Med-Surg Test 1

What is the general rule for starting antiretroviral therapy for an HIV pt?

CD4 T-cell counts: >500 -optional <500 - recommended <350 -treat

Use the TNM classification system for this cancer: Tumor shows extensive growth and infiltration, many lymph nodes involved, metastasis seen in many other tissues in the body.

T(4) N(4) M(4)

Use the TNM classification system for this cancer: The carcinoma is in situ, there is involvement of 2 lymph nodes, and there is no evidence of distant metastases.

T(is) N(2) M(0)

Stage this cancer: in situ a. stage 0 b. stage I c. stage II d. stage III e. stage IV

a. stage 0

How big must a tumor be before it is seen on any current scans? a. 0.5 cm b. 1 cm c. 1.5 cm d. 2 cm

b. 1 cm

Cell-Mediated Immunity

- Initiated through specific antigen recognition by T cells -immunity against pathogens that survive inside of cells (viruses & bacteria). -fungal infections -rejection of transplanted tissues -contact hypersensitivity reactions -Tumor immunity

Trends in the incidence and death rates of cancer include the fact that A. lung cancer is the most common type of cancer in men B. a higher percentage of women than men have lung cancer C. breast cancer is the leading cause of deaths in women D. African Americans have a higher death rate from cancer than whites

D. African Americans have a higher death rate from cancer than whites

Of the following, which is the most appropriate nursing intervention to help an HIV-infected pt adhere to a treatment regiment? A. "Set up" a drug pillbox for the pt every week. B. give the pt a videotape and a brochure to view and read at home. C. Tell the pt that the side effects of the drugs are bad but that they go away after a while. D. Assess the pt's routines and find adherence cues that fit into the pt's life circumstances.

D. Assess the pt's routines and find adherence cues that fit into the pt's life circumstances.

Ten days after receiving a bone marrow transplant, a pt has developed a skin rash on his palms and soles, jaundice, and diarrhea. What is the most likely etiology of these clinical manifestations? A. The pt is experiencing a type I allergic reaction. B. an atopic reaction is causing the pt's symptoms. C. The pt is experiencing rejection of the bone marrow. D. Cells in the transplanted bone marrow are rejecting the host tissue.

D. Cells in the transplanted bone marrow are rejecting the host tissue. (host-versus-graft-disease)

Which of the following accurately describes rejection following transplantation? A. hyperacute rejection can be treated with OKT3 B. Acute rejection can be treated with sirolimus or tacrolimus C. chronic rejection can be treated with tacrolimus or cyclosporine D. Hyperacute reaction can usually be avoided if crossmatching is done before the transplantation.

D. Hyperacute reaction can usually be avoided if crossmatching is done before the transplantation.

The nurse advises a friend who asks him to administer his allergy shots that A. it is illegal for nurses to administer injections outside of a medical setting. B. He is qualified to do it if the friend has epinephrine in an injectible syringe provided with his extract C. avoiding the allergens is a more effective way of controlling allergies, and allergy shots are not usually effective. D. Immunotherapy should only be administered in a setting where emergency equipment and drugs are available.

D. Immunotherapy should only be administered in a setting where emergency equipment and drugs are available.

A pt has begun immunotherapy for the treatment of intractable environmental allergies. When administering the pt's immunotherapy, which of the following is the nurse's priority action? A. Monitoring the pt's fluid balance B. Assessing the pt's need for analgesia C. Assessing the pt for changes in level of consciousness D. Monitoring for S&S of and adverse reaction

D. Monitoring for S&S of and adverse reaction

Which of the following nursing diagnoses is most appropriate for a pt experiencing myelosuppression secondary to chemotherapy for cancer treatment? A. Acute pain B. Hypothermia C. Powerlessness D. Risk for infection

D. Risk for infection

The nurse is caring for a 59-year-old woman who had surfer 1 day ago for removal of a suspected malignant abdominal mass. The pt is awaiting the pathology report. She is tearful and says that she is scared to die. The most effective nursing intervention at this point is to use the opportunity to A. motivate change in unhealthy lifestyles B. educate her about the seven warning signs of cancer C. instruct her about healthy stress relief and coping practices. D. allow her to communicate about the meaning of this experience

D. allow her to communicate about the meaning of this experience

Transmission of HIV from an infected individual to another most commonly occurs as a result of A. perinatal transmission B. sharing drug-using equipment C. low levels of virus in the blood D. anal or vaginal sexual intercourse

D. anal or vaginal sexual intercourse

The function of the monocytes in immunity is related to their ability to A. stimulate the production of T and B lymphocytes B. produce antibodies on exposure to foreign substance C. bind antigens and stimulate natural killer cell activation. D. capture antigens by phagocytosis and present them to lymphocytes

