EMT Chapter 21 Allergy and Anaphylaxis

Which of the following would MOST likely provide clues regarding the source of a patient's allergic reaction?
A. The patient's family history
B. The environment in which the patient is found
C. The time of year in which the exposure occurred
D. The patient's general physical appearance

B. The environment in which the patient is found

The effects of epinephrine are typically observed within _________ following administration.
Select one:
A. 1 minute
B. 30 seconds
C. 30 minutes
D. 1 hour

A. 1 minute

Which of the following statements regarding fire ants is correct?
A. Fire ant bites rarely cause anaphylaxis.
B. Fire ants often bite a person repeatedly.
C. Most people are allergic to fire ant toxin.
D. Fire ant bites typically occur on the face.

B. fire ants often bite a person repeatedly

The foreign substance responsible for causing an allergic reaction is called a(n):
A. histamine.
B. antibody.
C. allergen.
D. leukotriene.

C. allergen

Urticaria is the medical term for:
A. hives.
B. a wheal.
C. swelling.
D. burning.

A. hives

Most patients who die of anaphylaxis do so within the first ____ minutes following exposure.
A. 30
B. 90
C. 60
D. 5

A. 30

Common signs and symptoms of an allergic reaction include all of the following, EXCEPT:
A. persistent dry cough.
B. abdominal cramps.
C. drying of the eyes.
D. flushing of the skin.

C. drying of the eyes

The adult epinephrine auto-injector delivers ______ mg of epinephrine, and the infant-child auto-injector delivers ______ mg.
A. 0.3; 0.15
B. 0.01; 0.1
C. 0.03; 0.3
D. 0.1; 0.01

A. 0.3; 0.15

A raised, swollen, well-defined area on the skin that is the result of an insect bite or sting called:
A. purpura.
B. a pustule.
C. a wheal.
D. urticaria.

C. a wheal

A 73-year-old man presents with a generalized rash, which he thinks may have been caused by an antibiotic that he recently began taking. He has a history of coronary artery disease, hypertension, and emphysema. He is conscious and alert, his blood pressure is 144/94 mm Hg, and his pulse is 64 beats/min and regular. You auscultate his breath sounds and hear scattered wheezing, although he is not experiencing respiratory distress. You should:
A. administer oxygen if needed, transport the patient, and monitor him for signs of deterioration.
B. begin transport and request to administer epinephrine if his systolic blood pressure falls below 110 mm Hg.
C. ask him if he has epinephrine and request approval from medical control to administer it to the patient.
D. avoid the use of epinephrine because of his cardiac history, even if his symptoms become severe.

A. administer oxygen if needed, transport the patient, and monitor him for signs of deterioration

Two of the MOST common signs of anaphylaxis are:
A. hypertension and swollen hands.
B. expiratory stridor and tachycardia.
C. watery eyes and localized itching.
D. urticaria and angioedema.

D. urticaria and angioedema

Which of the following physiologic actions does epinephrine produce when given for an allergic reaction?
A. Blocking of further histamine release
B. Bronchoconstriction and vasoconstriction
C. Vasoconstriction and bronchodilation
D. Bronchodilation and vasodilation

C. Vasoconstriction and bronchodilation

While auscultating breath sounds of a patient who was stung multiple times by a yellow jacket, you hear bilateral wheezing over all lung fields. This indicates:
A. enlargement of the bronchioles in the lungs.
B. rapid swelling of the upper airway tissues.
C. a significant amount of fluid in the alveoli.
D. narrowing of the bronchioles in the lungs.

D. narrowing of the bronchioles in the lungs

Which of the following negative effects of anaphylaxis will be the MOST rapidly fatal if not treated immediately?
A. Severe hypotension
B. Diffuse urticaria
C. Upper airway swelling
D. Systemic vasodilation

C. Upper airway swelling

You respond to the residence of a 55-year-old woman with a possible allergic reaction to peanuts that she ate approximately 30 minutes ago. The patient is conscious and alert, but has diffuse urticaria and the feeling that she has a lump in her throat. As your partner applies oxygen to the patient, you should:
A. ascertain if she has a family history of allergies.
B. ask her when her last allergic reaction occurred.
C. ask her if she has prescribed epinephrine.
D. obtain a complete set of baseline vital signs.

