Dunphy Chapter 17 Hematological and Immune Problems
Tina, age 2, had a complete blood count (CBC) drawn at her last visit. It indicates that she has a microcytic hypochromic anemia. What should you do now at this visit? A. Obtain a lead level B. Instruct Tina's parents to increase the amount of milk in her diet. C. Start Tina on ferrous sulfate (Feosol) and check the CBC in 6 weeks. D. Recheck the CBC on this visit
A. Obtain a lead level - Provider should always check a lead level before starting iron supplementations in children because an elevated lead level will cause anemia despite a normal iron level.
Kathy, age 64, is a sun worshipper. She tells you that because she did not get skin cancer in her youth, she certainly will not get it now. How do you respond? A. "You're probably right; if you haven't had it by now, you're probably safe." B. "As you age, you have decreased pigment in your skin, which puts you at more risk." C. "You skin elasticity is decreased, so you have more of a chance of contracting skin cancer as you age." D. "Skin cancer is not dependent on age; anyone can get it."
B. "As you age, you have decreased pigment in your skin, which puts you at more risk."
The T in the TNM staging system refers to A. Tolerance B. Primary tumor C. Tumor marker D. Turgor
B. Primary tumor - N is for regional lymph nodes, and M is for distant metastasis
Mandy's 16 year old daughter has hepatitis A. Which of the following statements made by Mandy indicates that she understands the teaching you've just completed? A. "I guess she needs to be hospitalized until she's recovered." B. "We'll keep her at home with strict isolation precautions." C. "We'll stop at the store and buy plastic eating utensils." D. "We'll stop at the drugstore and pick up prescription medications immediately."
C. "We'll stop at the store and buy plastic eating utensils." - Clients with Hepatitis A should have separate eating and drinking utensils or use disposable ones.
Mrs. Jameson complains of unilateral blurry vision and partial blindness in the left eye. On physical examination, you find decreased peripheral vision on her left side. Funduscopic examination reveals cotton-wool spots. Your most likely diagnosis is A. Cryptococcosis B. Toxoplasmosis C. Cytomegalovirus infection D. Herpes simplex virus infection
C. Cytomegalovirus infection - Classic S&S include cotton-wool spots (cottage cheese and ketchup appearance), hemorrhage, and exudates on funduscopic examination
Skip, age 4, is brought in to the office by his mother. His symptoms are pallor, fatigue, bleeding, fever, bone pain, adenopathy, arthralgias, and hepatosplenomegaly. You refer him to a specialist to perform to confirm a diagnosis? A. An enzyme-linked immunosorbent assay B. A monospot test C. A prothrombin time, partial thromboplastin time, bleeding time, complete blood count, and peripheral smear D. A bone marrow spear
D. A bone marrow smear
Frank, a 66 year old white male who is on diuretic therapy, presents with an elevated hematocrit. He also has splenomegaly on examination, as well as subjective complaints of blurred vision, fatigue, headache, and tinnitus. You suspect A. Multiple myeloma B. Waldenstrom's macroglobulinemia C. Dehydration related to use of diuretics D. Polycythemia vera
D. Polycythemia vera - An elevated hematocrit due to contracted plasma volume, rather than increased red blood cell mass, may be due to diuretic use or may occur without obvious cause.
Caroline, an older adult, is homeless and has iron-deficiency anemia. She smokes and drinks when she can and has an ulcer. Which of the following is not one of the risk factors of iron-deficiency anemia? A. Smoking B. Poverty C. Ulcer disease D. Age older than 60
A. Smoking
Which of the following increases the risk of pancreatic cancer? A. A high-carbohydrate diet B. Cigarette smoking, diabetes, and a high-fat diet C. Diabetes and lack of activity D. Yo-yo dieting
B. Cigarette smoking, diabetes, and a high-fat diet
Which of the following white blood cell types is elevated in parasitic infections, hypersensitivity reactions, and autoimmune disorders? A. Neutrophils B. Eosinophils C. Basophils D. Monocytes
B. Eosinophils
Screening infants for anemia should occur at what age? A. 6 months B. No screening is recommended C. 9 months D. 12 months
C. 9 months - The cutoff points for a diagnosis of anema at this age are a hemoglobin below 11g/dl or a hematocrit below 33%.
Which of the following laboratory studies is used to determine if a client has had hepatitis? A. Serum protein B. Protein electrophoresis C. Antibody testing D. Globulin levels
C. Antibody testing - Antibody titers evaluate antibody-mediated responses.
Macrocytic normochromic anemias are caused by A. Acute blood loss B. An infection or tumor C. A nutritional deficiency of iron D. A deficiency of folic acid
D. A deficiency of folic acid - Cell size is large and irregular.
Which cancer can be cured with chemotherapy alone? A. Breast cancer B. Malignant melanoma C. Bladder cancer D. Testicular cancer
D. Testicular cancer
Which tumor marker may detect a tumor of the ovary or testes? A. Alpha fetoprotein B. Carcinoembryonic antigen C. Human chorionic gonadotropin D. Cancer antigen 125
A. Alpha fetoprotein - May be elevated with embryonal cell tumors of the ovary or testis, hepatocellular carcinoma, and choriocarcinoma.
