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The nurse discusses the prevention and management of allergic reactions with a patient who is a beekeeper and has developed a hypersensitivity to bee sting. Which of the following patient statements indicates a need for additional teaching?
- A. I will plan to take oral antihistamines daily before going to work.'
- B. I will get a prescription for epinephrine and learn to self-inject it.'
- C. I should wear a Medic Alert bracelet indicating my allergy to bee stings.'
- D. I am going to need job retraining so that I can work in a different occupation.'
Correct Answer: A
Rationale: Since the patient is at risk for bee stings and the severity of allergic reactions tends to increase with added exposure to allergen, taking oral antihistamines will not adequately control the patient's hypersensitivity reaction. The other patient statements indicate a good understanding of management of the problem.
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The nurse is caring for a patient who receives weekly immunotherapy and has missed the previous appointment. Which of the following actions should the nurse implement when the patient comes for the next injection?
- A. Schedule an additional dose that week.
- B. Administer the usual dosage of the allergen.
- C. Consult with the health care provider about giving a lower allergen dose.
- D. Re-evaluate the patient's sensitivity to the allergen with a repeat skin test.
Correct Answer: C
Rationale: Because there is an increased risk for adverse reactions after a patient misses a scheduled dose of allergen, the nurse should check with the health care provider before administration of the injection. A skin test is used to identify the allergen and would not be used at this time. An additional dose for the week may increase the risk for a reaction.
The nurse is teaching a patient on immunosuppressant therapy after a kidney transplant about the post-transplant drug regimen. Which of the following statements by the patient should alert the nurse that additional teaching is required?
- A. If I develop an acute rejection episode, I will need to have other types of drugs given IV.'
- B. I need to be monitored closely because I have a greater chance of developing malignant tumours.'
- C. After a couple of years, it is likely that I will be able to stop taking the calcineurin inhibitor.'
- D. The drugs are given in combination because they inhibit different aspects of transplant rejection.'
Correct Answer: C
Rationale: The calcineurin inhibitor will need to be continued for life. The other patient statements are accurate and indicate that no further teaching is necessary about those topics.
The nurse is admitting a patient to the hospital with a diagnosis of acute rejection of a kidney transplant. Which of the following actions should the nurse anticipate implementing?
- A. Administration of immunosuppressant medications
- B. Insertion of an arteriovenous graft for hemodialysis
- C. Placement of the patient on the transplant waiting list
- D. Drawing blood for human leukocyte antigen (HLA) and ABO compatibility
Correct Answer: A
Rationale: Acute rejection is treated with the administration of additional immunosuppressant drugs such as corticosteroids. Because acute rejection is reversible, there is no indication that the patient will require another transplant, hemodialysis, or HLA/ABO testing.
For early detection of an anaphylactic reaction in a patient who has received allergen testing using the cutaneous scratch method, which of the following actions should the nurse take first?
- A. Check blood pressure and pulse rate.
- B. Auscultate the lung sounds bilaterally.
- C. Monitor pupil size and reaction to light.
- D. Assess the arm at the site of the skin testing.
Correct Answer: D
Rationale: The initial symptoms of anaphylaxis are itching and edema at the site of the exposure. Hypotension, tachycardia, dilated pupils, and wheezes occur later. Rapid administration of epinephrine when excessive itching or swelling at the skin site is observed can prevent the progression to anaphylaxis.
After being stung by a wasp, a patient is brought to the clinic by a coworker. Upon arrival the patient is anxious and having difficulty breathing. Which of the following actions is priority for the nurse to implement?
- A. Have the patient lie down.
- B. Assess the patient's airway.
- C. Administer high-flow oxygen.
- D. Remove the stinger from the site.
Correct Answer: B
Rationale: The initial action with any patient with difficulty breathing is to assess and maintain the airway. The other actions also are part of the emergency management protocol for anaphylaxis, but the priority is airway maintenance.