EXAM 5 Ch 18

What is a wheal? A) a raised, swollen, well-defined area on the skin B) a poison C) small areas of generalized itching or burning that appear as multiple, small, raised areas on the skin D) an exaggerated immune response to any substance

A) a raised, swollen, well-defined area on the skin Answer: A Rationale: Insect stings and bites can cause a wheal, which is a raised, swollen, well-defined area on the skin. There is no specific treatment for these injuries, although applying ice sometimes makes them less irritating.

The signs and symptoms of an allergic reaction are caused by the release of: A) histamine. B) adrenalin. C) epinephrine. D) glucagon.

A) histamine. Answer: A Response: The two chief chemicals released by the body that result in the signs and symptoms of an allergic reaction are histamines and leukotrienes. Epinephrine (adrenalin) is used to treat allergic reactions.

The MOST reliable indicator of upper airway swelling during a severe allergic reaction is: A) stridor. B) anxiety. C) cyanosis. D) wheezing.

A) stridor. Answer: A Rationale: Stridor is a high-pitched sound that is most often heard during inhalation. It indicates swelling of the upper airway. Wheezing, a whistling sound, is caused by narrowed bronchioles; it indicates narrowing or swelling of the lower airway. Anxiety and cyanosis can occur from a variety of causes; they are not exclusive to airway swelling.

The adult EpiPen system delivers _____ mg of epinephrine, and the infant-child system delivers _____ mg. A) 0.15, 0.3 B) 0.3, 0.15 C) 0.15, 0.5 D) 0.5, 0.2

B) 0.3, 0.15 Answer: B Rationale: The adult EpiPen system delivers 0.3 mg of epinephrine via an automatic needle and syringe system; the infant-child system delivers 0.15 mg.

When administering epinephrine by auto-injector, the EMT should hold the injector in place for: A) 5 seconds. B) 10 seconds. C) 20 seconds. D) 30 seconds.

B) 10 seconds. Answer: B Rationale: When administering epinephrine via auto-injector, push the injector firmly against the thigh until it activates. Hold the injector in place for 10 seconds to ensure that all the medication is injected.

You are treating a woman who was stung numerous times by hornets. On assessment, you note that some of the stingers are still imbedded in her skin. You should: A) leave the stingers in place. B) scrape the stingers from her skin. C) pull the stingers out with tweezers. D) cover the stings with tight dressings.

B) scrape the stingers from her skin. Answer: B Rationale: Because of the venom left in the sac located at the end of the stinger, you should not grab the stingers in an attempt to remove them. Instead, scrape them off with a rigid object such as a credit card.

A young male is experiencing signs and symptoms of anaphylactic shock after being stung by a scorpion. His level of consciousness is diminished, his breathing is severely labored, you can hear inspiratory stridor, and his face is cyanotic. The patient has a prescribed epinephrine auto-injector. What should you do first? A) Assist him in administering his epinephrine. B) Apply high-flow oxygen via nonrebreathing mask. C) Provide ventilatory assistance with a bag-mask device. D) Elevate his legs and cover him with a warm blanket.

C) Provide ventilatory assistance with a bag-mask device. Answer: C Rationale: The patient is not breathing adequately, as noted by his decreased level of consciousness, severely labored breathing, inspiratory stridor, and cyanosis. Therefore, you should first assist his ventilations with a bag-mask device. He clearly requires epinephrine, but not before restoring adequate breathing first. Regardless of the situation, a patient's airway must be patent and his or her breathing must remain adequate at all times.

What is the best tool or method for assessing a patient's perfusion status? A) small-volume nebulizer B) bag-mask device C) pulse oximetry D) auto-injector

C) pulse oximetry Answer: C Rationale: In a patient experiencing an allergic reaction, pulse oximetry is a useful method that you can use to assess the patient's perfusion status. By using pulse oximetry, you can determine the percentage of oxygen saturation in the bloodstream, which will assist in identifying the degree of respiratory distress.

