Pathophysiology Test 2

The nurse is caring for a client with leukemia who is experiencing a blast crisis. What is the nurse's understanding of the client's condition? Select all that apply. A) A blast crisis is the rapid proliferation of immature cells. B) The new cells resulting from the client's condition have distinct morphology and specialized functions. C) This condition occurs in early stage leukemias, such as chronic myelogenous leukemia. D) The most immature cells in the body are labeled as blast cells. E) The cells resulting from a blast crisis are found in the bone marrow and/or blood.

A) A blast crisis is the rapid proliferation of blast cells in late stage leukemias such as chronic myelogenous leukemia. D) The most immature cells in the body are labeled as blast cells, and are found in the bone marrow and/or blood. E) The most immature cells in the body are labeled as blast cells, and are found in the bone marrow and/or blood.

The nurse is providing education to a client about to undergo an allogeneic hematopoietic stem cell transplant (HSCT). What statement by the client indicates the need for additional follow up by the nurse? A) "I can expect a full recovery with a low risk for complications." B) "I will require radiation treatment to my brain, since most chemo doesn't cross the blood-brain barrier." C) "I will receive multiple types of cancer treatment to promote a better outcome." D) "I have discussed all of my concerns related to fertility and sexuality."

A) Allogeneic hematopoietic stem cell transplantation (HSCT) is a cancer treatment that utilizes multiple cancer treatment modalities to promote better outcomes for clients, including radiation to the brain. Multiple early and long-term complications can occur with HSCT including nausea, vomiting, diarrhea mucositis, myelosuppression, liver and renal toxicity, and graft-versus-host disease (GVHD).

A nurse is providing education to a client with alopecia areata. Which statement by the client indicates an understanding of this condition? A) "My condition is a tissue-specific autoimmune disease." B) "My condition is due to my body perceiving my skin as foreign." C) "My condition is caused by initiating an inflammatory response to diseased tissue." D) "My condition is caused by anti-inflammatory cytokines."

A) Alopecia areata is a tissue-specific, not an organ-specific, autoimmune disease in which the immune system initiates an inflammatory response to normal tissue.

A patient with multiple myeloma will most likely exhibit signs and symptoms of which type of anemia? A) Normochromic B) Macrocytic C) Hypochromic D) Microcytic

A) Anemia (normocytic or normochromic) is a common symptom of multiple myeloma, resulting from the infiltration of bone marrow by plasma cells.

The nurse is reviewing laboratory results for a patient who is BRCA1 and BRCA2 positive. The nurse understands that the client and the client's immediate family may be at increased risk for which malignancies? Select all that apply. A) Prostate B) Multiple Myeloma C) Ovarian D) Pancreatic E) Melanoma

A) BRCA1 and BRCA2 are genes associated with inherited breast, ovarian, pancreatic, prostate, and melanoma cancers, but not multiple myeloma. C) BRCA1 and BRCA2 are genes associated with inherited breast, ovarian, pancreatic, prostate, and melanoma cancers, but not multiple myeloma. D) BRCA1 and BRCA2 are genes associated with inherited breast, ovarian, pancreatic, prostate, and melanoma cancers, but not multiple myeloma. E) BRCA1 and BRCA2 are genes associated with inherited breast, ovarian, pancreatic, prostate, and melanoma cancers, but not multiple myeloma.

Which individual is at most risk for developing chronic lymphocytic leukemia (CLL)? A) A 65-year-old Caucasian man B) A 65-year-old Asian man C) A 25-year-old Caucasian man D) A 25-year-old Asian man

A) CLL is primarily a disease of older adults, the incidence increasing dramatically in people over the age of 50 years. People as young as 30-39 years are being diagnosed with CLL, although this is less common. The incidence of CLL is highest among whites, while people of Asian descent have the lowest incidence rates.

The nurse is caring for a client diagnosed with systemic lupus erythematosus (SLE). What does the nurse understand about the etiology and pathogenesis of this condition? Select all that apply. A) Clinical manifestations are mediated by antibody formation and the creation of immune complexes (IC). B) Lupus is more common in men than in women. C) Lupus can be drug-induced by the body's overreaction to medications such as isoniazid, hydralazine, and procainamide. D) It is most common in individuals of Hispanic and Latino descent. E) The rate ICs are cleared in the liver and spleen are believed to be impaired in SLE.

A) Clinical manifestations of SLE are mediated by antibody formation and the creation of immune complexes (IC). The severity of the immune complexes depends on the characteristics of the antibody and the nature of the antigen. SLE is more common in women than in men, and is most common in individuals of African American and Asian descent. C) Lupus can be drug-induced by the body's overreaction to medications such as isoniazid, hydralazine, and procainamide. E) The rate at which ICs are cleared in the liver and spleen are believed to be impaired in SLE.

What finding should alert the nurse to a potential cytomegalovirus (CMV) infection in an HIV-infected patient? A) Blurry vision B) Burning on urination (dysuria) C) Sore throat D) Muscle aches

A) Cytomegalovirus (CMV) is a virus carried by 60% of the U.S. population. It can be found in blood, saliva, semen, cervical secretions, and urine. Normally, the immune system inhibits CMV replication. In individuals with severe immunosuppression (typically when the CD4+ T-lymphocyte count drops below 50 cells/mm3), active viral replication can occur with dissemination to target tissues such as the retina, gut, lungs, and CNS. CMV retinitis is the most common CMV infection, accounting for 80-90% of all CMV infections among AIDS patients. Dysuria, sore throat, and muscle aches are not typical symptoms of CMV.

When taking a health history from a patient during the period of chronic HIV, the nurse would expect to find: A) no clinical manifestations of HIV infection. B) nonspecific symptoms including fever, fatigue, headache, lymphadenopathy, arthralgias, and rash. C) fever, night sweats, diarrhea, and mucocutaneous abnormalities. D) opportunistic infections and malignancies.

A) During the period of chronic HIV infection and after the acute infection subsides, most individuals show no clinical manifestations of HIV infection for several years, even in the absence of treatment.

5) The nurse is teaching a community course about cancer prevention. Which contributing factors to malignancy will the nurse include in the teaching? Select all that apply. A) Lifestyle factors B) Hormonal influences C) Environmental variables D) Acute inflammation E) Oxidative stress

A) Environmental variables, oxidative stress, hormonal influences, lifestyle factors, and chronic inflammation (not acute inflammation) are factors that occur outside the cell and can alter the gene products (proteins) of the body's cells, and therefore change the activity and function of the cell or tissue, contributing to the initiation of cancer at the genetic level. B) Environmental variables, oxidative stress, hormonal influences, lifestyle factors, and chronic inflammation (not acute inflammation) are factors that occur outside the cell and can alter the gene products (proteins) of the body's cells, and therefore change the activity and function of the cell or tissue, contributing to the initiation of cancer at the genetic level. C) Environmental variables, oxidative stress, hormonal influences, lifestyle factors, and chronic inflammation (not acute inflammation) are factors that occur outside the cell and can alter the gene products (proteins) of the body's cells, and therefore change the activity and function of the cell or tissue, contributing to the initiation of cancer at the genetic level. E) Environmental variables, oxidative stress, hormonal influences, lifestyle factors, and chronic inflammation (not acute inflammation) are factors that occur outside the cell and can alter the gene products (proteins) of the body's cells, and therefore change the activity and function of the cell or tissue, contributing to the initiation of cancer at the genetic level.

When reviewing the medical record of a patient with Hodgkin lymphoma, the oncology nurse would expect to note the presence of: A) Reed-Sternberg cells. B) hypercalcemia. C) a history of substance abuse. D) malignant plasma cells.

A) Hodgkin lymphoma, named after the British physician who first described the disease, is a specific type of lymphoma characterized by the presence of Reed-Sternberg cells.

The nurse is caring for a client with Graves disease. What concept related to the client's condition does the nurse recognize as true? A) Autoantibodies against TSH stimulates thyroxine production. B) It occurs in hemolytic disease of the newborn due to ABO or Rh incompatibility. C) Antibodies to acetylcholine receptors cause decreased neuromuscular function. D) It is characterized by the vascular rejection of organ transplantation.

A) In Graves disease, an autoantibody is directed against thyroid-stimulating hormone (TSH) receptors on thyroid cells, which stimulates thyroxine production, leading to hyperthyroidism.

