Chapter 23: Anaphylaxis Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A child with no previous history of asthma is brought to the emergency department with wheezing, stridor, and shortness of breath. When the child is started on oxygen and given a nebulized bronchodilator treatment, the treatment team notes a wheal and flare rash on the child’s trunk. What medication will be given immediately?

a. Inhaled racemic epinephrine b. Intramuscular epinephrine c. Intravenous diphenhydramine d. Intravenous ranitidine

ANS: B a. Obtain transport to an emergency department immediately. b. Repeat the epinephrine dose if needed and notify a physician of the episode.

The patient has signs of anaphylaxis and should be given IM or SC epinephrine immediately as first-line therapy, with this repeated every 5 to 20 minutes as needed to prevent cardiovascular shock. Inhaled epinephrine is used for acute upper airway bronchospasm. Diphenhydramine and ranitidine are given as second-line treatment after epinephrine is administered or for mild, non-life-threatening allergic reactions.

2. A man self-administers aqueous epinephrine after experiencing a bee sting and developing angioedema and wheezing. What should the man do next?

NURSINGTB.COM c. Resume normal activity if symptom free after 30 to 60 minutes. d. Take oral diphenhydramine and report any symptoms to a provider.

ANS: A

The man has a history of anaphylaxis and experienced symptoms after contact with a trigger. The aqueous epinephrine should be used immediately but does not prevent the need for follow up in an emergency department for close observation, since continued reaction to the allergen can occur for 6 to 8 hours. The epinephrine dose may be given if needed before emergency personnel arrive, but a second dose is not enough to prevent ongoing reaction to the allergen.