A patient develops itching, redness and small blisters on the scalp after a delay following use of a new hair dye. Which type of hypersensitivity reaction is this?
Type IV, delayed and mediated by T cells
✓
Type I, immediate and mediated by IgE
Type II, cytotoxic and mediated by antibodies
Type III, mediated by immune complexes
Correct Answer
Type IV, delayed and mediated by T cells
Allergic contact dermatitis is a delayed reaction in which sensitized T cells drive local inflammation, producing redness, itching and vesicles after re-exposure. Type I, immediate and mediated by IgE causes rapid reactions such as hives and anaphylaxis. Type II, cytotoxic and mediated by antibodies destroys cells, as in autoimmune hemolytic anemia. Type III, mediated by immune complexes causes conditions such as serum sickness and vasculitis.
Category: Hypersensitivity Mechanisms
Question 2
Serum sickness and some forms of glomerulonephritis result from which hypersensitivity mechanism?
IgE on mast cells triggers the release of histamine
Antigen-antibody complexes deposit in tissues and activate complement
✓
Sensitized T cells activate macrophages in the skin
Antibodies attack antigens on the surface of blood cells
Correct Answer
Antigen-antibody complexes deposit in tissues and activate complement
In a type III reaction, complexes of antigen with IgG or IgM lodge in vessels and tissues, activate complement and attract neutrophils that damage the tissue. IgE on mast cells triggers the release of histamine describes type I. Sensitized T cells activate macrophages in the skin describes type IV. Antibodies attack antigens on the surface of blood cells describes type II.
Category: Hypersensitivity Mechanisms
Question 3
A person had no reaction to a first bee sting but developed hives after a later sting. What explains the difference?
The first sting used up the person's stored histamine
Bee venom becomes more toxic with each sting
The first sting led to IgE that primed mast cells and basophils
✓
Antibodies from the first sting gave lasting protection
Correct Answer
The first sting led to IgE that primed mast cells and basophils
Sensitization occurs on first exposure, when allergen-specific IgE attaches to mast cells and basophils; on re-exposure, the allergen binds that IgE and mediators are released. The first sting used up the person's stored histamine does not explain a stronger later reaction. Bee venom becomes more toxic with each sting is false; the immune response changes, not the venom. Antibodies from the first sting gave lasting protection describes immunity, the opposite of what happened.
Category: Hypersensitivity Mechanisms
Question 4
A patient developed hives and wheezing soon after a dose of penicillin. Which antibiotic is the patient also likely to react to?
Azithromycin
Doxycycline
Ciprofloxacin
Amoxicillin
✓
Correct Answer
Amoxicillin
Amoxicillin belongs to the same penicillin class, so cross-reactivity is likely, and the patient is taught to report the allergy at every facility and to know which related drugs to avoid. Azithromycin is a macrolide with a different structure. Doxycycline is a tetracycline and is not a penicillin. Ciprofloxacin is a fluoroquinolone and does not share the penicillin structure.
Category: Allergy Assessment
Question 5
During admission, a patient's parent says the patient had some kind of reaction to a medication as a child but cannot recall details. What should the nurse do?
Document it as an allergy
✓
Leave it off the chart until testing is done
Record it only as a side effect
Give the drug and observe closely
Correct Answer
Document it as an allergy
When the type of past reaction is unclear, the nurse errs on the side of caution and documents the allergy so the drug is not given without review. Leave it off the chart until testing is done exposes the patient to the drug in the meantime. Record it only as a side effect understates a possible hypersensitivity. Give the drug and observe closely risks a serious reaction.
Category: Allergy Assessment
Question 6
To limit the risk of a systemic reaction during allergy skin testing, which approach is used?
Intradermal tests before any prick tests
Prick or scratch tests before any intradermal tests
✓
Testing while the patient is wheezing
Leaving the patient alone during testing
Correct Answer
Prick or scratch tests before any intradermal tests
Superficial prick or scratch tests expose the patient to less allergen, so they are done first; intradermal testing follows only if needed, with emergency equipment nearby. Intradermal tests before any prick tests reverses the safe order. Testing while the patient is wheezing is avoided because bronchospasm raises the risk of a severe reaction. Leaving the patient alone during testing is unsafe, because the nurse must watch for anaphylaxis.
Category: Allergy Assessment
Question 7
A patient with contact dermatitis has inflamed, itchy skin after the irritant has been removed. Which measure relieves the inflammation and itching?
Hot packs
A heavily scented lotion
Cool compresses
✓
Wool wraps over the area
Correct Answer
Cool compresses
Cool compresses or aluminum acetate soaks calm inflammation and itching in contact dermatitis. Hot packs dilate vessels and usually worsen itching. A heavily scented lotion adds fragrance, a common irritant. Wool wraps over the area use a rough fabric that irritates inflamed skin.