The nurse is caring for a client with systemic inflammatory response syndrome (SIRS). Which assessment finding would the nurse anticipate? Select all that apply. A) A white blood cell (WBC) count less than 3,000 cells/mm3 or greater than 10,000 cells/mm3 B) A heart rate of greater than 90 beats per minute C) A respiratory rate of greater than 16 respirations per minute D) A body temperature of less than 36°C or greater than 38°C E) The presence of greater than 20% immature neutrophils

A) In adults, two of the following criteria must be met for the diagnosis of systemic inflammatory response syndrome (SIRS): (1) body temperature less than 36°C or greater than 38°C; (2) heart rate greater than 90 beats per minute; (3) respiratory rate greater than 20 breaths per minute or arterial partial pressure of carbon dioxide less than 32 mmHg; and (4) white blood cell (WBC count less than 4,000 cells/mm3 or greater than 12,000 cells/mm3) or the presence of greater than 10% immature neutrophils. B) In adults, two of the following criteria must be met for the diagnosis of systemic inflammatory response syndrome (SIRS): (1) body temperature less than 36°C or greater than 38°C; (2) heart rate greater than 90 beats per minute; (3) respiratory rate greater than 20 breaths per minute or arterial partial pressure of carbon dioxide less than 32 mmHg; and (4) white blood cell (WBC count less than 4,000 cells/mm3 or greater than 12,000 cells/mm3 or the presence of greater than 10% immature neutrophils. D) In adults, two of the following criteria must be met for the diagnosis of systemic inflammatory response syndrome (SIRS): (1) body temperature less than 36°C or greater than 38°C; (2) heart rate greater than 90 beats per minute; (3) respiratory rate greater than 20 breaths per minute or arterial partial pressure of carbon dioxide less than 32 mmHg; and (4) white blood cell (WBC count less than 4,000 cells/mm3 or greater than 12,000 cells/mm3 or the presence of greater than 10% immature neutrophils.

The nurse is caring for a client with a suspected autoimmune disorder. What concept related to the client's condition does the nurse recognize is true? Select all that apply. A) It is necessary to determine that immunologic findings do not have another cause. B) Diagnosis is currently based on serologic testing and clinical findings. C) Each method of serologic testing involves either concentrating or diluting the client's serum. D) Genetic testing is considered the most reliable way to diagnose autoimmune disorders. E) Serologic testing reveals autoantibodies directed against cellular components.

A) In order to diagnose an autoimmune disorder, it is necessary to determine that immunologic findings do not have another cause. B) In order to diagnose an autoimmune disorder, it is necessary to determine that immunologic findings do not have another cause. Diagnosis is currently based on serologic testing and clinical findings. E) Serologic testing reveals autoantibodies directed against cellular components. This means that the testing shows these autoantibodies present in the client, where otherwise they would not be present.

When counseling about HIV transmission, which patients does the nurse recognize as being at greatest risk for being newly diagnosed with HIV? A) Black men who have sex with men B) White men who have sex with men C) Black heterosexual men D) Black heterosexual women

A) In the United States, African Americans account for a disproportionate number of new HIV cases. In 2014, there were 11,201 new HIV diagnoses among black men who have sex with men (MSM), 9008 cases in white MSM, 4654 cases in black heterosexual women, and 2018 cases in black heterosexual men.

Which characteristics should the oncology nurse expect when assessing a patient recently diagnosed with indolent non-Hodgkin lymphoma (NHL)? A) No discernible symptoms B) Painful lymphadenopathy C) Night sweats and unexplained fever D) Anemia and fatigue

A) Indolent tumors, also called low-grade tumors, grow slowly and often do not result in discernible symptoms for patients at the time of diagnosis. Indolent lymphomas are frequently found accidentally in the course of a workup for another disorder.

The nurse is instructing an HIV-infected patient who is starting HAART. Which statement indicates that the teaching has been effective? A) "I will not stop taking my medication without contacting my doctor." B) "If side effects develop, I will stop the medication until symptoms subside." C) "I can stop my medication once my viral load is undetectable." D) "I cannot transmit the virus while I am taking my medication."

A) Interruption of antiretroviral therapy typically is not recommended, as cessation of treatment may result in viral rebound, leading to even more pronounced immunosuppression and worsening of the individual's overall health status.

The nurse is caring for a client with T1N0MX cancer. What is the nurse's understanding of the client's cancer staging? Select all that apply. A) The client has no regional lymph node spread. B) The client has carcinoma in situ. C) The client's primary tumor cannot be evaluated. D) The client has innumerable distant metastases. E) The client has not been evaluated for distant metastases.

A) N0 indicates no regional lymph node involvement. E) MX indicates that evaluation for distant metastasis has not occurred.

Which findings are typical of data collected on patients with AML who experience leukocytosis? A) Headache and diplopia B) Weakness and fatigue C) Fever and infection D) Ecchymosis and epistaxis

A) Patients with AML who experience leukocytosis (an abnormally elevated white blood cell count) occasionally present with headache, diplopia, cranial nerve palsies, and mental status changes.

The nurse is reviewing a client's list of medications. Which medications does the nurse understand to be anti-inflammatory in action? Select all that apply. A) Prednisone B) Aspirin C) Ibuprofen D) Acetaminophen E) Celecoxib

A) Prednisone is a steroidal anti-inflammatory drug. B) Aspirin and ibuprofen are considered non-steroidal anti-inflammatory drugs (NSAIDs). C) Aspirin and ibuprofen are considered non-steroidal anti-inflammatory drugs (NSAIDs). E) Celecoxib is a cyclooxygenase inhibitor and is anti-inflammatory in action.

When planning health education programming, the public health nurse is aware that the most common cause of secondary immunodeficiency disorders is: A) nutritional deficiencies. B) infection. C) aging. D) selected malignancies.

A) Secondary immunodeficiency disorders may result from a wide variety of internal and external factors, including aging, stress, nutritional deficiencies, selected malignancies, infection, and immunosuppressive treatment modalities. Worldwide, nutritional deficiencies are the most common cause of secondary immunodeficiency.

The nurse is caring for a client with serum sickness. What does the nurse understand to be a potential cause of this client's condition? Select all that apply. A) Drugs B) Pollen C) Phagocytes D) Foods E) Insect venom

A) Serum sickness is a disorder that occurs when the immune system reacts to medicines that contain foreign proteins used to treat immune conditions and is caused by antibiotics (e.g., penicillin), other drugs, various foods, and insect venom. D) Serum sickness is a disorder that occurs when the immune system reacts to medicines that contain foreign proteins used to treat immune conditions and is caused by antibiotics (e.g., penicillin), other drugs, various foods, and insect venom. E) Serum sickness is a disorder that occurs when the immune system reacts to medicines that contain foreign proteins used to treat immune conditions and is caused by antibiotics (e.g., penicillin), other drugs, various foods, and insect venom.

A patient in the chronic phase of chronic myelogenous leukemia (CML) will meet which criteria? A) Blast cells account for less than 10% of all cells in blood or bone marrow. B) Blast cells account for 10-19% of all cells in blood or bone marrow. C) Blast cells account for 20-49% of all cells in blood or bone marrow. D) Blast cells account for more than 50% of all cells in blood or bone marrow.

A) Staging systems for CML do not exist; instead, CML is classified according to phase (chronic, accelerated, or blast), which is based on the number of blast cells present in the blood and bone marrow. In chronic phase CML, blast cells account for fewer than 10% of all cells in the blood or bone marrow. In accelerated phase CML, blast cells increase and account for 10-19% of all cells in the blood or marrow. During the blastic phase, blast cells account for over 20% of all cells in the blood or marrow.

The nurse is assessing a client with local cellulitis due to an insect bite. Which symptoms will the nurse anticipate? A) Swelling B) Chills C) Redness D) Heat E) Pain

A) Swelling, redness, heat, and pain are all symptoms of acute, local inflammation. C) Swelling, redness, heat, and pain are all symptoms of acute, local inflammation. D) Swelling, redness, heat, and pain are all symptoms of acute, local inflammation. E) Swelling, redness, heat, and pain are all symptoms of acute, local inflammation.