C. ask her if she has prescribed epinephrine

You are assessing a young male who was stung on the leg by a scorpion. He is conscious and alert, his breathing is regular and unlabored, and his blood pressure is 122/64 mm Hg. Assessment of his leg reveals a wheal surrounded by an area of redness. He states that he had a "bad reaction" the last time he was stung by a scorpion, and carries his own epinephrine auto-injector. You should:
A. apply high-flow oxygen, apply a chemical cold pack directly to the injection site, and transport at once.
B. apply oxygen as needed, clean the area with soap and water or a mild antiseptic, and transport him to the hospital.
C. apply high-flow oxygen, obtain approval from medical control to assist him with his epinephrine, and transport.
D. assess his ABCs and vital signs in 15 minutes and allow him to drive himself to the hospital if he remains stable.

B. apply oxygen as needed, clean the area with soap and water or a mild antiseptic, and transport him to the hospital

Common side effects of epinephrine include all of the following, EXCEPT:
A. tachycardia.
B. headache.
C. drowsiness.
D. dizziness.

C. drowsiness

A 48-year-old male is found unconscious in the garden by his wife. When you arrive at the scene and assess the man, you find that he is unresponsive, has labored breathing, and has hives over his entire trunk. You should:
A. ask his wife if he has any known allergies.
B. maintain his airway and assist his ventilations.
C. perform a detailed secondary assessment.
D. administer oxygen and position him on his side.

B. maintain his airway and assist his ventilations

When an auto-injector is used to give epinephrine, the primary injection site is the:
A. medial part of the buttocks.
B. medial portion of the thigh.
C. lateral portion of the arm.
D. lateral portion of the thigh.

D. lateral portion of the thigh

A 37-year-old male is having a severe allergic reaction to penicillin. He does not have an epinephrine auto-injector, and your protocols do not allow you to carry epinephrine on the ambulance. How should you proceed with the treatment of this patient?
A. Administer oxygen, transport at once, and request a paramedic intercept.
B. Remain at the scene with the patient and request a paramedic ambulance.
C. Quickly determine if there are any bystanders who may carry epinephrine.
D. Ask the patient if he has any diphenhydramine tablets that you can administer.

A. Administer oxygen, transport at once, and request a paramedic intercept

Immediately after giving an epinephrine injection, you should:
A. notify medical control of your action.
B. properly dispose of the syringe.
C. reassess the patient's vital signs.
D. record the time and dose given.

B. properly dispose of the syringe

A 38-year-old woman was bitten by fire ants while at the park. Your primary assessment reveals that she is semiconscious; has labored breathing; and has a rapid, thready pulse. She has a red rash on her entire body, and her face is swollen. You should:
A. locate the area where the fire ants bit her.
B. perform a rapid secondary assessment.
C. assist her ventilations with 100% oxygen.
D. place her supine with her legs elevated.

C. assist her ventilations with 100% oxygen

Which of the following patients would MOST likely have a delayed onset of an allergic reaction?
A. A 45-year-old male who ingested penicillin
B. A 21-year-old female who inhaled pollen
C. A 50-year-old male who was exposed to latex
D. A 30-year-old male who was stung by a bee

A. a 45 year old male who ingested penicillin

The stinger from a honeybee should be:
A. irrigated with copious amounts of water.
B. squeezed with tweezers and removed.
C. left in place and covered.
D. scraped away from the skin.

D. scraped away from the skin

After administering 0.3 mg of epinephrine via auto-injector to a 22-year-old female with an allergic reaction, you note improvement in her breathing and resolution of her hives. However, she is still anxious and tachycardic. You should:
A. contact medical control and obtain authorization to administer another 0.3 mg of epinephrine.
B. consider administering 0.15 mg of epinephrine to completely resolve her allergic reaction.
C. monitor her closely but recall that anxiety and tachycardia are side effects of epinephrine.
D. transport her rapidly, because it is obvious that she is having a severe reaction to the epinephrine.

C. monitor her closely but recall that anxiety and tachycardia are side effects of epinephrine

Anaphylaxis is MOST accurately defined as a(n):
A. allergic reaction that causes bronchodilation and vasoconstriction.
B. moderate allergic reaction that primarily affects the vasculature.
C. extreme allergic reaction that may affect multiple body systems.
D. severe allergic reaction that typically resolves without treatment.

C. extreme allergic reaction that may affect multiple body systems

A 50-year-old male was stung by a honeybee approximately 15 minutes ago. He presents with respiratory distress, facial swelling, and hypotension. After placing him on oxygen and administering his epinephrine via auto-injector, you note that his breathing has improved. Additionally, his facial swelling is resolving and his blood pressure is stable. Your next action should be to:
A. notify medical control of the patient's response to your treatment.
B. visualize his airway to assess for oropharyngeal swelling.
C. record the time and dose of the injection and transport promptly.
D. reassess his breathing and blood pressure in 15 minutes.

