In the presence of convincing history of a severe systemic reaction, the next diagnostic step for those with initially negative skin test is

Correct Answer: B

Rationale: In the context of pediatric nursing, understanding the diagnostic approach to severe systemic reactions is crucial for providing safe and effective care to children. In this scenario, the correct next diagnostic step for patients with initially negative skin tests but a convincing history of a severe systemic reaction is to repeat the skin test after 4-6 weeks (Option B). The rationale behind choosing to repeat the skin test is based on the principle of delayed hypersensitivity reactions. It takes time for the body to sensitively react to an allergen, so a negative result immediately after an exposure does not rule out an allergy. Repeating the skin test after a few weeks allows for the development of a detectable immune response. Option A, in vitro serum assay for venom-specific IgE, may not be as sensitive as a repeat skin test for detecting an IgE-mediated allergic reaction. Option C, serum tryptase level, and Option D, plasma histamine, are not typically used as initial diagnostic tests for confirming an allergic reaction to a specific allergen. Educationally, this question highlights the importance of understanding the limitations of initial diagnostic tests and the value of timing in evaluating allergic reactions in pediatric patients. It underscores the need for thorough assessment, critical thinking, and evidence-based practice in pediatric nursing to ensure accurate diagnosis and appropriate management of allergic conditions.

Correct Answer: A

Rationale: In fatal anaphylaxis, one of the principal pathologic features is acute bronchial obstruction. This is the correct answer because anaphylaxis is a severe, life-threatening allergic reaction that can cause the airways to constrict rapidly, leading to difficulty in breathing and potentially fatal respiratory distress. Option B, hypotension, is incorrect because while hypotension can occur in anaphylaxis due to systemic vasodilation and fluid shifts, it is not a principal pathologic feature in fatal cases. Option C, behavioral change, is also incorrect as it is not a typical presentation of anaphylaxis. Option D, abdominal pain, is not a primary feature of anaphylaxis but may occur in some cases due to gastrointestinal involvement. In an educational context, understanding the pathophysiology of anaphylaxis is crucial for pediatric nurses to recognize and respond promptly to this life-threatening condition. Recognizing the key features such as acute bronchial obstruction can guide nurses in providing timely and appropriate interventions such as administering epinephrine and managing airway compromise to prevent fatal outcomes in pediatric patients experiencing anaphylaxis.

Correct Answer: C

Rationale: In this question, the correct answer is C) abdominal pain. Acute IgE-mediated food allergies typically manifest with symptoms like urticaria (hives), pruritis (itching), and diarrhea due to the body's immune response to the allergen. Abdominal pain is not a classic symptom of an IgE-mediated food allergy reaction. Urticaria and pruritis are common skin manifestations seen in IgE-mediated food allergies due to the release of histamine in response to the allergen. Diarrhea can occur as the body tries to expel the allergen through the gastrointestinal tract. Educationally, understanding the symptoms of food allergies is crucial for healthcare providers, especially those working with pediatric patients who may have allergies. Recognizing these symptoms promptly can lead to appropriate and timely interventions to prevent severe allergic reactions. It is essential for nurses to be able to differentiate between various symptoms to provide effective care and support to pediatric patients with food allergies.

Correct Answer: C

Rationale: Stevens-Johnson syndrome (SJS) is a severe skin reaction that can be triggered by certain medications. In this case, the correct answer is C) sulfonamide. Sulfonamide antibiotics, such as sulfamethoxazole, have been associated with causing SJS in pediatric patients. These drugs can lead to a hypersensitivity reaction that manifests as SJS. Option A) dapsone is primarily used in the treatment of leprosy and dermatitis herpetiformis; it is not commonly linked to SJS in comparison to sulfonamides. Option B) hydralazine is an antihypertensive medication that is more commonly associated with drug-induced lupus than with SJS. Option D) procainamide is an antiarrhythmic drug that is known to be associated with drug-induced lupus, rather than SJS. Educationally, understanding the medications that can cause severe adverse reactions like SJS is crucial for pediatric nurses. Being able to identify high-risk medications can help prevent adverse events in pediatric patients. Nurses need to be aware of the signs and symptoms of SJS and understand the importance of monitoring patients closely when administering medications known to have this potential side effect. This knowledge can significantly impact patient safety and outcomes in pediatric nursing practice.

Correct Answer: A

Rationale: In pediatric nursing practice, understanding different types of immune reactions is crucial for providing safe and effective care to children. In this question, the correct answer is A) serum sickness, which is a classic example of a type III (immune complex) reaction. Serum sickness occurs when there is an excessive immune response to antigens in the blood, leading to the formation of immune complexes that deposit in tissues and cause inflammation. This reaction is characteristic of type III hypersensitivity reactions, where immune complexes are deposited in various tissues, leading to inflammatory responses. Option B) TB skin test reactions are examples of type IV (delayed-type) hypersensitivity reactions, not type III reactions. These reactions involve T cells and do not typically involve immune complexes. Option C) contact dermatitis (neomycin) is an example of a type IV hypersensitivity reaction, specifically a contact hypersensitivity reaction mediated by T cells. Option D) graft versus-host disease is a complication of allogeneic stem cell transplantation and is caused by donor T cells attacking the recipient's tissues. This is not an example of a type III hypersensitivity reaction. Understanding the differences between these types of immune reactions is essential for pediatric nurses to accurately assess and manage various immune-related conditions in children. Recognizing the specific characteristics of each type of hypersensitivity reaction helps nurses provide appropriate care and interventions to pediatric patients experiencing these immune responses.