The nurse is assessing a client for signs and symptoms of cancer. Which assessment findings does the nurse understand may indicate the presence of cancer? Select all that apply. A) A change in bowel or bladder habits B) Abdominal pain C) Thickening or a lump in any part of the body D) The recent development of a fever E) An obvious change in a mole

A) The American Cancer Society developed the acronym CAUTION to assist the public in remembering common signs and symptoms of cancer. These include a Change in bowel or bladder habits, A sore that does not heal, Unusual bleeding or discharge, Thickening or lump in the breast or any part of the body, Indigestion or difficulty swallowing, Obvious change in a mole, and/or Nagging cough or hoarseness. A common misconception is that cancer will be painful, and therefore obvious to patients and healthcare providers. C) The American Cancer Society developed the acronym CAUTION to assist the public in remembering common signs and symptoms of cancer. These include a Change in bowel or bladder habits, A sore that does not heal, Unusual bleeding or discharge, Thickening or lump in the breast or any part of the body, Indigestion or difficulty swallowing, Obvious change in a mole, and/or Nagging cough or hoarseness. E) The American Cancer Society developed the acronym CAUTION to assist the public in remembering common signs and symptoms of cancer These include a Change in bowel or bladder habits, A sore that does not heal, Unusual bleeding or discharge, Thickening or lump in the breast or any part of the body, Indigestion or difficulty swallowing, Obvious change in a mole, and/or Nagging cough or hoarseness.

A 1-year-old baby is being seen at the clinic because his parents are worried that he is always sick. The healthcare team is concerned that the baby may have a primary immunodeficiency (PI). Which assessment data would support a diagnosis of PI? A) Four or more new ear infections within 1 year and failure to gain weight normally B) One bout of pneumonia in a year and failure to gain weight normally C) One month on antibiotics with little effect and failure to gain weight normally D) One serious sinus infection in a year and failure to gain weight normally

A) The Jeffrey Modell Foundation and the American Red Cross have identified 10 warning signs of PI in an attempt to assist with early detection. If an individual has two or more of the following, a diagnosis of PI should be considered: four or more new ear infections within 1 year; two or more serious sinus infections within 1 year; two or more months on antibiotics with little effect; two or more pneumonias within 1 year; failure of an infant to gain weight or grow normally; recurrent, deep skin or organ abscesses; persistent thrush or fungal infection on skin; need for intravenous antibiotics to clear infection; two or more deep-seated infections including septicemia; a family history of PI.

The nurse is providing education for a client diagnosed with HER2/neu positive breast cancer. What will the nurse include in the teaching about this condition? A) "HER2/neu positivity is a result of gene amplification in your condition." B) "Your children may be at a higher risk for the development of cancer." C) "Your condition is less likely to be poorly differentiated." D) "You are at greater risk for developing Burkitt lymphoma."

A) The client's diagnosis is a result of the amplification of the HER2/neu gene in the client's breast cancer.

The nurse preceptor on a cancer ward is educating a novice nurse about the theory of carcinogenesis. Which statements by the novice nurse requires additional follow up by the nurse preceptor? A) "During step 2, promotion, a cancer-causing agent damages DNA." B) "Vitamins may modify how carcinogens can affect my body's cells." C) "Step 3, progression, involves the accumulation of mutations in my body's cells." D) "Promoters are characterized by their ability to initiate carcinogenesis."

A) The first step of carcinogenesis, initiation, is when a cancer-causing agent damages cellular DNA.

In evaluating the effectiveness of induction therapy in a child with acute lymphocytic leukemia, the nurse should expect: A) eradication of 99% of leukemic cells. B) no rejection of stem cell transplantation. C) elimination of residual disease. D) complete eradication of the disease.

A) The goal of induction therapy is to eradicate 99% of leukemic cells.

When assessing a patient with newly diagnosed Hodgkin lymphoma (HL), the oncology nurse is most likely to palpate enlarged lymph nodes in the: A) neck. B) axilla. C) inguinal area. D) postauricular area.

A) The most commonly involved site of lymph node enlargement is the neck; 60- 80% of patients have enlarged supraclavicular and/or cervical nodes. Enlarged lymph nodes in the axillae and the inguinal area are less common.

The nurse is caring for a client with acute inflammation. What possible outcomes of acute inflammation does the nurse anticipate while caring for the client? Select all that apply. A) Fibrosis formation B) Abscess formation C) Chronic inflammation D) Serous inflammation E) Resolution

A) The possible outcomes of acute inflammation are resolution, fibrosis, abscess formation, and chronic inflammation. Acute inflammation can progress to chronic inflammation if the cause is not eradicated, but serous inflammation is a fluid accumulation as a result of tissue injury. Serous inflammation is not a classification of an outcome of acute inflammation. B) The possible outcomes of acute inflammation are resolution, fibrosis, abscess formation, and chronic inflammation. Acute inflammation can progress to chronic inflammation if the cause is not eradicated, but serous inflammation is a fluid accumulation as a result of tissue injury. Serous inflammation is not a classification of an outcome of acute inflammation. C) The possible outcomes of acute inflammation are resolution, fibrosis, abscess formation, and chronic inflammation. Acute inflammation can progress to chronic inflammation if the cause is not eradicated, but serous inflammation is a fluid accumulation as a result of tissue injury. Serous inflammation is not a classification of an outcome of acute inflammation. E) The possible outcomes of acute inflammation are resolution, fibrosis, abscess formation, and chronic inflammation. Acute inflammation can progress to chronic inflammation if the cause is not eradicated, but serous inflammation is a fluid accumulation as a result of tissue injury. Serous inflammation is not a classification of an outcome of acute inflammation.

The pediatric oncology nurse is caring for a 5-year-old child newly diagnosed with acute lymphocytic leukemia (ALL). How should the nurse respond when the parent asks about the prognosis of this disease? A) "Five-year-old children fare better than infants or teens." B) "Male children tend to have a better prognosis than females." C) "African American children have a slightly higher survival rate than Caucasian children." D) "Children with a white blood cell count below 50,000/μL have a poorer prognosis."

A) The prognostic variables for childhood ALL include (1) age at diagnosis, children between the ages of 1 and 9 years faring better than infants or older children; (2) white blood cell count at diagnosis, as counts above 50,000/mL are indicative of a poorer prognosis; (3) central nervous system (CNS) status at diagnosis, CNS involvement signifying greater risk for relapse; (4) gender, girls faring better than boys (although this is not evident in all studies); and (5) race, survival rates for Caucasian children being slightly higher than those for African American and Hispanic children.

The nurse is administering a tuberculin skin test for a client. What is the nurse's understanding of the hypersensitivity response associated with this test? Select all that apply. A) The test causes a release of lymphokines, which attract macrophages. B) Macrophages release lysozymes, resulting in local tissue damage. C) The antigen-presenting cell encounters a cytotoxic T-cell. D) Antigens invade the body and bind to antibodies in circulation. E) Antigen-antibody complexes activate complement.

A) The tuberculin skin test is an example of evaluating whether a type IV, cell mediated hypersensitivity reaction occurred. It is a delayed-type hypersensitivity (DTH) reaction occurring in response to soluble protein antigens. In this type of reaction, antigen-presenting cells encounter cytotoxic T cells, causing the release of lymphokines, which attract macrophages. Macrophages then release lysozymes, resulting in local tissue damage. B) The tuberculin skin test is an example of evaluating whether a type IV, cell mediated hypersensitivity reaction occurred. It is a delayed-type hypersensitivity (DTH) reaction occurring in response to soluble protein antigens. In this type of reaction, antigen-presenting cells encounter cytotoxic T cells, causing the release of lymphokines, which attract macrophages. Macrophages then release lysozymes, resulting in local tissue damage. C) The tuberculin skin test is an example of evaluating whether a type IV, cell mediated hypersensitivity reaction occurred. It is a delayed-type hypersensitivity (DTH) reaction occurring in response to soluble protein antigens. In this type of reaction, antigen-presenting cells encounter cytotoxic T cells, causing the release of lymphokines, which attract macrophages. Macrophages then release lysozymes, resulting in local tissue damage.

The nurse is educating an older adult client about age-related changes in immunity. Which statements will the nurse include in the education? Select all that apply. A) "There is a higher incidence of cancer with advanced age." B) "Abscesses, scar formation, and persistent inflammation are more common with advanced age." C) "Older adults are more susceptible to infection." D) "Older adults have decreased immunity due to an increase in tissue integrity." E) "Both types of immune responses are affected with advanced age."

A) There is a higher incidence of cancer in older adults. C) Older adults are more susceptible to infection. E) Both cell-mediated and humoral immune responses are affected with advanced age.