C. record the time and dose of the injection and transport promptly

Because the stinger of a honeybee remains in the wound following a sting:
A. it can continue to inject venom for up to 20 minutes.
B. the body's immune system deactivates the bee's venom.
C. the toxicity of the venom decreases within 10 minutes.
D. the stinger should quickly be removed with tweezers.

A. it can continue to inject venom for up to 20 minutes

A 19-year-old female was stung multiple times on the legs by fire ants. She states that she is allergic to fire ants, but does not carry her own epinephrine. The patient is conscious and alert and complains of pain to the area of the bites. Her blood pressure is 122/70 mm Hg, her pulse is 100 beats/min and strong, and her respirations are 18 breaths/min and unlabored. You should:
A. position her legs well above the level of her heart.
B. administer oxygen and transport her to the hospital.
C. request a paramedic unit to administer epinephrine.
D. advise her to see her physician as soon as possible.

B. administer oxygen and transport her to the hospital

You have administered one dose of epinephrine to a 40-year-old female to treat an allergic reaction that she developed after being stung by a scorpion. Your reassessment reveals that she is still having difficulty breathing, has a decreasing mental status, and has a blood pressure of 80/50 mm Hg. You should:
A. monitor her en route to the hospital and call medical control if she worsens.
B. crush up an antihistamine tablet and place it in between her cheek and gum.
C. request permission from medical control to give another dose of epinephrine.
D. administer a nebulized bronchodilator to improve the status of her breathing.

C. request permission from medical control to give another dose of epinephrine

Which of the following statements regarding epinephrine administration via the intramuscular (IM) route is correct?
A. The 1:1000 concentration should be used.
B. The maximum single adult dose is 0.15 mg.
C. The IM route should not be used in children.
D. The preferred injection site is the upper arm

A. The 1:1000 concentration should be used

Chemicals that are responsible for the signs and symptoms of an allergic reaction to a bee sting include:
A. leukocytes and epinephrine.
B. the bee venom itself.
C. histamines and leukotrienes.
D. adrenaline and histamines.

C. histamines and leukotrienes

Which of the following MOST accurately defines an allergic reaction?
A. An exaggerated immune system response to any substance
B. Destruction of the immune system by an external substance
C. A release of erythrocytes in response to a foreign substance
D. A direct negative effect on the body by an external substance

A. an exaggerated immune system response to any substance

Epinephrine is indicated for patients with an allergic reaction when:
A. the reaction produces severe urticaria.
B. a paramedic is present at the scene.
C. wheezing and hypotension are present.
D. the patient is anxious and tachycardic.

C. wheezing and hypotension are present

Which of the following medications blocks the release of histamines?
A. Albuterol (Ventolin)
B. Acetaminophen (Tylenol)
C. Diphenhydramine (Benadryl)
D. Epinephrine (Adrenalin)

C. Diphenhydramine (Benadryl)

Which of the following sounds indicates swelling of the upper airway?
A. Rales
B. Stridor
C. Wheezing
D. Rhonchi

B. stridor

When administering epinephrine via auto-injector, you should hold the injector in place for:
A. 8 seconds.
B. 3 seconds.
C. 10 seconds.
D. 15 seconds.

B. 3 seconds

Which of the following physiologic actions does epinephrine produce when given for an allergic reaction?
A. Bronchoconstriction and vasoconstriction
B. Blocking of further histamine release
C. Bronchodilation and vasodilation
D. Vasoconstriction and bronchodilation

D. vasoconstriction and bronchodilation

Most patients who die of anaphylaxis do so within the first ____ minutes following exposure.
A. 90
B. 30
C. 60
D. 5

B. 30

A 73-year-old man presents with a generalized rash, which he thinks may have been caused by an antibiotic that he recently began taking. He has a history of coronary artery disease, hypertension, and emphysema. He is conscious and alert, his blood pressure is 144/94 mm Hg, and his pulse is 64 beats/min and regular. You auscultate his breath sounds and hear scattered wheezing, although he is not experiencing respiratory distress. You should:
A. avoid the use of epinephrine because of his cardiac history, even if his symptoms become severe.
B. begin transport and request to administer epinephrine if his systolic blood pressure falls below 110 mm Hg.
C. administer oxygen if needed, transport the patient, and monitor him for signs of deterioration.
D. ask him if he has epinephrine and request approval from medical control to administer it to the patient.

C. administer oxygen if needed, transport the patient, and monitor him for signs of deterioration