Brunner: Medical-Surgical Nursing, 11th EditionTest BankChapter 53: Assessment and Management of Patients With Allergic DisordersMultiple Choice1. A 44-year-old man has asthma. His father and brother also suffer from asthma, as does his 15-year-old son. Asthma is an allergic response based on a genetic predisposition. The specific allergen initiated by immunological mechanisms is usually mediated by:A) Immunoglobulin A (IgA)B) Immunoglobulin M (IgM)C) Immunoglobulin G (IgG)D) Immunoglobulin E (IgE)Ans: DChapter: 53Cognitive Level: ComprehensionDifficulty: ModerateIntegrated Process: CaringObjective: 1Patient Needs: A-1Feedback: Atopy refers to allergic reactions characterized by the action of IgE antibodies and a genetic predisposition to allergic reactions. IgG is the most common immunoglobulin and is found in intravascular and intercellular compartments. IgA and IgM are found in mucous secretions.2. A 20-year-old college student suffers an acute asthma attack. In response to the asthma attack, lymphokines are secreted to:A) Decrease B cell productionB) Increase cell growthC) Decrease macrophagesD) Redirect target cellsAns: BChapter: 53Cognitive Level: ComprehensionDifficulty: ModerateIntegrated Process: CaringObjective: 1Patient Needs: A-1Feedback: T cells assist B cells in producing antibodies. T cells secrete substances known as lymphokines that encourage cell growth, promote cell activation, direct the flow of cell activity, destroy target cells, and stimulate macrophages. Macrophages present the antigen to the T cells and initiate the immune response. They also digest antigens and assist in removing cells and other debris. The antigen-binding site of a T cell has a structure much like that of an immunoglobulin. It recognizes epitopes through complementary interactions. Unlike a specific antibody, a T cell dose not bind free antigens.3. The occupational health nurse is called to the office of an executive who ate a piece of cake that he was unaware had been made with peanut oil. His symptoms include wheezing, inspiratory stridor, and air hunger. He is suffering from which type of hypersensitivity?A) Anaphylactic (type I)B) Cytotoxic (type II)C) Immune Complex (type III)D) Delayed Type (type IV)Ans: AChapter: 53Cognitive Level: ComprehensionDifficulty: ModerateIntegrated Process: CaringObjective: 2Patient Needs: A-1Feedback: The most severe form of a hypersensitivity reaction is anaphylaxis. An unanticipated severe allergic reaction that is often explosive at 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 IV, also known as cellular hypersensitivity, occurs 24 to 72 hours after exposure to an allergen.4. A patient begins to complain of back pain and itching within 15 minutes of receiving a blood transfusion. The patient 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: BChapter: 53Cognitive Level: ApplicationDifficulty: DifficultIntegrated Process: CaringObjective: 2Patient Needs: A-1Feedback: A type II hypersensitivity reaction resulting in red blood cell destruction is associated with drug-induced immune hemolytic anemia, Rh-hemolytic disease of the newborn, and incompatibility reactions with blood transfusions. The most severe form of a hypersensitivity reaction is anaphylaxis. An unanticipated severe allergic reaction that is often explosive at 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 IV, also known as cellular hypersensitivity, occurs 24 to 72 hours after exposure to an allergen.5. A nurse has received her annual purified protein derivative (PPD). Seventy-two hours after the PPD is administered, she develops a reddened urticarial wheal. This skin reaction is related to:A) Leukotrienes initiating inflammatory responsesB) Bradykinin increasing permeabilityC) Prostaglandins producing smooth muscle contractionD) Mediating sensitized T cells and macrophagesAns: DChapter: 53Cognitive Level: ApplicationDifficulty: DifficultIntegrated Process: CaringObjective: 2Patient Needs: A-1Feedback: Type IV hypersensitivity, also known as cellular hypersensitivity, occurs 24 to 72 hours after exposure to an allergen. It is mediated by sensitized T cells and macrophages. Prostaglandins, composed of unsaturated fatty acids, produce smooth muscle contraction, as well as vasodilation and increased capillary permeability. Leukotrienes are chemical mediators that initiate the inflammatory response causing smooth muscle contraction, bronchial constriction, and mucous secretion in the airways. Bradykinin is a polypeptide with the ability to cause increased vascular permeability, vasodilation, hypotension, and contraction of many types of smooth muscle, such as bronchi.6. A 30-year-old male patient is suffering from severe asthma-related signs and symptoms. Which of the following medications are recommended to prevent asthma?A) Diphenhydramine (Benadryl)B) Zafirlukast (Accolate)C) Albuterol sulfate (Ventolin)D) EpinephrineAns: BChapter: 53Cognitive Level: ComprehensionDifficulty: ModerateIntegrated Process: CaringObjective: 3Patient Needs: D-2Feedback: Many manifestations of inflammation can be attributed in part to leukotrienes. Medications categorized as leukotriene antagonists or modifiers such as zafirlukast (Accolate) block the synthesis or action of leukotrienes and prevent signs and symptoms associated with asthma. Albuterol sulfate relaxes smooth muscle during an asthma attack. Diphenhydramine prevents histamine's effect on smooth muscle. Epinephrine relaxes bronchial smooth muscle.7. A patient admitted to the emergency room for an allergic reaction to a bee sting will present with which of the following alterations in his laboratory values?A) Elevated eosinophilsB) Elevated sodiumC) Elevated albuminD) Decreased glucoseAns: AChapter: 53Cognitive Level: ApplicationDifficulty: DifficultIntegrated Process: Nursing ProcessObjective: 1Patient Needs: D-4Feedback: Higher percentages of eosinophils are considered moderate to severe eosinophilia. Moderate eosinophilia is defined as 15% to 40% eosinophils and is found in patients with allergic disorders as well as in patients with malignancy, immunodeficiencies, parasitic infections, congenital heart disease, and those receiving peritoneal dialysis. Elevated sodium is noted with gross changes in water and salt balance. Elevated albumin is noted with damage to the blood-brain barrier. Decreased glucose is noted with insulin shock.8. A patient is scheduled for RAST which of the precautionary steps is most important for the nurse to follow?A) Test during a bronchospasmB) Perform scratch tests after the RASTC) Perform prick tests after the RASTD) Emergency equipment should be availableAns: DChapter: 53Cognitive Level: ComprehensionDifficulty: ModerateIntegrated Process: CaringObjective: 4Patient Needs: D-3Feedback: When the validity of the skin test is in doubt, a RAST, or provocative challenge test, may be performed. If a skin test is indicated, there is a reasonable suspicion that a specific allergen is producing symptoms in an allergic patient. However, several precautionary steps must be observed before skin testing with allergens: Testing is not performed during periods of bronchospasm, Epicutaneous tests (scratch and prick tests) are performed before other testing methods in an effort to minimize the risk of systemic reaction. Emergency equipment must be readily available to treat anaphylaxis.9. A patient has severe allergic reactions to grass, mold, and dust. He is scheduled for a skin test to determine his sensitivity. He states he has been taking corticosteroids to help control his symptoms. What nursing intervention should the nurse implement?A) The patient should take his corticosteroids regularly prior to testing.B) The nurse should only test for grass, mold, and dust initially.C) The nurse should have an emergency kit available in case of anaphylaxis.D) The nurse should cancel the test until he is off the corticosteroids.Ans: DChapter: 53Cognitive Level: ApplicationDifficulty: DifficultIntegrated Process: Nursing ProcessObjective: 5Patient Needs: D-1Feedback: False negative results may occur because of improper technique, outdated allergen solutions, and prior use of medications that suppress skin activity. Corticosteroids and antihistamines, including allergy medications, suppress skin test reactivity and are usually withheld 48 to 96 hours before testing. The patient should be tested for all possible allergens. When testing is performed, the emergency kit should be available. The most important nursing intervention is to cancel the test until he is off the corticosteroids for 48 to 96 hours.10. The nurse has transferred a patient to the radiology department for a CAT scan with contrast when she hears a code called in the radiology room. The nurse suspects her patient may have had a(n):A) Myocardial infarctionB) Cerebrovascular accidentC) Anaphylactic reactionD) Pulmonary embolismAns: CChapter: 53Cognitive Level: ApplicationDifficulty: DifficultIntegrated Process: CaringObjective: 4Patient Needs: D-3Feedback: Many medications have been implicated in anaphylaxis. Those that are most frequently reported include antibiotics, radiocontrast agents, intravenous anesthetics, aspirin and other nonsteroidal anti-inflammatory drugs, and opioids. A myocardial infarction, cerebrovascular accident, or pulmonary embolism are all possibilities for impending death. However, antibiotics and radiocontrast agents cause the most serious anaphylactic reactions, producing reactions in about 1 of every 5,000 exposures.11. A 22-year-old man is allergic to bee stings. What is the most important educational intervention the nurse should implement?A) The patient should be