Physiological changes in the immune system of older adults include A. An increase in immunoglobulin A and G antibodies B. A high rate of T-lymphocyte proliferation C. An increase in the number of cytotoxic T cells D. An increase in CD8, which affects regulation of the immune system
A. An increase in immunoglobulin A and G antibodies
Your client, Mr. Jones, has Sjorgen's syndrome. Which treatment do you suggest? A. Artificial tears and chewing sugarless gum B. Frequent rinsing out of the mouth with mouthwash C. Drinking at least one glass of milk per day D. Removing wax from the ears at regular intervals
A. Artificial tears and chewing sugarless gum - Sjorgen's syndrome is a multisystem autoimmune disease characterized by dysfunction of the exocrine glands, specifically notable for dry eyes and dry mouth.
Sara comes today with numerous petechiae on her arms. You know that she is not taking warfarin (Coumadin). What other drugs do you ask her about? A. Aspirin or aspirin compounds B. Antihypertensive agents C. Oral contraceptives D. Anticonvulsants
A. Aspirin or aspirin compounds
Which of the following cancers is associated with Epstein-Barr virus? A. Burkitt's lymphoma B. Kaposi's sarcoma C. Lymphoma D. Adult T-cell leukemia
A. Burkitt's lymphoma - Kaposi's sarcoma is associated with human cytomegalovirus - Lymphoma is associated with the human herpesvirus 6 - Adult T-cell leukemia is associated with the human T-lymphotropic viruses
Clients with AIDS typically experience the neurological symptomatic triad consisting of A. Cognitive, motor, and behavioral changes B. Seizures, paresthesias, and dysesthesias C. Kaposi's sarcoma, cryptococcal meningitis, and depression D. Seizures, depression, and paresthesias
A. Cognitive, motor, and behavioral changes - All are potential symptoms of AIDS, but the key word is neurological.
Which of the following is not an effective strategy to prevent the nausea and vomiting associated with the effects of radiation and chemotherapy? A. Decreasing the amount of liquids B. Eating a soft, bland diet low in fat and sugar C. Relaxation D. Distraction
A. Decreasing the amount of liquids - It is important to maintain an adequate fluid intake to prevent dehydration, which may result in vomiting.
You have a new client, Robert, age 67, who present with a generalized lymphadenopathy. You know that this is indicative of A. Disseminated malignancy, particularly of the hematological system B. Cancer of the liver C. Sjorgen's syndrome D. Pancreatic cancer
A. Disseminated malignancy, particularly of the hematological system - Such as lymphoma or leukemia
A client with HIV infection has a fever of unknown origin (FUO). Which of the following is a possible cause of an FUO in a client with HIV? A. Drug fever B. Upper respiratory infection C. Nothing specific; this is a systemic disease manifestation D. Urinary tract infection
A. Drug fever - A fever of unknown origin in clients with HIV is defined as temperature > 101 on multiple occasions over 4 weeks duration in an outpatient and 3 weeks duration in an inpatient, with an uncertain diagnosis after three appropriate investigations of cultures and the like.
Which is the most abundant immunoglobulin (Ig) found in the blood, lymph, and intestines? A. IgG B. IgA C. IgM D. IgD
A. IgG - IgG is active against bacteria, bacterial toxins, and viruses
Sally has HIV infection and asks which method of birth control, other than abstinence, would be best for her. You suggest A. Latex condoms B. The spermicide nonoxynol-9 C. An intrauterine device (IUD) D. An oral contraceptive
A. Latex condoms
Which of the following is a benign neoplasm? A. Leiomyoma B. Osteosarcoma C. Glioma D. Seminoma
A. Leiomyoma - Benign neoplasm of the smooth muscle
Despite successful primary prophylaxis, which infection remains a common AIDS-defining diagnosis? A. Pneumocystitis jiroveci pneumonia (PCP) B. Cryptococcosis C. Cryptosporidiosis D. Candidiasis
A. Pneumocystitis jiroveci pneumonia - Before the appearance of AIDS, Pneumocystitis jiroveci pneumonia was a rare disease that immunosuppressed persons and clients with leukemia sometimes developed.
Systemic lupus erythematosus is diagnosed on the basis of A. Positive antinuclear antibody (ANA), malar rash, and photosensitivity B. Positive ANA, weight loss, and night sweats C. Negative ANA, photosensitivity, and renal disease D. Leukopenia, negative ANA, and photosensitivity
A. Positive antinuclear antibody (ANA), malar rash, and photosensitivity
Sue has sickle cell anemia. In regulating her and monitoring her hemoglobin and hematocrit levels, you want to maintain them at A. Slightly below normal B. Strictly at normal C. Slightly above normal D. Around normal with only minor fluctuations
A. Slightly below normal - Clients with sickle cell anemia should have their hemoglobin and hematocrit levels maintained at a level slightly below normal because this protects from some of the vaso-occlusive infarctive complications related to the viscosity characteristics of sickle cell anemia.
