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Brunner: Medical-Surgical Nursing, 11th Edition

Test Bank
Chapter 53: Assessment and Management of Patients With Allergic Disorders

Multiple Choice

1. A 44-year-old man has asthma. His father and brother also suffer from asthma, as does his 15year-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: D
Chapter: 53
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Caring
Objective: 1
Patient Needs: A-1
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. 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 production
B) Increase cell growth
C) Decrease macrophages
D) Redirect target cells
Ans: B
Chapter: 53
Cognitive Level: Comprehension
Difficulty: Moderate

Integrated Process: Caring


Objective: 1
Patient Needs: A-1
Feedback: 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: A
Chapter: 53
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Caring
Objective: 2
Patient Needs: A-1
Feedback: 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: B
Chapter: 53
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Caring
Objective: 2
Patient Needs: A-1
Feedback: 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 responses
B) Bradykinin increasing permeability
C) Prostaglandins producing smooth muscle contraction
D) Mediating sensitized T cells and macrophages
Ans: D
Chapter: 53
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Caring
Objective: 2
Patient Needs: A-1
Feedback: 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) Epinephrine
Ans: B
Chapter: 53
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Caring
Objective: 3
Patient Needs: D-2
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.

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 eosinophils
B) Elevated sodium
C) Elevated albumin
D) Decreased glucose
Ans: A
Chapter: 53
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 1
Patient Needs: D-4
Feedback: 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 bronchospasm
B) Perform scratch tests after the RAST
C) Perform prick tests after the RAST
D) Emergency equipment should be available
Ans: D
Chapter: 53
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Caring
Objective: 4
Patient Needs: D-3
Feedback: 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: D
Chapter: 53
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process

Objective: 5
Patient Needs: D-1
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.

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 infarction
B) Cerebrovascular accident
C) Anaphylactic reaction
D) Pulmonary embolism
Ans: C
Chapter: 53
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Caring
Objective: 4
Patient Needs: D-3
Feedback: 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: B
Chapter: 53

Cognitive Level: Application


Difficulty: Difficult
Integrated Process: Teaching/Learning
Objective: 4
Patient Needs: B-2
Feedback: 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 thigh
B) 1:1500 dilution intracardiac
C) 1:2000 dilution intravenous
D) 1:2500 dilution intramuscular
Ans: A
Chapter: 53
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 4
Patient Needs: D-2
Feedback: 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 allergies
B) Ineffective individual coping with chronicity of condition and need for environmental
modification
C) Decreased attention span related to allergic rhinitis
D) Fluid volume deficit related to ineffective breathing pattern
Ans: B

Chapter: 53
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 5
Patient Needs: D-1
Feedback: 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 bedroom
B) Allow the dog in bed but vacuum daily
C) Sleep with a down comforter and pillows
D) Sleep with the windows open
Ans: A
Chapter: 53
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 5
Patient Needs: B-2
Feedback: 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 gloves
B) Wash hands with antibacterial soap
C) Maintain room temperature at 80 F

D) Keep hands well moisturized


Ans: D
Chapter: 53
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 6
Patient Needs: D-1
Feedback: 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: B
Chapter: 53
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 3
Patient Needs: D-2
Feedback: 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 venules

B) Contraction of bronchial smooth muscle


C) Dilation of large blood vessels
D) Decreased secretion of gastric and mucosal cells
Ans: B
Chapter: 53
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 1
Patient Needs: D-4
Feedback: 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 sting
B) Skin reaction from tape adhesive
C) Hay fever
D) Rheumatoid arthritis
Ans: A
Chapter: 53
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 2
Patient Needs: D-4
Feedback: 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)
B)
C)
D)

Hay fever
Goodpasture's syndrome
Lupus erythematosus
Rheumatoid arthritis

Ans: B
Chapter: 53
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 2
Patient Needs: D-4
Feedback: 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 gravis
B) Serum sickness
C) Allergy to freshwater fish
D) Contact dermatitis from tape adhesive
Ans: D
Chapter: 53
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 2
Patient Needs: D-4
Feedback: 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 rice
B) Root vegetables and tomatoes
C) Eggs and wheat

D) Rye flour and cheese


Ans: C
Chapter: 53
Cognitive Level: Application
Difficulty: Easy
Integrated Process: Teaching/Learning
Objective: 3
Patient Needs: D-3
Feedback: 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: C
Chapter: 53
Cognitive Level: Comprehension
Difficulty: Difficult
Integrated Process: Communication/Documentation
Objective: 3
Patient Needs: D-4
Feedback: 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) Forearm
B) Thigh
C) Deltoid muscle
D) Abdomen

Ans: B
Chapter: 53
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 4
Patient Needs: D-2
Feedback: 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) Diphenhydramine
B) Alkylamine
C) Cetirizine
D) Astemizole
Ans: D
Chapter: 53
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 3
Patient Needs: D-2
Feedback: 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) Allergic
B) Irritant
C) Phototoxic
D) Photoallergic
Ans: D
Chapter: 53

Cognitive Level: Analysis


Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 3
Patient Needs: D-4
Feedback: 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 sore
B) A food allergy
C) A latex allergy
D) Facial eczema
Ans: C
Chapter: 53
Cognitive Level: Analysis
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 6
Patient Needs: D-4
Feedback: 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: D
Chapter: 53
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 3

Patient Needs: D-4


Feedback: 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) Tinnitus
B) Temporary hearing loss
C) Dizziness
D) Stinging or burning sensations
Ans: D
Chapter: 53
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 3
Patient Needs: D-2
Feedback: 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: B
Chapter: 53
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 3
Patient Needs: D-3
Feedback: 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.