CHAPTER 27 IMMUNOLOGIC EMERGENCIES
Your patient is having a reaction after taking a new ACE inhibitor for hypertension. Which of the following would you MOST likely see? A) Angioedema B) Hypertension C) Diaphoresis D) Hyperthermia
A) Angioedema
What cells release histamine when they recognize antigen-antibody complexes? A) Mast cells B) Helper T cells C) Antigens D) Lymphocytes
A) Mast cells
Which of the following is usually associated with an anaphylactoid reaction? A) Radiological dyes B) Shellfish C) Tree nuts D) Latex exposure
A) Radiological dyes
Which of the following is your FIRST priority when responding to the scene of a patient complaining of anaphylaxis? A) Scene safety B) Respiratory support C) Airway maintenance D) Fluid resuscitation
A) Scene safety
Which of the following is CORRECT regarding corticosteroids? A) They impair the body's ability to respond to disease. B) They increase the number of red blood cells produced. C) They suppress cancer cell reproduction. D) They lower the body's risk for infection.
A) They impair the body's ability to respond to disease.
Which sign associated with an allergic reaction should concern a caregiver the MOST? A) Wheezing B) Warm, flushed skin C) GI distress D) Urticaria
A) Wheezing
Diphenhydramine is administered in anaphylaxis because it: A) blocks histamine receptors. B) causes vasoconstriction. C) treats bronchospasm. D) relaxes smooth vessels.
A) blocks histamine receptors.
Which of the following events occurs in an anaphylactic reaction? A. Histamine causes vasodilation and increased vascular permeability, which leads to edema. B. Epinephrine causes vasodilation and increased vascular permeability, which leads to vascular volume loss. C. Histamine causes relaxation of bronchial and gastrointestinal smooth muscle. D. Epinephrine released from the adrenal glands causes bronchoconstriction and wheezing.
A. Histamine causes vasodilation and increased vascular permeability, which leads to edema.
Your patient was given epinephrine for airway edema secondary to anaphylaxis. Five minutes later, you are en route. The patient's vital signs are BP 120/70, HR 120, and respirations 20. He starts to complain of chest pain. Which of the following is the most likely scenario? A. The chest pain is a side effect of epinephrine administration. B. He is experiencing unstable angina. C. These are bounceback effects of his airway clearing. D. He is having a myocardial infarction.
A. The chest pain is a side effect of epinephrine administration.
Which of the following is most common in women? A. systemic lupus erythematosus B. rheumatoid arthritis C. psoriasis D. scleroderma
A. systemic lupus erythematosus
Which of the following does not typically occur with anaphylaxis? A. vasoconstriction. B. bronchoconstriction C. capillary permeability D. hypotension
A. vasoconstriction.
What is the preferred route and dose of epinephrine for adult suffering from allergic reaction? A) 0.3-0.5 mg SQ B) 0.3-0.5 mg IM C) 3-5 mg SQ D) 3.0-5.0 mg IV
B) 0.3-0.5 mg IM
Your patient is a 23-year-old man who was complaining of shortness of breath following a bee sting. He is audibly wheezing and his respiratory rate is 22 breaths per minute. His skin is cool and clammy and he is tachycardic. What is the primary drug used to treat this patient? A) Atropine B) Epinephrine C) Diphenhydramine D) Albuterol
B) Epinephrine
All of the following are examples of possible antigen ingestion EXCEPT: A) Taking a newly prescribed antibiotic B) Getting stung by a wasp C) Eating a cookie with peanuts in it D) Eating shrimp and other shellfish
B) Getting stung by a wasp
All of the following are signs or symptoms of histamine release EXCEPT: A) Constriction of bronchioles B) Increased vascular permeability C) Edema in the airway D) Peripheral vasodilation
B) Increased vascular permeability
Which of the following body response is aimed at limiting exposure to an antigen? A) Hives and urticaria B) Slight bronchoconstriction C) Increased circulation to the brain D) Diaphoresis and anxiety
B) Slight bronchoconstriction
A foreign substance that elicits the response of the immune system is called: A) histamine. B) antigen. C) antibody. D) stimulant.
B) antigen.
What is the usual pediatric dose of diphenhydramine? A. 0.1 mg/kg of body weight B. 1 to 2 mg/kg of body weight C. 0.01 mg/kg of body weight D. 0.5 mg/kg of body weight
B. 1 to 2 mg/kg of body weight
Your patient is in acute circulatory compromise due to an anaphylactic reaction. You should expect: A. the patient to be calm. B. the blood pressure to be low. C. the radial pulse to be bounding. D. the blood pressure to be elevated.
