthma exacerbations?

A) Diphenhydramine (Benadryl)
B) Montelukast (Singulair)
C) Albuterol sulfate (Ventolin)
D) Epinephrine

Answer 3

Montelukast (Singulair)

Question 4

A nurse is preparing a patient for allergy skin testing. Which of the following precautionary steps is most important for the nurse to follow?

A) The patient must not have received an immunization within 7 days.
B) The nurse should administer albuterol 30 to 45 minutes prior to the test.
C) Prophylactic epinephrine should be administered before the test.
D) Emergency equipment should be readily available.

Question 5

A patient who is scheduled for a skin test informs the nurse that he has been taking corticosteroids to help control his allergy symptoms. What nursing intervention should the nurse implement?

A) The patient should take his corticosteroids regularly prior to testing.
B) The patient should only be tested for grass, mold, and dust initially.
C) The nurse should have an emergency cart available in case of anaphylaxis during the test.
D) The patients test should be cancelled until he is off his corticosteroids.

Question 6

A patient has developed severe contact dermatitis with burning, itching, cracking, and peeling of the skin on her hands. What should the nurse teach the patient 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 $75 \mathrm{~F}$ to $80 \mathrm{~F}$ whenever possible.
D) Keep her hands well-moisturized at all times.

Question 7

A patient with severe environmental allergies is scheduled for an immunotherapy injection. What should be included in teaching the patient about this treatment?

A) The patient will be given a low dose of epinephrine before the treatment.
B) The patient 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 administered by the peripheral intravenous route.

Question 8

The nurse in an allergy clinic is educating a new patient about the pathology of the patients 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

Question 9

The nurse is providing care for a patient who has experienced a type I hypersensitivity reaction. What condition is an example of such a reaction?

A) Anaphylactic reaction after a bee sting
B) Skin reaction resulting from adhesive tape
C) Myasthenia gravis
D) Rheumatoid arthritis

Question 10

A nurse is caring for a teenage girl who has had an anaphylactic reaction after a bee sting. The nurse is providing patient teaching prior to the patients discharge. In the event of an anaphylactic reaction, the nurse informs the patient that she should self-administer epinephrine in what site?

A) Forearm
B) Thigh
C) Deltoid muscle
D) Abdomen

Question 11

A nurse has included the nursing diagnosis of Risk for Latex Allergy Response in a patients plan of care. The presence of what chronic health problem would most likely prompt this diagnosis?

A) Herpes simplex
B) HIV
C) Spina bifida
D) Hypogammaglobulinemia

Question 12

A patient has a documented history of allergies presents to the clinic. She states that she is frustrated by her chronic nasal congestion, anosmia (inability to smell) and inability to concentrate. The nurse should identify which of the following nursing diagnoses?

A) Deficient Knowledge of Self-Care Practices Related to Allergies
B) Ineffective Individual Coping with Chronicity of Condition and Need for Environmental
Modification
C) Acute Confusion Related to Cognitive Effects of Allergic Rhinitis
D) Disturbed Body Image Related to Sequelae of Allergic Rhinitis

Question 13

A patients decline in respiratory and renal function has been attributed to Goodpasture syndrome, which is a type II hypersensitivity reaction. What pathologic process underlies the patients health problem?

A) Antigens have bound to antibodies and formed inappropriate immune complexes.
B) The patients body has mistakenly identified a normal constituent of the body as foreign.
C) Sensitized $\mathrm{T}$ cells have caused cell and tissue damage.
D) Mast cells have released histamines that directly cause cell lysis.

Question 14

A child is undergoing testing for food allergies after experiencing unexplained signs and symptoms of hypersensitivity. What food items would the nurse inform the parents are common allergens?

A) Citrus fruits and rice
B) Root vegetables and tomatoes
C) Eggs and wheat
D) Hard cheeses and vegetable oils

Question 15

A patient 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 patient will present with what alteration in laboratory values?

A) Increased eosinophils
B) Increased neutrophils
C) Increased serum albumin
D) Decreased blood glucose

Question 16

A nurse is aware of the need to assess patients risks for anaphylaxis. What health care procedure constitutes the highest risk for anaphylaxis?

A) Administration of the measles-mumps-rubella (MMR) vaccine
B) Rapid administration of intravenous fluids
C) Computed tomography with contrast solution
D) Administration of nebulized bronchodilators

Question 17

After the completion of testing, a childs allergies have been attributed to her familys cat. When introducing the family to the principles of avoidance therapy, the nurse should promote what action?

A) Removing the cat from the familys home
B) Administering OTC antihistamines to the child regularly
C) Keeping the cat restricted from the childs bedroom
D) Maximizing airflow in the house

Question 18

The nurse is providing health education to the parents of a toddler who has been diagnosed with food allergies. What should the nurse teach this family about the childs health problem?

A) Food allergies are a life-long condition, but most families adjust quite 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.

Question 19

A child has been diagnosed with a severe walnut allergy after suffering an anaphylactic reaction. What is a priority for health education?

A) The need to begin immunotherapy as soon as possible
B) The need for the parents to carry an epinephrine pen
C) The need to vigilantly maintain the childs immunization status
D) The need for the child to avoid all foods that have a high potential for allergies

Question 20

An adolescent patients history of skin hyperreactivity and inflammation has been attributed to atopic dermatitis. The nurse should recognize that this patient consequently faces an increased risk of what health problem?

