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Chapter 34 Assessment and Management of Patients With Inflammatory Rheumatic Disorders
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Chapter 34 Assessment and Management of Patients WithInflammatory Rheumatic Disorders
1. A patient with a family history of allergies has suffered an allergic response based on a genetic
predisposition. This atopic response is usually mediated by what immunoglobulin?
A) Immunoglobulin A
B) Immunoglobulin M C) Immunoglobulin G D) Immunoglobulin E Ans: D
Feedback:
Atopy refers to allergic reactions characterized by the action of IgE antibodies and a
genetic predisposition to allergic reactions.
2. 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 1)
B) Cytotoxic (type II)
C) Immune complex (type III)
D) Delayed-type (type IV) Ans: A
Feedback:
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.
3. A patient is learning about his new diagnosis of asthma with the asthma nurse. What
medication has the ability to prevent the onset of acute asthma exacerbations?
A) Diphenhydramine (Benadryl) B) Montelukast (Singulair)
C) Albuterol sulfate (Ventolin) D) Epinephrine
Ans: B
Feedback:
Many manifestations of inflammation can be attributed in part to leukotrienes. Medications
categorized as leukotriene antagonists or modifiers such as montelukast (Singulair) block the
synthesis or action of leukotrienes and prevent signs and symptoms associated with asthma.
Diphenhydramine prevents histamine's effect on smooth muscle. Albuterol sulfate relaxes
smooth muscle during an asthma attack. Epinephrine relaxes bronchial smooth muscle but is
not used on a preventative basis.
4. A nurse is preparing a patient for allergy skin testing. Which of the following precautionary
steps is most important for the nurse to follow?
A) The patient must not have received an immunization within 7 days.
B) The nurse should administer albuterol 30 to 45 minutes prior to the test.
C) Prophylactic epinephrine should be administered before the test. D) Emergency
equipment should be readily available.
Ans: D
Feedback:
Emergency equipment must be readily available during testing to treat anaphylaxis.
Immunizations do not contraindicate testing. Neither epinephrine nor albuterol is given prior
to testing.
, 5. A patient who is scheduled for a skin test informs the nurse that he has been taking
corticosteroids to help control his allergy symptoms. What nursing intervention should the
nurse implement?
A) The patient should take his corticosteroids regularly prior to testing. B) The patient
should only be tested for grass, mold, and dust initially.
C) The nurse should have an emergency cart available in case of anaphylaxis during the test.
D) The patient's test should be cancelled until he is off his corticosteroids. Ans: D
Feedback:
Corticosteroids and antihistamines, including over-the-counter allergy medications,
suppress skin test reactivity and should be stopped 48 to 96 hours before testing, depending
on the duration of their activity. Emergency equipment must be at hand during allergy testing,
but the test would be postponed.
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