# The nurse is teaching a school-aged child and parent how to use an epinephrine auto-injector after a documented peanut anaphylaxis. Which statements indicate the teaching has been effective? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372847&lang=en  
> language: en  
> subject: Health Promotion and Maintenance  
> category: HPM

## Question

The nurse is teaching a school-aged child and parent how to use an epinephrine auto-injector after a documented peanut anaphylaxis. Which statements indicate the teaching has been effective? Select all that apply.

1

"If symptoms are not improving 5 to 15 minutes after the first dose, we will administer a second auto-injector dose into the opposite thigh."

2

"We will first give diphenhydramine and wait to see if breathing becomes difficult before using the auto-injector, because epinephrine can cause heart problems."

3

"We will inject the auto-injector into the outer mid-thigh through clothing if needed and hold it in place for 3 seconds before removing."

4

"We will keep two auto-injectors together and readily available at all times and check their expiration dates regularly."

5

"After giving the auto-injector we will call 911 immediately, even if the symptoms seem to be improving, because a delayed second-phase reaction can occur."

## Explanation

Statements 1, 3, 4, and 5 are correct. If symptoms do not improve 5 to 15 minutes after the first dose, a second auto-injector may be administered. Inject into the outer mid-thigh through clothing if necessary and follow the device-specific hold time. Keep two auto-injectors together and readily available, and check expiration dates regularly. After epinephrine, activate emergency medical services even if symptoms improve because symptoms can recur. Statement 2 is incorrect: epinephrine is first-line for anaphylaxis and should not be delayed while waiting for an antihistamine or for breathing to worsen.

## In-depth explanation

Epinephrine is the only first-line treatment for anaphylaxis — every other step (antihistamine, steroid, fluids) is supportive. Delay is the leading cause of fatal anaphylaxis. The triggers for use are airway swelling, respiratory distress, hypotension or shock, OR two or more body systems involved (skin + GI, etc.) — not "stopped breathing."

## Clinical scenario

**School-aged child with documented peanut anaphylaxis**. The nurse is providing discharge teaching on **epinephrine auto-injector** use and the post-event action plan. The child and parent return-demonstrate using a trainer device.

## Key concepts

- **Epinephrine auto-injector** — Single-dose intramuscular device (0.15 mg pediatric or 0.3 mg adult) for self-administration in anaphylaxis.
- **Anaphylaxis** — IgE-mediated severe systemic allergic reaction with airway, breathing, or circulation involvement; potentially fatal within minutes.
- **Biphasic reaction** — Recurrent anaphylaxis 1 to 72 hours after the initial event without re-exposure; reason for ED observation after epinephrine use.

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