exam #2 chap 15, 35, 36, 37, 38 medsurgII

For a patient receiving a cytotoxic drug that will likely result in bone marrow depression, which of the following teaching considerations should be the priority for the nurse with the patient and family members or caregivers? A. Wash hands often and avoid people with colds, flu, or other infections. B. Do not expect fatigue and weakness, which are uncommon. C. Expect gastrointestinal upset. More nausea and vomiting may occur when the blood cell counts are low. D. Take acetaminophen for fever.

A. Patients receiving a drug that depresses bone marrow function are at high risk of developing serious infections. Every effort should be made to prevent infections in the patient. Although the patient may be included in the vigilance necessary to make sure that those in proximity understand precautions, it is especially important that this be communicated to all others in the patient's environment. Fatigue and weakness also often occur with bone marrow depression and require medical monitoring. There is no particular correlation between nausea and vomiting and blood cell counts. Any fever should be reported, and antibiotics are given rather than antipyretics.

The nurse instructs a patient on the administration of clarithromycin. Which of the following patient teaching instructions is appropriate? A. Take the medication on an empty stomach. B. Take the medication with a calcium supplement. C. Take the medication with a class of milk. D. Take the medication with cheese.

A. Patients should take azithromycin on an empty stomach. The other choices all involve combination with a calcium-containing substance, which should not be administered with azithromycin.

A nurse is preparing to administer the first dose of piperacillin-tazobactam (Zosyn) to a patient in an infusion clinic. The nurse should take which of the following precautions? A. Ask the patient about past allergic reactions to penicillins. B. Ask the patient about past allergic reactions to aminoglycosides. C. Mix the piperacillin-tazobactam with lidocaine to reduce pain of infusion. D. Instruct the patient to eat a snack to decrease stomach upset from piperacillin-tazobactam

A. Penicillin allergy is the most common cause of drug-induced anaphylaxis. Piperacillin-tazobactam (Zosyn) is a combination product containing an extended-spectrum antipseudomonal penicillin and a beta-lactamase inhibitor. Cross-allergenicity occurs among all the penicillins; therefore, asking the patient about past reactions to penicillins is a necessary intervention before giving this medication. Drug administration is intravenous; thus, it is unlikely to cause stomach upset. After diluting the drug in intravenous fluid, administration occurs slowly through a small-bore needle in a large vein to prevent vein irritation and pain during infusion. It is important to monitor the site and ensure that it remains patent throughout the administration.

Which of the following foods should not be taken with tetracycline? A. orange juice with calcium B. cranberry juice cocktail C. tomato juice D. lemonade

A. Tetracycline is contraindicated with calcium or dairy products.

Which laboratory value should the nurse assess in patients who are receiving demeclocycline? A. blood urea nitrogen B. aspartate aminotransferase C. alanine aminotransferase D. creatinine

A. When administering demeclocycline, it is important to monitor the patient's blood urea nitrogen (BUN). Increases in the BUN are secondary to antianabolic Effect

A man has had a urinary tract infection, and a prescriber orders phenazopyridine (Pyridium). Which of the following adverse effects should he report to his health care provider? A. yellowing of the skin B. edema C. pain D. malaise

A. Yellowing of the skin indicates an accumulation of phenazopyridine.

When obtaining a health history from a patient with possible abnormal immune function, what question would be a priority for the nurse to ask? a. "Have you ever been treated for a sexually transmitted infection"? b. "When was your last menstrual period"? c. "Do you have abdominal pain or discomfort"? d. "Have you ever received a blood transfusion"?

"Have you ever received a blood transfusion"?

A nurse is caring for a client who is receiving chemotherapy and has a platelet count of 30,000/mm3. Which statement by the client indicates a need for additional teaching?

"I floss my teeth every morning"

A nurse is teaching a client who is receiving radiation treatment for left lower lobe lung cancer. Which client statement indicates a need for further teaching?

"I'll use hats to protect my head from the sun when my hair falls out"

A client reports to a physician's office for intradermal allergy testing. Before testing, the nurse provides client teaching. Which client statement indicates a need for further education? "I'll go directly to the pharmacy with my EpiPen prescription." "The test may be mildly uncomfortable." "If I notice tingling in my lips or mouth, gargling may help the symptoms." "I may experience itching and irritation at the site of the testing."

