Deck 21: Anaphylactic Reactions

Question 1

A patient who is severely short of breath and covered with hives states that she is allergic to crab but tried some crab dip 10 minutes ago. Which one of the following questions would the EMT ask first?

A) "How many allergic reactions have you had?"
B) "Why did you eat the dip if you are allergic to crab?"
C) "What medications are you currently taking?"
D) "Do you have an epinephrine auto-injector?"

Answer 1

D

Question 2

A patient informs you that any time she is exposed to a particular soap, she experiences a mild allergic reaction. As a knowledgeable EMT, you should recognize that:

A) the soap contains an antigen.
B) the patient's airway will swell shut if she inhales the soap.
C) the soap contains antibodies that react in the patient's body.
D) she must have been exposed to the soap as an infant.

Answer 2

A

Question 3

What is the most severe form of an allergic reaction called?

A) Hypersensitivity
B) Anaphylaxis
C) Antigen response
D) Rhinorrhea

Answer 3

B

Question 4

What is the most common cause of an allergic reaction?

A) Bee stings
B) Medications
C) Food
D) Pollen

Question 5

A young female patient, who is allergic to peanuts, was just exposed to peanut butter. Assessment reveals her to be alert and oriented with swollen lips and hives on her face. She is breathing adequately at a rate of 18 breaths per minute and has a heart rate of 82. Your partner advises you that her blood pressure is 118/72 mmHg and room air SpO₂ 92%. She states that she also has asthma for which she uses an inhaler. Of the following, what would you do first?

A) Assist her with her inhaler.
B) Provide supplemental oxygen.
C) Start positive pressure ventilation.
D) Determine the amount of peanut butter consumed.

Question 6

When reassessing a patient you are treating for an anaphylactic reaction, what finding would be of the most concern to the EMT?

A) Respiratory rate change from 28 to 10 breaths per minute
B) Red, warm, and dry skin
C) Pulse oximetry reading of 95% despite high-concentration oxygen
D) New hives appearing on the chest

Question 7

A 39-year-old female, who is allergic to peanuts, thinks that she may have accidentally ingested some. When assessing her, which statement would be suggestive that the patient is in the early stages of an anaphylactic reaction?

A) "I feel as though I am getting a fever."
B) "My heart suddenly feels as though it is skipping some beats."
C) "I feel dizzy and weak."
D) "I suddenly feel like a have a lump in my throat."

Question 8

A panicked and anxious patient tells you that he is allergic to peanuts and thinks he may have accidentally eaten some. He states that the last time he ate peanuts he almost died and needed to have a "tube put in his throat." When assessing the patient, which of the following signs or symptoms would provide the best evidence that the patient is having an allergic, and possibly an anaphylactic, reaction?

A) Hives on his chest
B) Panic and anxiety
C) Elevated blood pressure
D) Cool and clammy skin

Question 9

The EMT exhibits an understanding of allergic reactions and anaphylaxis when she makes which one of the following statements?

A) "An allergic reaction only occurs when the patient ingests or inhales an allergen; anaphylaxis occurs when the allergen is injected."
B) "Allergic reactions are caused by pollen and food; anaphylactic reactions are caused by venoms and medications."
C) "Anaphylaxis is a severe allergic reaction that will lead to death without emergency care."
D) "Anaphylaxis describes a severe allergic reaction that occurs the first time a person is exposed to an allergen."

Question 10

When assessing a patient with an anaphylactic reaction, which one of the following findings would you expect?

A) Weak radial pulse
B) Rapid and strong carotid pulse
C) Normal to slightly increased blood pressure
D) Slow and bounding radial pulse

Question 11

A 23-year-old male has called EMS for swollen lips and hives. As you enter the scene, what observation would make the EMT suspicious that the patient is having an allergic reaction?

A) A glucometer on a table in the living room
B) A new container of penicillin on a table with two pills missing
C) Other family members complaining of similar symptoms
D) A bottle of expired nitroglycerin on the kitchen counter

Question 12

On scene you assisted a patient with his epinephrine auto-injector after he was stung multiple times by bees. You are now transporting the patient to the hospital. As you reassess the patient, which one of the following signs would best indicate that the epinephrine is benefiting the patient?

