Chapter 21 Workbook

Question 1

An exaggerated immune response to any substance

Answer 1

Allergic reaction

Question 2

A substance made by the body; released in anaphylaxis

Answer 2

Leukotrienes

Question 3

High-pitched, whistling breath sound usually resulting from bronchospasm or bronchoconstriction, usually heard on exhalation

Answer 3

Wheezing

Question 4

Raised areas on the skin that itch or burn, sometimes called hives

Answer 4

Urticaria

Question 5

A harsh, high-pitched inspiratory sound, usually resulting from upper airway obstruction

Answer 5

Stridor

Question 6

A substance that causes an allergic reaction

Answer 6

Allergen

Question 7

A raised, swollen area on the skin resulting from an insect bite or allergic reaction

Answer 7

Wheal

Question 8

A poison or harmful substance

Answer 8

Toxin

Question 9

Steps for assisting a patient with administration of an EpiPen include:
A. shaking the injector to mix the medication
B. placing the tip of the auto-injector against the lateral part of the patient’s thigh
C. recapping the injector before placing it in the trash
D. holding the injector in place for 30 seconds

Answer 9

B. placing the tip of the auto-injector against the lateral part of the patient’s thigh

Question 10

Which of the following is NOT one of the five common allergen categories?
A. Food
B. Insect bites
C. Plants
D. Environments

Answer 10

D. Environments

Question 11

One commonly observed sign of anaphylaxis includes:
A. burning with urination
B. angioedema
C. diarrhea
D. anosmia

Answer 11

B. angioedema

Question 12

Signs and symptoms of insect stings or bites include all of the following EXCEPT:
A. swelling
B. ecchymosis
C. localized heat
D. wheals

Answer 12

B. ecchymosis

Question 13

All of the following are true regarding allergic reactions EXCEPT:
A. Mild reactions will usually only require supportive care.
B. A stiff card should be used to remove an insect stinger if necessary.
C. All allergic reactions will require epinephrine administration.
D. Deterioration can be extremely rapid when anaphylaxis is present.

Answer 13

C. All allergic reactions will require epinephrine administration.

Question 14

Speed is essential because in severe cases of anaphylaxis, ______ can occur rapidly.
A. urticaria
B. compensation
C. death
D. recovery

Answer 14

C. death

Question 15

Questions to ask when obtaining a history from a patient appearing to have an allergic reaction include:
A. whether the patient has recently traveled
B. what the patient ate yesterday
C. asking bystanders if anyone else is ill
D. how the patient was exposed

Answer 15

D. how the patient was exposed

Question 16

The dosage of epinephrine in an adult EpiPen is:
A. 0.10 mg
B. 0.15 mg
C. 0.30 mg
D. 0.50 mg

Answer 16

C. 0.30 mg

Question 17

Epinephrine, whether made by the body or by a drug manufacturer, works rapidly to:
A. decrease the pulse rate and blood pressure
B. increase an allergic reaction
C. increase wheezing
D. relieve bronchospasm

Answer 17

D. relieve bronchospasm

Question 18

Because the stinger of the honeybee is barbed and remains in the wound, it can continue to inject venom for up to:
A. 1 minute
B. 15 minutes
C. 20 minutes
D. several hours

Answer 18

C. 20 minutes

Question 19

You should not use tweezers or forceps to remove an embedded stinger because:
A. squeezing may cause the stinger to inject more venom into the wound
B. the stinger may break off in the wound
C. the tweezers are not sterile and may cause infection
D. removing the stinger may cause bleeding

Answer 19

A. squeezing may cause the stinger to inject more venom into the wound

Question 20

Your assessment of the patient experiencing an allergic reaction should include evaluations of all of the following EXCEPT the:
A. respiratory system
B. circulatory system
C. skin
D. reproductive system

Answer 20

D. reproductive system

Question 21

Allergic reactions to certain foods, such as shellfish or nuts, may take up to ______ minutes before a reaction appears.
A. 10
B. 20
C. 30
D. 60

Answer 21

C. 30

Question 22

Wheezing occurs because excessive _____ and mucus are secreted into the bronchial passages.
A. fluid
B. carbon dioxide
C. blood
D. oxygen

Answer 22

A. fluid

Question 23

True/False
Allergic reactions can occur in response to almost any substance.

Answer 23

True

Question 24

True/False
An allergic reaction occurs when the body has an immune response to a substance.

Answer 24

True

Question 25

True/False Wheezing is a low-pitched breath sound, usually resulting from blockage of the airway, and is heard on expiration.

Answer 25

False

Question 26

True/False For a patient appearing to have an allergic reaction with respiratory distress, give high-flow oxygen.

Answer 26

True

Question 27

Wheezing, a high pitched, whistling breath sound, is typically heard on ______.

Answer 27

expiration

Question 28

Small areas of generalized itching or burning that appear as multiple, small, raised areas on the skin are called ______.

Answer 28

urticaria

Question 29

The stinger of the honeybee is ______, so the bee cannot withdraw it.

Answer 29

barbed

Question 30

An allergic reaction involving multiple body systems is called ______.

Answer 30

anaphylaxis

Question 31

The presence of ______ ______ or respiratory distress indicates that the patient is having a severe enough allergic reaction to lead to death.

Answer 31

circulatory compromise

Question 32

Epinephrine reverses hypotension by constricting the ______ ______.

