Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) - Assessment and Management of Patients With Allergic Disorders

Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) - Assessment and Management of Patients With Allergic Disorders Related

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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 I)
  • B. Cytotoxic (type II)
  • C. Immune complex (type III)
  • D. Delayed-type (type IV)
Correct Answer: A

Rationale: 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) 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 (type IV), also known as cellular hypersensitivity, occurs 24 to 72 hours after exposure to an allergen.

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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 I)
  • B. Cytotoxic (type II)
  • C. Immune complex (type III)
  • D. Delayed type (type IV)
Correct Answer: B

Rationale: A type II hypersensitivity reaction resulting in red blood cell destruction is associated with blood transfusions. This type of reaction does not result from types I, III, or IV reactions.

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.
Correct Answer: A

Rationale: The time from exposure to the antigen to onset of symptoms is a good indicator of the severity of the reaction: the faster the onset, the more severe the reaction. None of the other statements is an accurate description of the course of anaphylactic reactions.

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
Correct Answer: C

Rationale: Patients with spina bifida are at a particularly high risk for developing a latex allergy. This is not true of patients with herpes simplex, HIV, or hypogammaglobulinemia.

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
Correct Answer: C

Rationale: Identifying the offending agent is a priority in the care of a patient with dermatitis. Antihistamines are not administered topically and epinephrine is not used to treat dermatitis. Inadequate perfusion occurs with PAD or vasoconstriction.

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.
Correct Answer: A

Rationale: If a patient is experiencing an allergic response, the nurses initial action is to assess the patient for signs and symptoms of anaphylaxis. Erythema and urticaria may be present, but these are not the most significant or most common signs of anaphylaxis. Assessment must precede interventions, such as administering an antihistamine. Epinephrine is indicated in the treatment of anaphylaxis, not for every allergic reaction.

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