You are called to a local baseball park for a 23-year-old man with difficulty breathing. He states that he ate a package of peanuts approximately 30 minutes ago and denies any allergies or past medical history. Your assessment reveals widespread urticaria, tachycardia, and a BP of 90/60 mm Hg. You can hear him wheezing, even without a stethoscope. You should be MOST suspicious of a(n): A) acute asthma attack. B) mild allergic reaction. C) severe allergic reaction. D) moderate allergic reaction.

C) severe allergic reaction. Answer: C Rationale: The patient's signs and symptoms indicate a severe allergic reaction, which is rapidly progressing to anaphylactic shock. Signs and symptoms of a severe allergic reaction include difficulty breathing, urticaria (hives) over large parts of the body, and signs of shock (eg, tachycardia, hypotension). Certain foods, such as shellfish and nuts, may result in a relatively slow onset of symptoms, but the symptoms can become just as severe.

The negative effects associated with anaphylactic shock are the result of: A)severe internal fluid loss. B) inadequate pumping of the heart. C) vasodilation and bronchoconstriction. D) the nervous system's release of adrenalin.

C) vasodilation and bronchoconstriction. Answer: C Rationale: Anaphylaxis is an extreme allergic reaction that is life threatening and involves multiple organ systems. In severe cases, anaphylaxis can rapidly result in death. One of the most common signs of anaphylaxis is wheezing, a high-pitched, whistling breath sound that is typically heard on expiration, usually resulting from bronchospasm/ bronchoconstriction and increased mucus production.

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 (Benadryl) tablets that you can administer.

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

Common signs and symptoms of an allergic reaction include all of the following, EXCEPT: a) drying of the eyes. b) flushing of the skin. c) persistent dry cough. d) abdominal cramps.

a) drying of the eyes.

Epinephrine is indicated for patients with an allergic reaction when: a) wheezing and hypotension are present. b) the reaction produces severe urticaria. c) the patient is anxious and tachycardic. d) a paramedic is present at the scene.

a) wheezing and hypotension are present.

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 severely labored breathing, and has hives over his entire trunk. You should: a) apply the automated external defibrillator (AED) in the event that cardiac arrest occurs. b) maintain his airway and assist his ventilations. c) perform a detailed secondary assessment. d) ask his wife if he has any known allergies.

b) maintain his airway and assist his ventilations.

When administering epinephrine via auto-injector, you should hold the injector in place for: a) 15 seconds. b) 20 seconds. c) 10 seconds. d) 5 seconds.

c) 10 seconds.

Which of the following MOST accurately defines an allergic reaction? a) a direct negative effect on the body by an external substance b) a release of erythrocytes in response to a foreign substance c) an exaggerated immune system response to any substance d) destruction of the immune system by an external substance

c) an exaggerated immune system response to any substance

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. In addition to administering oxygen, you should: a) ask him if he has epinephrine and request approval from medical control to administer it to the patient. b) avoid the use of epinephrine because of his cardiac history, even if his symptoms become severe. c) contact medical control if needed, transport the patient, and monitor him for signs of deterioration. d) begin transport and request to administer epinephrine if his systolic blood pressure falls below 110 mm Hg.

c) contact medical control if needed, transport the patient, and monitor him for signs of deterioration.

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) advise her to see her physician as soon as possible. b) request a paramedic unit to administer epinephrine. c) position her legs well above the level of her heart. d) administer oxygen and transport her to the hospital.

d) administer oxygen and transport her to the hospital.

A 38-year-old female was bitten by fire ants while at the park with her kids. Your primary assessment reveals that she is semiconscious, has profoundly labored breathing, and has a rapid, thready pulse. She has a red rash on her entire body and her face is very swollen. You should: a) perform a rapid secondary assessment. b) place her supine with her legs elevated 6″ to 12″. c) administer 0.3 mg of epinephrine. d) assist her ventilations with 100% oxygen.

d) assist her ventilations with 100% oxygen.

The two MOST common signs of anaphylaxis are: a) watery eyes and localized itching. b) expiratory stridor and tachycardia. c) hypertension and swollen hands. d) wheezing and widespread urticaria.

d) wheezing and widespread urticaria.