Answer 32

blood vessels

Question 33

You have been called to a park where a local church is holding a potluck dinner. As you exit your ambulance, a woman approaches you holding her 7 year old son, who is wheezing and having difficulty breathing. She informs you that he had inadvertently eaten a brownie with nuts, and he is allergic to nuts. You lift the child’s shirt and find small, raised areas that he is trying to scratch. They are likely to be: A. leukotrienes B. histamines C. urticaria D. toxins

Answer 33

C. urticaria

Question 34

You have been called to a park where a local church is holding a potluck dinner. As you exit your ambulance, a woman approaches you holding her 7 year old son, who is wheezing and having difficulty breathing. She informs you that he had inadvertently eaten a brownie with nuts, and he is allergic to nuts. Why is this patient wheezing? A. He has had an envenomation. B. His bronchioles are constricting. C. His bronchioles are dilating. D. His uvula has swollen.

Answer 34

B. His bronchioles are constricting.

Question 35

You have been called to a park where a local church is holding a potluck dinner. As you exit your ambulance, a woman approaches you holding her 7 year old son, who is wheezing and having difficulty breathing. She informs you that he had inadvertently eaten a brownie with nuts, and he is allergic to nuts. The child’s mother has an EpiPen that contains the appropriate dose of epinephrine for a child. What dose would that be? A. 0.8 mg B. 0.5 mg C. 0.4 mg D. 0.15 mg

Answer 35

D. 0.15 mg

Question 36

You have been called to a park where a local church is holding a potluck dinner. As you exit your ambulance, a woman approaches you holding her 7 year old son, who is wheezing and having difficulty breathing. She informs you that he had inadvertently eaten a brownie with nuts, and he is allergic to nuts. When assisting with an auto-injector, how long should you hold the pen against the thigh? A. 3 seconds B. 5 seconds C. 10 seconds D. 30 seconds

Answer 36

A. 3 seconds

Question 37

You have been called to a park where a local church is holding a potluck dinner. As you exit your ambulance, a woman approaches you holding her 7 year old son, who is wheezing and having difficulty breathing. She informs you that he had inadvertently eaten a brownie with nuts, and he is allergic to nuts. After removing the auto-injector from the child’s thigh, you should do all of the following EXCEPT: A. record the time B. record the dose C. reassess his vital signs D. place ice over the injection site

Answer 37

D. place ice over the injection site

Question 38

List the common side effects of epinephrine.

Answer 38

Increased blood pressure, tachycardia, pallor, dizziness, chest pain, headache, nausea, vomiting, anxiety, sweating, and palpitations

Question 39

What are the five general categories that most often cause allergic reactions?

Answer 39

Insect bites and stings Medications Plants Food Chemicals

Question 40

What are the steps for administering or assisting with the administration of an EpiPen?

Answer 40

Obtain an order from medical control (or follow protocol or standing orders) Follow standard precautions Make sure the medication was prescribed for that patient Check for discoloration or expiration of medication Remove the cap and wipe the thigh with alcohol, if possible Place the tip of the auto-injector against the lateral part of the thigh Push firmly until activation Hold the auto-injector in place until the medication is injected (3 seconds) Remove and dispose Rub the area for 10 seconds Record the time and dose Reassess and record the patient’s vital signs Consider an additional administration (if possible) in 5 minutes if symptoms do not improve

Question 41

What are the common respiratory and cardiovascular signs and symptoms of an allergic reaction?

Answer 41

Respiratory: Shortness of breath (dyspnea) Sneezing or itchy, runny nose Chest or throat tightness Dry cough Hoarseness Rapid, noisy, or labored respirations Wheezing and/or stridor Circulatory: Decreased blood pressure (hypotension) Increased pulse (tachycardia) Pale skin Loss of consciousness and coma

Question 42

Ambulance Calls You are dispatched to assist a 12 year old child who was climbing a tree and apparently disturbed a wasp nest. When you arrive, the child is lying under the tree, and the nest is on the ground next to her. How would you best manage this patient?

Answer 42

Based on the information you have, there is no way to determine if the child fell out of the tree or climbed down. You should assume that the child fell, which will require you to consider full spinal precautions. You also have the issue of scene safety because the damaged hive is now lying on the ground next to the patient. You must take care not to receive multiple stings yourself, so proceed with caution. If the child is having a severe allergic reaction, hopefully you will have access to an EpiPen Junior. Provide oxygen (if appropriate) and prompt transport according to local protocols.

Question 43

Ambulance Calls You are dispatched to a local seafood restaurant for a person who is having difficulty breathing. On arrival, you find a 22 year old woman with facial edema, cyanosis around the lips, audible wheezing, and urticaria on her face and upper body. Her boyfriend tells you she ate shrimp and she is allergic to them. He also tells you she has some medicine in her purse and hands you an EpiPen prescribed to her. How would you best manage this patient?

Answer 43

Obtain a physician’s order to administer the EpiPen to the patient (if required by local protocol). Check the EpiPen for clarity, expiration date, and so on. Administer the EpiPen and promptly dispose of the auto-injector. Apply high-flow oxygen and provide rapid transport. Monitor the patient and assess vital signs frequently.

Question 44

As you begin to assess a patient suspected of anaphylactic shock, which of these steps would be done first? A. Assess and treat for life threats. B. Assess lung sounds. C. Provide high flow oxygen. D. Obtain a pulse oximetry reading.

Answer 44

A. Assess and treat for life threats.

Question 45

After assisting with an EpiPen, what is the first thing that should be done? A. Make sure the medication is not expired. B. Take a set of vital signs. C. Place the used EpiPen in a biohazard container. D. Rub the area for 10 seconds.

Answer 45

C. Place the used EpiPen in a biohazard container.

Question 46

When using the EpiPen auto injector, do all of the following EXCEPT: A. remove the safety cap B. wipe the thigh with antiseptic C. push the auto injector firmly against the thigh for about 3 seconds D. place ice over the injection site

Answer 46

D. place ice over the injection site