"If I notice tingling in my lips or mouth, gargling may help the symptoms."

A client presents at the clinic with an allergic disorder. The client asks the nurse what an "allergic disorder" means. What would be the nurse's best response? "It means you are very sensitive to something inside of yourself." "It is a harmless reaction to something in the environment." "It is a muted response to something in the environment." "It is a hyperimmune response to something in the environment that is usually harmless."

"It is a hyperimmune response to something in the environment that is usually harmless."

A patient will be receiving radiation for 6 weeks for the treatment of breast cancer and asks the nurse why it takes so long. What is the best response by the nurse?

"It will decrease the incidence of leukopenia and thrombocytopenia"

A patient tells the nurse, "I can't believe I have ineffective immune function and am getting sick again. I exercise rigorously and compete regularly." What is the best response by the nurse? a. "Something must be seriously wrong. You should not be getting sick since you are so healthy" b. "Maybe you need to stop exercising so much. It can't be good for you" c. "It is possible that you are immunocompromised and may haveHIV" d. "Rigorous exercise can cause negative effects on immuneresponse

"Rigorous exercise can cause negative effects on immuneresponse

A patient was seen in the clinic 3 days previously for allergic rhinitis and was given a prescription for a corticosteroid nasal spray. The patient calls the clinic and tells the nurse that the nasal spray is not working. What is the best response by the nurse? "I am sorry that you are feeling poorly but this is the only medication that will work for your problem." "The full benefit of the medication may take up to 2 weeks to be achieved." "You may be immune to the effects of this medication and will need something else in its place." "You need to come back to the clinic to get a different medication since this one is not working for you."

"The full benefit of the medication may take up to 2 weeks to be achieved."

A patient was seen in the clinic 3 days previously for allergic rhinitisand was given a prescription for a corticosteroid nasal spray. Thepatient calls the clinic and tells the nurse that the nasal spray is notworking. What is the best response by the nurse? a. "You need to come back to the clinic to get a different medicationsince this one is not working for you" b. "You may be immune to the effects of this medication and willneed something else in its place" c. "The full benefit of the medication may take up to 2 weeks to beachieved" d. "I am sorry that you are feeling poorly but this is the onlymedication that will work for your problem"

"The full benefit of the medication may take up to 2 weeks to beachieved"

The nurse receives a phone call at the clinic from the family memberof a patient with AIDS. The family member states that the patientstarted "acting funny" after reporting headache, tiredness, and a stiffneck. Checking the temperature resulted in a fever of 103.2°F. Whatshould the nurse tell the family member? a. "The patient probably has a case of the flu, and you should giveTylenol" b. "The patient may have cryptococcal meningitis and will need tobe evaluated by the physician" c. "This is one of the side effects from antiretroviral therapy and willrequire changing the medication" d. "The patient probably has Pneumocystis pneumonia and will needto be evaluated by the physician"

"The patient may have cryptococcal meningitis and will need tobe evaluated by the physician"

A client is receiving immunotherapy as part of the treatment plan for an allergic disorder. After administering the therapy, the client states, "I guess I can go home now." Which response by the nurse would be most appropriate? a) "You need to stay about another half-hour so we can make sure you don't have a reaction." b)"It's okay to leave but make sure to call us if you start to feel strange after an hour or so." c) "You must stay here so that you can get another injection of a different substance to which you're allergic." d)"We need to schedule your next appointment first and then you can leave."

"You need to stay about another half-hour so we can make sure you don't have a reaction." Explanation: Although severe systemic reactions are rare, the risk of serious and potentially fatal anaphylaxis exists. Therefore, the client needs to remain in the office or clinic for at least 30 minutes after the injection to be observed for possible systemic symptoms. The client should not be allowed to leave until 30 minutes pass. If more than one allergen is being used, the injections typically occur at the same time.

Patients undergoing radiation therapy to the head and neck may experience ____________ which is a severe impairment of taste.

"mouth blindness,"

The nurse is caring for a client who is scheduled for chemotherapy. Which is the best statement the nurse can make about the client experiencing chemotherapy-induced alopecia?

"the hair loss is usually temporary"

A patient is scheduled for cryosurgery for cervical cancer and tells the nurse, "I am not exactly sure what the doctor is going to do." What is the best response by the nurse?