instructed to take benadryl before cutting the grass.B) The patient should be instructed to use an epinephrine pen if he has a bee sting.C) The patient should be instructed to go to the emergency immediately after a sting.D) The patient should be instructed to use an albuterol inhaler if he is stung.Ans: BChapter: 53Cognitive Level: ApplicationDifficulty: DifficultIntegrated Process: Teaching/LearningObjective: 4Patient Needs: B-2Feedback: The patient should be instructed on the use of epinephrine in the event of a bee sting. If avoidance of exposure to allergens is impossible, the patient should carry and administer epinephrine to prevent an anaphylactic reaction in the event of exposure to the allergen. If the patient is stung and uses an epinephrine pen, he should go to the emergency room afterward. The use of benadryl and albuterol would be ineffective in the event of anaphylaxis.12. A patient presents to the emergency room in cardiac arrest following a bee sting. The nurse should have epinephrine:A) 1: 1000 dilution in the upper thighB) 1:1500 dilution intracardiacC) 1:2000 dilution intravenousD) 1:2500 dilution intramuscularAns: AChapter: 53Cognitive Level: ApplicationDifficulty: DifficultIntegrated Process: Nursing ProcessObjective: 4Patient Needs: D-2Feedback: Oxygen is provided in high concentrations during cardiopulmonary resuscitation or when the patient is cyanotic, dyspneic, or wheezing. Epinephrine, in a 1:1000 dilution, is administered subcutaneously in the upper extremity or thigh and may be followed by a continuous IV infusion. Most adverse events associated with administration of epinephrine occur when the dose is excessive or it is given intravenously.13. A patient visits the clinic with complaints of nasal congestion, anosmia, and inability to concentrate. The primary nursing diagnosis is:A) Deficient knowledge of self-care practices related to allergiesB) Ineffective individual coping with chronicity of condition and need for environmental modificationC) Decreased attention span related to allergic rhinitisD) Fluid volume deficit related to ineffective breathing patternAns: BChapter: 53Cognitive Level: ApplicationDifficulty: DifficultIntegrated Process: Nursing ProcessObjective: 5Patient Needs: D-1Feedback: The most appropriate nursing diagnosis is ineffective individual coping with chronicity of condition and need for environmental modification. This nursing diagnosis is of the subjective and objective data. Deficient knowledge of self-care is important but requires a broader range of interventions based on the data collection. Decreased attention span and fluid volume deficit do not address the assessment data.14. A woman has a miniature dachshund that sleeps with her. Her newlywed husband has allergic rhinitis. The nurse should instruct the couple to:A) Remove the pet from the bedroomB) Allow the dog in bed but vacuum dailyC) Sleep with a down comforter and pillowsD) Sleep with the windows openAns: AChapter: 53Cognitive Level: ComprehensionDifficulty: ModerateIntegrated Process: Nursing ProcessObjective: 5Patient Needs: B-2Feedback: In avoidance therapy, every attempt is made to remove the allergen that acts as a precipitating factor. Simple measures and environmental controls are often effective in decreasing symptoms. Examples include use of air conditioners, air cleaners, humidifiers, and dehumidifiers; removal of dust-catching furnishings, carpets, and window coverings; and removal of pets from the home or the bedroom. Vacuuming the bedroom daily is an important activity, but the dog should still be removed from the room. The patient and his wife should be instructed to use pillow and mattress covers that are impermeable to dust mites. The use of goose down should be avoided; it is important to use allergy-free synthetic bedding.15. A nurse has developed severe contact dermatitis with burning, itching, cracking, and peeling of the skin. The nurse should be instructed to:A) Wear powdered latex glovesB) Wash hands with antibacterial soapC) Maintain room temperature at 80 FD) Keep hands well moisturizedAns: DChapter: 53Cognitive Level: ComprehensionDifficulty: ModerateIntegrated Process: Teaching/LearningObjective: 6Patient Needs: D-1Feedback: Treatment of patients with atopic dermatitis must be individualized. Guidelines for treatment include decreasing itching and scratching by wearing cotton fabrics, washing with a mild detergent, humidifying dry heat in the winter, maintaining room temperature at 20 to 22 C or 68 to 72 F, using antihistamines such as diphenhydramine, and avoiding animals, dust, sprays, and perfumes. Keeping the skin moisturized with daily baths to hydrate the skin and the use of topical skin moisturizers are encouraged.16. A patient is scheduled for an immunotherapy, preseasonal therapy injection. Which of the following should be included in teaching the patient about the injection?A) The injection will cure the response to the allergen.