Chapter 20 Immunologic

1. Which of the following MOST accurately defines an allergic reaction?
A. an exaggerated immune system response to any substance
B. destruction of the immune system by an external substance
C. a release of erythrocytes in response to a foreign substance
D. a direct negative effect on the body by an external substance

Answer: A Question Type: General Knowledge Page: 647

2. Chemicals that are responsible for the signs and symptoms of an allergic reaction to a bee sting include:
A. the bee venom itself.
B. adrenaline and histamines.
C. leukocytes and epinephrine.
D. histamines and leukotrienes.

Answer: D Question Type: General Knowledge Page: 647

3. Anaphylaxis is MOST accurately defined as a(n):
A. moderate allergic reaction that primarily affects the vasculature.
B. extreme allergic reaction that may affect multiple body systems.
C. severe allergic reaction that typically resolves without treatment.
D. allergic reaction that causes bronchodilation and vasoconstriction.

Answer: B Question Type: General Knowledge Page: 647

4. The two MOST common signs of anaphylaxis are:
A. wheezing and widespread urticaria.
B. watery eyes and localized itching.
C. expiratory stridor and tachycardia.
D. hypertension and swollen hands.

Answer: A Question Type: General Knowledge Page: 647

5. Urticaria is the medical term for:
A. hives.
B. burning.
C. swelling.
D. a wheal.

Answer: A Question Type: General Knowledge Page: 647

6. The foreign substance responsible for causing an allergic reaction is called a(n):
A. allergen.
B. antibody.
C. histamine.
D. leukotriene.

Answer: A Question Type: General Knowledge Page: 647

7. Which of the following patients would MOST likely have a delayed onset of an allergic reaction?
A. a 21-year-old female who inhaled pollen
B. a 30-year-old male who was stung by a bee
C. a 45-year-old male who ingested penicillin
D. a 50-year-old male who was exposed to latex

Answer: C Question Type: General Knowledge Page: 648

8. Which of the following statements regarding fire ants is correct?
A. Fire ants often bite a person repeatedly.
B. Fire ant bites rarely cause anaphylaxis.
C. Fire ant bites typically occur on the face.
D. Most people are allergic to fire ant toxin.

Answer: A Question Type: General Knowledge Page: 648

9. A raised, swollen, well-defined area on the skin that is the result of an insect bite or sting is called:
A. a pustule.
B. purpura.
C. urticaria.
D. a wheal.

Answer: D Question Type: General Knowledge Page: 649

10. Because the stinger of a honeybee remains in the wound following a sting:
A. the stinger can easily be removed with tweezers.
B. the body’s immune system deactivates the venom.
C. the toxicity of the venom decreases within 10 minutes.
D. it can continue to inject venom for up to 20 minutes.

Answer: D Question Type: General Knowledge Page: 649

11. The stinger from a honeybee should be:
A. left in place and covered.
B. scraped away from the skin.
C. squeezed with tweezers and removed.
D. irrigated with copious amounts of water.

Answer: B Question Type: General Knowledge Page: 649

12. Most patients who die of anaphylaxis do so within the first __________ following exposure.
A. 5 minutes
B. 30 minutes
C. 60 minutes
D. 90 minutes

Answer: B Question Type: General Knowledge Page: 649

13. You are assessing a young male who was stung on the leg by a scorpion. He is conscious and alert, his breathing is regular and unlabored, and his blood pressure is 122/64 mm Hg. Assessment of his leg reveals a wheal surrounded by an area of redness. He states that he had a "bad reaction" the last time he was stung by a scorpion, and carries his own epinephrine auto-injector. You should:
A. apply high-flow oxygen, apply a chemical cold pack directly to the injection site, and transport at once.
B. apply high-flow oxygen, obtain approval from medical control to assist him with his epinephrine, and transport.
C. assess his ABCs and vital signs in 15 minutes and allow him to drive himself to the hospital if he remains stable.
D. apply oxygen as needed, clean the area with soap and water or a mild antiseptic, and transport him to the hospital.

Answer: D Question Type: Critical Thinking Page: 649

14. Which of the following would MOST likely provide clues regarding the source of a patient’s allergic reaction?
A. the patient’s family history
B. the patient’s general physical appearance
C. the environment in which the patient is found
D. the time of season in which the exposure occurred

Answer: C Question Type: General Knowledge Page: 650

15. 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. contact medical control if needed, transport the patient, and monitor him for signs of deterioration.
B. ask him if he has epinephrine and request approval from medical control to administer it to the patient.
C. avoid the use of epinephrine because of his cardiac history, even if his symptoms become severe.
D. begin transport and request to administer epinephrine if his systolic blood pressure falls below 110 mm Hg.

Answer: A Question Type: Critical Thinking Page: 650

16. 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. Ask the patient if he has any diphenhydramine (Benadryl) tablets that you can administer.
B. Administer oxygen, transport at once, and request a paramedic intercept.
C. Remain at the scene with the patient and request a paramedic ambulance.
D. Quickly determine if there are any bystanders who may carry epinephrine.

Answer: B Question Type: Critical Thinking Page: 650

17. Which of the following negative effects of anaphylaxis will be the MOST rapidly fatal if not treated immediately?
A. diffuse urticaria
B. severe hypotension
C. upper airway swelling
D. systemic vasodilation

Answer: C Question Type: General Knowledge Page: 651

18. 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. assist her ventilations with 100% oxygen.
C. administer 0.3 mg of epinephrine.
D. place her supine with her legs elevated 6″ to 12″.

Answer: B Question Type: Critical Thinking Page: 651

19. 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. perform a detailed secondary assessment.
B. maintain his airway and assist his ventilations.
C. ask his wife if he has any known allergies.
D. apply the automated external defibrillator (AED) in the event that cardiac arrest occurs.

