Chapter 23: Allergic Reaction

1) What is another name for a severe allergic reaction?

A) Urticaria

B) Respiratory distress

C) Anaphylaxis

D) Stridor

C) Anaphylaxis

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

A) Severe reactions often occur immediately, but they are occasionally delayed 30 minutes or more.

B) A severe allergic reaction can be prevented by the use of an epinephrine auto-injector before exposure to the substance.

C) Allergies do not develop until a person is in his late teens to early 20s.

D) A severe allergic reaction occurs only when the patient has never been exposed to the substance before.

A) Severe reactions often occur immediately, but they are occasionally delayed 30 minutes or more.

3) Which of the following is not a sign or symptom of an allergic reaction involving the skin?

A) Cyanosis

B) Flushing

C) Hives

D) Itching

A) Cyanosis

4) 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?

A) Minor anaphylactic reaction

B) Moderate anaphylactic reaction

C) Allergic reaction from the hornets' stings

D) Anaphylactic reaction from the "nox-a-sting" swabs

C) Allergic reaction from the hornets' stings

5) Which of the following is most likely to be a complaint of a patient suffering from anaphylaxis?

A) "I am having severe muscle pains."

B) "My legs are numb and I can't move them."

C) "My throat feels like it is closing."

D) "I can't remember what happened."

C) "My throat feels like it is closing."

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

A) Clear, adequate air movement

B) Fine, wet crackles or rales

C) Coarse-sounding rhonchi

D) Wheezing

D) Wheezing

7) 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 suddenly cannot 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?

A) Anaphylaxis

B) Heat stroke

C) Allergic reaction

D) Hyperventilation syndrome

A) Anaphylaxis

8) Which of the following happens to blood vessels during an anaphylactic reaction?

A) Constriction

B) No change

C) Spasm

D) Dilation

D) Dilation

9) 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?

A) Advise the parents that these symptoms are related to the ear infection and the antibiotic will take care of these symptoms if taken as directed.

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

C) Advise the parents to call the pediatrician for a different antibiotic.

D) Immediately administer EpiPen Jr.®

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

10) 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?

A) Asthma

B) Heat exhaustion

C) Allergic reaction

D) Anaphylaxis

D) Anaphylaxis

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

A) Low blood pressure due to vasodilation

B) High blood pressure due to tachycardia

C) High blood pressure due to vasoconstriction

D) Low blood pressure due to bradycardia

A) Low blood pressure due to vasodilation

12) 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?

A) Anaphylaxis

B) Dyspnea

C) Shock

D) Mild allergy

A) Anaphylaxis

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

A) Swelling in the brain decreases the respiratory drive.

B) Swelling of the airway tissues causes difficulty breathing.

C) Allergens clump together and block blood flow through the lungs.

D) Allergens bind to hemoglobin, preventing it from carrying oxygen.

B) Swelling of the airway tissues causes difficulty breathing.

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

A) Infants have not yet developed antibodies to allergens.

B) Infants have received natural immunity to allergens from their mothers before birth.

C) Allergens do not affect infants.

D) None of the above

A) Infants have not yet developed antibodies to allergens.

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

A) Urticaria occurs due to fluid being shunted from the skin, causing dehydration of tissue.

B) Blood vessels constrict, capillaries become leaky, and bronchoconstriction occurs.

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

D) Bronchodilation occurs, blood vessels dilate, and swelling appears in areas around the vocal cords.

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

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

A) Pathogen

B) Allergen

C) Antibody

D) Pyrogen

B) Allergen

17) Which of the following does not commonly lead to anaphylaxis?

A) Peanuts

B) Cat dander

C) Wasp stings

D) Penicillin

B) Cat dander

18) 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?

A) You are showing early signs of an anaphylactic reaction.

B) You have come into contact with poison ivy in the patient's yard.

C) You have been exposed to an infectious disease through contact with the patient.

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

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

19) 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?

A) Only perform a history on this patient, not a physical exam, so you can avoid contacting him with your gloves.

B) Ask the nursing staff if the patient has an epinephrine auto-injector available in case of a reaction to your gloves.

C) Put on latex gloves anyway, you must protect yourself with BSI.

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

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

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

A) Assessing whether the patient is able to speak without difficulty

B) Finding out how the patient was exposed to the substance to which she is allergic

C) Looking for hives and swelling

D) Determining whether the patient's systolic blood pressure is over 100 mmHg

A) Assessing whether the patient is able to speak without difficulty

21) 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?

A) Assist him with the administration of his epinephrine auto-injector.

B) Advise the patient that he does not require treatment and transport at this time.

C) Try to find out if the casserole contained seafood.

D) Transport the patient rapidly before the onset of anaphylaxis.

C) Try to find out if the casserole contained seafood.

22) 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?

A) Administer high-concentration oxygen.

B) Read the candy wrapper to see if it contains peanuts.

C) Perform rapid extrication.

D) Search the patient for an epinephrine auto-injector.

A) Administer high-concentration oxygen.

23) 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?

A) Elevate the patient's head.

