ATI LPN
Timby's Introductory Medical-Surgical Nursing Thirteenth, North American Edition
Chapter 34 : Caring for Clients With Immune-Mediated Disorders Questions
Question 1 of 5
A client presents to the clinic with reports of itching and hives after taking an aspirin this morning. What medication does the nurse anticipate administering that blocks histamine receptors?
Correct Answer: A
Rationale: Diphenhydramine is an antihistamine used for allergic reactions. Flunisolide is a nasal decongestant agent and is used locally to the nasal mucosa. Beclomethasone dipropionate is a nasal steroid spray and inhalant. Pseudoephedrine hydrochloride only constricts nasal membranes.
Question 2 of 5
A client calls the clinic and asks the nurse if using oxymetazoline nasal spray would be all right to relieve nasal congestion caused by seasonal allergies. What instructions should the nurse provide to the client to avoid complications?
Correct Answer: B
Rationale: Overusing oxymetazoline nasal spray can cause rebound congestion. The medication does not cause fungal infection. Corticosteroids should be tapered, but it is not necessary to taper oxymetazoline. Oxymetazoline does not cause sleepiness so the client can operate machinery or drive.
Question 3 of 5
A client is taking oral corticosteroids after having an exacerbation of asthma. What should the nurse be sure to include when instructing the client how to take the medication?
Correct Answer: D
Rationale: Taking the oral corticosteroids in the morning with food will help reduce the gastrointestinal upset that may be experienced. The medication causes weight gain not weight loss, does not cause drowsiness, and should not be taken on an empty stomach.
Question 4 of 5
A client is taking the immunosuppressant medication, azathioprine (Imuran), for the treatment of Crohn's disease. What statement made by the client demonstrates an understanding of the side effects of this medication?
Correct Answer: A
Rationale: The client should be instructed to be sure to report any signs of infection since this drug suppresses the immune system and makes the client susceptible to infections. It is important for a client to drink 3 L of fluid when taking the immunosuppressant drug cyclosporine to prevent hemorrhagic cystitis, but this is not necessary for azathioprine. It is not necessary to inform the physician if the client is not having a bowel movement daily. The client should not stop taking the medication for any reason unless discussed with the physician.
Question 5 of 5
The nursing instructor is discussing hypersensitivity responses with a clinical group. What allergic reaction(s) would the nursing instructor talk about? Select all that apply.
Correct Answer: C,D,E
Rationale: Once sensitization occurs, one of four types of hypersensitivity responses can occur. These may be immediate or delayed depending on the time it takes for the immune system to mount a response. An immediate hypersensitivity response is due to antibodies interacting with allergens and occurs rapidly. There are three types of immediate hypersensitivity responses: type I, atopic or anaphylactic, which is mediated by immunoglobulin E (IgE) antibodies; type II, cytotoxic, which is mediated by immunoglobulin M or G (IgM or IgG) antibodies; and type III, immune complex, which is mediated by IgG antibodies. The first two types of responses occur within minutes; type III responses reach a peak within 6 hours after exposure to an allergen. The nurse would not discuss atypical and unmediated hypersensitivity responses in this scenario.