Chapter 22 Testbank

You are called to the local park on a hot summer day for an 8-year-old child in respiratory distress. The child can barely speak and appears to be getting sleepy. Vital signs are blood pressure 90/60, pulse 120, and respiratory rate 32. Your physical exam reveals a swollen tongue, inspiratory stridor, wheezing, and hives on the neck and chest. What condition do you suspect?

anaphylaxis

You are called to a residence for a 60-year-old male complaining of chest pain. You find the patient seated in bed. His past medical history includes hypertension and high cholesterol. The patient presents with hives over the chest, stridor, a swollen tongue, and wheezing in the upper fields. He denies any shortness of breath or respiratory distress. What condition do you suspect?

Anaphylaxis

You are called to a residence for a 58-year-old male complaining of chest pain. He has a history of a prior myocardial infarction. The patient presents with hives over the chest, stridor, a swollen tongue, and wheezing of the upper fields. He denies any shortness of breath. What should your next question be?

Are you allergic to anything?

You are called to a residence for a 60-year-old male complaining of chest pain. He is alert and oriented to time, place, and person. His past medical history includes hypertension and high cholesterol. The patient presents with hives over the chest, stridor, a swollen tongue, and wheezing in the upper fields. He is breathing 24 times per minute and speaking in complete sentences. He denies any shortness of breath or respiratory distress. What should be your first action?

Apply oxygen by nonrebreather mask.

You are called to a residence for a 50-year-old male complaining of difficulty breathing. He is alert and oriented to time, place, and person. The patient presents with hives over the chest, stridor, a swollen tongue, and wheezing in the upper fields. He is breathing 32 times per minute. He is speaking in two- to three-word sentences. What is the best treatment for the patient?

Administering epinephrine with consent from medical control

You are called to a farmhouse on a sunny spring afternoon. Upon arrival, a frantic mother tells you that her 3-year-old daughter was playing in the yard, accidentally stepped on a hornets' nest, and was stung repeatedly. The patient is alert, screaming and crying, and can follow her mother's commands. Her arms and legs are swollen and show the marks of several stings. Her body is covered in hives. Her vital signs are blood pressure 90/40, pulse 110, respiratory rate 24, and oxygen saturation 99 percent. Her lung sounds are clear and equal bilaterally. Her mother states she put "nox-a sting" on the bites but the bites only seemed to get worse. What condition is the patient suffering from?

An allergic reaction from the hornet's stings

You are called to a farmhouse on a sunny spring afternoon. Upon arrival, a frantic mother tells you that her 4-year-old daughter was playing in the yard and stung repeatedly by several bees. The patient is alert, screaming and crying, and can follow her mother's commands. Her arms and legs are swollen and show the marks of several stings. Her body is covered in hives. Her vital signs are blood pressure 90/40, pulse 110, respiratory rate 24, and oxygen saturation 99 percent. Her lung sounds are clear and equal bilaterally. You decide to administer oxygen. What is the best method?

Administer oxygen by blow-by

You are called to a farmhouse on a sunny spring afternoon. Upon arrival, a frantic mother tells you that her 3-year-old daughter was playing in the yard and accidentally stepped on a hornets' nest and was stung repeatedly. The patient is alert, screaming and crying, and can follow her mother's commands. Her arms and legs are swollen and show the marks of several stings. Her body is covered in hives. Her vital signs are blood pressure 90/40, pulse 110, respiratory rate 24, and oxygen saturation 99 percent. Her lung sounds are clear and equal bilaterally. The nearest hospital is 45 minutes away and the nearest ALS unit is 15 minutes away. Should ALS be dispatched?

Yes, the patient's allergic reaction could potentially worsen.

You are on the scene of a 22-year-old female patient who is unresponsive. The patient's mother states that she is deathly allergic to peanuts and accidentally ate stir fry cooked in peanut oil. The patient is unresponsive with agonal respirations at 6 per minute. What is your first action?

Insert an oral airway and apply oxygen at 15 liters per minute by bag-valve mask.

You are on the scene of a 22-year-old female patient who is unresponsive. The patient's mother states that she is deathly allergic to peanuts and accidentally ate stir fry cooked in peanut oil. The patient is unresponsive with agonal respirations at 6 per minute. You insert an oral airway and administer oxygen at 15 liters per minute by bag-valve mask. You notice that it is difficult to bag the patient. Your partner listens to lung sounds and states they are very diminished in the upper fields and absent in the lower fields. What is the best action?