Which combination of antiretroviral drugs would the nurse be most likely to administer in a patient when antiviral drug resistance testing is not available? A) Ritonavir-boosted protease inhibitors (RTV-boosted PIs) and nucleoside reverse transcriptase inhibitors (NRTIs) B) Nonnucleoside reverse transcriptase inhibitors (NNRTIs) and NRTIs C) Protease inhibitors and fusion inhibitors D) Early inhibitors and integrase strand transfer inhibitors (INSTIs)

A) To guide the choice of medications, treatment of individuals who have early- stage HIV infection should be preceded by genotypic antiviral resistance testing. When genotypic antiviral drug resistance testing is unavailable, HAART still may be initiated. Resistance to ritonavir (RTV)-boosted protease inhibitors typically develops slowly, and NRTIs are not prone to clinically significant TDR. As such, a combination of RTV-boosted PIs and NRTIs is recommended for individuals who do not undergo genotypic antiviral drug resistance testing.

The nurse is caring for a client with serum sickness. Which interventions will the nurse anticipate will be included in the client's collaborative plan of care? Select all that apply. A) Aspirin for joint pain B) Levothyroxine treatment for hypothyroidism C) Diphenhydramine for pruritus D) Systemic corticosteroid therapy for severe reactions E) Prochlorperazine for nausea

A) Treatment for serum sickness is directed to remove the sensitizing antigen and provide relief from symptoms. Pharmacologic treatment often includes aspirin for joint pain and antihistamines for pruritus. For severe reactions, epinephrine or systemic corticosteroids may be prescribed. C) Treatment for serum sickness is directed to remove the sensitizing antigen and provide relief from symptoms. Pharmacologic treatment often includes aspirin for joint pain and antihistamines for pruritus. For severe reactions, epinephrine or systemic corticosteroids may be prescribed. D) Treatment for serum sickness is directed to remove the sensitizing antigen and provide relief from symptoms. Pharmacologic treatment often includes aspirin for joint pain and antihistamines for pruritus. For severe reactions, epinephrine or systemic corticosteroids may be prescribed.

The nurse is caring for a client who began experiencing symptoms of systemic lupus erythematosus (SLE) about one year ago. What does the nurse understand to be potential causes of this condition? Select all that apply. A) Heredity B) Trigger microorganisms C) Environment D) Substance abuse E) Self-antigen from a tissue in the body

A) Two primary factors are believed to cause autoimmune diseases: heredity and environment. Because autoimmunity does not develop in all individuals who have a genetic predisposition, it is believed that other factors precipitate the altered immune state. This is often referred to as a trigger event. A trigger event may be a virus, a microorganism, a chemical substance, or a self-antigen from a body tissue that has been hidden from the immune system during the development of an autoimmune disease. B) Two primary factors are believed to cause autoimmune diseases: heredity and environment. Because autoimmunity does not develop in all individuals who have a genetic predisposition, it is believed that other factors precipitate the altered immune state. This is often referred to as a trigger event. A trigger event may be a virus, a microorganism, a chemical substance, or a self- antigen from a body tissue that has been hidden from the immune system during the development of an autoimmune disease. C) Two primary factors are believed to cause autoimmune diseases: heredity and environment. Because autoimmunity does not develop in all individuals who have a genetic predisposition, it is believed that other factors precipitate the altered immune state. This is often referred to as a trigger event. A trigger event may be a virus, a microorganism, a chemical substance, or a self- antigen from a body tissue that has been hidden from the immune system during the development of an autoimmune disease. E) Two primary factors are believed to cause autoimmune diseases: heredity and environment. Because autoimmunity does not develop in all individuals who have a genetic predisposition, it is believed that other factors precipitate the altered immune state. This is often referred to as a trigger event. A trigger event may be a virus, a microorganism, a chemical substance, or a self- antigen from a body tissue that has been hidden from the immune system during the development of an autoimmune disease.

The nurse is caring for a client with an allergic reaction. What is the nurse's understanding of this type of hypersensitivity reaction? A) It is a Type I reaction, an IgE mediated disorder. B) It is a Type II reaction, an antibody-mediated disorder. C) It is a type III reaction, a complement-mediated disorder. D) It is a type IV reaction, a T-cell mediated disorder.

A) Type I reactions are IgE-mediated disorders. Type II reactions are antibody- mediated disorders and involve IgG or IgM antibodies, not IgE. Type III reactions are complement-mediated immune disorders. Type III reactions lead to localized inflammation, not systemic like types I and II. Type IV reactions are T-cell-mediated disorders, not involving IgE.

The nurse is caring for a client with acute inflammation of the right knee resulting from a bacterial infection. Which vascular events are occurring as a result of the inflammation? Select all that apply. A) Vascular permeability B) Cellular infiltration C) Prolonged vasoconstriction D) Thrombosis E) Release of chemical mediators

A) When acute inflammation occurs as a result of a bacterial infection, chemical mediators are released which result in the following vascular events: vasodilation, vascular permeability, cellular infiltration, and thrombosis formation. While there is a brief period of vasoconstriction after the initial tissue insult, it is followed by a prolonged period of vasodilation. B) When acute inflammation occurs as a result of a bacterial infection, chemical mediators are released which result in the following vascular events: vasodilation, vascular permeability, cellular infiltration, and thrombosis formation. While there is a brief period of vasoconstriction after the initial tissue insult, it is followed by a prolonged period of vasodilation. D) When acute inflammation occurs as a result of a bacterial infection, chemical mediators are released which result in the following vascular events: vasodilation, vascular permeability, cellular infiltration, and thrombosis formation. While there is a brief period of vasoconstriction after the initial tissue insult, it is followed by a prolonged period of vasodilation.

Lab results for a client are consistent with inflammation. What is the nurse's understanding of inflammation? Select all that apply. A) It is defined as a protective tissue response. B) It is a response to tissue injury. C) It involves the destruction of tissue. D) It indicates the presence of an infection. E) It begins the process of tissue repair.

A, B, C, E Explanation: A) Inflammation is a protective tissue response that involves the destruction of damaged tissue, and begins the process of tissue repair. B) Inflammation is a protective tissue response that involves the destruction of damaged tissue, and begins the process of tissue repair. C) Inflammation is a protective tissue response that involves the destruction of damaged tissue, and begins the process of tissue repair. E) Inflammation is a protective tissue response that involves the destruction of damaged tissue, and begins the process of tissue repair.

A nurse is caring for a client with lymphocytosis. Which possible causes of this finding does the nurse identify? Select all that apply. A) Parasitic infections B) Lymphoma C) Inflammatory bowel disease D) Tuberculosis E) Myelogenous leukemia

B) Acute viral infections (e.g. chicken pox), certain bacterial infections (e.g. pertussis and tuberculosis), and lymphoma are examples of causes of lymphocytosis. D) Acute viral infections (e.g. chicken pox), certain bacterial infections (e.g. pertussis and tuberculosis), and lymphoma are examples of causes of lymphocytosis.

The nurse is educating a client who has breast cancer that has metastasized to the bone. Which statement by the client requires additional follow up by the nurse? A) "My cancer has spread from its primary site." B) "I have two different types of cancer." C) "Like all cancer, mine is the result of damaged DNA or RNA." D) "My cancer may have developed by nature, nurture, or a combination of the two."

B) Although the cancer is located in more than one location in the case of metastatic cancer, the histology remains the same as the site of origin.

A client's laboratory results are consistent with chronic inflammation. Which potential causes of chronic inflammation does the nurse suspect? Select all that apply. A) Malnutrition B) Autoimmune diseases C) Poor blood supply D) Prolonged exposure to irritants E) Unresolved or repeated acute infections

B) Autoimmune diseases, prolonged exposure to irritants, and unresolved or repeated acute infections are understood to be causative factors, not causative factors for chronic inflammation. Malnutrition and a poor blood supply are understood to be risk factors for chronic inflammation. D) Autoimmune diseases, prolonged exposure to irritants, and unresolved or repeated acute infections are understood to be causative factors, not causative factors for chronic inflammation. Malnutrition and a poor blood supply are understood to be risk factors for chronic inflammation. E) Autoimmune diseases, prolonged exposure to irritants, and unresolved or repeated acute infections are understood to be causative factors, not causative factors for chronic inflammation. Malnutrition and a poor blood supply are understood to be risk factors for chronic inflammation.

Which laboratory test results would the nurse check to determine the effectiveness of an antiretroviral medication in an HIV-infected patient? A) Western blot B) HIV RNA C) HIV ELISA D) Phenotypic resistance analyses

B) HIV RNA test quantitates viral load in plasma and is used to monitor the response to antiretroviral therapy.

20) When assessing a patient with HIV-related lipodystrophy, the nurse would expect to find: A) truncal obesity and hypoglycemia. B) dyslipidemia and insulin resistance. C) hypoglycemia and dyslipidemia. D) increased subcutaneous fat deposits and truncal obesity.

