NCLEX-RN cheat sheet · Hematology and oncology
Immune disorders, HIV and anaphylaxis
Anaphylaxis, drug, latex and food allergies, HIV and PEP, lupus, hypersensitivity, transplant rejection
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The immune system can be destroyed, as in HIV, or turn on the body, as in lupus and allergy. Anaphylaxis can kill in minutes.
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At a glance
Anaphylaxis
| What to know | |
|---|---|
| Signs | A sense of doom, itching and hives, swelling of the eyes, lips and throat. Then wheezing, a tight throat, an airway that may close, and a sudden drop in blood pressure |
| First | Stop the trigger if you can, like an infusing drug. Call for help and stay with the client. Epinephrine is the first-line drug: give it right away |
| Epinephrine | Check it's clear and colorless. Adults and children 30 kg or more: 0.3 to 0.5 mg (1 mg/mL) IM into the outer thigh, up to 0.5 mg per dose. Children under 30 kg: 0.01 mg/kg, up to 0.3 mg. It can go through clothing; repeat every 5 to 10 minutes, in a new spot |
| Then | Support the airway and give oxygen. Then antihistamines, a bronchodilator like albuterol, and steroids, as ordered. Monitor continuously; IV fluids ready if blood pressure falls |
| Antihistamines | Ease itching and hives, but don't replace epinephrine: never wait for them first |
| Teach | Triggers, an emergency action plan, the auto-injector. Tell every provider about the allergy; wear a medical alert bracelet |
The allergy history
- Before every drug, check for a documented allergy to it.
- Ask what happened, and when. Hives, swelling or trouble breathing suggest a true allergy; an upset stomach usually doesn't.
- Record the reaction, not just the drug name. An order matches a documented allergy: hold it and call the prescriber.
- Penicillin: about 1 in 10 people say they're allergic, but most aren't when tested. A wrong label means broader antibiotics, more resistance and side effects.
- After a severe skin reaction, like Stevens-Johnson syndrome, penicillin and other beta-lactams are avoided for good, however long ago. Otherwise, cross-reactivity depends on the specific drug, so report the history accurately; the prescriber decides.
Latex reactions
| Reaction | What you see |
|---|---|
| Irritant contact dermatitis | Not an allergy, and the most common: dry, itchy, irritated hands |
| Allergic contact dermatitis | Delayed: a poison-ivy-like rash 1 to 4 days after contact |
| Latex allergy | Immediate: hives, a runny nose, wheezing, rarely shock. Milder symptoms usually come first: take them seriously |
Prevent: Non-latex gloves when contact with infectious material is unlikely; latex gloves powder-free and reduced-protein, no oil-based lotion. Allergic client: a latex-free environment and vial stopper, a medical alert bracelet.
HIV
| What to know | |
|---|---|
| Spread | Blood, semen, vaginal and rectal fluids, breast milk: shared needles, needlesticks, sex, pregnancy, birth or breastfeeding. Not by hugging, shaking hands, sharing dishes or toilet seats, air, water or insects |
| Testing | Recommended for everyone 13 to 64 as routine care, more often with higher risk. An opportunistic infection may be the first sign |
| Treatment | Antiretroviral therapy for everyone with HIV, started as soon as possible: daily pills, or injections every 1 or 2 months. It doesn't cure; the viral load falls and the CD4 count recovers. Take it exactly as prescribed to prevent resistance; call the provider before stopping for side effects |
| Undetectable | An undetectable viral load means effectively no risk of sexual transmission |
| Infections | Thrush, salmonella, toxoplasmosis, TB; latent TB can reactivate. Best protection: the medicines. Avoid undercooked eggs, unpasteurized dairy or juice, raw sprouts, untreated lake or river water |
| PEP | After a possible exposure: a 28-day course, started within 72 hours, and the sooner the better. Report a needlestick at once. It doesn't replace pre-exposure prophylaxis or condoms |
Transplant rejection
| What to know | |
|---|---|
| Timing | Hyperacute: within minutes, from a mismatched blood type; the organ must be removed. Acute: first week to 3 months. Chronic: damages the organ over years |
| Signs | By organ: less urine with a kidney, high glucose with a pancreas, breathlessness with a heart or lung, jaundice and bleeding with a liver. Flu-like aches and chills; fever and pain over the organ are rare. A biopsy confirms it |
| Drugs | Lifelong immunosuppression. Tacrolimus: trough levels; infection and cancer risk; no grapefruit or live vaccines; watch kidney function, glucose and tremor. Adalimumab: a TB test before starting, no live vaccines |
Hypersensitivity types
| Type | What happens | Examples |
|---|---|---|
| I | Immediate allergy, through IgE, up to anaphylaxis | Pollen, foods, drugs, venom, latex |
| II | Cytotoxic: antibodies destroy cells | Hemolytic transfusion reaction |
| III | Immune complexes lodge in tissue | Lupus, rheumatoid arthritis |
| IV | Delayed, through T cells | Contact dermatitis, the TB skin test, graft rejection |
Food allergens: Nine major in the US: milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, soy, sesame. Teach clients to read every label.