Request orders from medical control to administer epinephrine

You are on the scene of a 22-year-old female patient who is unresponsive. The patient's mother states that she is deathly allergic to peanuts and accidentally ate stir fry cooked in peanut oil. The patient is unresponsive with agonal respirations at 6 per minute. You insert an oral airway and administer oxygen at 15 liters per minute by bag-valve mask. You notice that it is difficult to bag the patient. Your partner listens to lung sounds and states they are very diminished in the upper fields and absent in the lower fields. After administering epinephrine per medical control via an auto-injector, your partner reassesses the lung sounds. He tells you that she is now wheezing loudly in all fields. What is your suspicion regarding the patient's condition?

The patient's condition is improving.

You are on the scene of a 30-year-old male patient who is unresponsive. You suspect the patient is suffering from a severe anaphylactic reaction. The patient is unresponsive with agonal respirations at 6 per minute. You insert an oral airway and administer oxygen at 15 liters per minute by bag-valve mask. You notice that it is difficult to bag the patient. Your partner listens to lung sounds and states they are diminished in the upper fields and absent in the lower fields. After administering epinephrine per medical control via an auto-injector, your partner reassesses the lung sounds. He tells you that she is now wheezing loudly in all fields. What is the next action you should perform?

Contact medical control and request to administer another dose of epinephrine.

Which of the following is a general term for a substance to which the body may have an anaphylactic reaction?

allergen

What is another name for a severe allergic reaction?

anaphylaxis

Which of the following does NOT commonly lead to anaphylaxis?

Cat dander

Upon delivering a patient to the emergency department, you remove your gloves and find that your hands are red and itchy. Which of the following is most likely?

You are having an allergic reaction to the latex in the gloves.

As you prepare to enter a patient's room in a nursing home, you see a sign posted on the door indicating that the patient has a latex allergy. Which of the following is the BEST way to care for the patient?

Ask the nursing facility staff to find synthetic exam gloves to wear for contact with this patient.

A severe allergic reaction will usually occur within what time period following exposure to the substance to which the patient is allergic?

2 to 4 minutes

Which of the following statements concerning severe allergic reactions is true?

The quicker the onset of symptoms, the greater the likelihood of a severe allergic reaction.

Which of the following is NOT a sign or symptom of an allergic reaction involving the skin?

cyanosis

Which of the following is MOST likely to be a complaint of a patient suffering from anaphylaxis?

"My throat feels like it is closing."

Which of the following would you expect to hear when auscultating the lungs of a patient having an anaphylactic reaction?

wheezing

You have responded to a park where you find a 23-year-old female sitting on a bench near a running trail. She states that she has been running for the past 30 minutes, and all of a sudden she can't catch her breath. She states that this has never happened before and she usually runs 5 miles a day. Your assessment reveals that she is flushed, her pulse is fast and weak, her respirations are fast and she is wheezing, and she has hives on her arms and chest. She is most likely suffering from which of the following?

anaphylaxis

Which of the following is included in the primary assessment of a conscious patient suffering from anaphylactic shock?

Assessing whether the patient is able to speak without difficulty

You are managing a patient who has been stung by a bee and has had an allergic reaction to bee stings in the past. The patient has some localized redness and swelling in the area of the bee sting but is not having difficulty breathing. Of the following, which would be performed first for this patient?

Continue the focused assessment.

Your patient is experiencing signs and symptoms of an allergic reaction. Which of the following is a priority in this patient's care?

Administer oxygen by nonrebreather mask.

Which of the following is the reason why infants rarely experience anaphylactic reactions?

Infants have not yet developed antibodies to allergens.

Which of the following is a trade name for an epinephrine auto-injector?

Epi-pen

Which of the following occurs to blood vessels during an anaphylactic reaction?

dilation

Which of the following changes commonly occurs in the cardiovascular system during anaphylaxis?

Low blood pressure due to vasodilation

Which of the following explains why a patient may experience difficulty breathing during anaphylaxis?

Swelling of the airway tissues causes difficulty breathing.

Which of the following is an action caused by epinephrine in anaphylaxis?

vasoconstriction

The epinephrine contained in an auto-injector is in which of the following forms?

liquid

How many dose(s) of medication does the Twinject epinephrine auto-injector contain?

two

Most epinephrine auto-injectors, except the Twinject, contain how many doses of epinephrine?

one

Which of the following is the adult dosage of subcutaneous epinephrine in anaphylaxis?