B) HIV-associated lipodystrophy syndrome refers to a collection of morphologic and metabolic abnormalities that include insulin resistance, glucose intolerance, dyslipidemia, and fat redistribution (i.e., truncal obesity and peripheral wasting). Glucose intolerance and insulin resistance results in hyperglycemia (elevated blood glucose), and peripheral wasting results in decreased subcutaneous fat deposits in regions of the face, arms, legs, and buttocks.

When developing a plan of care for a patient with acute myelogenous leukemia (AML), the oncology nurse should keep in mind that: A) consolidation therapy uses low-dose chemotherapy to maintain remission. B) induction therapy reduces the leukemic cell burden. C) consolidation therapy is given to induce remission. D) induction therapy eliminates all cancer cells

B) Induction chemotherapy is given to induce a complete remission. Although induction therapy substantially reduces the leukemic cell burden, it is generally assumed that residual disease still exists and that some leukemic cells (fewer than 1 0 9 cells) will have survived induction therapy. This minimal residual disease is the target of consolidation therapy.

In a child with acute lymphocytic leukemia (ALL), which manifestations are due to thrombocytopenia? A) Weakness and fatigue B) Bleeding and bruising C) Fever and enlarged lymph nodes D) Bone pain and limping

B) Infection related to neutropenia, weakness and fatigue related to anemia, and bleeding related to thrombocytopenia may be clinically evident on diagnosis in children. Children with ALL may present with additional signs and symptoms that are consistent with site-specific organ infiltration of leukemic cells, such as bone pain and enlarged lymph nodes.

The nurse is performing a skin assessment on a client diagnosed with systemic lupus erythematosus (SLE). Which assessment findings does the nurse anticipate? Select all that apply. A) Paronychia B) Facial butterfly rash C) Discoid lesions D) Alopecia E) Contact dermatitis

B) Integumentary assessment findings associated with systemic lupus erythematosus (SLE) include the presence of a facial butterfly rash, discoid lesions, alopecia, photosensitivity, maculopapular rash on exposed body surfaces, erythematous fingertip lesions, splinter hemorrhages, and ulcers. Paronychia is a soft tissue infection of the fingernail as is not associated with SLE. Contact dermatitis refers to a local hypersensitivity reaction that occurs when an allergen comes into contact with the skin. C) Integumentary assessment findings associated with systemic lupus erythematosus (SLE) include the presence of a facial butterfly rash, discoid lesions, alopecia, photosensitivity, maculopapular rash on exposed body surfaces, erythematous fingertip lesions, splinter hemorrhages, and ulcers. Paronychia is a soft tissue infection of the fingernail as is not associated with SLE. Contact dermatitis refers to a local hypersensitivity reaction that occurs when an allergen comes into contact with the skin. D) Integumentary assessment findings associated with systemic lupus erythematosus (SLE) include the presence of a facial butterfly rash, discoid lesions, alopecia, photosensitivity, maculopapular rash on exposed body surfaces, erythematous fingertip lesions, splinter hemorrhages, and ulcers. Paronychia is a soft tissue infection of the fingernail as is not associated with SLE. Contact dermatitis refers to a local hypersensitivity reaction that occurs when an allergen comes into contact with the skin.

The nurse is caring for a newborn baby. What is the nurse's understanding of this client's immunity? A) The infant is not protected against antigens during the first month of life. B) Maternal IgA is transferred to breastfed infants. C) Breastfeeding does not provide any additional immunity to the baby. D) An infant only receives immunity during gestation.

B) Maternal IgA is transferred to the infant during breastfeeding, supporting immunity.

The nurse is caring for a client who experienced an immune response resulting from exposure to a foreign material. Which blood components or pathophysiological processes represent foreign materials? Select all that apply. A) Autologous stem cells B) One unit of packed red blood cells (PRBCs) C) Thromboembolism D) Normal saline solution E) Renal calculus

B) Packed red blood cells from another person originate outside one's own body, and are therefore considered a foreign material. D) Normal saline solution does not originate within one's own body, and is therefore considered foreign material.

The nurse is caring for a client with a diagnosis of lymphedema. Which body component does the nurse recognize as making up the peripheral lymphoid organs? Select all that apply. A) Bone marrow B) Tonsils C) Lymph nodes D) Thymus E) Spleen

B) Peripheral lymphoid organs include the tonsils, lymph nodes, and spleen. C) Peripheral lymphoid organs include the tonsils, lymph nodes, and spleen. E) Peripheral lymphoid organs include the tonsils, lymph nodes, and spleen.

The nurse is caring for a client diagnosed with appendicitis. The nurse understands that this is an example of which type of inflammation? A) Serous inflammation B) Purulent inflammation C) Fibrinous inflammation D) Ulceration

B) Purulent (suppurative) inflammation is the formation of pus, which contains many neutrophils, cellular debris, and edema fluid. Appendicitis and suppurative tonsillitis are examples of suppurative inflammation.

The nurse is teaching a community health class about the epidemiology of cancer. Which statement should the nurse include in the teaching? A) "Cancer is the leading cause of death in developing countries." B) "Racial disparities in cancer incidence are affected by healthcare accessibility." C) "Because of intensive antismoking campaigns, lung cancer no longer has the highest death rate among cancers." D) "Brain tumors are the least commonly diagnosed malignancies in children."

B) Racial disparities in cancer incidence exist due to limited healthcare accessibility in minority groups.

The oncology nurse assessing a patient with Rai stage II chronic lymphocytic leukemia (CLL) will most likely find: A) lymphocytosis and no enlargement of the lymph nodes, spleen, or liver. B) lymphocytosis, an enlarged spleen, and possibly an enlarged liver. C) lymphocytosis, anemia, and possibly an enlarged spleen or liver. D) lymphocytosis, thrombocytopenia, and possibly anemia, enlarged lymph nodes, spleen, or liver.

B) Rai stage II is characterized by lymphocytosis plus an enlarged spleen (and possibly an enlarged liver), with or without enlarged lymph nodes. The red blood cell and platelet counts are near normal.

The oncology nurse is preparing a teaching plan for a patient with Binet Stage B chronic lymphocytic leukemia (CLL). Which patient statement indicates that the patient understands her current stage? A) "I have two areas of lymph node involvement, and my red cell and platelet counts are good." B) "I have three areas of lymph node involvement, and my red cell and platelet counts are good." C) "I have three areas of lymph node involvement, and my red cell and platelet counts are low." D) "I have two areas of lymph node involvement, and my red cell and platelet counts are low."

B) The Binet system classifies CLL according to the number of affected lymphoid tissues in an effort to better address prognostic indicators. The areas of lymphoid tissue to be assessed include the axillary, cervical, and inguinal lymph nodes (unilateral or bilateral); the spleen; and the liver. In Stage A, the assessment indicates fewer than three areas of involvement with no anemia or thrombocytopenia. In Stage B, the assessment indicates three or more areas of enlarged lymphoid tissue with no anemia or thrombocytopenia. In Stage C, the assessment indicates anemia (hemoglobin less than 10 g/dL) and/or thrombocytopenia (platelets less than 100,000/mm3).

In the initial stages of distal symmetric polyneuropathy (DSP) in an HIV-infected patient, the nurse would expect to find on physical assessment: A) a diminished brachioradialis reflex. B) a diminished ankle reflex. C) a hyperreflexive patellar reflex D) a positive Babinski sign

B) The most common manifestations of DSP involve absent or diminished ankle jerks and diminished vibration and pinprick sensations in the distal lower extremities.

The school nurse is talking with a high school class about sexual transmission of HIV. Which of the following would the nurse advise the students? A) "Oral-penile intercourse carries the highest risk of transmission." B) "Penile-vaginal and penile-anal intercourse most efficiently transmit the virus." C) "HIV-infected females cannot transmit HIV to their partners." D) "Kissing can transmit HIV."

B) The primary mode of transmission worldwide is through sexual contact. The most efficient sexual transmission modes are penile-anal intercourse and penile-vaginal intercourse.

The nurse is caring for a client with a healing surgical incision. Which organs does the nurse understand are integral to regulating the client's inflammation? Select all that apply. A) Skin B) Spleen C) Thymus D) Kidneys E) Appendix

B) The sympathetic nervous system innervates lymph node-related organs such as the spleen, thymus, bone marrow, and lymph nodes, which are integral to regulating the inflammatory response. C) The sympathetic nervous system innervates lymph node-related organs such as the spleen, thymus, bone marrow, and lymph nodes, which are integral to regulating the inflammatory response.