D. capture antigens by phagocytosis and present them to lymphocytes

The primary difference between benign and malignant neoplasms is the A. rate of cell proliferation B. site of malignant tumor C. requirements for cellular nutrients D. characteristic of tissue invasiveness

D. characteristic of tissue invasiveness

For which of the following individuals is genetic carrier screening indicated? A. A pt with a history of type 1 diabetes B. A pt with a family history of sickle cell disease C. A pt whose mother and sister died of breast cancer D. A pt who has a long-standing history of iron-deficiency anemia

B. A pt with a family history of sickle cell disease

If a person is heterozygous for a given gene, it means that the person A. is a carrier for a genetic disorder B. is affected by the genetic disorder C. has two identical alleles for the gene D. has two different alleles for the gene

D. has two different alleles for the gene

This type of reaction most commonly occurs with kidney transplants, the organ must be immediately removed, and it is irreversible. a. hyperacute b. acute c. chronic

a. hyperacute

In which stage of cancer can the patient's activity and lifestyle choices actually reverse the proliferation of the altered cancer cells? a. initiation b. promotion c. progression

b. promotion

Previous administrations of chemotherapy agents to a cancer pt have resulted in diarrhea. Which of the following dietary modifications should the nurse recommend? A. A bland, low-fiber diet B. High-protein, high-calorie diet C. A diet high in fresh fruits and veggies D. A diet emphasizing whole and organic foods

A. A bland, low-fiber diet

What cellular features of cancer cells distinguish them from normal cells (Select ALL that apply) A. Cells lack contact inhibition B. Cells return to a previous undifferentiated state C. Oncogenes maintain normal cellular expression D. Proliferation occurs when there is a need for more cells. E. New proteins characteristic of embryonic stage emerge on cell membrane.

A. Cells lack contact inhibition B. Cells return to a previous undifferentiated state E. New proteins characteristic of embryonic stage emerge on cell membrane.

Which of the following statements accurately describe HIV infection (Select ALL that apply). A. HIV infection has an inevitable and predictable immunodeficiency syndrome (AIDS) B. late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS) C. Untreated HIV infection can remain in the early chronic stage for a decade or more D. Untreated HIV infection usually remains in the early chronic stage for 1 year or less E. Opportunistic diseases occur more often when the CD4+T cell count is low and the viral load is low.

A. HIV infection has an inevitable and predictable immunodeficiency syndrome (AIDS) B. late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS) C. Untreated HIV infection can remain in the early chronic stage for a decade or more

When teaching a pt infected with HIV regarding transmission of the virus to others, which of the following statements made by the pt would identify a need for further action? A. I will need to isolate an tissues I use so as not to infect my family B. I will notify all of my sexual partners so they can get tested for HIV C. Unprotected sexual contact is the most common mode of transmission D. I do not need to worry about spreading this virus to others by sweating at the gym

A. I will need to isolate an tissues I use so as not to infect my family

Which of the following strategies can the nurse teach the pt to eliminate the risk of HIV transmission? A. Using sterile equipment to inject drugs B. Cleaning equipment used to inject drugs C. Taking zidovudine (AZT, ZDV, Retrovir) during pregnancy D. Using latex or polyurethane barriers to cover genitals during sexual contact.

A. Using sterile equipment to inject drugs

The most common cause of secondary immunodeficiencies is A. drugs B. stress C. malnutrition D. human immunodeficiency virus

A. drugs

The primary protective role of the immune system related to malignant cells is A. surveillance for cells with tumor-associated antigens B. binding with free antigen released by malignant cells. C. production of blocking factors that immobilize cancer cells D. Responding to new set of antigenic determinants on cancer cells.

A. surveillance for cells with tumor-associated antigens

Which of the following antibiotic-resistant organisms cannot be killed by normal hand soap? A. vancomycin-resistant-enterococci B. methicillin-resistant- Staphylococcus aureus C. penicillin-resistant Streptococccus pneumoniae D. B-Lactamase producing Klebisella pneumoniae

A. vancomycin-resistant-enterococci

What is a TAA (tumor-associated antigen)?

Altered cell surface antigens that are found on cancer cells as a result of malignancy. The immune system uses these to detect and destroy cancer cells.