0.3 mg

Which of the following is the dosage of subcutaneous epinephrine in a pediatric patient?

0.15 mg

At which of the following sites should the EMT administer an epinephrine auto-injector?

thigh

Which of the following needs to be considered by the EMT before administering an epinephrine auto-injector?

All of the choices need to be considered

Your patient has eaten a casserole that may have contained seafood. The patient is worried because he has a seafood allergy. Upon assessment, you find no signs or symptoms of anaphylaxis. The patient's vital signs are stable and he has an epinephrine auto-injector prescribed to him. Which of the following actions is most appropriate?

Try to find out if the casserole contained seafood.

Your patient is a 45-year-old female who is allergic to sesame seeds, which she accidentally ingested when she ate a deli sandwich. She is having difficulty breathing, and she has hives, watery eyes, a weak pulse of 120 per minute, and swelling of the face and tongue. Which of the following is the BEST course of immediate action?

Contact medical control for orders to administer the patient's epinephrine auto-injector.

Within what period of time should the EMT expect most anaphylaxis patients to respond to the administration of subcutaneous epinephrine?

Within 2 minutes

Which of the following is NOT an indication that epinephrine is helping the anaphylaxis patient's condition?

Increased dyspnea

You are on the scene of a motor vehicle collision in which a car has driven off the roadway and is resting at the bottom of an embankment. The driver is in severe respiratory distress and is unable to speak. His skin is flushed and he has hives. A Medic-Alert bracelet indicates an allergy to peanuts. You notice a candy bar wrapper on the floor of the car. Which of the following should you do first?

Administer high-concentration oxygen.

Which of the following is NOT a side effect of epinephrine?

bradycardia

Which of the following is the proper method of disposing of a used epinephrine auto-injector?

Place the device in a rigid biohazardous sharps disposal container.

Your patient has a history of severe anaphylaxis and carries several auto-injectors. You have administered one of the auto-injectors, but the patient's condition continues to worsen. Which of the following is the next best course of action?

Contact medical control.

After activating the auto-injector, how long should it be held in place before removing it from the patient's thigh?

10 seconds

A 35-year-old female has just eaten lobster and is now complaining of itchy, watery eyes. Her blood pressure is beginning to fall, but she denies difficulty breathing. Which of the following best describes her condition?

anaphylaxis

Your patient states that he is having an allergic reaction to a bee sting. He denies difficulty breathing, has normal vital signs, and has no evidence of hives. He has no signs of distress. Which of the following should you do for this patient?

Immediately administer oxygen.

You are transporting a 41-year-old female suffering from severe anaphylaxis. Her respiratory rate is 42 per minute, she is cyanotic, and she has a decreased level of responsiveness. Which of the following is the highest priority of care for this patient?

Assist ventilations with a bag-valve mask.

You are treating a 28-year-old female who is 34 weeks pregnant. She has a history of bee sting anaphylaxis and was stung by a bee while in the garden. She is having severe respiratory distress and her blood pressure is 72/50 mmHg. Which of the following is the BEST option for the EMT?

Administer the Epi-Pen® only on the advice of medical control.

When documenting the administration of an epinephrine auto-injector, which of the following should be included?

all of the above

You are unsure if a patient's condition requires the administration of an epinephrine auto-injector. Which of the following actions is most appropriate?

none of the above

A patient to whom you have administered epinephrine should be reassessed every ________ minutes.

5

If a patient was having a myocardial infarction, not an allergic reaction, and received an epinephrine auto-injection, which of the following would most likely occur?

Stronger and faster heartbeat

Which of the following does a physician NOT take into consideration when writing a prescription for a patient to obtain an epinephrine auto-injector?

How far the patient lives from medical attention

Which of the following is NOT an indication for the administration of an epinephrine auto-injector?

The patient possesses an epinephrine auto-injector.

Your patient is a 7-year-old girl who was prescribed an antibiotic for an ear infection. After 4 days on the antibiotic, the patient is experiencing hives and itching on her face, throat, and neck. Which of the following should you do?

Provide supportive care and monitor the patient's condition during transport to the hospital.

Which of the following is the result of histamine and other chemicals in the body during anaphylaxis?

Capillaries become leaky, bronchoconstriction occurs, and swelling appears in areas around the vocal cords.