The nurse is providing education for a client diagnosed with an adenoma. Which statement by the client requires further follow up by the nurse? A) "This is a well-differentiated neoplasm." B) "This is a malignancy of the mesenchymal tissue." C) "This means that the affected cells were encapsulated." D) "This is a slow-growing condition."

B) This response is wrong because an adenoma is benign, not malignant.

The nurse is reviewing discharge instructions with a client whose colon cancer exhibits VEGF overexpression. Which statement regarding the client's condition is true? A) Angiogenesis only occurs in VEGF overexpressing tumors. B) VEGF causes the growth of new vessels, forming a microcirculatory system. C) ATP production is inhibited by the presence of VEGF. D) VEGF positive tumor cells do not require glycolysis to generate energy for growth.

B) Vascular endothelial growth factor (VEGF) causes the growth of new vessels, forming a microcirculatory system to and within a tumor.

The nurse is providing education for a client with Crohn disease. Which statement will the nurse include when teaching the client about the disease? A) "Crohn disease is an active allergic response." B) "Crohn disease is the result of an acute inflammatory response." C) "Crohn disease is a chronic inflammatory disorder." D) Crohn disease is a chronic inflammatory disorder caused by the immune system targeting healthy tissues of the digestive tract. The cause of Crohn disease is understood to be multifactorial, but is not the result of an allergic response, nor an acute inflammatory response. Crohn disease is not caused by the immune system targeting diseased tissue.

C C) Crohn disease is a chronic inflammatory disorder caused by the immune system targeting healthy tissues of the digestive tract. The cause of Crohn disease is understood to be multifactorial, but is not the result of an allergic response, nor an acute inflammatory response. Crohn disease is not caused by the immune system targeting diseased tissue.

A nurse cares for a client experiencing an acute-phase inflammatory response. Which clinical manifestation does the nurse expect upon physical assessment? A) Leukopenia B) Decreased serum proteins C) Pyrexia D) Decreased erythrocytes

C) An acute-phase inflammatory response occurs due to the release of chemical mediators (cytokines), causing systemic effects. Effects include fever (pyrexia), increased serum proteins, and leukocytosis (not leukopenia). Decreased erythrocytes (RBCs) is not a result of an acute- phase inflammatory response.

Which statement by the oncology nurse is most appropriate when teaching an asymptomatic patient in the early stage of chronic lymphocytic leukemia (CLL) about treatment? A) "CLL requires aggressive treatment in the early stages." B) "There is no treatment because CLL is not curable." C) "CLL is treated conservatively in the early stages." D) "In those who are asymptomatic, chemotherapy is used to induce remission."

C) CLL generally progresses slowly, often with long periods of stability and occasional spontaneous remissions. Because the disease occurs primarily in older adults, follows an indolent course, and is not curable, a conservative approach to treatment is generally indicated. In patients with early-stage disease and without symptoms, watchful waiting is generally indicated. For patients with symptoms and/or more progressive disease, chemoimmunotherapy may be used.

Which symptoms would the nurse expect in a patient with chronic lymphocytic leukemia (CLL) who is being admitted to the oncology unit with B symptoms? A) Agranulocytosis and hypogammaglobinemia B) Anemia, thrombocytopenia, and autoimmune hemolytic anemia C) Night sweats and fever but no infection D) Lymphadenopathy, splenomegaly, and hepatomegaly

C) Constitutional symptoms (B symptoms) may be present and include fever greater than 100.5°F for 2 weeks without evidence of infection, night sweats without evidence of infection, unintentional weight loss that can be 10% of body weight in the preceding 6 months, and fatigue that interferes with the patient's ability to perform activities of daily living.

Which statement by a patient recently diagnosed with acute myelogenous leukemia indicates that the patient does not understand the staging process? A) "Staging helps my doctors plan my treatment." B) "Staging will help determine my prognosis." C) "Staging can help the doctors determine how long I have to live." D) "Staging is useful for research on my type of cancer."

C) For all cancers, the stage of the disease determines the treatment. Staging or classifying cancers, such as leukemias, serves a number or very important functions such as (1) helping the clinician to plan an appropriate treatment strategy, (2) providing some indication of prognosis, (3) facilitating communication between clinicians and across institutions, and (4) facilitating clinical research. A classification system also helps the patient understand the prognosis so that the patient and family can make the needed adjustments in their lives. Staging does not predict how long a patient has to live.

How should a nurse respond when a patient with human immunodeficiency virus (HIV) asks about the course of the disease? A) "The disease will progress to AIDS within a few years." B) "You will probably be relatively asymptomatic for 20 years." C) "The disease has a variable progression, so it's hard to know right now." D) "Death typically occurs within 10 to 15 years."

C) HIV progression is highly variable. Some individuals progress to AIDS within a few years of infection; others remain relatively asymptomatic after 20 or more years of infection.

Which laboratory result would the nurse expect in a patient with acute myelogenous leukemia (AML)? A) Polycythemia B) Thrombocytosis C) Pancytopenia D) Hemoglobinemia

C) In AML, crowding of the bone marrow with abnormal cells results in loss of function and eventually leads to pancytopenia (anemia, neutropenia, and thrombocytopenia), as the bone marrow is unable to produce sufficient numbers of normal hematopoietic cells. Pancytopenia may lead to anemia, infections, and bleeding.

Laboratory results indicate that the viral load of a newly diagnosed, untreated HIV-infected client has stabilized. The nurse explains to the patient that: A) he has primary HIV infection. B) he is experiencing seroconversion. C) he has reached the viral set point. D) he has chronic HIV.

C) In untreated individuals, the viral load tends to stabilize approximately 6 months after infection. This stable viral load is known as the viral set point, and higher levels have been shown to correlate with rapid CD4+ T-lymphocyte depletion and subsequent disease progression.

The nurse is preparing to administer prednisone to a client with an inflammatory condition. Which statement by the client requires further follow up by the nurse? A) "I will elevate the affected area." B) "I can anticipate that my swelling will decrease." C) "I will take the medication to treat the cause of my inflammation." D) "Applying ice to the affected area may not be helpful."

C) It is important to note that steroidal anti-inflammatory drugs such as prednisone do not treat the underlying cause of inflammation. Instead, prednisone treats the symptoms related to inflammation, such as redness, heat, swelling, and loss of function.

The nurse is preparing to administer a human papilloma virus (HPV) vaccine to a client. What does the nurse understand about infections and cancer incidence? A) The HPV vaccine is effective for preventing all types of HPV infections. B) HPV vaccination is effective for the treatment of cervical cancer. C) Many of the leading cancers in the world are due to infections like HPV. D) Screening for cervical cancer is no longer necessary after receiving the HPV vaccine.

C) Many of the leading cancers in the world are due to infections like HPV.

Multiple myeloma occurs predominantly in which patients? A) Young Black patients B) Young White patients C) Elderly Black patients D) Elderly White patients

C) Multiple myeloma occurs primarily in individuals over age 60, and it occurs twice as often in Blacks as in Whites.

The nurse is providing education for a client diagnosed with systemic lupus erythematosus (SLE). Which statement will the nurse include in the teaching material? A) "Excessive inflammation occurs when you have less white blood cells." B) "Removal of dead cells in your body causes an immune response." C) "Your body is in a state of imbalance due to problems removing dead cells." D) "Excessive inflammation occurs when you have abnormally-shaped cells."

C) Removal of dead cells is necessary to maintain homeostasis, and is impaired in a client with systemic lupus erythematosus (SLE). Excessive inflammation is characterized by overexpression of leukocyte adhesion molecules, not leukopenia. Removal of dead cells by phagocytosis does not cause an immune response in SLE. If dead cells are not cleared, they may leak intracellular antigens, resulting in inflammation. Abnormally-shaped cells are not a characteristic of SLE and will not be included in the client teaching.

A nurse is caring for a client with non-small cell lung cancer (NSCLC) that has metastasized to the brain. What changes in the client's cells have occurred to allow metastasis? Select all that apply. A) Alterations in lectin binding allow cancer cells to avoid sticking to leukocytes and platelets. B) Human leukocyte antigen (HLA) may be present, allowing malignant cells to escape detection by the immune system. C) The cytoskeleton loses rigidity, making cells more amenable to proliferation. D) Further growth is inhibited at the primary site, encouraging cells to spread to other sites in the body. E) Altered cytoskeletal control leads to the loss of internal and external cellular functions.