B. the blood pressure to be low.
Which medication would be the BEST choice for reducing the bronchospasm and laryngeal edema associated with anaphylaxis? A) Solu-Medrol B) Oxygen C) Albuterol D) Dexamethasone
C) Albuterol
You respond for a patient showing signs of anaphylaxis. During your history, you discover that she has just starting taking Vasotec for hypertension. Which of the following should you suspect? A) An immediate hypersensitivity response B) Angioneurotic edema C) An anaphylactoid reaction D) An IgE mediated allergic reaction
C) An anaphylactoid reaction
You are caring for a young woman who has been stung by a wasp. There is redness and a hard knot where she was stung. Her vital signs are stable and she denies respiratory distress. Which of the following is MOST appropriate for this patient? A) Administer 0.3 mg of epinephrine SQ. B) Assist her with her EpiPen™. C) Continue with your focused history. D) Administer nebulized albuterol.
C) Continue with your focused history.
What is an unfortunate side effect of the treatment for autoimmune disease? A) Patients often develop peripheral neuropathy. B) The patient has a dramatic increase in red blood cells. C) The patient is less able to fight infectious diseases. D) Patients experience increased gastrointestinal motility.
C) The patient is less able to fight infectious diseases.
An allergic reaction, as contrasted with an anaphylactic reaction will: A) have a more rapid onset with more serious symptoms. B) require fluids to support blood pressure. C) have a more gradual onset with milder symptoms. D) present a patient with an altered mental status.
C) have a more gradual onset with milder symptoms.
A sensitization is defined as: A) an exaggerated response to a particular antigen. B) the cascade of events that occurs following activation by a foreign substance. C) the primary exposure of an individual to an antigen. D) the manifestation of severe, systemic effects of a histamine release.
C) the primary exposure of an individual to an antigen.
Which of the following is a potentially life-threatening condition involving the head, neck, face, and upper airway? A) Hives B) Wheals C) Urticaria D) Angioedema
D) Angioedema
Which of the following is considered an ominous sign late in anaphylaxis? A) Hypotension B) Tachycardia C) Hypertension D) Bradycardia
D) Bradycardia
Which of the following mediators is responsible for many of the manifestations of anaphylaxis? A) Antibodies B) Basophils C) Macrophages D) Histamine
D) Histamine
Your patient is experiencing profuse hives, itching, dyspnea, coughing, tachycardia, and dizziness after eating seafood five minutes ago. You might also expect to see all of the following additional signs EXCEPT: A) Cyanosis B) Laryngeal edema C) Bronchospasm D) Hypertension
D) Hypertension
You are responding to a patient who has a weepy rash that itches intensely. She states that a couple of days ago she cleaned out a wooded area behind her home. How should you manage this apparent allergic reaction? A) Provide oxygen via NRB and 100 mg of Benadryl IM. B) Benadryl IV and 0.3 mg of 1:1000 epinephrine. C) Benadryl and 0.5 mg of 1:10,000 epinephrine. D) None of the above are appropriate treatments.
D) None of the above are appropriate treatments.
What is the role of diphenhydramine in anaphylaxis? A) Relaxes the smooth muscle in the lungs B) Causes constriction of peripheral blood vessels C) Reduces wheezes in the upper airways D) Prevents histamine from binding to histamine receptors
D) Prevents histamine from binding to histamine receptors
Fluid released from leaky capillaries as a result of histamine results in: A) mottling. B) eczema. C) hypersensitivity. D) urticaria.
D) urticaria.
Which presentation is most consistent with a patient experiencing an allergic reaction? A. 16-year-old girl reports being stung on the right thumb by a bee. Her thumb is swollen and slightly red with a small blanched area at the site of the sting. She says she doesn't think she has ever been stung by a bee before and she wonders if she could be allergic. She has no hoarseness, difficulty breathing, or difficulty swallowing. Her lung sounds are clear and equal. An examination of the skin reveals no rash. Vital signs: HR 92, BP 114/74, RR 20. B.A 6-year-old complains of stinging and burning of his eyes after the application of mosquito repellent to his face. His mother fears he may be having an allergic reaction to the product. His right eye is watering and slightly bloodshot. He has no other complaints. An examination of his skin shows several mosquito bites, but no rash. His lung sounds are clear and equal. Vital signs: HR 100, BP 92/66, RR 24. C. 45-year-old man began vomiting and experienced diarrhea 3 hours after eating a sandwich he purchased at a convenience store. His son, who ate part of the sandwich, is complaining of nausea and stomach cramps. Both patients have normal vital signs. D. 23-year-old woman states that she thinks she is having an allergic reaction to an antibiotic she was prescribed for a urinary tract infection. She is somewhat embarrassed that the intensely itching rash she experienced on the palm of her right hand and behind her right knee has disappeared. Her lung sounds are clear and equal. Vital signs: HR 76, BP 110/74, RR 16.
D. 23-year-old woman states that she thinks she is having an allergic reaction to an antibiotic she was prescribed for a urinary tract infection. She is somewhat embarrassed that the intensely itching rash she experienced on the palm of her right hand and behind her right knee has disappeared. Her lung sounds are clear and equal. Vital signs: HR 76, BP 110/74, RR 16.
Which is the preferred route of administration of 1:1,000 epinephrine for a patient with significant airway edema? A. subcutaneous B. intraosseous C. intravenous D. intramuscular
D. intramuscular