A) Increasing heart rate
B) Complaint of fatigue
C) Decreasing wheezing
D) Decreasing blood pressure

Question 13

A patient states that he is allergic to poison ivy and was burning it yesterday when he accidentally inhaled some of the smoke. Today, he awoke and found a red rash to the back of his left hand and called 911. Assessment reveals him to be alert and oriented, with easy respirations, and a blood pressure of 128/70 mmHg. Your next action would be to:

A) provide immediate and rapid transport.
B) assist the patient with his epinephrine auto-injector.
C) obtain a medical history.
D) call for advanced life support (ALS) assistance.

Question 14

You are responding to a call for an allergic reaction. Your partner is a new EMT and this is his first call. When prepping him for what might lie on scene, what instruction regarding the assessment and treatment of an allergic reaction and/or anaphylaxis would be correct?

A) "If the allergic reaction was caused by exposure to chocolate or eggs, we will not be able to administer epinephrine."
B) "Epinephrine really should be given to any patient suffering even a mild allergic reaction to prevent anaphylaxis."
C) "Our first priority will not be to determine what caused the allergic reaction, but to treat the patient according to his or her symptoms."
D) "If the allergic reaction was caused by food, we will need to administer activated charcoal."

Question 15

An awake but confused patient experiencing an allergic reaction begins to exhibit stridorous respirations. The EMT knows that the underlying condition responsible for this presentation is:

A) constriction of the small airways.
B) spasm of the lower airway.
C) swelling to the upper airway.
D) loss of the gag reflex.

Question 16

A patient who is responsive to painful stimuli is covered with hives. He has labored respirations and a weak and rapid pulse. His vital signs are: pulse 128, respirations 24, and blood pressure 80/50 mmHg. Given this presentation, the EMT should be suspicious of what condition?

A) Sensitization
B) Anaphylaxis
C) Hypersensitivity
D) Localized allergic reaction

Question 17

You have arrived by the side of a lethargic patient who is allergic to latex and was exposed to it when she spilled a latex-containing powder on her right hand. She is only able to speak a few words with each breath. Additionally, her tongue is swollen and respirations are rapid, labored, and noisy. What action is your immediate priority?

A) Insert an oropharyngeal airway.
B) Wash the latex powder from the patient's hand.
C) Obtain a heart rate and blood pressure.
D) Start positive pressure ventilation.

Question 18

During the primary assessment, which finding would most lead the EMT to suspect an allergic reaction?

A) Hives to the face and neck
B) Blood pressure of 100/60 mmHg
C) Heart rate of 112 beats per minute
D) Complaint of dizziness

Question 19

Which statement indicates that the EMT understands airway management in a patient suffering from anaphylaxis?

A) "When providing positive pressure ventilation, it may be difficult to pass air through the swollen tissues."
B) "Epinephrine will help the patient's blood pressure, but not the swollen tissue in the airway."
C) "The best way to open the airway in a patient with upper airway edema is to place the patient in an upright position."
D) "If an oral or nasal airway is used, the airway will be opened and positive pressure ventilation will not be needed."

Question 20

When the signs and symptoms of anaphylaxis are rapid, the EMT must realize that:

A) the reaction tends to be severe.
B) the reaction tends to be localized.
C) there is an increased amount of antigens.
D) epinephrine will not be effective.

Question 21

You have assisted an adult patient with his epinephrine auto-injector. When giving a report to the emergency department nurse, you should inform her that ________ mg of epinephrine was administered.

A) 0.15
B) 0.25
C) 0.30
D) 1

Question 22

A football player in full uniform has been stung by a bee. Your assessment reveals him to be confused with stridorous respirations and weak radial pulses. His skin is warm and flushed and covered with hives. Vital signs are: pulse 164, respirations 28, blood pressure 74/58 mmHg, and SpO₂ at 87%. The coach notifies you that the patient is allergic to bees and hands you the patient's epinephrine pen. Your next action would be to:

A) completely expose the patient and administer the epinephrine into his anterior thigh.
B) lift the shirt over the abdomen and administer the epinephrine into his abdomen below the umbilicus.
C) lift the shoulder pads and shirt and administer the epinephrine into his upper arm muscle.
D) administer the epinephrine through a padless area of the pants over the side of his thigh.