C) The cytoskeleton loses rigidity, making cancer cells more amenable to proliferation. E) Altered cytoskeletal control leads to the loss of internal and external cellular functions.

The nurse is caring for an older adult client with active tuberculosis (TB) who has a negative TB skin test. The nurse understands that this phenomenon is due to: A) prior exposure to TB producing antibody immunity. B) hyperactivity of the immune system occurring with active TB (anergy). C) a diminished immune response due to changes in immunity occurring with age. D) decreased immunity associated with treatment with immune-suppressive agents.

C) The immune response is often diminished in older adults, owing to changes in the immune system that occur with age. This diminished responsiveness is called anergy, and it can result in a negative TB skin test, even when the client has active disease.

The nurse is educating a client about the functions of the immune system. Which statements will the nurse include in the teaching materials? Select all that apply. A) "The immune system's primary function is autoimmunity." B) "The immune system is responsible for hypersensitivity reactions." C) "The immune system protects against invading microorganisms." D) "The immune system prevents cancer cell proliferation." E) "The immune system mediates the healing of damaged tissue."

C) The immune system is responsible from protection against invading microorganisms, prevention of cancer cell proliferation, and the healing of damaged tissue. D) The immune system is responsible from protection against invading microorganisms, prevention of cancer cell proliferation, and the healing of damaged tissue. E) The immune system mediates the healing of damaged tissue through release of various chemical mediators and immune processes.

The nurse is teaching a patient about the use of early HAART to treat HIV. Which statement by the patient indicates that he does not understand the teaching? A) "Early HAART increases the risk of drug toxicities that will limit treatment options in the future." B) "Early HAART can increase the risk of developing drug-resistant mutants that will limit treatment options for symptomatic disease." C) "Early HAART does not affect the ability to transmit drug-resistant mutants to uninfected people." D) "Early HAART reduces the risk of transmitting HIV to uninfected people."

C) The potential benefits for early therapy include preservation of immune function, prolongation of clinical latency, and a possible reduced risk of transmission. Potential risks of early therapy include drug toxicities, possible development of drug-resistant mutants that will limit treatment options in symptomatic disease, and the risk of transmitting drug-resistant mutants to uninfected individuals, thus limiting their treatment options.

A nurse is caring for a client with a retinoblastoma. What aspect of the cell cycle does the nurse understand to be the cause of this client's condition? A) This condition occurs during cellular angiogenesis. B) This condition is a result of TP53 activation, which contributes to apoptosis. C) This condition developed during the DNA synthesis phase of the cell cycle. D) The presence of retinoblastoma protein is the cause of this condition.

C) The retinoblastoma protein is formed during the DNA synthesis phase of the cell cycle. The retinoblastoma protein is so named because if both of the alleles of the retinoblastoma gene are mutated, it results in retinoblastoma, a tumor of the retina in the eye.

The nurse is caring for a client with a diagnosis of metastatic cancer with a pathogenic bone fracture. The nurse understands that this condition occurs by which mechanism? A) Increased osteoblastic growth factors (ObGFs) results in a fragile bony structure. B) Increased osteoclast activating factors (OcAFs) result in increased pressure in the bone, resulting in pathogenic fracture. C) Pathogenic fractures occur by either increased pressure in the bone, or breakdown of the bony matrix. D) Pathogenic fractures occur due to the breakdown of the bone network and loss of the bony matrix.

C) The same type of cancer can cause pathogenic fractures by different mechanisms. The two mechanisms by which pathogenic fractures occur involve increased osteoblastic growth factors (ObGFs) resulting in increased pressure in the bone, and increased osteoclast activating factors (OcAFs) resulting in loss of bony matrix and a fragile bone structure.

The nurse is teaching an HIV-infected patient about highly active antiretroviral therapy (HAART). The nurse should consider the teaching effective if the patient says: A) "HAART reduces antiretroviral drug toxicity." B) "HAART includes drugs from two different antiretroviral drug classes." C) "HAART with a minimum of three antiretroviral medications reduces the chance of developing viral resistance." D) "Therapy starts with one medication with others added as needed."

C) Typically, treatment of HIV combines a minimum of three medications that diminish viral replication. Use of a combination of antiretroviral drugs, which is sometimes referred to as highly active antiretroviral therapy (HAART), helps to decrease viral resistance to the medications. A risk of HAART is the development of drug toxicity.

Which of the following is the nurse most likely to expect in a newborn with DiGeorge syndrome? A) Reduced B-cells B) Hyperplasia of the parathyroid glands C) Hypoplasia of the thymus gland D) Hypercalcemia

C) Variable T-cell deficiency caused by defective embryologic development of the third and fourth pharyngeal pouches; leads to hypoplasia or aplasia of the thymus and parathyroid glands.

Which patient statement indicates to the nurse that more teaching regarding early highly active antiretroviral therapy (HAART) is needed? A) "Early HAART can have negative effects." B) "Early HAART can preserve my immune function." C) "Early HAART can reduce the risk of viral transmission." D) "Early HAART reduces the potential for developing drug-resistant strains."

D) Although HAART is indicated for all individuals with HIV, early treatment has both positive and negative effects. The potential benefits for early therapy include preservation of immune function, prolongation of clinical latency, and a reduced risk of transmission. Risks of early therapy include drug toxicities, possible development of drug-resistant mutants that limit treatment options in symptomatic disease, and the risk of transmitting drug-resistant mutants to uninfected individuals, limiting their treatment options.

In response to an HIV-infected patient asking about tuberculosis (TB), the nurse should explain that: A) TB is often transmitted at the time of HIV transmission. B) HIV infection increases the risk of acquiring TB. C) HIV suppresses the activation of latent TB. D) TB is the leading cause of death in HIV-infected people.

D) Among individuals who are infected with HIV, TB is the leading cause of death.

The nurse is assessing a client diagnosed with an early stage malignancy. What does the nurse understand about the local effects of cancer? A) A new lump or tissue thickening will determine the extent of the cancer. B) Lymphadenopathy means the cancer is progressing. C) A growing tumor is not likely to exert pressure on the surrounding tissue. D) Assessment findings are likely to be linked to the tissue source of the tumor.

D) Assessment findings in an early stage malignancy are most likely to be linked to the tissue source of the tumor.

A nurse is caring for a group of clients. Which clients have disorders associated with chronic inflammation? Select all that apply. A) A client with a knee replacement B) A client with osteoporosis C) A client with bacterial meningitis D) A client with major depression E) A client with advanced Alzheimer disease (AD)

D) Both major depression and Alzheimer disease (AD) are associated with chronic inflammation. Other conditions associated with chronic inflammation include asthma, atherosclerosis, diabetes mellitus, and obesity. E) Both major depression and Alzheimer disease (AD) are associated with chronic inflammation. Other conditions associated with chronic inflammation include asthma, atherosclerosis, diabetes mellitus, and obesity.

The nurse is caring for a client recently discovered to have grade 2 colon cancer. Which statement by the client is consistent with the client's continuum of care? A) "I am in the middle of cancer treatment." B) "I am due for a survivorship follow up visit." C) "I have just completed chemoradiation therapy." D) "I am still discussing my diagnosis with my providers."

D) Cancer grade involves a histological analysis of cancer cells and, in the continuum of care, typically occurs while diagnosis discussions are taking place. Grading of differentiation is important to determine prior to cancer treatment.

The nurse prepares to administer a glucocorticoid agent to a client with an inflammatory disorder. What is the nurse's understanding of the purpose of glucocorticoids in the hypothalamic-pituitary-adrenal (HPA) axis? A) Glucocorticoids cause the release of cytokines that downregulate the inflammatory response. B) Glucocorticoids increase the number of active immune cells in the body. C) Glucocorticoids stimulate the pituitary, decreasing inflammation. D) Glucorticoids act with cytokines to decrease the inflammatory response.

D) Cortisol is produced by the adrenal glands, and affects the immune cells, pituitary, and hypothalamus. The release of anti-inflammatory cytokines act with the release of glucocorticoids to attenuate the inflammatory response. Additionally, while the interaction between cortisol, the hypothalamus, and the pituitary attenuate inflammation, it is the hypothalamus which stimulates the pituitary to release adrenocorticotropic hormone, and not vise versa.

An HIV-infected patient has cytomegalovirus (CMV) retinitis and a CD4+ lymphocyte count of 150 cells/mm3. How should the nurse interpret this data? A) The patient has primary HIV infection. B) The patient is in the chronic stage of HIV infection. C) The patient has symptomatic HIV. D) The patient has AIDS.

