Chapter 53: Assessment and Management of Patients With Allergic Disorders

Chapter 53: Assessment and Management of Patients With Allergic Disorders

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

Multiple Choice

 

 

 

 

1. A 44-year-old man has come to the clinic with an asthma exacerbation. He tells the nurse that his father and brother also suffer from asthma, as does his 15 year-old son.  The nurse explains that this is an allergic response based on a genetic predisposition.  The specific allergen initiated by immunological mechanisms is usually mediated by
2. A) Immunoglobulin A
3. B) Immunoglobulin M
4. C) Immunoglobulin G
5. D) Immunoglobulin E

 

Ans:  D

Chapter:  53

Client Needs:  A-1

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  1

Page and Header:  1607, Physiologic Overview

 

Feedback:  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. At an office birthday party one of the executives eats a piece of cake that he was unaware had been made with peanut oil. He begins wheezing, with an inspiratory stridor and air hunger. The occupational health nurse is called to the office. The nurse says he is suffering from which type of hypersensitivity?
3. A) Anaphylactic (Type 1)
4. B) Cytotoxic (Type II)
5. C) Immune complex (Type III)
6. D) Delayed type (Type IV)

 

Ans:  A

Chapter:  53

Client Needs:  A-1

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  2

Page and Header:  1609, Physiologic Overview

 

Feedback:  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) or immune complex, 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.

 

 

 

 

3. A 30-year-old male patient comes into the emergency department with severe asthma-related signs and symptoms. What medication is recommended to prevent the signs and symptoms of asthma?
4. A) Diphenhydramine (Benadryl)
5. B) Zafirlukast (Accolate)
6. C) Albuterol sulfate (Ventolin)
7. D) Epinephrine

 

Ans:  B

Chapter:  53

Client Needs:  D-2

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  3

Page and Header:  1619, Allergic Rhinitis

 

Feedback:  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.

 

 

 

 

4. The nurse is preparing a patient for RAST. Which of the precautionary steps is most important for the nurse to follow?
5. A) Test during a bronchospasm
6. B) Scratch tests are performed after the RAST
7. C) Prick tests are performed after the RAST
8. D) Emergency equipment should be available

 

Ans:  D

Chapter:  53

Client Needs:  D-3

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  4

Page and Header:  1612, Diagnostic Evaluation

 

Feedback:  In cases of doubt about the validity of the skin test, 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, precautionary steps must be observed before skin testing with allergens: testing is not performed during periods of bronchospasm, and 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.

 

 

 

 

5. A patient who is scheduled for a skin test to determine his sensitivity has severe allergic reactions to grass, mold, and dust. The patient tells the nurse he has been taking corticosteroids to help control his symptoms.  What nursing intervention should the nurse implement?
6. A) The patient should take his corticosteroids regularly prior to testing.
7. B) The nurse should only test for grass, mold, and dust initially.
8. C) The nurse should have an emergency cart available in case of anaphylaxis.
9. D) The nurse should cancel the test until he is off the corticosteroids.

 

Ans:  D

Chapter:  53

Client Needs:  D-1

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  5

Page and Header:  1613, Diagnostic Evaluation

 

Feedback:  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. You would not test the patient if he is taking his steroids; you would not test for grass, mold, or dust; and there would be no need for an emergency cart.