A) Bronchitis
B) Systemic lupus erythematosus (SLE)
C) Rheumatoid arthritis
D) Asthma

Question 21

The nurse is planning the care of a patient 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 patients 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

Question 22

A patient has been brought to the emergency department by EMS after being found unresponsive. Rapid assessment reveals anaphylaxis as a potential cause of the patients condition. The care team should attempt to assess for what potential causes of anaphylaxis? Select all that apply.

A) Foods
B) Medications
C) Insect stings
D) Autoimmunity
E) Environmental pollutants

Question 23

A school nurse is caring for a child who appears to be having an allergic response. What 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 OTC antihistamine.
D) Administer epinephrine.

Question 24

A patient is receiving a transfusion of packed red blood cells. Shortly after initiation of the transfusion, the patient begins to exhibit signs and symptoms of a transfusion reaction. The patient is suffering from which type of hypersensitivity?

A) Anaphylactic (type 1)
B) Cytotoxic (type II)
C) Immunecomplex (type III)
D) Delayed type (type IV)

Question 25

Which of the following individuals would be the most appropriate candidate for immunotherapy?

A) A patient who had an anaphylactic reaction to an insect sting
B) A child with allergies to eggs and dairy
C) A patient who has had a positive tuberculin skin test
D) A patient with severe allergies to grass and tree pollen

Question 26

A nurse has asked the nurse educator if there is any way to predict the severity of a patients anaphylactic reaction. What would be the nurses best response?

A) The faster the onset of symptoms, the more severe the reaction.
B) The reaction will be about one-third more severe than the patients last reaction to the same antigen.
C) There is no way to gauge the severity of a patients 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.

Question 27

A nurse knows of several patients who have achieved adequate control of their allergy symptoms using over-the-counter antihistamines. Antihistamines would be contraindicated in the care of which patient?

A) A patient who has previously been treated for tuberculosis
B) A pregnant woman at 30 weeks gestation
C) A patient who is on estrogen-replacement therapy
D) A patient with a severe allergy to eggs

Question 28

A patient 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?

Question 29

A child has been transported to the emergency department (ED) after a severe allergic reaction. The ED nurse is evaluating the patients respiratory status. How should the nurse evaluate the patients respiratory status? Select all that apply.

A) Facilitate lung function testing.
B) Assess breath sounds.
C) Measure the childs oxygen saturation by oximeter.
D) Monitor the childs respiratory pattern.
E) Assess the childs respiratory rate.

Question 30

A patient with multiple food and environmental allergies tells the nurse that he is frustrated and angry about having to be so watchful all the time and wonders if it is really worth it. What would be the nurses best response?

A) I can only imagine how you feel. Would you like to talk about it?
B) Lets find a quiet spot and Ill teach you a few coping strategies.
C) Thats the same way that most patients who have a chronic illness feel.
D) Do you think that maybe you could be managing things more efficiently?

Question 31

A nurse at an allergy clinic is providing education for a patient starting immunotherapy for the treatment of allergies. What education should the nurse prioritize?

A) The importance of scheduling appointments for the same time each month
B) The importance of keeping appointments for desensitization procedures
C) The importance of avoiding antihistamines for the duration of treatment
D) The importance of keeping a diary of reactions to the immunotherapy

Question 32

A patient has presented with signs and symptoms that are consistent with contact dermatitis. What aspect of care should the nurse prioritize when working with this patient?

A) Promoting adequate perfusion in affected regions
B) Promoting safe use of topical antihistamines
C) Identifying the offending agent, if possible
D) Teaching the patient to safely use an EpiPen

Question 33

A patient was prescribed an oral antibiotic for the treatment of sinusitis. The patient has now stopped, stating she developed a rash shortly after taking the first dose of the drug. What is the nurses most appropriate response?

A) Encourage the woman to continue with the medication while monitoring her skin condition closely.
B) Refer the woman to her primary care provider to have the medication changed.
C) Arrange for the woman to go to the nearest emergency department.
D) Encourage the woman to take an OTC antihistamine with each dose of the antibiotic.

Question 34

A patient has sought care, stating that she developed hives overnight. The nurses inspection confirms the presence of urticaria. What type of allergic hypersensitivity reaction has the patient developed?

A) Type I
B) Type II
C) Type III
D) Type IV

Question 35

The nurse is providing care for a patient who has a diagnosis of hereditary angioedema. When planning this patients 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

Question 36

A junior nursing student is having an observation day in the operating room. Early in the day, the student tells the OR nurse that her eyes are swelling and she is having trouble breathing. 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

Question 37

A nurse is caring for a patient who has allergic rhinitis. What intervention would be most likely to help the patient meet the goal of improved breathing pattern?

A) Teach the patient to take deep breaths and cough frequently.
B) Use antihistamines daily throughout the year.
C) Teach the patient to seek medical attention at the first sign of an allergic reaction.
D) Modify the environment to reduce the severity of allergic symptoms.

Question 38

The nurse is creating a care plan for a patient suffering from allergic rhinitis. Which of the following outcomes 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

Question 39

A 5-year-old boy has been diagnosed with a severe food allergy. What is an important parameter to address when educating the parents of this child about his 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.

Question 40

A patient is brought to the emergency department (ED) in a state of anaphylaxis. What is the ED nurses priority for care?

A) Monitor the patients level of consciousness.
B) Protect the patients airway.
C) Provide psychosocial support.
D) Administer medications as ordered.