Which of the following statements about metabolic side effects of ART is true (Select ALL that apply) A.These are an annoying set of symptoms that are ultimately harmless B. Body changes include ventral fat accumulation and peripheral wasting. C. Lipid abnormalities include increases of triglycerides and decreases in high-density cholesterol. D. Insulin resistance and hyperlipidemia can be treated with drugs to control glucose and cholesterol. E. compared to non-infected people, insulin resistance and hyperlipidemia are difficult to treat in HIV pt.s

B. Body changes include ventral fat accumulation and peripheral wasting. C. Lipid abnormalities include increases of triglycerides and decreases in high-density cholesterol. D. Insulin resistance and hyperlipidemia can be treated with drugs to control glucose and cholesterol.

The nurse is caring for a pt newly diagnosed with HIV. The pt asks what would determine the actual development of AIDS. The nurse's response is based on the knowledge that which of the following is a diagnostic criterion for AIDS? A. Presence of HIV antibodies B. CD4+ T cell count <200/ul C. Whit blood cell count <5000 /ul D. Presence of oral hairy leukoplakia

B. CD4+ T cell count <200/ul

Antiretroviral drugs are used to A. cure acute HIV infection B. Decrease viral RNA levels C. treat opportunistic diseases D. decrease pain and symptoms in terminal disease

B. Decrease viral RNA levels

The nurse is caring for a pt receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this pt is at risk for tumor lysis syndrome (TLS) and will monitor the pt closely for which of the following abnormalities associated with this oncologic emergency? A. Hypokalemia B. Hypocalcemia C. Hypouricemia D.Hypophosphatemia

B. Hypocalcemia

A pt's hemoglobin and hematocrit have necessitated a transfusion of packed RBS's. Shortly after the first unit of packed RBC's is hung, the pt develops S&S of a transfusion reaction. Which of the following hypersensitivity reactions has the pt experienced? A. Type I B. Type II C. Type III D. Type IV

B. Type II

Screening for HIV infection generally involves A. laboratory analysis of blood to detect HIV antigen B. electrophoretic analysis for HIV antigen in plasma C. laboratory analysis of blood to detect HIV antibodies D. analysis of lymph tissues for the presence of HIV RNA

C. laboratory analysis of blood to detect HIV antibodies

A father who has an X-linked recessive disorder and a wife with a normal genotype will A. pass the carrier state to his male children B. pass the carrier state to all of his children C. pass the carrier state to his female children D. not pass on the genetic mutation to any of his children

C. pass the carrier state to his female children

One function of cell-mediated immunity is A. formation of antibodies B. activation of the complement system C. surveillance for malignant cell changes. D. opsonization of antigens to allow phagocytosis by neutrophils

C. surveillance for malignant cell changes.

Following infection with HIV A. the virus replicates mainly in B lymphocytes before spreading to CD4+ T cells. B. infection of monocytes may occur, but antibodies quickly destroy these cells. C. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells D. a long period of dormancy develops during which HIV commonly cannot be found in the blood and there is little viral replication.

C. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells

When caring for a pt with a known latex allergy, the nurse would monitor the pt closely for a cross-sensitivity to which of the following foods (Select ALL that apply). A. Grapes B. Oranges C. Bananas D. Potatoes E. Tomatoes

Grapes, Bananas, Potatoes, Tomatoes (Also avocados, chestnuts, kiwi, water chestnuts, guava, hazelnuts, peaches, and apricots) Due to similar protiens

While obtaining a health history, a nurse learns that a client is allergic to bee stings. When obtaining this client's medication history, the nurse should determine if the client keeps which med on hand? a. diphenhydramine (Benadryl) b. pseudoephedrine (Sudafed) c. guaifenesin (robitussin) d. loperamide (Imodium)

a. diphenhydramine (Benadryl)

Which type of WBC is the most numerous? a. neutrophil b. lymphocyte c. eosinophil d. basophil

a. neutrophil (65%) Lymphocytes are next, eosinophils (2%), then basophils

Which of the following statements made by the nurse is most appropriate in teaching pt interventions to minimize the effects of seasonal allergic rhinitis? a. You will need to get of your pets. b. You should sleep in an air-conditioned room. c. You would do best to stay indoors during the winter months. d. You will need to dust your house with a dry feather duster twice a week.

b. You should sleep in an air-conditioned room.

