APHA Emergency Response to Reactions 3 — Questions and Answers
Question 1: Which of the following medications is considered second-line therapy AFTER epinephrine in the management of anaphylaxis?
- Corticosteroids such as methylprednisolone
- Antihistamines such as diphenhydramine
- Both corticosteroids and antihistamines as adjunct agents (Correct answer)
- Beta-2 agonists such as albuterol
Correct answer: Both corticosteroids and antihistamines as adjunct agents
Antihistamines and corticosteroids are adjunctive treatments used after epinephrine but neither replaces epinephrine as the primary intervention.
Question 2: What is the recommended injection site for epinephrine administration during anaphylaxis?
- Deltoid muscle of the upper arm
- Anterolateral aspect of the mid-outer thigh (Correct answer)
- Gluteal muscle
- Subcutaneous tissue of the abdomen
Correct answer: Anterolateral aspect of the mid-outer thigh
The anterolateral thigh provides faster absorption of epinephrine than the deltoid or subcutaneous routes during anaphylaxis.
Question 3: A clinic administering vaccines must have which emergency supply immediately available per CDC guidance?
- Epinephrine 1:1000 injectable, a timing device, and a telephone/means to call 911 (Correct answer)
- Oral diphenhydramine, blood pressure cuff, and pulse oximeter
- IV normal saline, atropine, and defibrillator
- Corticosteroid injection, oxygen tank, and crash cart
Correct answer: Epinephrine 1:1000 injectable, a timing device, and a telephone/means to call 911
CDC and ACIP require vaccination sites to have epinephrine 1:1000 for injection, a clock or timer, and the ability to call emergency services.
Question 4: A nurse vaccinates a patient who is taking a beta-blocker. The patient develops anaphylaxis. What clinical challenge should the nurse anticipate?
- Increased risk of delayed urticaria rather than anaphylaxis
- Reduced effectiveness of epinephrine and paradoxical bradycardia (Correct answer)
- Faster absorption of epinephrine due to vasodilation
- Higher risk of injection site cellulitis
Correct answer: Reduced effectiveness of epinephrine and paradoxical bradycardia
Beta-blockers can blunt epinephrine's effect and may cause paradoxical bradycardia due to unopposed alpha-adrenergic stimulation during anaphylaxis.
Question 5: Which of the following best characterizes a local allergic reaction versus anaphylaxis after vaccination?
- Local reactions involve only the injection site with no systemic signs, while anaphylaxis involves multiple organ systems (Correct answer)
- Local reactions always precede anaphylaxis and should be treated with epinephrine preemptively
- Anaphylaxis occurs only with respiratory symptoms, not isolated skin reactions
- Local reactions require antihistamines, while anaphylaxis requires corticosteroids
Correct answer: Local reactions involve only the injection site with no systemic signs, while anaphylaxis involves multiple organ systems
Local allergic reactions are confined to the injection site, while anaphylaxis involves systemic involvement of skin, respiratory, cardiovascular, or gastrointestinal systems.
Question 6: After a vasovagal syncope episode during vaccination, what is the recommended recovery position?
- Seated upright to prevent aspiration
- Supine with legs elevated (Trendelenburg or modified) (Correct answer)
- Left lateral decubitus (recovery position)
- Prone to maintain airway patency
Correct answer: Supine with legs elevated (Trendelenburg or modified)
Lying supine with legs elevated improves cerebral blood flow in vasovagal syncope by enhancing venous return to the heart.
Question 7: How soon after vaccination should a vaccine provider be prepared to respond to anaphylaxis?
- Within the first 30 seconds only
- Within the first 15 minutes, though reactions may occur up to 30 minutes post-injection (Correct answer)
- Only within the first 5 minutes when epinephrine levels are highest
- Up to 2 hours, as delayed reactions are most common
Correct answer: Within the first 15 minutes, though reactions may occur up to 30 minutes post-injection
Most anaphylactic reactions occur within 15 minutes of vaccination, but the standard observation window extends to 30 minutes for higher-risk patients.
APHA Emergency Response to Reactions 3
Which of the following medications is considered second-line therapy AFTER epinephrine in the management of anaphylaxis?