Your 18 year old client, Mandy, has infectious mononucleosis. What might you expect her blood work to reflect? A. Thrombocytopenia and elevated transaminase B. Elevated white blood cells (WBCs) C. Decreased WBCs D. Decreased serum globulins
A. Thrombocytopenia and elevated transaminase - Infectious mononucleosis is a lymphocytic leukocytosis that may be confused with leukmia and other disorders. The presence of heterophile antibodies (monospot test) in the context of clinical and hematological findings is diagnostic.
Samantha is being given platelets because of acute leukemia. One "pack" of platelets should raise her count by how much? A. 2,000-4,000 mm3 B. 5,000-8,000 mm3 C. 9,000-12,000 mm3 D. About 15,000 mm3
B. 5,000-8,000 mm3 - One pack equals about 50ml.
Select a statement that is true about the erythrocyte sedimentation rate (ESR). A. It is a very specific indicator of inflammation B. A rise in the ESR is a normal part of aging C. It is useful in detecting pancreatic cancer D. It is diagnostic for rheumatoid arthritis
B. A rise in the ESR is a normal part of aging - The ESR is a very nonspecific indicator of inflammation and is often elevated in inflammatory musculoskeletal conditions; it is not, however, diagnostic for rheumatoid arthritis.
Sam is being worked up for pancreatic cancer. He states that the doctor wants to put a "scope" in and inject dye into his ducts. He wants to know more about this. What procedure is he referring to? A. Percutaneous transhepatic cholangiography B. An endoscopic retrograde cholangiopancreatography C. An angiography D. An upper gastrointestinal (GI) series
B. An endoscopic retrograde cholangiopancreatography - An endoscope is inserted via the mouth and passed by the stomach and into the small intestine, where the dye is injected into the pancreatic ducts and x-rays are taken to determine if any obstruction is apparent.
Some pharmacological adjuncts to analgesics in clients with uncontrolled cancer pain include A. Anticonvulsants and tricyclic antidepressants B. Anticonvulsants, tricyclic antidepressants, and corticosteroids C. Selective serotonin receptor inhibitors D. Benzodiazepines
B. Anticonvulsants, tricyclic antidepressants, and corticosteroids - Pain that is poorly controlled with opioids and NSAIDs is often neuropathic in nature, meaning that it is a result of direct nerve injury, such as nerve compression
Sickle cell anemia is an autosomal recessive disorder caused by the hemoglobin S gene. An abnormal hemoglobin leads to chronic hemolytic anemia with numerous clinical manifestations and becomes a chronic multisystem disease, with death from organ failure, usually between ages 40 and 50. The hemoglobin S gene is carried by A. Approximately 4% of the U.S. population B. Approximately 8% of American blacks C. Approximately 4% of Latinos D. Approximately 12% of Native Americans
B. Approximately 8% of American blacks - The hemoglobin S gene is carried by approximately 8% of American blacks and 1 birth in 400 in American blacks will produce a child with sickle cell.
Tobacco has been linked to which of the following types of cancer? A. Colon cancer B. Bladder cancer C. Prostate cancer D. Cervical cancer
B. Bladder cancer - Tobacco use has been linked to an increased risk for bladder, pancreatic, laryngeal, esophageal, oropharyngeal, and some types of gastric cancer.
Samual, age 5, is receiving radiation therapy for his acute lymphocytic leukemia. He is at increased risk of developing which type of cancer as a secondary malignancy when he becomes an adult? A. Chronic lymphocytic leukemia B. Brain tumor C. Liver cancer D. Esophageal cancer
B. Brain tumor
Which bone tumor arises from cartilage and is usually located in the pelvis, femur, proximal humerus, or ribs? A. Osteosarcoma B. Chondrosarcoma C. Ewing's sarcoma D. Fibrosarcoma
B. Chondrosarcoma - It is the second most common bone malignancy, seen most frequently in men between ages 30 and 60.
Julia asks how smoking increases the risk for folic acid deficiency. You respond that smoking A. Causes small-vessel disease and constricts all vessels that transport essential nutrients. B. Decreases the vitamin C absorption C. Affects the liver's ability to store folic acid D. Causes nausea, thereby inhibiting the appetite and ingestion of foods rich in folic acid
B. Decrease the vitamin C absorption - Vitamin C is necessary for folic acid absorption
The three most common signs and symptoms of primary HIV infection are A. Weight loss, pharyngitis, and fatigue B. Fever, fatigue, and pharyngitis C. Night sweats, rash, and headache D. Myalgias, fatigue, and fever
B. Fever, fatigue, and pharyngitis
Which of the following is a genotoxic carcinogen? A. Vinyl chloride polymers B. Chemotherapy drugs C. Asbestos D. Wood and leather dust
B. Genotoxic carcinogens directly alter DNA and cause mutations
Which of the following is an X-linked recessive disorder commonly seen in African American men? A. Sickle cell anemia B. Glucose-6-phosphate dehydrogenase deficiency C. Pyruvate kinase deficiency D. Bernard-Soulier syndrome
B. Glucose-6-phosphate dehydrogenase deficiency - It is an enzyme defect that causes episodic hemolytic anemia because of the decreased ability of red blood cells to deal with oxidative stresses.