Category: Allergic Skin Disorders
Question 8
Which nasal discharge is typical of allergic rhinitis?
Thick, green drainage
Blood-streaked crusts
Foul-smelling yellow drainage
Thin, clear, watery drainage
✓
Correct Answer
Thin, clear, watery drainage
Allergic rhinitis produces abundant serous drainage along with sneezing, congestion and itching of the nose and eyes. Thick, green drainage suggests a bacterial infection. Blood-streaked crusts point to dryness or mucosal injury. Foul-smelling yellow drainage also suggests infection rather than allergy.
Category: Allergic Rhinitis
Question 9
A patient whose allergic rhinitis is triggered by dust mites asks how to reduce exposure at home. What should the nurse recommend?
Use allergen-resistant covers on the pillow and mattress
✓
Add more carpeting and upholstered furniture
Keep the bedroom warm and humid
Wash bedding only when it looks dirty
Correct Answer
Use allergen-resistant covers on the pillow and mattress
Encasing pillows and mattresses blocks contact with mites that live in bedding, and works best combined with frequent washing and cleaning. Add more carpeting and upholstered furniture gives mites more places to collect. Keep the bedroom warm and humid creates the conditions mites thrive in. Wash bedding only when it looks dirty allows mites to build up; bedding should be washed regularly.
Category: Allergic Rhinitis
Question 10
Which patient with allergic rhinitis is a candidate for allergen immunotherapy?
One whose symptoms stop once the family cat is rehomed
One with a positive skin test to a pollen that cannot be avoided
✓
One with nonallergic rhinitis and negative skin tests
One who wants quick relief from a sudden sneezing fit
Correct Answer
One with a positive skin test to a pollen that cannot be avoided
Immunotherapy is indicated when a positive skin test and a matching history point to an allergen the patient cannot avoid; gradually increasing doses then reduce reactions on natural exposure. One whose symptoms stop once the family cat is rehomed is controlled by avoidance alone. One with nonallergic rhinitis and negative skin tests has no allergen to desensitize against. One who wants quick relief from a sudden sneezing fit needs symptom medication, since immunotherapy takes years to work.
Category: Allergic Rhinitis
Question 11
Parents of an infant with atopic dermatitis ask which conditions their child may develop later. Which answer reflects the atopic march?
Psoriasis and rosacea
Rheumatoid arthritis and lupus
Asthma and allergic rhinitis
✓
Acne and seborrheic dermatitis
Correct Answer
Asthma and allergic rhinitis
The atopic march describes allergic disease that often begins with eczema and food allergy in early childhood and progresses to asthma and allergic rhinitis. Psoriasis and rosacea are inflammatory skin conditions not part of the allergic progression. Rheumatoid arthritis and lupus are autoimmune diseases. Acne and seborrheic dermatitis are not allergic disorders.
Category: Allergic Skin Disorders
Question 12
Which teaching should the nurse include for a patient with chronic urticaria?
Wear tight, snug-fitting clothing
Take hot showers to soothe the skin
Drink alcohol only with meals
Avoid ibuprofen and other NSAIDs
✓
Correct Answer
Avoid ibuprofen and other NSAIDs
NSAIDs can cause hives and worsen existing urticaria, so they are avoided along with heat, stress, tight clothing and alcohol. Wear tight, snug-fitting clothing adds pressure that can aggravate wheals. Take hot showers to soothe the skin uses heat, which worsens urticaria. Drink alcohol only with meals still exposes the patient to alcohol, which can intensify the reaction.
Category: Allergic Skin Disorders
Question 13
Which test helps confirm suspected cold urticaria?
An ice cube is placed on the forearm and the site is watched for a wheal
✓
A patch of allergens is taped to the back and read later
A skin biopsy is taken from an existing wheal
Blood is drawn for a thyroid hormone level
Correct Answer
An ice cube is placed on the forearm and the site is watched for a wheal
In cold urticaria, cold exposure releases histamine, so a wheal forming where ice was applied confirms it. A patch of allergens is taped to the back and read later is patch testing for contact dermatitis. A skin biopsy is taken from an existing wheal is used for persistent wheals to rule out urticarial vasculitis. Blood is drawn for a thyroid hormone level looks for thyroid disease linked to chronic urticaria, not cold sensitivity.
Category: Allergic Skin Disorders
Question 14
A patient suddenly develops swelling of the lips and tongue. Which assessment is the nurse's priority?