Question 23

After you assist a patient with his epinephrine auto-injector, which one of the following statements made by the patient best indicates that the epinephrine is working and the patient is improving?

A) "My breathing feels a lot easier."
B) "My heart feels as though it is racing."
C) "I am getting a little bit of a headache."
D) "I am more relaxed and getting sleepy."

Question 24

Five minutes after assisting a patient with his epinephrine auto-injector, you determine the patient to be getting progressively worse. The patient has a second auto-injector available; however, written protocols do not address the administration of a second dose. Which one of the following should be your next best action?

A) Request advanced life support (ALS) assistance.
B) Administer the second dose of epinephrine.
C) Continue to monitor the patient.
D) Contact medical direction for further orders.

Question 25

Why would the patient experiencing an allergic reaction tell you that it is easier to breathe following administration of epinephrine?

A) Drying of mucus in the airways
B) Dilation of the bronchioles
C) Increased blood flow to the lungs
D) Decreased blood pressure

Question 26

You have just assisted a patient with his epinephrine auto-injector. The patient states that he has never taken epinephrine before. You would inform him of which one of the following?

A) "The epinephrine may make you drowsy, so just close your eyes."
B) "Be prepared to feel dizzy and nauseated. These are common when taking epinephrine."
C) "You may feel a little shaky, but that is normal and will pass."
D) "If you pass out, that is normal. I will just give you some oxygen if that happens."

Question 27

The EMT shows he understands the use of an epinephrine auto-injector for treating a patient with an anaphylactic reaction when he makes which one of the following statements?

A) "The epinephrine auto-injector is used only when a patient is stung by a bee or suffers an insect bite."
B) "It is critical that the EMT identify the cause of the allergic reaction prior to administering epinephrine through the auto-injector."
C) "The epinephrine auto-injector should never be used if the patient has developed the allergic reaction after eating chocolate."
D) "Epinephrine administered through an auto-injector can be used for all anaphylactic and anaphylactoid reactions, regardless of the cause."

Question 28

Which of the following explains why patients experiencing an anaphylactic reaction have difficulty breathing?

A) Allergens use the available oxygen molecules.
B) Antibodies depress the brain's respiratory center.
C) Histamine constricts the bronchioles.
D) Antigens increase the body's need for oxygen.

Question 29

You are staffing an information booth at the county fair when a mother and her 15-year-old son approach. The mother informs you that her son is severely allergic to bee stings and had an epinephrine auto-injector prescribed to him when he was 5 years old. She hands you the 0.15 mg auto-injector and notes that it expired several years ago. Which one of the following statements would be most appropriate for you to make?

A) "Call your doctor as soon as possible for a new injector because this one is out of date."
B) "We have some on the ambulance. I can get you one until you are able to get a new one from your doctor."
C) "Make sure to call the doctor since this is out of date. Also ask him if he wants to add a steroid to the injector."
D) "Call your doctor to get a new injector and ask him if he wants to change the dose."

Question 30

When administering epinephrine to an infant or child, the EMT would place the injector at what site?

A) Outer buttock
B) Hip muscle
C) Upper arm
D) Lateral thigh

Question 31

Five minutes after you assist a patient with her epinephrine auto-injector, the patient states that she feels much better and would like to refuse additional care and transport to the hospital. What statement would be most appropriate given the situation?

A) "If you feel better now, there is probably no need to go to the hospital. I will get the refusal form for you to sign."
B) "Once we help you take your epinephrine, the law requires that you be transported to a hospital for additional care."
C) "Epinephrine can make you very sleepy. You can refuse but just make sure that someone is here to keep an eye on you."
D) "The epinephrine will wear off in 10 to 20 minutes. Let's see how you are doing then before thinking about refusing transport."