A platelet count less than 150,000/mm3 may indicate A. Possible hemorrhage B. Hypersplenism C. Polycythemia vera D. Malignancy
B. Hypersplenism - As well as possible bone marrow failure or accelerated consumption of platelets
Jill has just been given a diagnosis of HIV infection and has a normal initial Pap test. When do the Centers for Disease Control and Prevention (CDC) guidelines state that she should have a repeat Pap test? A. In 3 months B. In 6 months C. In 1 year D. She should have a colposcopy every year rather than a Pap test
B. In 6 months - CDC recommends that if a woman infected with HIV has a normal initial Pap test, then a second evaluation should be done in 6 moths to reduce the likelihood of a false-negative initial test.
In teaching your client about the American Cancer Society's CAUTION model, which identifies signs of many cancers, you teach her that the N stands for A. Night sweats B. Nagging cough C. Nausea and vomiting D. Noxious odor
B. Nagging cough - Or hoarseness
Pernicious anemia is a result of A. Not enough folic acid B. Not enough intrinsic factor C. Not enough Vitamin D D. Not enough iron
B. Not enough intrinsic factor
Pernicious anemia is a result of A. Not enough folic acid B. Not enough intrinsic factor C. Not enough Vitamin D D. Not enough iron
B. Not enough intrinsic factor. - Pernicious anemia is a result of the parietal cells of the stomach lining failing to secrete enough intrinsic factor to ensure intestinal absorption of Vitamin B12.
Stu, age 49, has slightly reduced hemoglobin and hematocrit readings. What is your next action after you ask him about his diet? A. Repeat the laboratory tests B. Perform a fecal occult blood test C. Start him on an iron preparation D. Start him on folic acid
B. Perform a fecal occult blood test - Tests for fecal occult blood in the stools should be done on all clients suspected of having iron-deficiency anemia.
Which of the following is not an inherited condition that causes hemolytic anemia? A. Hereditary spherocytosis B. Pernicious anemia C. Glucose-6-phosphate dehydrogenase deficiency D. Sickle cell anemia
B. Pernicious anemia - Caused by an inadequate absorption of vitamin B12. Symptoms develop slowly and subtly and may not be recognized right away.
Allie, age 5, is being treated with radiation for cancer. Her mother asks about the effect radiation will have on Allie's future growth. Although she knows that a specialist will be handling Allie's care, her mother asks for your opinion. How do you respond? A. "Let's worry about the cancer first, then see how her growth is affected." B. "Chemotherapy may effect her futur growth, but not radiation." C. "She will probably have growth hormone problems, in which case she can then begin growth hormone therapy." D. That's the least of your worries now; everything will turn out ok."
C. "She will probably have growth hormone problems, in which case she can then begin growth hormone therapy."
Maria asks if being overweight predisposes her to cancer. How do you respond? A. "No, you have the came risk as a normal-weight individual." B. "You have less of a risk of cancer than normal-weight individuals because you have protein stores to combat mutant cells." C. "Yes, you have an increased risk of hormone-dependent cancers because of your obesity." D. "Yes, you have an increased risk because you have many more cells in all the organs of your body."
C. "Yes, you have an increased risk of hormone-dependent cancers because of your obesity." - Because of excessive body fat. Sex hormones are synthesized from fat, and obese people have excessive amounts of the hormones that feed hormone-dependent malignancies such as cancer of the breast, bowel, ovary, endometrium, and prostate.
Joan had a modified mastectomy with radiation therapy 10 years ago. She asks when she can have her blood pressure or needle sticks taken in the affected arm. How do you respond? A. "If it's been 10 years and you've had no problems, you can discontinue those precautions." B. "Because you didn't have a radical mastectomy, you can do those things now." C. "You must observe these precautions forever." D. "As long as you do limb exercises and have established collateral drainage, you can discontinue these precautions."
C. "You must observe these precautions forever." - Lymphadema may occur many years after a mastectomy (whether radical or modified) or radiation therapy on the affected side.
Sandra, age 19, is pregnant. She is complaining of breathlessness, tiredness, and weakness and is pale. After diagnosing anemia, you order medication and tell her to take it A. Only with meals because it can be irritating to the stomach B. In the morning if she experiences morning sickness C. 1 hour before eating or between meals D. At bedtime
C. 1 hour before eating or between meals - Sandra's symptoms indicate anemia, which is probably caused by a poor diet. She probably has an iron and folic acid deficiency.