This type of reaction most commonly occurs when the recipient's T-cytotoxic lymphocytes attack the foreign organ, it is usually reversible with additional or increased immunosuppressant therapy, and long-tern use of therapy is necessary to combat the rejection. a. hyperacute b. acute c. chronic

b. acute

A nurse encourages a client with an immunologic disorder to eat a nutritionally balanced diet to promote optimal immunologic function. Which snacks have the greatest probability of stimulating autoimmunity? a. raisins and carrot sticks b. potato chips and chocolate milk shakes c. fruit salad and mineral water d. applesauce and saltine crackers

b. potato chips and chocolate milk shakes

Which cells in the body proved immunologic surveillance, in which they continually check cell surface antigens and detect and destroy cells with abnormal or altered antigenic determinants? a. A cells b. basophils c. T cells d. All lymphocytes

c. T cells B cells help too (create antiibodies that are directed at specific antigens of the cancer cells)

Which nonpharmacologic interventions should a nurse include in a care plan for a client who has moderate rheumatoid arthritis? Select ALL that apply: a. massaging inflamed joints b. avoiding ROM exercise c. applying splints to inflamed joints d. using assistive devices at all times e. selecting clothing that has Velcro fasteners f. applying moist heat to joints

c. applying splints to inflamed joints e. selecting clothing that has Velcro fasteners f. applying moist heat to joint

This type of reaction most commonly occurs when there is infiltration of the organ with B and T lymphocytes, treatment is supportive and the recipient is placed on the transplant list again. a. hyperacute b. acute c. chronic

c. chronic

A client receiving a blood transfusion experiences an acute hemolytic reaction. Which nursing intervention is the most important? a. immediately stop the transfusion, infuse dextrose 5% in water, and call physician b. slow the transfusion and monitor the client closely c. stop the transfusion, notify the blood bank, and administer antihistamines d. immediately stop the transfusion, infuse normal saline solution, call the physician, and notify the blood bank.

d. immediately stop the transfusion, infuse normal saline solution, call the physician, and notify the blood bank.

Clients with cancer who receive multiple blood transfusions are at risk for forming antibodies against the blood. What precautions should the nurse take when administering blood to a client with a history of multiple transfusions? a. use a blood filter to filter the leukocytes b. ask all clients about previous blood product administration c. administer allogeneic blood products d. make sure that leukocyte-reduced blood products are ordered.

d. make sure that leukocyte-reduced blood products are ordered.

A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately? a. serum potassium level of 4.9 mEq/L b. serum sodium level of 135 mEq/L c. temperature of 99.2F d. urine output of 20 mL/hour

d. urine output of 20 mL/hour

Identify the correct suffix associated with the description of tumor: Benign surface epithelium a. oma b.carcinoma c.sarcoma

a. oma ex: papilloma

IgD

-present on lymphocyte surface -assists in differentiation of B lymphocytes

What are the main risks to pt's receiving anti-rejection meds?

- increased risk of infection -increased risk of malignancies

Describe the late chronic stage of HIV.

-AIDS -Must meet One of the following criteria: -CD4 T-cells below 200 -One opportunistic infection -One opportunistic cancers -Wasting Syndrome -Aids dementia complex

Teach a pt about allergen recognition and control.

-various preventive measure can help control allergy symptoms but the pt will never be completely desensitized or free of all symptoms. -identifying the allergen is key -elimination of allergen from diet if food -Stress management for asthma and urticaria -Environment control for airborn allergens: air-condition, damp dusting daily, covering mattresses with hypoallergenic covers, wearing a mask outside during work -avoid drug if allergen is drug -if insect sting, carry epi pen and tourniquet, alert bracelet.

Using the acronym CAUTION, provide the seven warning signs of cancer.

1. Change in bowel or bladder habits 2. A sore that does not heal 3. Unusual bleeding of discharge from any body orifice 4. Thickening or a lump in the breast or elsewhere 5. Indigestion or difficulty swallowing 6. Obvious change in a wart or mole 7. Nagging cough or hoarseness

The nurse is alerted to possible anaphylactic shock immediately after a pt has received intramuscular penicillin by the development of A. edema and itching at the injection site B. Sneezing and itching of the nose and eyes. C. A wheal-and flare reaction at the injection site D. Chest tightness and production of thick sputum

A. edema and itching at the injection site

Emerging infections can affect health care by (Select ALL that apply) A. revealing antibiotic resistance B. generating scientific discoveries C. creating a strain on limited resources D. challenging established medical traditions E. limiting travel options for nursing personnel.

A. revealing antibiotic resistance B. generating scientific discoveries C. creating a strain on limited resources D. challenging established medical traditions

The nurse is providing care for a pt who has been living with HIV for several years. Which of the following assessment findings most clearly indicates an acute exacerbation of the disease? A. A new onset of polycythemia B. Presence of mononucleosis-like symptoms. C. A sharp decrease in the pt's CD4+ count D. A sudden increase in the pt's WBC count

C. A sharp decrease in the pt's CD4+ count

A 33-year-old pt has recently been diagnosed with stage II cervical cancer. The nurse would understand that the pt's cancer A. Is in situ B. Has metastasized C. Has spread locally D. Has spread extensively

C. Has spread locally

In a person having an acute rejection of a transplanted kidney, which of the following would help the nurse understand the course of events (Select ALL that apply). A. a new transplant should be considered B. Acute rejection can be treated with OKT3 C. Acute rejection usually leads to chronic rejection D. Corticosteroids are the most successful drugs used to treat acute rejection. E. Acute rejection is common after a transplant and can be treated with drug therapy.