Question 32

A patient informs you that he found out he is allergic to certain molds and was prescribed an epinephrine auto-injector. He asks you how the epinephrine will help him the next time he is exposed to mold. Your response would be:

A) "It will quickly destroy the allergen in the mold."
B) "It will provide antibodies to your body and give you temporary immunity."
C) "It will reverse the reaction by mimicking the parasympathetic nervous system in your body."
D) "It will cause the blood vessels to constrict and increase your blood pressure."

Question 33

You have been called for a male patient experiencing a severe allergic reaction. The patient is very confused and having great difficulty breathing. He has an epinephrine auto-injector; however, your service does not have protocols related to its use. In EMT class, you went over and passed a test on the use of an epinephrine auto-injector for allergic reactions. In this case, you should:

A) assist the patient with his epinephrine auto-injector.
B) provide oxygen and respiratory support followed by immediate transport.
C) assist the patient with his epinephrine using implied consent as justification.
D) contact the physician prescribing the medication for permission to use the auto-injector.

Question 34

Prior to assisting a patient with his epinephrine auto-injector, the EMT must ensure that:

A) the patient is improving.
B) on- or off-line medical direction exists.
C) the medication is yellow in color.
D) the patient's heart rate and blood pressure are stable.

Question 35

In which situation would the EMT contact medical direction prior to administering epinephrine to a patient suffering an anaphylactic reaction?

A) She has an allergy to chocolate or eggs.
B) Her heart rate is 144 beats per minute.
C) She is hypotensive and tachycardic.
D) The patient is not prescribed an auto-injector.

Question 36

For the EMT to achieve the best results when assisting with epinephrine, the medication should be placed into:

A) an artery.
B) the skin.
C) a vein.
D) a muscle.

Question 37

After assisting a patient with the use of an epinephrine auto-injector, you note that the patient's blood pressure has improved. As a knowledgeable EMT, you realize that this has occurred due to epinephrine's ability to:

A) relax the smooth muscle of the blood vessels.
B) constrict blood vessels.
C) increase the number of circulating red blood cells.
D) increase the oxygen-carrying capacity of the red blood cells.

Question 38

You are called to an out-patient surgery center for a patient who developed an allergic reaction while receiving an intravenous (IV) antibiotic. The EMT would document the route of exposure as:

A) injection.
B) contact.
C) ingestion.
D) topical.

Question 39

Which one of the following assessment findings would indicate that the patient is suffering from an anaphylactic reaction and requires immediate intervention?

A) Hives and a heart rate of 96 beats per minute
B) Localized swelling around the site of a bee sting
C) Swollen lips with a blood pressure of 84/50 mmHg
D) Edema to the feet with an SpO₂ of 93% on room air

Question 40

How should an EMT assist a patient in taking his epinephrine auto-injector?

A) Press the injector onto the lateral thigh, and wait for it to automatically inject.
B) Place the injector against the deltoid muscle in the arm, and push the plunger to slowly inject the medication.
C) Pinch the skin on the anterior thigh, press the injector against the skin, and wait until it activates.
D) Pinch the skin on the lateral thigh, press the injector against the skin, and rapidly push the plunger to inject the medication.

Question 41

A patient with an allergy to bees and a prescribed Epi-pen was working in the garden when she noted swelling to the right side of her face. Assessment reveals swelling that is red and hot to the right cheek area. Her airway is patent, respirations easy and adequate, and radial pulse strong. Her vital signs are: pulse 76, respirations 16, blood pressure 156/62 mmHg, and SpO₂ at 99%. Which one of the following should you do next?

A) Perform a secondary assessment.
B) Assist the patient with her Epi-pen.
C) Treat as an anaphylactoid reaction.
D) Immediate and rapid transport

Question 42

A patient has just taken her first dose of Zocor for her high cholesterol. Within minutes, she begins to develop hives, shortness of breath, and low blood pressure. In this case, the EMT would recognize a/an:

A) sensitized immune response.
B) anaphylaxis.
C) hypersensitivity reaction.
D) anaphylactoid reaction.

Question 43

What statement would you agree with regarding both anaphylactic and anaphylactoid reactions?