Sickle cell anemia affects African Americans. Approximately 1 in 400 African Americans in the United States has sickle cell disease (SCD). Advances in treatment have been made, but life expectancy is still limited. The mean survival time for men with the disease is approximately A. 24 years B. 34 years C. 42 years D. 52 years
C. 42 years - 42 for men and 48 for women
The "gold standard" for definitive dianosis of sickle cell anemia is A. A reticulocyte count B. The sickle cell test C. A hemoglobin electrophoresis D. A peripheral blood smear
C. A hemoglobin electrophoresis - Test that determines the presence of hemoglobin S
Mindy, age 6, recently was discharged from the hospital after a sickle cell crisis. You are teaching her parents to be alert to the manifestations of splenic sequestration and tell them to be alert to A. Vomiting and diarrhea B. Decreased mental acuity C. Abdominal pain, pallor, and tachycardia D. Abdominal pain and vomiting
C. Abdominal pain, pallor, and tachycardia - These are all manifestations of splenic sequestrations
Marsha states that a relative is having a carcinoembryonic antigen (CEA) test done to detect some type of cancer. She wants to know what kind. You tell her a CEA is performed to detect A. Adenocarcinoma of the prostate B. Medullary cancer of the thyroid C. Adenocarcinomas of the colon, lung, breast, ovary, stomach and pancreas D. Multiple myeloma
C. Adenocarcinomas of the colon, lung, breast, ovary, stomach and pancreas
What is the most significant reason why alcohol use is discouraged in persons with HIV infection or AIDS? A. Alcohol interferes with the pharmacokinetics of most AIDS drugs B. Filling up on empty calories of alcohol replaces the desire for food. C. Alcohol decreases the ability of persons to adhere to a prescribed medical regimen D. If clients become addicted to alcohol, when AIDS advances, they will become addicted to pain killers
C. Alcohol decreases the ability of persons to adhere to a prescribed medical regimen.
The primary reason for newborn screening for sickle cell disease is to A. Present the parents with the option for genetic screening in the future B. Test siblings if it is proved that the newborn has sickle cell disease C. Allow for the prevention of septicemia with prophylactic medication D. Prevent a sickle cell crisis
C. Allow for the prevention of septicemia with prophylactic medication - Prophylactic medication (penicillin) and prompt clinical intervention for infection and future crises.
The placement of a high dose of radioactive material directly into a malignant tumor and giving a lower dose to the normal tissues is referred to as A. Radiotherapy B. Teletherapy C. Brachytherapy D. Ionization therapy
C. Brachytherapy - Also referred to as internal, interstitial, or intracavitary radiation.
Fecal occult blood testing (FOBT) is most effective in identifying A. Cancers in the right colon B. Polyps C. Cancers in the sigmoid colon D. Cancers in the transverse colon
C. Cancers in the sigmoid colon
Which type of leukemia produces symptoms with an insidious onset including weakness, fatigue, massive lymphadenopathy, pruritic vesicular skin lesions, anemia, and thrombocytopenia? A. Acute lymphocytic leukemia B. Acute myelogenous leukemia C. Chronic lymphocytic leukemia D. Chronic myelogenous leukemia
C. Chronic lymphocytic leukemia
The first choice of therapy for a client who is positive for HIV and has oral candidiasis is A. Fluconazole (Diflucan) 100mg PO QD B. Ketoconazole (Nizoral) 200mg PO QD C. Clotrimazole troches (10mg) five times daily or nystatin (Mycostatin) suspension 500,000-1,000,000 units three to five times daily D. Griseofulvin (Grisactin) 500mg BID
C. Clotrimazole troches (10mg) five times daily or nystatin (Mycostatin) suspension 500,000-1,000,000 units three to five times daily - Because of the common recurrence of oral candidiasis and increased rates of drug resistance, systemic fungicides, such as fluconazole, ketoconazole, and griseofulvin, should be reserved for severe cases, such as esophageal candidiasis and clients with dysphagia.
Before initiating cancer therapy, the first crucial step is to A. Stage the disease B. Define the goals of therapy C. Confirm the diagnosis using tissue biopsy D. Choose a treatment plan from the many therapeutic options
C. Confirm the diagnosis using tissue biopsy
Robin has HIV infection and is having a problem with massive diarrhea. You suspect the cause is A. Cryptococcosis B. Toxoplasmosis C. Cryptosporidiosis D. Cytomegalovirus
C. Cryptosporidiosis - When patients with HIV infection have massive diarrhea, a protozoa of the cryptosporidium genus is the most likely cause.
Which is the best serum test to perform to spot an iron-deficiency anemia early before it progresses to full-blown anemia? A. Hemoglobin B. Hematocrit C. Ferritin D. Reticulocytes
C. Ferritin - A serum measurement of ferritin, the body's iron-storing protein, can tell exactly how much iron is on hand in the body.
Maurice is an intravenous drug abuser with chronic hepatitis B (HBV). The development of which type of hepatitis poses the greatest risk to a client with HBV? A. Hepatitis A B. Hepatitis C C. Hepatitis D D. Hepatitis E
C. Hepatitis D
When Judy tells you that she has hemophilia, you know that A. Both of her parents also have the disease B. Her maternal grandfather probably had the disease and it skipped a generation C. Her father had the disease and her mother was a carrier D. Her mother had the disease
C. Her father had the disease and her mother was a carrier - Hemophilia is a classic example of an X-linked recessive disease and, as a rule, only males are affected. In rare instances, female carriers are clinically affected if their normal X chromosomes are disproportionately inactivated.