Answer: B Question Type: Critical Thinking Page: 651

20. You respond to the residence of a 55-year-old female with a possible allergic reaction to peanuts that she ate approximately 30 minutes ago. The patient is conscious and alert, but has diffuse urticaria and the feeling that she has a lump in her throat. As your partner applies oxygen to the patient, you should:
A. ask her if she has prescribed epinephrine.
B. obtain a complete set of baseline vital signs.
C. ascertain if she has a family history of allergies.
D. ask her when her last allergic reaction occurred.

Answer: A Question Type: Critical Thinking Page: 652

21. Which of the following medications blocks the release of histamines?
A. albuterol (Ventolin)
B. epinephrine
C. acetaminophen (Tylenol)
D. diphenhydramine (Benadryl)

Answer: D Question Type: General Knowledge Page: 652

22. Common signs and symptoms of an allergic reaction include all of the following, EXCEPT:
A. abdominal cramps.
B. drying of the eyes.
C. flushing of the skin.
D. persistent dry cough.

Answer: B Question Type: General Knowledge Page: 652

23. Which of the following sounds indicates swelling of the upper airway?
A. rales
B. stridor
C. rhonchi
D. wheezing

Answer: B Question Type: General Knowledge Page: 653

24. While auscultating breath sounds of a patient who was stung multiple times by a yellow jacket, you hear bilateral wheezing over all lung fields. This indicates:
A. rapid swelling of the upper airway tissues.
B. a significant amount of fluid in the alveoli.
C. narrowing of the bronchioles in the lungs.
D. enlargement of the bronchioles in the lungs.

Answer: C Question Type: Critical Thinking Page: 653

25. Which of the following physiologic actions does epinephrine produce when given for an allergic reaction?
A. bronchodilation and vasodilation
B. vasoconstriction and bronchodilation
C. bronchoconstriction and vasoconstriction
D. blocking of further histamine release

Answer: B Question Type: General Knowledge Page: 654

26. Epinephrine is indicated for patients with an allergic reaction when:
A. wheezing and hypotension are present.
B. the patient is anxious and tachycardic.
C. a paramedic is present at the scene.
D. the reaction produces severe urticaria.

Answer: A Question Type: General Knowledge Page: 654

27. The adult epinephrine auto-injector delivers ______ mg of epinephrine, and the pediatric auto-injector delivers ______ mg.
A. 0.1, 0.01
B. 0.01, 0.1
C. 0.03, 0.3
D. 0.3, 0.15

Answer: D Question Type: General Knowledge Page: 655

28. When using an auto-injector to give epinephrine, the primary injection site is the:
A. medial part of the buttocks.
B. lateral portion of the arm.
C. lateral portion of the thigh.
D. medial portion of the thigh.

Answer: C Question Type: General Knowledge Page: 656

29. When administering epinephrine via auto-injector, you should hold the injector in place for:
A. 5 seconds.
B. 10 seconds.
C. 15 seconds.
D. 20 seconds.

Answer: B Question Type: General Knowledge Page: 656

30. Immediately after giving an epinephrine injection, you should:
A. properly dispose of the syringe.
B. record the time and dose given.
C. reassess the patient’s vital signs.
D. notify medical control of your action.

Answer: A Question Type: General Knowledge Page: 656

31. A 50-year-old male was stung by a honeybee approximately 15 minutes ago. He presents with respiratory distress, facial swelling, and hypotension. After placing him on oxygen and administering his epinephrine via auto-injector, you note that his breathing has improved. Additionally, his facial swelling is resolving and his blood pressure is stable. Your next action should be to:
A. reassess his breathing and blood pressure in 15 minutes.
B. visualize his airway to assess for oropharyngeal swelling.
C. notify medical control of the patient’s response to your treatment.
D. record the time and dose of the injection, and transport promptly.

Answer: D Question Type: Critical Thinking Page: 656

32. You have administered one dose of epinephrine to a 40-year-old female to treat an allergic reaction that she developed after being stung by a scorpion. Your reassessment reveals that she is still having difficulty breathing, has a decreasing mental status, and has a blood pressure of 80/50 mm Hg. You should:
A. monitor her en route to the hospital and call medical control if she worsens.
B. crush up an antihistamine tablet and place it in between her cheek and gum.
C. request permission from medical control to give another dose of epinephrine.
D. administer a nebulized bronchodilator to improve the status of her breathing.

Answer: C Question Type: Critical Thinking Page: 657

33. The effects of epinephrine are typically observed within _________ following administration.
A. 30 seconds
B. 1 minute
C. 30 minutes
D. 1 hour

Answer: B Question Type: General Knowledge Page: 658

34. Common side effects of epinephrine include all of the following, EXCEPT:
A. drowsiness.
B. tachycardia.
C. headache.
D. dizziness.

Answer: A Question Type: General Knowledge Page: 659

35. 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. position her legs well above the level of her heart.
B. administer oxygen and transport her to the hospital.
C. request a paramedic unit to administer epinephrine.
D. advise her to see her physician as soon as possible.

Answer: B Question Type: Critical Thinking Page: 659

36. After administering 0.3 mg of epinephrine via auto-injector to a 22-year-old female with an allergic reaction, you note improvement in her breathing and dissipation of her hives. However, she is still anxious and tachycardic. You should:
A. contact medical control and obtain authorization to administer another 0.3 mg of epinephrine.
B. transport her rapidly, as it is obvious that she is having a severe reaction to the epinephrine.
C. monitor her closely but recall that anxiety and tachycardia are side effects of epinephrine.
D. consider administering 0.15 mg of epinephrine to completely resolve her allergic reaction.

Answer: C Question Type: Critical Thinking Page: 659