Case study · 6 questions

Anaphylaxis NCLEX Case Study: 6 Next Gen Questions

An NCLEX anaphylaxis case study set on a medical-surgical unit: six unfolding questions, each with a rationale. Work through each screen as the story unfolds, and check each answer to see the explanation. This case study is free, with no sign-up.

Start the case study

What this case tests

NCLEX anaphylaxis questions: six clinical judgment steps

The case follows one client. The chart gains new entries as the story unfolds, and each question tests one step of the NCSBN Clinical Judgment Measurement Model, in order.

Question 1 · Select All That ApplyRecognize cues

Question 2 · Drag-and-Drop ClozeAnalyze cues

Question 3 · Drop-Down ClozePrioritize hypotheses

Question 4 · Matrix Multiple ChoiceGenerate solutions

Question 5 · Drop-Down TableTake action

Question 6 · HighlightEvaluate outcomes

Work through the case on the exam screen

The case opens in the NCLEX-style test interface, one screen at a time, with the chart beside each question. Submit each answer to see the correct answer and the rationale before the story moves on. Your progress is saved in this browser, and the last screen shows your score and where you gained and lost points.

Start the case study

Answer key

Anaphylaxis case study: answers and rationales

Try the questions first. Open one to read its answer and rationale.

Question 1: Recognize cuesWhich of the following findings require immediate follow-up? Select all that apply.

The abrupt cough, abdominal cramps and low pulse oximetry reading develop during the infusion and differ from the baseline assessment. The pulse of 118/min, respiratory rate of 28/min and blood pressure of 88/48 mm Hg confirm a systemic change. Respiratory and digestive findings can occur in anaphylaxis even when hives and facial swelling are absent, so the nurse does not wait for a rash. The knee discomfort and the local wound redness were present before the infusion and do not explain the abrupt change. Being oriented does not make the new breathing findings safe, but it is not itself an adverse change. Takeaway: a sudden respiratory and digestive change during an infusion needs emergency assessment even without hives.

Sources: CDC: Preventing and Managing Adverse Reactions; DailyMed: Epinephrine injection 1 mg/mL; DailyMed: Ceftriaxone for Injection

Question 2: Analyze cuesDrag words from the choices below to fill in each blank in the following sentence.

The cough and low oxygen reading involve breathing, the new abdominal cramps involve the digestive system, and the fall in blood pressure to 88/48 mm Hg with a pulse of 118/min adds a circulatory change. Their abrupt occurrence together during drug exposure raises concern for a reaction affecting multiple body systems. Anaphylaxis does not require a visible rash: some clients have no skin findings. The absence of hives therefore remains compatible with the emergency suggested by the other cues. Focusing on one system or treating the reaction as localized would overlook the combined change from the baseline assessment. Takeaway: interpret the whole pattern; absent hives do not exclude anaphylaxis.

Sources: CDC: Preventing and Managing Adverse Reactions; DailyMed: Epinephrine injection 1 mg/mL; DailyMed: Ceftriaxone for Injection

Question 3: Prioritize hypothesesComplete the following sentence by choosing from the list of options.

The new cough, wheezes, increased respiratory rate and pulse oximetry reading of 88% indicate a threat to breathing. Rapid progression of anaphylaxis can lead to respiratory failure, so this risk takes priority over the leg infection that was present before the infusion. The lack of hives does not reduce the urgency of the respiratory findings. Emergency treatment begins while the team reassesses airway, oxygenation and circulation; a visible skin reaction is not required before responding. Takeaway: new respiratory compromise during anaphylaxis takes priority over stable background concerns.

Sources: CDC: Preventing and Managing Adverse Reactions; DailyMed: Epinephrine injection 1 mg/mL; DailyMed: Ceftriaxone for Injection

Question 4: Generate solutionsFor each potential nursing intervention, click to specify whether the intervention is indicated or not indicated for the client.

Epinephrine is the first drug treatment and has been requested without delay, and the nurse also supports breathing and circulation. Oxygen is indicated for the respiratory compromise, and rapid IV normal saline supports the low blood pressure of 88/48 mm Hg. Keeping the IV access supports emergency treatment, so the catheter stays in after the antibiotic is stopped; removing it would limit access. Observation continues after apparent improvement because symptoms can return; the disappearance of a cough alone does not end the monitoring plan. Takeaway: provide oxygen, rapid IV fluid support and continued observation alongside immediate epinephrine.

Sources: CDC: Preventing and Managing Adverse Reactions; DailyMed: Epinephrine injection 1 mg/mL; DailyMed: Ceftriaxone for Injection

Question 5: Take actionFor each medication-administration decision below, click to specify the correct selection for this client.