D) HIV-related conditions develop as CD4+ T-lymphocyte counts decline. Early conditions include headache and fatigue. Over time, the conditions become more severe and include fever, night sweats, diarrhea, and mucocutaneous abnormalities. The most advanced stage of HIV infection is AIDS, characterized by severe immunodeficiency (i.e., CD4+ T-lymphocyte count < 200 cells/mm3), opportunistic infections (such as CMV), and/or malignancies.

The nurse is caring for a client who is five months pregnant and HIV positive. What is the nurse's understanding of the neonate's HIV status? A) The neonate will be HIV positive. B) The neonate will initially test positive for antibodies. C) The neonate's risk for contracting HIV is unaffected by the mother's HIV positivity. D) The neonate may or may not be infected with HIV.

D) IgG crosses the placenta during the last few weeks of pregnancy and is stored in fetal tissue. As a result of this transfer, a neonate born to an HIV-positive mother tests positive for antibodies. It is important to note, however, that the child is not necessarily infected with the virus.

In a patient with chronic myelogenous leukemia (CML), which manifestation(s) would the nurse expect to find caused by splenomegaly? A) Excessive sweating and night sweats B) Joint pain with joint splinting C) Weakness and fatigue D) Abdominal pain referred to the left shoulder

D) Infiltration of the abnormal cells in the spleen can cause splenomegaly with abdominal pain, discomfort, early satiety, and upper left quadrant pain that is sometimes referred to the left shoulder.

The nurse is providing education to the parent of an infant about innate immunity. Which statement by the parent indicates an understanding of the material? A) "Innate immunity is a delayed response of the immune system." B) "Innate immunity responds to a specific antigen to prevent illness." C) "Innate immunity is the basis for vaccinations." D) "Innate immunity is the body's first line of defense."

D) Innate immunity is the immune system's initial, nonspecific response to antigens in general, and is the body's first line of defense against potentially harmful foreign material. In contrast, acquired immunity is a delayed response to a specific antigen, and is the basis for receiving vaccinations.

The nurse is providing education to a client prescribed with intranasal cromolyn. Which statement will the nurse include in the client teaching about this medication? A) "This medication increases your antibodies to the offending allergens." B) "It's best to use this medication when your symptoms are not tolerable." C) "Do not use this medication for more than a week at a time." D) "This medication stabilizes your cells in an effort to fight the offending allergens."

D) Intranasal cromolyn is a mast cell stabilizer, which works to stabilize mast cells and prevents mast cell degranulation. This medication does not increase antibodies to fight offending allergens and should be take prior to exposure of the antigen, if possible. Intranasal corticosteroids, not mast cell stabilizers, should only be taken for a week at a time, due to the risk of rebound

The nurse acts as a preceptor to a novice nurse, who is caring for a client with a penicillin allergy. Which statement by the novice nurse requires further follow up by the nurse preceptor? A) "The client has a type I hypersensitivity disorder." B) "The client likely has certain food allergies." C) "I will administer the prescribed doxycycline." D) "I will administer the prescribed amoxicillin."

D) It is important to know that individuals with an allergy history may have cross-reactivities to other substances. In the case of penicillin allergy, cross-reactivity to other related classes of antibiotics is possible, so extreme precautions must be taken before administering parenteral antibiotics. Amoxicillin is a penicillin-type antibiotic and should not be used in the client with a penicillin allergy. Administering this medication increases the client's risk for a hypersensitivity type I allergic reaction.

Which statement by a patient with non-Hodgkin lymphoma (NHL) indicates that more teaching about chemotherapy is needed? A) "High grade NHL is treated with combination chemotherapy." B) "A watch and wait approach may be used in indolent NHL." C) "Slow growing NHL may be treated with one chemotherapeutic agent." D) "Chemotherapy is more effective in treating indolent disease."

D) Low-grade or slow-growing NHL may be treated with only one drug. Intermediate or high- grade NHLs that are considered fast growing or aggressive are typically treated with combination chemotherapy. Because chemotherapy works best on cells that are actively dividing, chemotherapy for NHL is more effective for treating aggressive disease than indolent disease. In some cases of indolent disease without symptoms, watchful waiting or waiting until symptoms appear may be the treatment of choice.

The nurse is preparing to provide education to a client with a diagnosis of a malignant neoplasm. What is the nurse's understanding of the client's condition? A) This condition is life-threatening. B) In this condition, cells typically grow slowly. C) Malignant cells have minimal nuclear variation in size and shape. D) Malignant cells represent a range of ploidy statuses.

D) Malignant cells represent a range of ploidy statuses, exhibit nuclear variation in size and shape, and involve the affected cells growing more rapidly than normal.

The nurse is educating a client with an autoimmune disorder about immune tolerance. Which statement should the nurse include in the teaching? A) "Humoral tolerance refers to the ability to differentiate foreign antigens from self-antigens." B) "Self-tolerance refers to the elimination of self-reactive T-cells and B-cells in the thymus." C) "Central tolerance refers to the loss of self-tolerance that occurs as a result of the development of autoantibodies." D) "Peripheral tolerance occurs when certain immune cells are not eliminated in the central lymphoid organs."

D) Peripheral tolerance occurs from the deletion or inactivation of autoreactive T-cells or B-cells that escaped elimination in the central lymphoid organs.

The nurse is providing education for a client diagnosed with systemic lupus erythematosus (SLE). Which statement by the client indicates an understanding of the teaching? A) "I can anticipate my care to be managed solely by my rheumatologist." B) "I can expect to no longer need treatment after I finish my prescribed medications." C) "My medications are the mainstay of my treatment." D) "I will use high sun protection factor (SPF) sunscreen when I spend time outdoors."

D) Several nonpharmacologic measures, along with other medical interventions, are important in the comprehensive management of SLE. Individuals who have been diagnosed with SLE are taught the importance of protection from sunlight, maintaining adequate nutritional intake, getting enough exercise, stopping smoking, and receiving appropriate immunizations.

The oncology nurse is preparing to administer pembrolizumab, a targeted cancer treatment, to a client with non-small cell lung cancer (NSCLC). What is the nurse's understanding of targeted cancer treatment? A) Targeted therapy has a higher degree of toxicity than standard chemotherapy. B) In targeted therapy, a normal gene is inserted to replace an abnormal gene. C) Targeted therapy is only available through clinical trials. D) Targeted therapy is known as personalized medicine.

D) Targeted therapy is also referred to as personalized medicine. Targeted therapies inhibit or block a receptor or pathway involved in the mechanism by which the cancer grows and spreads

The nurse is caring for a group of clients with conditions involving inflammation. Which condition is most closely related to the concept of immunity? A) Asthma B) Frostbite C) Colon cancer D) Hypersensitivity reaction

D) The client with the condition most closely related to immunity is the client with a hypersensitivity reaction. Asthma is most closely related to the concept of oxygenation Frostbite is a condition related to the concept of thermoregulation, and colon cancer is more closely related to the concept of cellular regulation.

When planning care, the nurse recognizes that which primary immunodeficiency disorder (PID) is a pediatric emergency? A) Selective IgA deficiency B) X-linked agammaglobulinemia C) Transient hypogammaglobulinemia of infancy D) Severe combined immunodeficiency

D) The most commonly reported primary immunodeficiency disorders include selective IgA deficiency, X-linked agammaglobulinemia, hypogammaglobulinemia, common variable immunodeficiency, specific antibody deficiency, and transient hypogammaglobulinemia of infancy. A fourth disorder, severe combined immunodeficiency (also known as "bubble boy" disease), is the most serious PID and is considered a pediatric emergency; unless it is treated by stem cell transplantation, death within the first or second year of life often occurs.

A client with a burn injury asks, "Why does swelling happen after a burn?" What is the nurse's best initial response? A) "Swelling occurs because the vessels dilate, which slows the flow of blood." B) "Swelling occurs because the vessels leak fluid into the surrounding tissue." C) "Swelling occurs because of the release of chemicals that impact the vessels." D) "Swelling occurs in order to prepare the injured area for healing."

D) The nurse's best response is to answer the question by responding first with the general reason that the body induces swelling after a burn injury. With a burn injury, the vessels dilate, slowing the velocity of blood flow; however, there is an increase of blood flow to the injured site. While the other responses are correct, they do not specifically address the client's question about the purpose of swelling after a burn injury.