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 injection is administered year-round.Ans: BChapter: 53Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Teaching/LearningObjective: 3Patient Needs: D-2Feedback: Preseasonal injections are given 2 to 3 months before symptoms are expected. The treatment is discontinued after the season begins. The patient must remain in the clinic 30 minutes after the injection to be monitored for systemic symptoms. Therapeutic failure is evident when a patient does not experience a decrease in symptoms within 12 to 24 months. The injection will not cure the response to the allergen.17. The nurse is aware that histamine plays an important role in the immune response and the effects of histamine can manifest in assessment findings. Which response can occur as a result of histamine release?A) Constriction of small venulesB) Contraction of bronchial smooth muscleC) Dilation of large blood vesselsD) Decreased secretion of gastric and mucosal cellsAns: BChapter: 53Cognitive Level: ApplicationDifficulty: DifficultIntegrated Process: Nursing ProcessObjective: 1Patient Needs: D-4Feedback: Histamine's effects during the immune response include contraction of bronchial smooth muscle, resulting in wheezing and bronchospasm; an increase in secretion of gastric and mucosal cells; dilation of small venules; and constriction of large blood vessels.18. A hypersensitivity reaction is characterized by an immediate reaction beginning within minutes of exposure to an antigen. Which of the following conditions is an example of such a reaction?A) Anaphylactic reaction immediately following a bee stingB) Skin reaction from tape adhesiveC) Hay feverD) Rheumatoid arthritisAns: AChapter: 53Cognitive Level: AnalysisDifficulty: ModerateIntegrated Process: Nursing ProcessObjective: 2Patient Needs: D-4Feedback: Anaphylactic (type I) hypersensitivity is an immediate reaction mediated by IgE antibodies and requires previous exposure to the specific antigen. Type II reactions, or cytotoxic hypersensitivity, occur when the system mistakenly identifies a normal constituent of the body as foreign. Type III, or immune complex hypersensitivity, occurs as the result of two factors: the increased amount of circulating complexes and the presence of vasoactive amines. Type IV, or delayed-type hypersensitivity, occurs 24 to 72 hours after exposure to an allergen and is mediated by sensitized T cells and macrophages.19. Which of the following is an example of a hypersensitivity reaction characterized by the body mistakenly identifying its normal constituent as foreign?A) Hay feverB) Goodpasture's syndromeC) Lupus erythematosusD) Rheumatoid arthritisAns: BChapter: 53Cognitive Level: AnalysisDifficulty: DifficultIntegrated Process: Nursing ProcessObjective: 2Patient Needs: D-4Feedback: Type II reactions, or cytotoxic hypersensitivity, occur when the system mistakenly identifies a normal constituent of the body as foreign. An example of this type of reaction is Goodpasture's syndrome.20. The nurse is caring for a patient who has experienced a delayed hypersensitive reaction. Which of the following is an example of a hypersensitivity reaction characterized by a delayed reaction that occurs 24 to 72 hours after exposure to an antigen?A) Myasthenia gravisB) Serum sicknessC) Allergy to freshwater fishD) Contact dermatitis from tape adhesiveAns: DChapter: 53Cognitive Level: AnalysisDifficulty: ModerateIntegrated Process: Nursing ProcessObjective: 2Patient Needs: D-4Feedback: Type IV, or delayed-type hypersensitivity, occurs 24 to 72 hours after exposure to an allergen and is mediated by sensitized T cells and macrophages. An example is contact dermatitis from an allergy to tape adhesive or cosmetics.21. The nurse is providing information to the parents of a child with food allergies. Which of the following food items is a common allergen?A) Citrus fruit and riceB) Root vegetables and tomatoesC) Eggs and wheatD) Rye flour and cheeseAns: CChapter: 53Cognitive Level: ApplicationDifficulty: EasyIntegrated Process: Teaching/LearningObjective: 3Patient Needs: D-3Feedback: The most common offenders of food allergies are nuts, eggs, milk soy, wheat, and chocolate.22. The nurse examines the patient's skin after interdermal skin testing at the appropriate time for evaluating response and determines that the area presents a wheal (9 to 15 mm) with associated erythema. The nurse records the result as:A) 1+B) 2+C) 3+D) 4+Ans: CChapter: 53Cognitive Level: ComprehensionDifficulty: DifficultIntegrated Process: Communication/DocumentationObjective: 3Patient Needs: D-4Feedback: The interpretations of skin testing reactions are negative, wheal soft with minimal erythema; 