B) Transport rapidly.

C) Search for an epinephrine auto-injector.

D) Assist ventilations with a bag-valve mask.

D) Assist ventilations with a bag-valve mask.

24) 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, but does so in short two- to three-word statements. What condition do you suspect?

A) Anaphylaxis

B) Asthma

C) Acute myocardial infarction

D) Angina pectoris

A) Anaphylaxis

25) 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?

A) Administer epinephrine with medical control consent.

B) Insert an oral airway and apply oxygen at 15 liters per minute by nonrebreather mask.

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

D) Perform a complete assessment and confirm that the patient is actually in anaphylaxis.

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

26) 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?

A) Transport rapidly, bypassing the emergency department and taking the patient directly to the obstetrics unit of the hospital.

B) Immediately administer the patient's EpiPen®.

C) Do not administer the EpiPen® under any circumstances.

D) Administer the EpiPen® only on the advice of medical control.

D) Administer the EpiPen® only on the advice of medical control.

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

A) Ask a family member if this is the type of situation when the patient usually takes his auto-injector.

B) Administer the epinephrine, just in case.

C) Consult with a paramedic on your service for advice.

D) None of the above

D) None of the above

28) 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?

A) Administering epinephrine with consent from medical control

B) Oxygen at 15 liters per minute by nonrebreather mask

C) Oxygen at 15 liters per minute by bag-valve mask

D) Rapid transport to the nearest facility

A) Administering epinephrine with consent from medical control

29) If a patient is having a myocardial infarction-not an allergic reaction-and receives an epinephrine auto-injection, which of the following will most likely occur?

A) Bradycardia

B) Stronger and faster heartbeat

C) No reaction if administered inadvertently

D) Relief of shortness of breath

B) Stronger and faster heartbeat

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

A) Patient's medical history

B) Severity of previous allergic reactions

C) How far the patient lives from medical attention

D) Patient's known allergies

C) How far the patient lives from medical attention

31) 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?

A) Transport immediately.

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

C) Contact dispatch to see where the closest ALS unit is.

D) Insert an oropharyngeal airway (OPA).

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

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

A) Increased blood pressure

B) Increased heart rate

C) Increased dyspnea

D) Both B and C

C) Increased dyspnea

33) Which of the following is not a side effect of epinephrine?

A) Pallor

B) Vomiting

C) Bradycardia

D) Chest pain

C) Bradycardia

34) You respond to a local swim park for a 29-year-old male who was stung by a bee and "passed out." Upon arrival, you find the patient unresponsive to all stimuli 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?

A) Request an ALS unit.

B) Hyperventilate the patient.

C) Request orders from medical control for an emergency cricothyroidotomy.

D) Request orders from medical control to administer epinephrine.

D) Request orders from medical control to administer epinephrine.

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

A) Decreased heart rate

B) Vasoconstriction

C) Bronchoconstriction

D) All of the above

B) Vasoconstriction

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

A) Autodrenalin®

B) AllerPen®

C) Anajector®

D) EpiPen®

D) EpiPen®

37) Most epinephrine auto-injectors contain how many doses of epinephrine?

A) Two

B) Three

C) One

D) None of the above

C) One

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

A) Abdomen

B) Upper arm

C) Thigh

D) Buttocks

C) Thigh

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

A) Bend the needle at an angle to prevent accidental punctures and place it in the trash.

B) Place the device in a rigid biohazardous sharps disposal container.

C) Leave it at the scene for the patient or his family to dispose of.

D) Take it to the hospital for disposal in the emergency department.

B) Place the device in a rigid biohazardous sharps disposal container.

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

A) 30 seconds

B) 10 seconds

C) 1 minute

D) It should be removed from the injection site immediately.

B) 10 seconds

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

A) Patient's response to the medication

B) Site of medication administration

C) Time the medication was administered

D) All of the above

D) All of the above

42) 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?

A) Divert transport to a hospital with critical care capabilities.

B) Continue supportive care en route to the hospital.

C) Contact medical control.

D) Immediately administer a second auto-injector.

C) Contact medical control

43) After administering epinephrine per medical control via an auto-injector to an unresponsive anaphylactic adult patient, your partner reassesses the lung sounds. He tells you that the patient is now wheezing loudly in all fields whereas before the injection they were diminished in the upper fields and absent in the lower. What is your suspicion regarding the patient's condition?

A) The patient's condition is worsening.

B) The patient's condition is improving.

C) There is no change in the patient's condition.

D) The patient is about to go into cardiac arrest.

B) The patient's condition is improving.

44) You are on the scene of a 40-year-old male patient who is anaphylactic and still unresponsive following a single epinephrine injection. Prior to giving the injection, you inserted an oral airway and administered oxygen at 15 liters per minute by bag-valve mask and your partner found diminished lung sounds. Following the epinephrine administration, your partner reassesses lung sounds and tells you that the patient is now wheezing loudly in all fields. What is the next action you should perform?

A) Discontinue bagging the patient.

B) Place the patient on a nonrebreather mask.

C) Hyperventilate the patient.

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

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