Prostate cancer is associated with which of the following viruses? A. Herpes simplex virus types 1 and 2 B. Human herpesvirus 6 C. Human cytomegalovirus D. Human T-lymphotropic viruses
C. Human cytomegalovirus
Pregnant women may be prone to thrombophilias, which may be inherited or acquired. Which of the following is an example of a factor that predisposes pregnant women to acquired thrombophilic states in pregnancy? A. Factor V Leiden B. Homocystine C. Immobilization and malignancy D. Protein S and protein C
C. Immobilization and malignancy
Which hypersensitivity reaction results in a skin test that is erythematous with edema within 3-8 hours? A. Anaphylactic reaction B. Cytotoxic reaction C. Immune complex-mediated reaction D. Delayed hypersensitivity reaction
C. Immune complex-mediated reaction - May result from serum sickness, systemic lupus erythematosus, or rheumatoid arthritis
Jimmy is a 6 month old with newly diagnosed sickle cell disease. His mother brings him to the clinic for a well-baby visit. Which of the following should you do on this visit? A. Tell the parents that Jimmy will not be immunized because of his diagnosis B. Tell the parents that Jimmy should not go to day care C. Immunize Jimmy with diptheria, tetanus, and pertussis. Haemophilus influenzae type B (HIB); hepatitis B (HBV); and poliomyelitis vaccines D. Immunize Jimmy with measles, mumps, and rubella; HIB, HBV vaccines only
C. Immunize Jimmy with diptheria, tetanus, and pertussis. Haemophilus influenzae type B (HIB); hepatitis B (HBV); and poliomyelitis vaccines - Children with sickle cell disease should receive all the standard well-baby care, but in addition to the standard immunizations, they should receive the pneumococcal vaccine at age 2 years
Your client, Jackson, has decreased lymphocytes. You suspect A. Bacterial infection B. Viral infection C. Immunodeficiency D. Parasitic infection
C. Immunodeficiency - A decrease in lymphocytes would be most consistent with immunodeficiency disorders, long-term corticosteroid therapy, or debilitating diseases such as Hodgkin's lymphoma or lupus erythematosus - Lymphocytes are increased primarily in viral infections and only occasionally in bacterial infections. - Eosinophils are elevated in parasitic infections such as malaria, trichinosis, and ascariasis
Jan is having biological therapy for her pancreatic cancer. What kind of treatment is this? A. Surgery B. Radiation therapy C. Immunotherapy D. Chemotherapy
C. Immunotherapy - Uses the body's natural ability (immune system) to fight disease or to protect the body from adverse effects of treatment.
How often should you order a complete blood count for your client? A. Routinely B. Before dental work C. In the case of infection D. If she is pregnant
C. In the case of infection
Thalassemia is caused by A. Blood loss B. Impaired production of all blood-forming elements C. Increased destruction of red blood cells D. Autoimmune antibodies
C. Increased destruction of red blood cells - Caused by decreased synthesis of hemoglobin and malformation of red blood cells that increases their hemolysis.
Lorie, age 29, appears with the following signs: pale conjunctiva and nailbeds, tachycardia, heart murmur, cheilosis, stomatitis, splenomegaly, koilonychia, and glossitis. What do you suspect? A. Vitamin B12 deficiency B. Folate deficiency C. Iron-deficiency anemia D. Chronic fatigue syndrome
C. Iron-deficiency anemia - Classic signs of iron-deficiency anemia
The Center for Disease Control and Prevention's definition of AIDS includes the presence of which of the following disorders, with or without laboratory evidence of HIV infection? A. Pneumonia in clients younger than age 60 B. Dementia in clients younger than age 60 C. Kaposi's sarcoma in clients younger than age 60 D. Primary brain lymphoma in clients older than age 60
C. Kaposi's sarcoma in clients younger than age 60 - Kaposi's sarcoma in a client younger than age 60 is considered conclusive evidence of AIDS according to CDC.
Multiple myeloma is a plasma cell malignancy in which the bone marrow is replaced, and there is bone destruction and paraprotein formation. Myeloma is a disease of older adults overall (median age at presentation, 65 years). Common presenting symptoms include A. Nausea and vomiting and chronic cough B. Fatigue and splenomegaly C. Lower back pain and hypercalcemia D. Nausea and vomiting and fatigue
C. Lower back pain and hypercalcemia - Bone pain is a common presenting symptom, most frequently manifested as low back pain or pain in the rib, and may present as a pathological fracture, especially in the femoral neck. Hypercalcemia is often present related to the leakage of calcium occurring from bone destruction.