B. Acute rejection can be treated with OKT3E. Acute rejection is common after a transplant and can be treated with drug therapy.

The goals of cancer treatment are based on the principle that A. surgery is the single most effective treatment for cancer B. initial treatment is always directed toward cure of the cancer C. a combination of treatment modalities is effective for controlling many cancers D. although cancer cure is rare, quality of life can be increased with treatment modalities

C. a combination of treatment modalities is effective for controlling many cancers

A pt is undergoing plasmapheresis for treatment of systemic lupus erythematosus. The nurse explains that plasmapheresis is used in her treatment to A. remove T lymphocytes in her blood that are producing anti-nuclear antibodies B. remove normal particles in her blood that are being damaged by autoantibodies. C. exchange her plasma that contains antinuclear antibodies with a substitute fluid. D. replace viral-damaged cellular components of her blood with replacement whole blood.

C. exchange her plasma that contains antinuclear antibodies with a substitute fluid.

What is the relevance of finding Oncofetal Antigens in an adult patient?

Oncofetal antigens are commonly found during fetal periods of life, but then disappear. Usually detecting these antigens means that cells are regaining their embryonic capabilities to differentiate = bad for the adult.

Select all nursing considerations when caring for a pt who has recently received radiation therapy for cancer treatment. a. organize care to limit time in room with patient. b. use shielding c. wear a film badge to monitor exposure d. limit the pt's fluid intake for the first 12 hours.

a. organize care to limit time in room with patient. b. use shielding c. wear a film badge to monitor exposure

Plasmapheresis

The removal of plasma (separated from the blood) containing components causing or thought to cause disease, then replaced with fluids, fresh-frozen plasma, or albumin.

Select All dangerous side effects of interluekin therapy. a. Capillary leak syndrome b. pulmonary edema c. head aches d. rashes

a. Capillary leak syndrome b. pulmonary edema

Grade this tumor: Cells differ slightly from normal cells and are well differentiated. a. Grade I b. Grade II c. Grade III d. Grade IV

a. Grade I

Which of the following is a significant sign of a side effect after interluekin therapy? a. Hypotension b. Weight gain c. Hypertension d. Increased WBC count

a. Hypotension

Select All nursing considerations that apply to administering chemotherapy: a. carefully handle bodily secretions from pt for 24-48 hours after chemo. b. limit visitors directly after administration c. the RN can delegate administration after they have showed proper handling. d. wear gloves during administration or while handling the meds

a. carefully handle bodily secretions from pt for 24-48 hours after chemo. d. wear gloves during administration or while handling the meds

Select ALL common adverse effects of chemotherapy drugs. a. fatigue b. constipation c. anorexia d. taste alterations

a. fatigue c. anorexia d. taste alterations

A side effect common to all biologic therapies is: a. flulike syndrome b. bone marrow suppression c. central nervous system deficits d. nausea, vomiting, anorexia, and diarrhea

a. flulike syndrome

To prevent the debilitating cycle of fatigue-depression-fatigue in pt's receiving radiation therapy, the nurse encourages the pt to a. implement a walking program b. ignore the fatigue as much as possible c. do the most stressful activities when fatigue is tolerable d. schedule rest periods throughout the day whether fatigue is present or not.

a. implement a walking program

Identify the correct suffix associated with the description of tumor: Benign growth on the meninges a. oma b.carcinoma c.sarcoma

a. oma ex: meningioma

Identify the correct suffix associated with the description of tumor: Malignant tumor of nerve cells a. oma b.carcinoma c.sarcoma

a. oma ex: neuroblastoma

Identify the correct suffix associated with the description of tumor: Benign bone growth a. oma b.carcinoma c.sarcoma

a. oma ex: osteoma

Grade this tumor: Cells are more abnormal and moderately differentiated a. Grade I b. Grade II c. Grade III d. Grade IV

b. Grade II

An allogenic hematopoietic stem cell transplant is considered as treatment for a pt with acute myelogenous leukemia. The nurse explains that during this procedure a. there is no risk for graft-versus-host disease because the donated marrow is treated to remove cancer cells. b. bone marrow is obtained from a donor who has an HLA match with the pt c. The pt's bone marrow will be removed, treated, stored, and then reinfused after intensive chemotherapy d. there is no need for posttransplant protective isolation because the stem cells are infused directly into the blood.