Distribution of any hives
Airway patency and breathing
✓
Blood glucose level
Pain level at the swollen sites
Correct Answer
Airway patency and breathing
Angioedema of the lips, tongue or throat can block the airway, leading to hypoxia, brain damage and death, so airway and breathing come first. Distribution of any hives is assessed after the airway is secured. Blood glucose level is unrelated to the immediate threat. Pain level at the swollen sites matters for comfort but not before airway.
Category: Anaphylaxis and Angioedema
Question 15
A patient with a severe peanut allergy asks whether a bakery's nut-free cookies are safe. What should the nurse explain?
Baking destroys peanut proteins, so the risk is gone
Only eating whole peanuts can cause a reaction
Equipment used for peanut items can contaminate nut-free foods
✓
A nut-free label means the food never touched peanuts
Correct Answer
Equipment used for peanut items can contaminate nut-free foods
Shared mixers, pans and surfaces carry allergen into other foods, so the patient should ask how food was prepared and avoid items made on shared equipment. Baking destroys peanut proteins, so the risk is gone is false; peanut allergens withstand heat. Only eating whole peanuts can cause a reaction ignores hidden peanut in recipes and cross-contact. A nut-free label means the food never touched peanuts is not guaranteed when equipment is shared.
Category: Food Allergy
Question 16
Which patient is at particular risk for latex allergy?
A healthy adult who has never had surgery
An older adult with well-controlled hypertension
A patient who follows a vegetarian diet
A patient with spina bifida who has had many surgeries
✓
Correct Answer
A patient with spina bifida who has had many surgeries
Spina bifida and repeated surgeries bring frequent contact with latex catheters, gloves and equipment, which promotes sensitization. A healthy adult who has never had surgery has little latex exposure. An older adult with well-controlled hypertension has no added risk from that condition. A patient who follows a vegetarian diet has no diet-related latex risk.
Category: Latex Allergy
Question 17
A patient with a type I latex allergy asks which foods may also cause a reaction. Which foods should the nurse name?
Bananas, avocados and kiwi
✓
Rice, potatoes and oats
Eggs, milk and cheese
Fish, shrimp and crab
Correct Answer
Bananas, avocados and kiwi
Proteins in several fruits resemble latex proteins, so some latex-allergic people also react to bananas, avocados, kiwis, chestnuts and similar foods. Rice, potatoes and oats are not known latex cross-reactors. Eggs, milk and cheese are common food allergens but are not linked to latex. Fish, shrimp and crab are seafood allergens unrelated to latex.
Category: Latex Allergy
Question 18
When preparing a medication for a patient with latex allergy, the nurse finds the vial has a rubber stopper. What should the nurse do?
Wipe the stopper with alcohol and draw up as usual
Remove the stopper rather than puncturing it
✓
Puncture the stopper several times to vent it
Use a latex glove to hold the vial
Correct Answer
Remove the stopper rather than puncturing it
Needles pushed through rubber stoppers can carry latex into the medication, so removing the stopper avoids exposure. Wipe the stopper with alcohol and draw up as usual cleans the surface but does not prevent latex contamination. Puncture the stopper several times to vent it increases the chance of latex entering the drug. Use a latex glove to hold the vial directly exposes the patient to latex.
Category: Latex Allergy
Question 19
Which finding after contact with latex gloves points to a type I latex allergy?
A blistering rash that appears the following day
Dry, cracked skin after months of frequent handwashing
Hives, a runny nose and wheezing soon after glove contact
✓
Redness only where the gloves rubbed the skin
Correct Answer
Hives, a runny nose and wheezing soon after glove contact
Type I latex allergy is an immediate IgE-mediated reaction, so urticaria, rhinitis, wheezing or even anaphylaxis begin shortly after exposure. A blistering rash that appears the following day fits delayed allergic contact dermatitis. Dry, cracked skin after months of frequent handwashing fits irritant contact dermatitis, which involves no immune response. Redness only where the gloves rubbed the skin suggests friction irritation rather than allergy.
Category: Latex Allergy
Question 20
A patient stung by a wasp reports tingling, warmth and sneezing. Which new finding signals that the reaction has become severe?
Itchy, watery eyes
Nasal congestion
A feeling of warmth in the mouth
Falling blood pressure with bluish lips
✓
Correct Answer
Falling blood pressure with bluish lips
Severe anaphylaxis progresses rapidly to bronchospasm, laryngeal edema, hypotension and cyanosis, which call for immediate emergency treatment. Itchy, watery eyes are part of a mild reaction. Nasal congestion is also a mild finding. A feeling of warmth in the mouth is an early, mild symptom.
Category: Anaphylaxis and Angioedema