You are examining Joseph, age 9 months, and note a palpable right supraclavicular node. You know that this finding is suspicious for A. Candidiasis B. Cryptococcosis C. Lymphoma of the mediastinum D. Abdominal malignancy
C. Lymphoma of the mediastinum - Palpable supraclavicular lymph nodes are not normal in infants, children or adults. A right sided palpable node is more commonly associated with lymphoma of the mediastinum, whereas a palpable left-sided node is more commonly associated with an abdominal malignancy
When a neonate is initially protected against measles, mumps, and rubella because the mother is immune, this is an example of which type of immunity? A. Natural active B. Artificial active C. Natural passive D. Artificial passive
C. Natural passive
Julie's brother has chronic lymphatic leukemia. She overheard that he was in stage IV and asks what this means. According to the Rai classification system, stage IV is a stage A. At which the lymphocytes are greater than 10,000mm3 B. With an absolute lymphocytosis, in which the client may live 7-10 years or more C. Of thrombocytopenia, in which the life expectancy may be only 2 years D. Of anemia
C. Of thrombocytopenia, in which the life expectancy may be only 2 years
Which of the following indicates that Jim, a 32 year old client with AIDS, has oropharyngeal candidiasis? A. Small vesicles B. Fissured, white, thickened plaques C. Removable white plaques D. Flat-topped papules with thin, bluish-white spiderweb lines
C. Removable white plaques
A client with HIV infection has a CD4 count of 305 and an HIV RNA level of 13,549. The client is asymptomatic. What is your course of action? A. Negotiate with your client a time to start therapy B. Recheck the laboratory results in 1 month. If the counts remain like this, start treatment. C. Start therapy now because the client's CD4 count is less than 500 and the HIV RNA level is greater than 10,000. D. Wait to start therapy until the client becomes asymptomatic
C. Start therapy now because the client's CD4 count is less than 500 and the HIV RNA level is greater than 10,000. - Regardless of being asymptomatic, CDC recommends starting treatment in a patient with CD4 less than 500 and HIV RNA levels greater than 10,000
Which of the following situations might precipitate a sickle cell crisis in an infant? A. Taking the infant to visit a relative B. Hepatitis B immunization C. Taking the infant to a home Miami Dolphins football game D. Having the infant sleep on its back
C. Taking the infant to a home Miami Dolphins football game - Certain precautions must be taken for infants with sickle cell disease to prevent vaso-occlusive crisis. Any activity or situation that would cause dehydration should be avoided. An example is sitting in a stroller in the heat for any length of time.
What is the meaning of the term "shift to the left" or "left shift"? A. This indicates a rise in basophils B. This indicates a rise in monocytes C. This indicates a rise in neutrophils D. This indicates a rise in lymphocytes
C. This indicates a rise in neutrophils - An elevated WBC count and a relative increase in segmented and band neutrophils. Usually seen in acute bacterial infections, it indicates clinically that the body is responding to an acute need before the neutrophils can fully mature in the bone marrow.
Shelley has esophageal cancer and asks you if alcohol played a part in its development. How do you respond? A. "Your cancer was caused by your cigarette smoking, nothing else." B. "Alcohol is also a carcinogen." C. "Alcohol directly alters the DNA and causes mutations." D. "Alcohol modifies the metabolism of carcinogens in the esophagus and increases their effectiveness."
D. "Alcohol modifies the metabolism of carcinogens in the esophagus and increases their effectiveness."
Nancy recently had a mastectomy and refuses to look at the site. Her husband does all the dressing changes. When she comes into the office for a postoperative checkup, what would you say to her? A. "You'll look at it when you're ready." B. "You must look at it today." C. "Everything's going to be ok. It looks fine." D. "You have to accept this eventually; just glance at it today."
D. "You have to accept this eventually, just glance at it today." - You'll look at it when you're ready may mean that she will never be ready. It is better to take a matter of fact approach and attempt to have her at least glance at it.
Barbie, age 27, had her spleen removed after an automobile accident. You are seeing her in the office for the first time since her discharge from the hospital. She asks you how her surgery will affect her in the future. How do you respond? A. "Your red blood cell production will be slowed." B. "Your lymphatic system may have difficulty transporting lymph fluid to the blood vessels." C. "You'll have difficulty storing the nutritional agents needed to make red blood cells." D. "You may have difficulty salvaging iron from old red blood cells for use."
D. "You may have difficulty salvaging iron from old red blood cells for use."
Under which of the following circumstances is the reticulocyte count elevated? A. Aplastic anemia B. Iron-deficiency anemias C. Poisonings D. Acute blood loss
D. Acute blood loss - The reticulocyte count indicates the percentage of newly maturing red blood cells released into the circulating blood from the bone marrow.
Which ethnic group has the highest overall cancer incidence rate? A. Native Americans B. Asian and Pacific Islanders C. Hispanics D. African Americans
D. African Americans
A loss of DNA control over differentiation that occurs in response to adverse conditions is referred to as A. Hyperplasia B. Metaplasia C. Anaplasia D. Dysplasia
D. Dysplasia - Dysplastic cells show an abnormal degree of variation in size, shape and appearance and a disturbance in the usual arrangement.