b. bone marrow is obtained from a donor who has an HLA match with the pt

The primary use of biologic therapy in cancer treatment is to: a. prevent the fatigue associated with chemotherapy and high-dose radiation. b. enhance or supplement the effects of the host's immune responses to tumor cells. c. depress the immune system and circulating lymphocytes, as well as increasing a sense of well-being. d. protect normal rapidly reproducing cells of the gastrointestinal system from damage during chemotherapy.

b. enhance or supplement the effects of the host's immune responses to tumor cells.

When teaching the pt with cancer about chemotherapy, the nurse should a. avoid telling the pt about possible side effects of the drugs to prevent anticipatory anxiety. b. explain that antiemetics, antidiarrheals, and analgesics will be provided as needed to control side effects. c. assure the pt that the side effects from chemotherapy are merely uncomfortable, not life threatening. d. inform the pt that chemotherapy-related alopeci is usually permanent but can be managed with lifelong use of wigs.

b. explain that antiemetics, antidiarrheals, and analgesics will be provided as needed to control side effects.

The nurse uses many precautions during IV administration of vesicant chemotherapeutic agents primarily to prevent a. septicemia b. extravasation c. catheter occlusion d. anaphylactic shock

b. extravasation

During initial chemotherapy a pt with leukemia develops hyperkalemia and hyperuricemia. The nurse recognizes these symptoms as an oncologic emergency and anticipates that the priority treatment will be a. establishing ECG monitoring b. increasing urine output with hydration therapy c. administering a bisphosphate such as pamidronate d. restricting fluids and administering hypertonic sodium chloride solution.

b. increasing urine output with hydration therapy Due to tumor lysis syndrome

While caring for a pt who is at the nadir of chemotherapy, the nurse establishes the highest priority for the nursing diagnosis of a. diarrhea b. grieving c. risk for infection d. imbalanced nutrition: less than body requirements

c. risk for infection

The rationale for treatment of cancer with radiation includes the knowledge that a. radiation damages cellular DNA only in abnormal cells b. malignant cells respond to the effects of radiation because they more frequently go through mitosis. c. damage to cells will occur only during M and G2 phases of the cell cycle, necessitating a series of treatment. d. normal cells are able to repair radiation-induced damage to DNA and do not have permanent radiation damage.

b. malignant cells respond to the effects of radiation because they more frequently go through mitosis.

A nurse is preparing to discharge a child with leukemia observes a family member who has a cold sharing a meal with the child. How should the nurse approach the situation? a. instruct the family members not to share food because it isn't healthful. b. offer a face mask to the person with the cold and use this as an opportunity for further teaching. c. tell the family members to be careful to avoid the child if they're sick d. post isolation signs on the child's door and carefully assess the health status of all visitors.

b. offer a face mask to the person with the cold and use this as an opportunity for further teaching.

Stage this cancer: tumor limited to the tissue of origin; localized tumor growth. a. stage 0 b. stage I c. stage II d. stage III e. stage IV

b. stage I

When a pt is undergoing brachytherapy, it is important for the nurse to recognize that a. the pt will undergo simulation to identify and mark the field of treatment. b. the pt is a source of radiation and personnel must wear film badges during care. c. the goal of this treatment is only palliative and the pt should be aware of the expected outcome. d. computerized dosimetry is used to determine the maximum dose of radiation to the tumor within an acceptable dose to normal tissue.

b. the pt is a source of radiation and personnel must wear film badges during care.

A small lesion is discovered in a pt's lung when an x-ray is performed for cervical spine pain. The definitive method of determining if the lesion is malignant is by a. lung scan b. tissue biopsy c. CT or PET scan d. presence of oncofetal antigens in the blood

b. tissue biopsy

Identify the correct suffix associated with the description of tumor: Malignant growth in the cartilage a. oma b.carcinoma c.sarcoma

c.sarcoma ex: chondrosarcoma

Grade this tumor: Cells are very abnormal and poorly differentiated a. Grade I b. Grade II c. Grade III d. Grade IV

c. Grade III

Stage this cancer: limited local spread a. stage 0 b. stage I c. stage II d. stage III e. stage IV

c. Stage II

Normal tissues that may manifest early, acute responses to radiation therapy include: a. spleen and liver b. kidney and nervous tissue c. bone marrow and gastrointestinal mucosa d. hollow organs such as the stomach and bladder

c. bone marrow and gastrointestinal mucosa

Which is the most common side effect of chemotherapy. a. depression b. Increased WBC count c. myelosuppression d.constipation

c. myelosuppression

Grade this tumor: Cells are immature and primitive and undifferentiated. Cell of origin is difficult to determine. a. Grade I b. Grade II c. Grade III d. Grade IV

d. Grade IV

Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia? a. have the client use a soft toothbrush and electric razor, avoid using enemas, ans watch for signs of bleeding. b. put on a make, gown, and gloves when entering the client's room. c. provide a clear liquid, low-sodium diet d. eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing.

d. eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing.

