# Situation: A 62-year-old man who weighs 80 kg is receiving his first dose of an intravenous (IV) antibiotic on the medical ward. Ten minutes into the infusion, he develops generalized hives, hoarseness, and wheezing; his blood pressure is 80/50 mmHg and heart rate 96/min. He takes metoprolol daily for hypertension. The infusion has been stopped and help has been called. He recovers and is prescribed two adrenaline (epinephrine) auto-injectors. During discharge teaching he asks: if he uses the first device at home and his throat tightness eases, but 10 minutes later he still feels faint and dizzy, what should he do?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629729  
> language: ko  
> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: A 62-year-old man who weighs 80 kg is receiving his first dose of an intravenous (IV) antibiotic on the medical ward. Ten minutes into the infusion, he develops generalized hives, hoarseness, and wheezing; his blood pressure is 80/50 mmHg and heart rate 96/min. He takes metoprolol daily for hypertension. The infusion has been stopped and help has been called.

He recovers and is prescribed two adrenaline (epinephrine) auto-injectors. During discharge teaching he asks: if he uses the first device at home and his throat tightness eases, but 10 minutes later he still feels faint and dizzy, what should he do?

## 보기

1. Skip the second device, since his throat has already improved
2. Use the second device now and still go to the hospital **✔ 정답**
3. Use the second device, then stay home if he feels well after it
4. Wait until 30 minutes have passed before using the second device

**정답: 2**

## 해설

A second adrenaline dose may be needed 5–15 minutes after the first when symptoms persist, and faintness and dizziness suggest continuing low blood pressure even though the airway has improved. Every use of an auto-injector is followed by emergency care, because the effect of adrenaline is short and a biphasic reaction can occur hours later. Both rules apply together here.

## 심화 해설

Two rules apply together
This item combines two rules for adrenaline (epinephrine) auto-injectors. First, a second dose may be needed 5 to 15 minutes after the first if symptoms persist. Second, every use of an auto-injector is followed by emergency care. In his scenario, the throat tightness eases after the first dose, but 10 minutes later he still feels faint and dizzy. He should use the second device now and still go to the hospital.

Why faintness matters
Anaphylaxis can affect several body systems at once. Improvement in one, such as the airway, does not mean the whole reaction is over. Faintness and dizziness suggest continuing low blood pressure, which is a sign of ongoing shock. Because adrenaline acts quickly but its effect is short, a second dose is given when symptoms persist after 5 to 15 minutes. He should lie down with his legs raised while waiting for help, rather than standing or walking, which can worsen low blood pressure.

Why hospital care is always needed
The effect of adrenaline wears off within minutes to hours, and symptoms may return. A biphasic reaction, a second wave of anaphylaxis, can occur hours later even without further exposure to the trigger. In the hospital, he can be observed, given more adrenaline, fluids, oxygen, and other treatment if needed. Watch out! Feeling well after the second dose does not make staying home safe.

Why the other options are wrong

| Option | Problem |
| --- | --- |
| Skip the second device since his throat improved | Persistent faintness suggests ongoing hypotension |
| Use the second device, then stay home if he feels well | Every use needs hospital care because of the risk of a biphasic reaction |
| Wait 30 minutes before the second device | The repeat interval is 5 to 15 minutes; waiting leaves possible shock untreated |
| Use the second device now and go to the hospital | Both rules applied |

Discharge teaching for auto-injectors
The nurse teaches him to carry both auto-injectors at all times, to inject into the mid-outer thigh, through clothing if necessary, and to call for emergency help at the first use. He should avoid the antibiotic that caused the reaction and tell every health care provider about it, and wear a medical alert identification. Because he takes metoprolol, which can reduce the response to adrenaline, his physician may review his medications.

Exam takeaway
If symptoms persist 5 to 15 minutes after the first auto-injector, use the second; after any use, go to the hospital. Key point! Partial improvement does not end anaphylaxis, and a biphasic reaction can occur hours later.

## 임상 시나리오

Second Auto-Injector DosePersistent faintness 10 minutes after the first dose
Give a second adrenaline dose if symptoms persist 5 to 15 minutes after the first. Faintness suggests ongoing low blood pressure.

Every use of an auto-injector is followed by emergency hospital care because adrenaline is short-acting and a biphasic reaction can occur.

Lie down with legs raised while waiting for help; carry both devices and wear medical alert identification.

CautionDo not stay home after feeling better, and do not wait 30 minutes before the second dose.

## 핵심 개념

- **Auto-injector** — A spring-loaded device that delivers a preset intramuscular dose of adrenaline.
- **Biphasic reaction** — A return of anaphylaxis symptoms hours after the first reaction without further exposure.
- **Hypotension** — Low blood pressure, which in anaphylaxis causes faintness and dizziness.
- **Medical alert identification** — A bracelet or card that tells others about a person's serious allergy or condition.

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