Health maintenance in adults with sickle cell anemia includes which of the following? A. Early sterilization should be performed to prevent transmission of the disease B. Administer hepatitis A vaccine C. Avoid use of oral contraceptives because of increased risk of clotting D. Give folic acid 1mg PO daily
D. Give folic acid 1mg PO daily
One major approach to cancer prevention is A. Colonoscopy B. New drug trials C. Pap smears for women of all ages D. Host modification
D. Host modification - The three major approaches to cancer prevention are education, regulation, and host modification. Host modification refers to increasing knowledge about cancer genetics.
An increase of which immunoglobulin (Ig) signifies atopic disorders such as allergic rhinitis, allergic asthma, atopic dermatitis, and parasitic infection? A. IgG B. IgM C. IgA D. IgE
D. IgE
Your client, Shirley, has an elevated mean cell volume (MCV). What should you be considering in terms of diagnosis? A. Iron-deficiency anemia B. Hemolytic anemias C. Lead poisoning D. Liver disease
D. Liver disease - MCV indicates the average size of individual RBCs. MCV is elevated in megaloblastic anemias, liver disease, and some drugs
Bladder cancer can be detected early by A. An annual urine culture B. A bladder tumor marker blood test C. An annual cystoscopy D. None of the above, there is no early detection
D. None of the above, there is no early detection
Sherri's blood work return with a decreased mean cell volume (MCV) and a decreased mean cellular hemoglobin concentration (MCHC). What should you do next? A. Order a serum iron and total iron binding capacity (TIBC) B. Order a serum ferritin C. Order a serum folate level D. Order a serum iron, TIBC, and serum ferritin level
D. Order a serum iron, TIBC, and serum ferritin level - A decreased MCV and MCHC is indicative of a microcytic, hypochromic anemia.
The test in which a small, radioactive tracer dose of cyanocobalamin is given by mouth an then a 24 hour urine sample is collected and assayed for radioactivity is the A. Coombs' test B. Oligonucleotide probe test C. Spherocytic test D. Schilling test
D. Shilling test
Your client, Ms. Jones, has an elevated platelet count. You suspect A. Systemic lupus erythematosus B. Infectious mononucleosis C. Disseminated intravascular coagulation (DIC) D. Splenectomy
D. Splenectomy - Increased platelet count is seen in myeloproliferative leukemias, polycythemia vera, and status post splenectomy
What is the mechanism of action of steroid hormones in cancer chemotherapy? A. They interfere with DNA or RNA synthesis B. They interfere with DNA replication by attacking DNA synthesis throughout the cell cycle C. They inhibit protein synthesis D. They alter the host environment for cell growth
D. They alter the host environment for cell growth
Prophylaxis for the first episode of Pneumocystitis jiroveci pneumonia in an adult or adolescent client infected with HIV is A. Isoniazid (Nydrazid) 300mg PO and pyridoxine (Vitamin B6 [Beesix] 50mg PO QD for 12 days B. Clarithromycin (Biaxin) 500mg PO BID for 2 weeks C. Rifampin (Rimactane) 600mg PO QD for 12 months D. Trimethoprim-sulfamethoxazole (TMP-SMZ) (Bactrim) DS 1 tablet PO QD for 10 days
D. Trimethoprim-sulfamethoxazole (TMP-SMZ) (Bactrim) DS 1 tablet PO QD for 10 days
You suspect that your new client Doug has hepatitis C, although he is asymptomatic at this point in time. Your suspicion is based on his medical history, which includes which of the following factors that has been identified as a red flag for this disease? A. Lactose intolerance B. Frequent sore throats and upper respiratory infections C. A history of mononucleosis at age 17 D. Unsafe sexual behaviors
D. Unsafe sexual behaviors
A metastatic tumor from below the diaphragm is suspected when you palpate which of the following nodes in the left supraclavicular space? A. Wringer's node B. Sims' node C. Wiskott-Aldrich node D. Virchow's node
D. Virchow's node - Virchow's node is an enlarged left supraclavicular node usually infiltrated with a metastatic tumor from below the diaphragm, especially of gastrointestinal origin
Antibodies (inhibitors) directed against factor VIII can arise spontaneously in a number of situations. These include A. Clients who have mitral regurgitation B. As sequelae to a strep infection C. Clients on antibiotics D. Women who are several weeks postpartum after a normal labor and delivery
D. Women who are several weeks postpartum after a normal labor and delivery
When the donor and recipient of a transplant are identical twins, this is referred to as a(n) A. Isograft B. Autograft C. Allograft D. Xenograft
A. Isograft
What is the earliest visual sign of oral and pharyngeal squamous cell carcinoma? A. Leukoplakia B. Mucosal erythroplasia C. Loss of sensation in the tongue D. Difficulty chewing or swallowing
B. Mucosal erythroplasia - Red inflammatory lesions. Leukoplakia (thickened white patches of the tongue or mucous membranes) is the most common premalignant lesion.