A) Anaphylaxis is caused by medications; anaphylactoid reactions are not.
B) Administering epinephrine in an anaphylactoid reaction can be fatal.
C) Both anaphylactoid and anaphylactic reactions are treated the same.
D) Anaphylactoid reactions seldom involve the airway while anaphylaxis does.

Question 44

You are providing bag-valve-mask ventilations to a patient in anaphylactic shock. There is increasing resistance to ventilation, despite using proper technique. Which of the following is the best way to address this situation?

A) Stop ventilations and administer an albuterol metered-dose inhaler.
B) Occlude the pop-off valve on the bag-valve mask and continue ventilations.
C) Increase both the ventilatory rate and force of ventilation.
D) Turn the patient to her side and apply manual pressure over the epigastrium.

Question 45

Regarding the pathophysiology underlying anaphylaxis, which of the following is true?

A) Histamine causes the capillaries to become leaky.
B) High blood pressure forces blood from the blood vessels.
C) IgE immunoglobulins make antibodies that cause bronchoconstriction.
D) Smooth muscle dilation on the lungs impairs the exchange of oxygen.

Question 46

You have been summoned to an apartment for a 58-year-old female complaining of hives on her chest and abdomen. When asked, she states that she has had several episodes of the hives over the past six months, but allergy testing has not been able to pinpoint a cause. Based on this information, which one of the following would best classify the cause of the reaction?

A) Iatrogenic
B) Anaphylactoid
C) Anaphylactic
D) Idiopathic

Question 47

Within the body, the release of histamine would cause dilation of the:

A) blood vessels.
B) small airways.
C) upper airway.
D) salivary glands.

Question 48

A mother has called you for her 9-year-old daughter who was stung in the right hand by a bee. She states that her older daughter is allergic to bees and she is scared that the patient may also be allergic, although she has never been stung before. Assessment of the patient reveals a red, painful, and swollen area on the back of the girl's right hand. The primary assessment is unremarkable and her vital signs are normal. The mother hands you her older daughter's epinephrine pen. You would:

A) administer the epinephrine into the patient's thigh.
B) ask the mother to administer the pen into the patient's thigh.
C) wash the patient's hand with soap and water.
D) contact medical direction for permission to use the Epi-pen.

Question 49

You have been called to a residence for a female patient who awoke with swollen lips and a rash to her arms and abdomen. In addition, she exhibits a mild expiratory wheeze in all lung fields. She states that she called her doctor who advised her to take some Benadryl and call 911 for emergency care. How will the Benadryl, acting as an antihistamine, benefit the patient?

A) It helps her immune system to deactivate the allergen.
B) It acts as an allergen to stop the allergic reaction.
C) It stops the constriction of the patient's small airways.
D) It dilates her blood vessels and delivers more blood to the brain.

Question 50

Which one of the following is the primary difference between an anaphylactic reaction and an anaphylactoid reaction?

A) An anaphylactoid reaction may occur without prior sensitization to the antigen; anaphylaxis requires prior sensitization.
B) Anaphylactoid reactions are less severe than anaphylactic reactions.
C) Epinephrine is contraindicated in anaphylactoid reactions, but not in anaphylactic reactions.
D) Anaphylactoid reactions are commonly caused by environmental substances; anaphylactic reactions are most commonly caused by foods.

Question 51

You have been called to a kindergarten class for a 5-year-old boy who is allergic to peanuts. He ate some in the form of a birthday treat brought to school by a classmate who is celebrating a birthday. From the door of the classroom, you note the patient to have swollen lips and hives to his face and arms. As you begin the primary assessment, which one of the following should you do first?

A) Contact the patient's parents for permission to treat him.
B) Inspect the inside of his mouth.
C) Determine how many peanuts he ingested.
D) Check breath sounds for wheezing and assess the vital signs.

Question 52

A patient suffers an allergic reaction after taking penicillin. In this case, the penicillin would be recognized as a/an:

A) IgE immunoglobulin.
B) antigen.
C) mast cell.
D) antibody.

Question 53

A patient has been stung by a bee. Which one of the following findings would be present in anaphylaxis, but not in a local allergic reaction?

A) Anxiousness
B) Swelling at the site of the sting
C) Hives
D) Hypotension