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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?
Correct Answer: C
Rationale: Unlike first-generation H1 receptor antagonists, newer antihistamines bind to peripheral rather than central nervous system H1 receptors, causing less sedation, if at all. Tolerance to sedation did not usually occur with first-generation drugs and newer antihistamines are not combined with a stimulant.
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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
Correct Answer: D
Rationale: Nurses should be aware that atopic dermatitis is often the first step in a process that leads to asthma and allergic rhinitis. It is not linked as closely to bronchitis, SLE, and RA.
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.
Correct Answer: B
Rationale: Although severe systemic reactions are rare, the risk of systemic and potentially fatal anaphylaxis exists. Because of this risk, the patient must remain in the office or clinic for at least 30 minutes after the injection and is observed for possible systemic symptoms. Therapeutic failure is evident when a patient does not experience a decrease in symptoms within 12 to 24 months. Epinephrine is not given prior to treatment and the IV route is not used.
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
Correct Answer: B
Rationale: All patients with food allergies, especially seafood and nuts, should have an EpiPen device prescribed. The child does not necessarily need to avoid all common food allergens. Immunotherapy is not indicated in the treatment of childhood food allergies. Immunizations are important, but do not address food allergies.
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
Correct Answer: D
Rationale: Edema of the respiratory tract can compromise the airway in patients with hereditary angioedema. As such, this is a priority nursing diagnosis over pain and possible infection. Skin integrity is not threatened by angioedema.
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.
Correct Answer: B
Rationale: On discovery of a medication allergy, patients are warned that they have a hypersensitivity to a particular medication and are advised not to take it again. As a result, the patient would need to liaise with the primary care provider. There is no need for emergency care unless symptoms worsen to involve respiratory function. An antihistamine would not be an adequate or appropriate recommendation from the nurse.