Chemotherapy for the treatment of cancer would be most effective in a. a small tumor of the bone b. a young tumor of the the brain. c. a large tumor in a highly vascular area d. malignant changes in hemopoietic cells

d. malignant changes in hemopoietic cells

The late effects of chemotherapy and high-dose radiation may include: a. third-space syndrome b. chronic nausea and vomiting. c. persistent myelosuppression. d. secondary resistant malignancies.

d. secondary resistant malignancies.

Stage this cancer: extensive local and regional spread. a. stage 0 b. stage I c. stage II d. stage III e. stage IV

d. stage III

Stage this cancer: metastasis a. stage 0 b. stage I c. stage II d. stage III e. stage IV

e. stage IV

Is this a benign or malignant neoplasm? -It is undifferentiated, it has not metastasized, has marked vascularity, shows expansive growth and infiltration of other tissues.

malignant

Is this a benign or malignant neoplasm? -It is well differentiated, it has metastasized, and has infiltrated other tissues.

malignant

What is tumor lysis syndrome?

metabolic complication characterized by rapid release of intracellular components in response to chemotherapy

Emergency management of anaphylactic shock

-enurse patent airway -admin. high flow 02 via non-rebreather mask -remove insect stinger if present -establish IV access -Epi, albuteraol, benadryl, corticosteroids -manage hypotension (elevate legs, fluids) -monitor

S&S of anaphylaxis

-headache, dizziness paresthesia, feeling of impending doom -pruritis, angioedema, erythema, urticaria -hoarseness, coughing, sensation of narrowed airway, wheezing, stridor, dyspnea, tachypnea, respiratory arrest -hypotension, dysthythmias, tachycardia, cardiac arrest -cramping, abdominal pain, N&V, diarrhea

What are complications of plasmapheresis?

-hypotension -citrate toxicity (caused by hypocalcemia - headache, paresthesias, and dizziness).

IgA

-lines mucous membranes and protects body surfaces. -passed through breast milk and colostrum

Describe the acute infection stage of HIV

-occurs 2-4 weeks after initial infection and can last for 2-4 weeks. -fever, swollen lymph glands, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, diffuse rash. -High viral load noted and CD4 T cell counts fall temporarily then return to baseline.

Nursing considerations for a pt undergoing skin tests to identify allergens.

-pt should never be left alone -Assess for anaphylactic reactions. -Extract can be removed if severe reaction occurs -anti-inflammatory topical cream is applied to the site -Tourniquet can be applied if on arm. -Subq injection of dpi may be necessary.

Describe the early chronic infection stage of HIV>

-HIV antibody test will be positive -tends to be the asymptomatic stage -starts in the early months of the infection and can last up to 11 years if untreated. -CD4 T-cell counts remain above 500 cells/uL (low to normal range), and viral load is low.

Type 1 Hypersensitivity Reaction

-IgE mediated -Ex: Asthma, allergic rhinitis, atopic dermatitis, anaphylactic shock, urticaria, angioedema

Type III Hypersensitivity Reaction

-Immune-Complex Reaction -Local or systemic -Immediate or delayed -Ex: Systemic lupus erythematosus, acute glomerulonephritis, and rheumatoid arthritis.

List the stages of cancerous growth.

-Initiation -Promotion -Progression

Describe the intermediate chronic infection stage of HIV.

-More active stage, symptoms from earlier stages become worse (feet, night sweats, diarrhea, headaches, fatigue) -Thrush is seen -other infections begin to appear -CD4 T-cell count drops to 200-500 and viral load increases.

IgM

-Primary immune response -antibodies against ABO blood antigens

What is plasmapheresis used to treat?

-autoimmune diseases: SLE, glomerulonephritis, Goodpasture syndrome, myasthenia garvis, thrombocytopenic purpura, rheumatoid arthritis, and Guillain-Barre syndrome.

