Chapter 38 Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition

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Chapter 38  Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

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?

  1. A)  Immunoglobulin A
  2. B)  Immunoglobulin M
  3. C)  Immunoglobulin G
  4. 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?

  1. A)  Anaphylactic (type 1)
  2. B)  Cytotoxic (type II)
  3. C)  Immune complex (type III)
  4. 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.

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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?

  1. A)  Diphenhydramine (Benadryl)
  2. B)  Montelukast (Singulair)
  3. C)  Albuterol sulfate (Ventolin)
  4. 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?

  1. A)  The patient must not have received an immunization within 7 days.
  2. B)  The nurse should administer albuterol 30 to 45 minutes prior to the test.
  3. C)  Prophylactic epinephrine should be administered before the test.
  4. 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?

  1. A)  The patient should take his corticosteroids regularly prior to testing.
  2. B)  The patient should only be tested for grass, mold, and dust initially.
  3. C)  The nurse should have an emergency cart available in case of anaphylaxis during the test.
  4. 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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6. A patient has developed severe contact dermatitis with burning, itching, cracking, and peeling of the skin on her hands. What should the nurse teach the patient to do?

  1. A)  Wear powdered latex gloves when in public.
  2. B)  Wash her hands with antibacterial soap every few hours.
  3. C)  Maintain room temperature at 75F to 80F whenever possible.
  4. D)  Keep her hands well-moisturized at all times.

Ans: D

Feedback:

Powdered latex gloves can cause contact dermatitis. Skin should be kept well-hydrated and should be washed with mild soap. Maintaining roomtemperature at 75F to 80F is not necessary.

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