1+ wheal (5 to 8 mm) with associated erythema; 2+, wheal (7 to 10 mm) with associated erythema; 3+, wheal (9 to 15 mm), slight pseudopodia possible with associated erythema; 4+, wheal (12 mm+) with pseudopodia and diffuse erythema.23. The nurse is providing teaching to a teenage girl who is allergic to bee stings. In the event of an anaphylactic reaction, the nurse informs the patient that she should self-administer epinephrine in which of the following sites?A) ForearmB) ThighC) Deltoid muscleD) AbdomenAns: BChapter: 53Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Teaching/LearningObjective: 4Patient Needs: D-2Feedback: The patient 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 auto inject a premeasured dose of epinephrine into the subcutaneous tissue.24. A male patient who is employed as a long-distance truck driver requires an antihistamine for seasonal allergies. Which of the following antihistamines would allow him to continue his employment and manage his symptoms?A) DiphenhydramineB) AlkylamineC) CetirizineD) AstemizoleAns: DChapter: 53Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Nursing ProcessObjective: 3Patient Needs: D-2Feedback: Astemizole (Hismanal), loratadine (Claritin), and fexofenadine (Allegra) are nonsedating H1 antihistamines.25. The nurse performing an assessment on a patient who has come to the clinic with symptoms of contact dermatitis asks questions related to the onset of the dermatitis. Which of the following types of contact dermatitis requires light exposure in addition to allergen contact to produce immunologic reactivity?A) AllergicB) IrritantC) PhototoxicD) PhotoallergicAns: DChapter: 53Cognitive Level: AnalysisDifficulty: ModerateIntegrated Process: Nursing ProcessObjective: 3Patient Needs: D-4Feedback: Photoallergic reactions require light exposure in addition to allergen contact to produce immunologic reactivity.26. A 17-year-old girl with spina bifida has erythema and itching around her mouth after blowing up a balloon. This is likely due to which of the following?A) A developing cold soreB) A food allergyC) A latex allergyD) Facial eczemaAns: CChapter: 53Cognitive Level: AnalysisDifficulty: EasyIntegrated Process: Nursing ProcessObjective: 6Patient Needs: D-4Feedback: Health care workers and patients with exposure to latex, as in spina bifida, are at risk for developing a latex allergy. Symptoms of latex allergy can range from mild contact dermatitis and erythema to moderately severe symptoms of rhinitis and conjunctivitis, urticaria, and bronchospasm. Balloons, condoms, and catheters are some of the items that contain latex.27. Which of the following should be included when teaching the patient about a severe food allergy?A) The patient always has the food allergy for life.B) Eat minute amounts of the food to expose the body to the antigens.C) The antigen may cause constipation during a reaction.D) Carry an EpiPen at all times.Ans: DChapter: 53Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Teaching/LearningObjective: 3Patient Needs: D-4Feedback: The patient should carry an EpiPen at all times in case of an anaphylactic reaction. The food item needs to be eliminated from the diet. A reaction will cause an increase in secretion of gastric and mucosal cells with potential diarrhea. About one-third of proven allergies disappear in 1 to 2 years if the patient carefully avoids the offending foods.28. The nurse giving dexamethasone by otic administration should inform the patient that he may experience what adverse reaction?A) TinnitusB) Temporary hearing lossC) DizzinessD) Stinging or burning sensationsAns: DChapter: 53Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Teaching/LearningObjective: 3Patient Needs: D-2Feedback: Transient local stinging or burning sensations are a common adverse reaction to otic dexamethasone. The other options don't apply.29. The nurse is teaching a patient with allergies how to prevent anaphylaxis. Which recommendation is most appropriate?A) Dry mop all hardwood floors.B) Wear medical identification.C) Have carpeting installed in every room of the house.D) Advise family and friends not to visit during the winter.Ans: BChapter: 53Cognitive Level: ApplicationDifficulty: ModerateIntegrated Process: Teaching/LearningObjective: 3Patient Needs: D-3Feedback: If the patient became unconscious or couldn't report allergies, medical identification could provide information that health care providers would need to know to avoid anaphylaxis. The patient should wet mop hardwood floors because dry mopping scatters dust that can trigger allergies. The patient should minimize the amount of carpeting in the home because carpets trap allergens such as dust and dirt. Unless the patient is ill, the nurse should encourage visits by family and friends to promote healthy social interaction.