The prescription is 0.3 mg and the vial contains 1 mg/mL, so the first dose is 0.3 mL. The injection goes into the mid-outer thigh, not the buttock or deltoid. The prescription allows a repeat dose after 10 minutes if the reaction remains uncontrolled; persistent wheezing supports repeating it, while the absence of hives does not. Mild tremor can follow epinephrine and does not by itself establish that the reaction remains uncontrolled. The nurse continues to evaluate the full respiratory and circulatory response while preparing and administering treatment. Takeaway: use the prescribed dose and thigh site, and distinguish persistent reaction signs from an expected medication effect.

Sources: CDC: Preventing and Managing Adverse Reactions; DailyMed: Epinephrine injection 1 mg/mL; DailyMed: Ceftriaxone for Injection

Question 6: Evaluate outcomesClick to highlight the findings below that show the client is not improving.

The repeated cough and abdominal cramps are unchanged from the reaction assessment, so they show an incomplete response despite improved blood pressure and oxygenation. Mild tremor can follow epinephrine; that finding alone does not establish worsening anaphylaxis. The pulse has fallen from 118/min to 96/min, and the chronic knee discomfort remains at baseline and is not part of the acute reaction. Improved measurements do not cancel persistent respiratory and digestive symptoms. The nurse reports the incomplete response and continues the emergency reassessment and prescribed repeat-dose plan with the team. Takeaway: evaluate the whole response: improving measurements can coexist with persistent reaction symptoms.

Sources: CDC: Preventing and Managing Adverse Reactions; DailyMed: Epinephrine injection 1 mg/mL; DailyMed: Ceftriaxone for Injection

FAQ

NCLEX anaphylaxis questions: FAQ

What are the symptoms of anaphylactic shock?

Anaphylaxis is a serious allergic reaction that often starts within minutes of exposure to the trigger and can quickly become life-threatening. Breathing signs include shortness of breath, wheezing, stridor, a persistent cough, throat tightness and cyanosis. Signs of shock include low blood pressure, a weak pulse, dizziness or fainting, and collapse. Many clients have hives, itching, flushing or swelling of the lips, tongue or face, and some have vomiting or abdominal cramps. CDC notes that 10 to 20% of clients have no skin findings, so a missing rash never rules anaphylaxis out.

What is the priority medication for the nurse to administer during an anaphylactic reaction?

Epinephrine, injected into the muscle of the mid-outer thigh as soon as anaphylaxis is recognized. CDC calls it the first and most important treatment. An antihistamine such as diphenhydramine or a corticosteroid such as methylprednisolone may be added afterward, but CDC says neither should be the first or the only treatment, so giving diphenhydramine and waiting to see whether it works is a common wrong answer.

What are the immediate interventions for anaphylaxis?

Stop the drug or infusion that may be the trigger, call for help (the rapid response team in a hospital, 911 elsewhere) and give epinephrine IM into the mid-outer thigh without delay. Then give oxygen by face mask (CDC lists 8 to 10 L/min), treat low blood pressure with rapid IV fluids (CDC lists 1 to 2 L) and monitor the vital signs. Repeat the epinephrine if the signs persist, and keep the client under observation for several hours even after the symptoms clear, because anaphylaxis can come back.

How is adrenaline used to treat anaphylactic shock?

Adrenaline and epinephrine are the same drug. For an adult or a child of 30 kg or more, the dose from a 1 mg/mL vial is 0.3 to 0.5 mg (0.3 to 0.5 mL), injected into the muscle of the mid-outer thigh and never into the buttock, with no more than 0.5 mg in one injection. An auto-injector gives 0.3 mg (0.15 mg for a child of 15 to 30 kg) and can be injected through clothing. CDC says the dose can be repeated every 5 to 15 minutes as needed; the vial's label says every 5 to 10 minutes. Anxiety, tremor, palpitations, pallor and headache are known effects of the drug, so a mild tremor alone does not mean the reaction is getting worse.

Sources: CDC: Preventing and Managing Adverse Reactions; MedlinePlus (NLM): Anaphylaxis; DailyMed: Adrenalin (epinephrine injection) 1 mg/mL; DailyMed: EpiPen and EpiPen Jr (epinephrine injection) auto-injector; DailyMed: Ceftriaxone for Injection

Keep practicing

More NCLEX case studies

Heart Failure case studyMedical-surgical unit

6 questions

Pneumothorax case studyEmergency department

6 questions

All NCLEX case studies