Chapter 43Allergic Dysfunction: Nursing Management My Nursing Test Banks

Chapter 43Allergic Dysfunction: Nursing Management

MULTIPLE CHOICE

1.The nurse is determining if a client is experiencing an immune response. Which of the following is not one of the four Rs of the immune response?

1.

Recognize

2.

Remember

3.

Remove

4.

Respond

ANS: 3

The four Rs of the immune response are recognize, respond, remember, and regulate. The regulate action is turning on for the invader or turning off when the invader is destroyed. It is not about removing.

PTS:1DIF:AnalyzeREF:Allergic Dysfunction

2.A client is experiencing a transfusion reaction. The nurse realizes that a transfusion reaction is which type of hypersensitive reaction?

1.

Type 1

2.

Type 2

3.

Type 3

4.

Type 4

ANS: 2

Type 1 reactions are anaphylactic reactions. Type 2 is cytotoxic (e.g., transfusion reaction). Type 3 is immune complex. Type 4 is delayed hypersensitive.

PTS:1DIF:Analyze

REF:Table 43-2 Hypersensitive Reactions: Gell-Coombs Classification

3.During the health history, the clients says, I have many allergies. Of the following medications, which one would be for the treatment of allergies?

1.

Acetaminophen

2.

Docusate

3.

Diphenhydramine hydrochloride

4.

Guaifenesin

ANS: 3

Diphenhydramine hydrochloride (Benadryl) is an antihistamine that is used for allergic reactions. Guaifenesin (Robitussin) is an expectorant. Acetaminophen (Tylenol) is an antipyretic and analgesic. Docusate (Colace) is a stool softener.

PTS:1DIF:Analyze

REF: Table 43-6 Pharmacology Facts: Pharmaceutical Therapy for Symptom Relief of Chronic Allergies

4.After instructing a client about food allergies, the nurse would determine that additional instruction is needed when the client states that which of the following foods should be avoided?

1.

Carrots

2.

Peanuts

3.

Shellfish

4.

Strawberries

ANS: 1

Foods such as eggs, milk, nuts, shellfish, and soy wheat are common food allergens; carrots are not.

PTS:1DIF:Analyze

REF: Table 43-3 Categories of Sensitizing Agents (Allergens)

5.A client recovering from a kidney transplant needs to be assessed for a hypersensitivity reaction. Which type of hypersensitive reaction is associated with transplants?

1.

Type 1

2.

Type 2

3.

Type 3

4.

Type 4

ANS: 4

Type 1 reactions are anaphylactic reactions. Type 2 is cytotoxic. Type 3 is immune complex. Type 4 is delayed hypersensitive reaction evidenced by transplant rejection.

PTS:1DIF:Apply

REF:Table 43-2 Hypersensitive Reactions: Gell-Coombs Classification

6.An individual is petting a cat. Early response to an antigen would include all of the following EXCEPT:

1.

airway obstruction.

2.

itchy eyes.

3.

nasal secretions.

4.

sneezing.

ANS: 1

Early response to an antigen includes sneezing, an increase in nasal secretions, and itchy eyes. The late response can begin at the same time or be delayed hours. The late response does not occur in everyone and is characterized by more severe symptoms such as airway obstruction.

PTS:1DIF:Analyze

REF: Allergic Dysfunction: Primary and Secondary Response

7.The nurse is teaching a client how to avoid allergic reactions. Which of the following is not an appropriate recommendation?

1.

Avoid the allergen.

2.

Carry your prescribed medications.

3.

Use corticosteroids daily to prevent reactions.

4.

Wear a medical alert bracelet.

ANS: 3

Daily corticosteroid therapy is not recommended to prevent reactions. The client should eliminate exposure to the allergen and be prepared for a reaction if one occurs.

PTS: 1 DIF: Apply REF: Anaphylaxis: Planning and Implementation

8.A client begins to sneeze and have an increase in nasal secretions. The nurse realizes that the antibody that attaches to mast cells and plays a critical role in the allergic process is:

1.

IgA.

2.

IgD.

3.

IgE.

4.

IgG.

ANS: 3

IgE antibody attaches to a mast cell that subsequently releases histamine. This reaction produces allergic symptoms exhibited by clients. IgA protects against infections of the mucous membranes. IgD is found on the surface of B cells. IgG is the main immunoglobulin that is produced in response to an infection.

PTS: 1 DIF: Analyze REF: Allergic Dysfunction: Early Response

9.A client, receiving a dose of penicillin for an infection, begins to complain of difficulty breathing and has a respiratory rate of 38. This client is experiencing what type of reaction?

1.

Type 1

2.

Type 2

3.

Type 3

4.

Type 4

ANS: 1

An anaphylactic reaction is a type 1 reaction. Type 2 reactions are cytotoxic and are seen with blood transfusions. Type 3 reactions are immune related and are associated with rheumatoid arthritis or systemic lupus erythematosus. Type 4 reactions are seen with transplant rejections.

PTS:1DIF:Analyze

REF:Table 43-2 Hypersensitive Reactions: Gell-Coombs Classification

10.A client is prescribed a Leukotriene modifier as part of asthma treatment. The nurse should instruct the client that this medication:

1.

relaxes bronchospasm.

2.

increases mucociliary clearance.

3.

reduces inflammation.

4.

inhibits the allergic process.

ANS: 4

Leukotriene modifiers inhibit the allergic process. Beta-adrenergic agonists relax bronchospasm. System bronchodilators increase mucociliary clearance. Corticosteroids reduce inflammation.