Lupus (SLE)
- Chronic autoimmune disease that flares and settles. Most common in women 15 to 40; flares follow stress, infection, sunlight or some drugs.
- Butterfly rash across the cheeks and nose, sun sensitivity, joint pain, fatigue. Can inflame the heart lining, lung lining and kidneys.
- No single test: an ANA, low complement and inflammation markers support it.
- Hydroxychloroquine helps the joints, rash and fatigue, and prevents flares. Steroids, immunosuppressants for severe disease.
- Teach sun protection. On immunosuppressants: wash hands well, avoid sick people.
Priority and safety calls
- ★ Ten minutes into an IV antibiotic: a tight throat, hives and wheezing. Stop the infusion first, then epinephrine, help and the airway.
- ★ Hives, swollen lips and wheezing after a bee sting: IM epinephrine first. Antihistamines, bronchodilators and steroids follow; they don't replace it.
- Documented anaphylaxis to penicillin and a new amoxicillin order: amoxicillin is a penicillin. Hold it and call the prescriber.
- A client says she's "allergic to penicillin": ask what happened when she took it, and how long ago.
- A client with a latex allergy: a latex-free environment and latex-free vial stoppers for injections. Before a procedure, the team plans ahead.
- A nurse's needlestick from a client with HIV: report it at once; PEP starts as soon as possible, within 72 hours.
- Two weeks after a kidney transplant, less urine and feeling achy: report it now as possible rejection. Holding tacrolimus isn't the nurse's call.
How the NCLEX tests it
- Traps: an antihistamine before epinephrine, the wrong site, and dismissing an allergy history.
- Adult epinephrine: 0.3 to 0.5 mg IM into the outer thigh, repeated in a new spot if needed. Not 1 mg IV push.
- HIV spreads through body fluids, not casual contact: isolating for casual contact is a trap.
- Start PEP within 72 hours; waiting days is a trap.
- Lupus: butterfly rash, sun sensitivity, flares. Protect from sun and infection.
- In order: immediate allergy, cell destruction, immune complexes, delayed reactions.
- Falling urine output after a kidney transplant can mean rejection.
Practice it next
This sheet comes from Immune disorders, HIV and hypersensitivity and Allergies and anaphylaxis in our NCLEX-RN course. Try free practice questions, or see the lessons it was written from.
Quick self-quiz
- HIV destroys the ___ cells that fight infection.
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CD4 - Post-exposure prophylaxis is a ___-day course of medicines.
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28 - A positive TB skin test is a type ___ (delayed) reaction.
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4 - Clients on tacrolimus avoid ___.
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grapefruit - In anaphylaxis, give epinephrine IM into the outer ___.
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thigh - Allergic contact dermatitis to latex appears 1 to ___ days after contact.
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4 - There are ___ major food allergens in the United States.
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9
Sources
- Open RN, Health Alterations, 4.5 Autoimmune and Hypersensitivity Reactions
- Adrenalin (epinephrine injection) label, via openFDA
- CDC, STI Treatment Guidelines: Penicillin Allergy (2021)
- NIOSH, How to Prevent Latex Allergies
- NIH HIVinfo, HIV and AIDS: The Basics
- NIH HIVinfo, Post-Exposure Prophylaxis (PEP)
- Open RN, Health Alterations, 4.6 Systemic Lupus Erythematosus
- MedlinePlus, Transplant rejection
More hematology and oncology cheat sheets
- Blood products and transfusion reactions NCLEX cheat sheet
- Anemias, bleeding and oncologic emergencies NCLEX cheat sheet
Educational use only. This sheet is a study aid for the NCLEX-RN, not a substitute for clinical judgment, your facility’s policy or the provider’s orders. Where practice varies, follow facility policy and state law. NCLEX® and NCLEX-RN® are registered trademarks of NCSBN, which does not endorse these materials.