IgE

-causes symptoms of allergic reactions -parasitic protection

IgG

-crosses placenta -secondary immune response

List the stages of HIV

-Acute infection -Early chronic -Intermediate Chronic -Late Chronic (AIDS)

Nursing considerations for a pt undergoing immune therapy

-Always anticipate adverse reactions (pruritus, urticaria, sneezing, laryngeal edema, and hypotension). -If reaction site is larger than a quarter, report to provider -emergency equipment and essential drugs should always be available. -good record keeping. -use extremity away from a joint -site should be rotated -aspirate for blood before injection -observe for 20 minutes -warn pt to watch for delayed reaction for up to 24 hours.

Humoral Immunity

-Antibody mediated immunity -think plasma cells/B cells -uses all the immunoglobulins (Igs)

List 3 types of meds commonly used together to reduce transplant rejections.

-Corticosteroids: prednisone -Calcineuirin Inhibitors: cyclosporine, tacrolimus -Mycophenolate mofetil

Type II Hypersensitivity Reaction

-Cytotoxic and Cytolytic Reactions -IgM -Ex: Hemolytic transfusion reactions, Goodpasture Syndrome

Type IV Hypersensitivity Reaction

-Delayed hypersensitivity reactions -Ex: transplant rejection, tubercular caseous necrosis, contact dermatitis.

The reasons newborns are protected for the first 6 months of life from bacterial infections is because the maternal transmission of A. IgG B. IgA C. IgM D. IgE

A. IgG

Which of the following items would be most beneficial when providing oral care to a pt with metastatic cancer who is at risk for oral tissue injury secondary to chemotherapy? A. Firm-bristle toothbrush B. Hydrogen peroxide rinse C. Alcohol-based mouthwash D. 1 tsp salt in 1 L water mouth rinse

D. 1 tsp salt in 1 L water mouth rinse

The nurse is caring for a pt suffering from anorexia secondary to chemotherapy. Which of the following strategies would be most appropriate for the nurse to use to increase the pt's nutritional intake? A. Increase intake of liquids at mealtime to stimulate the appetite B. Serve three large meals per day plus snacks between each meal. C. Avoid the use of liquid protein supplements to encourage eating at mealtime. D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

D. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

Association between HLA antigens and diseases is most commonly found in what disease conditions? A. Malignancies B. Infectious diseases C. Neurologic diseases D. Autoimmune disorders

D. Autoimmune disorders

A characteristic of the stage of progression in the development of cancer is A. oncogenic viral transformation of target cells B. a reversible steady growth facilitated by carcinogens C. a period of latency before clinical detection of cancer D. proliferation of cancer cells in spite of host control mechanisms.

D. proliferation of cancer cells in spite of host control mechanisms.

In a type I hypersensitivity reaction, the primary immunologic disorder appears to be A. binding of IgG to an antigen on a cell surface. B. Deposit of antigen-antibody complexes in small vessels C. release of cytokines to interact with specific antigens D. release of chemical mediator from IgE-bound mast cells and basophils

D. release of chemical mediator from IgE-bound mast cells and basophils

A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving. a. A-positive blood to an A-negative client b. O-negative blood to an O-positive client c. O-positive blood to an A-positive client d. B-positive blood to an AB-positive client

a. A-positive blood to an A-negative client R-wrong blood type or wrong Rh compatibility will cause a hemolytic reaction

A nurse is monitoring a client who developed facial edema after receiving a medication. Which white blood cells stimulated the edema? a. basophils b. eosinophils c. monocytes d. neutrophils

a. basophils R: responsible for releasing histamine

A client with systemic lupus erythmatosus (SLE) has the classic rash of lesions on the cheeks and bridge of the nose. What term should the nurse use to describe this characteristic pattern? a. butterfly rash b. papular rash c. pustular rash d. bull's eye rash

a. butterfly rash

When administering a blood transfusion to a client with multiple traumatic injuries, the nurse monitors closely for evidence of a transfusion reaction. Shortly after the transfusion begins, the client complains of chest pain, nausea, and itching. When urticaria, tachycardia, and hypotension develop, the nurse stops the transfusion and and notifies the physician. The nurse suspects which type of hypersensitivity reaction? a. Type I (immediate, anaphylactic) b. type II (cytolytic, cytoxic) c. Type III (immune complex) d. Type IV (cell-mediated, delayed)

b. type II (cytolytic, cytoxic)

Identify the correct suffix associated with the description of tumor: Malignant glandular epithelium a. oma b.carcinoma c.sarcoma

b.carcinoma ex: adenocarcinoma

Is this a benign or malignant neoplasm? -It is well differentiated, shows expansive growth, it has not metastasized, it is encapsulated, and has not infiltrated other tissues.

benign