PTS:1DIF:Apply

REF: Table 43-5 Pharmacology Facts: Pharmaceutical Therapy for Asthma

11.A client is experiencing intense pruritis from contact dermatitis. Which of the following would be helpful for this client?

1.

Administer hydroxyzine HCL as prescribed.

2.

Cover the area with a warm compress.

3.

Instruct to scratch the skin with finger pads.

4.

Increase ambulation when itching occurs.

ANS: 1

Hydroxyzine HCL is an antihistamine used to relieve pruritis associated with contact dermatitis. Covering the area with a warm compress could cause the area to itch more. The client should be instructed to avoid scratching. Ambulation will not help reduce the itchiness.

PTS:1DIF:Apply

REF: Table 43-10 Pharmacology Facts: Pharmaceutical Therapy for Urticaria

12.A client calls for the nurse and says that her mouth has been itchy since she ate lunch. Which of the following should the nurse do to assist the client?

1.

Ask the client if she has ever been diagnosed with a food allergy.

2.

Ask the physician to prescribe an oral steroid.

3.

Assess the clients vital signs.

4.

Assess the clients tongue and throat

ANS: 1

When a person is allergic to a particular food, itching of the mouth may occur as they eat the food. The nurse should ask the client if she has ever been diagnosed with a food allergy. The client may or may not need an oral steroid. The clients vital signs will most likely not be affected so soon. No tongue or throat changes occur with a food allergy.

PTS:1DIF:ApplyREF:Food Allergy

13.The nurse begins to experience red, itchy hands after using gloves for client care. Which of the following should the nurse consider as causing these symptoms?

1.

Seasonal allergies

2.

Influenza

3.

Latex allergy

4.

Serum sickness

ANS: 3

Latex allergy is a reaction to certain proteins in latex rubber. Increasing the exposure to latex proteins increases the risk of developing allergic symptoms. Mild reactions include skin redness and itching. Red, itchy hands are not associated with seasonal allergies, influenza, or serum sickness.

PTS:1DIF:AnalyzeREF:Latex Allergy

MULTIPLE RESPONSE

1.A client is being instructed to avoid airborne allergens. Which of the following allergens would be considered airborne? (Select all that apply.)

1.

Animal dander

2.

Eggs

3.

Fungal spores

4.

Grass pollen

5.

Insect stings

6.

Milk

ANS: 1, 3, 4

Airborne allergens include pollens (e.g., grass, plants, and trees), mold (i.e., fungal spores), dust mites, animal dander, and house dust. Eggs and milk are ingested allergens. Insect stings are injected allergens.

PTS:1DIF:Apply

REF: Table 43-3 Categories of Sensitizing Agents (Allergens)

2.The nurse suspects a client is experiencing atopic asthma when which of the following are assessed? (Select all that apply.)

1.

Shortness of breath with exertion

2.

Nighttime coughing

3.

Chest tightness

4.

Wheezing

5.

Rash

6.

Ear pain

ANS: 1, 2, 3, 4, 5

Clinical manifestations of atopic asthma include shortness of breath with exertion, nighttime coughing, chest tightness, wheezing, and a rash. Ear pain is not associated with this disorder.

PTS:1DIF:Analyze

REF:Atopic Asthma: Assessment with Clinical Manifestations

3.Which of the following should the nurse instruct a client diagnosed with asthma on ways to reduce asthma triggers? (Select all that apply.)

1.

Remove carpets in bedrooms.

2.

Use stuffed animals as toys.

3.

Keep pets off of furniture.

4.

Avoid freshly cut grass.

5.

Avoid cigarette smoke.

6.

Use asthma medication approximately 10 minutes before exercise.

ANS: 1, 3, 4, 5, 6

Interventions to reduce triggers that exacerbate asthma include removing carpets in the bedroom, keeping pets off furniture, avoiding freshly cut grass, avoiding cigarette smoke, and using asthma medication approximately 10 minutes before exercise. The client should be instructed to not use stuffed animals as toys.

PTS: 1 DIF: Apply REF: Patient Playbook: Triggers for Asthma

4.A client is scheduled for a skin-prick test to diagnose the cause for his allergic reactions. Prior to this test, which of the following medications should the client be instructed to avoid? (Select all that apply.)

1.

Corticosteroids

2.

Antihistamines

3.

Benzodiazepines

4.

Theophylline

5.

Antidepressants

6.

Aspirin

ANS: 2, 3, 4, 5

Use of certain medications can interfere with the validity of a skin-prick response. These medications include antihistamines, benzodiazepines, theophylline, and antidepressants. Corticosteroids and aspirin have no effect on the skin-prick test.

PTS: 1 DIF: Apply REF: Atopic Asthma: Diagnostic Tests

5.A client is demonstrating signs of an anaphylactic reaction. Which of the following should the nurse do? (Select all that apply.)

1.

Place the client in the supine position.

2.

Assist the client to ambulate.

3.

Maintain the airway.

4.

Provide oral fluids.

5.

Begin an intravenous access line.

6.

Place the client in the prone position.

ANS: 1, 3, 5

Initial medical management of a client experiencing an anaphylactic reaction includes placing the client in the supine position, maintain the airway, and begin an intravenous access line. The client should not ambulate. The client should not ingest oral fluids. The client should be supine and not prone.

PTS:1DIF:Apply

REF: Table 43-8 Treatment of the Patient with Anaphylaxis

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