"the physician is going to use liquid nitrogen to freeze the area."

Antibodies react with antigens in a variety of ways:

(1) by coating the antigens' surfaces if they are particular substances (2) by neutralizing the antigens if they are toxins, (3) by precipitating the antigens out of solution if they are dissolved.

In response to recognizing TAAs as foreign, T-cell lymphocytes release several cytokines that elicit various immune system actions, including:

(1) proliferation of cytotoxic (cell-killing) T lymphocytes capable of direct destruction of cancer cells (2) induction of cancer cell apoptosis (3) recruitment of additional immune system cells that contribute to the destruction and degradation of cancer cells.

There are two major components of ART resistance:

(1) transmission of drug-resistant HIV at the time of initial infection (2) selective drug resistance in patients who are receiving nonsuppressive regimens.

signs and symptoms of HSOS may include:

(hepatic sinusoidal obstructive syndrome) - weight gain, hepatomegaly, increased bilirubin, and ascites.

Comparison of Cellular and Humoral Immune Responses

* Humoral Responses (B Cells) Bacterial phagocytosis and lysis Anaphylaxis Allergic hay fever and asthma Immune complex disease Bacterial and some viral infections * Cellular Responses (T Cells) Transplant rejection Delayed hypersensitivity (tuberculin reaction) Graft-versus-host disease Tumor surveillance or destruction Intracellular infections Viral, fungal, and parasitic infections

Patients with CACS complain of loss of appetite, early satiety, and fatigue. As many as _____% of all patients with cancer experience some degree of cachexia

*Cancer-Related Anorexia-Cachexia Syndrome - 80

Prevention of HIV Infection

*Education - condoms (LATEX) - polyurethane female condom - pre-exposure prophylaxis (PrEP) -HIV status should be checked every 3 months to be sure that the person has not become infected - male circumcision,

As the ANC declines below ________ cells/mm3, the risk of infection rises.An ANC less than ________cells/mm3 reflects a severe risk of infection

*absolute neutrophil count (ANC) 1,500 500

Neutropenia, an abnormally low ANC, is associated with an increased risk of infection.

*absolute neutrophil count (ANC) true

radiation safety precautions (brachytherapy) include limiting time with client, wearing dose meter badges, keeping pregnant staff or visitors and children out of room, limiting visits to ____ minutes and keeping ___ feet away from the radiation source

- 30 - 6 feet

Cryptococcus Neoformans

- A fungal infection - another common opportunistic infection among patients with AIDS - it causes neurologic disease.

what type of diet is suggested to patients that had a Hematopoietic Stem Cell Transplantation

- A neutropenic diet is usually prescribed for patients to decrease the risk of exposure to foodborne infections from bacteria, yeast, molds, viruses, and parasites

Immunotherapy Indications

- Allergic rhinitis, conjunctivitis, or allergic asthma - History of a systemic reaction to Hymenoptera and specific immunoglobulin E antibodies to Hymenoptera venom - Desire to avoid the long-term use, potential adverse effects, or costs of medications - Lack of control of symptoms by avoidance measures or the use of medications

Interpretation of negative HIV Test Results

- Antibodies to HIV are not present in the blood at this time, which can mean that the patient has not been infected with HIV or, if infected, the body has not yet produced antibodies (stage 0). - The patient should continue taking precautions. - The test result does not mean that the patient is immune to the virus, nor does it mean the patient is not infected; it just means that the body may not have produced antibodies yet. * If viral test used, a negative result is more consistent with the conclusion that the patient is uninfected.

Interpretation of Positive HIV Test Results

- Antibodies to HIV are present in the blood (the patient has been infected with the virus, and the body has produced antibodies). - HIV is active in the body, and the patient can transmit the virus to others. - Despite HIV infection, the patient does not necessarily have AIDS. - The patient is not immune to HIV (the antibodies do not indicate immunity).

Assessment of Neutropenic Fever in Patients With Cancer

- Any one-time temperature of 38.3°C (101°F) or - Any temperature of ≥38°C (100.4°F) or ≥1 h - <500 neutrophils/mcL or <1000 neutrophils/mcL and predicted to decline to ≤500 neutrophils/mcL over the next 48 hour

IgM antibodies

- Appears mostly in intravascular serum - Appears as the first immunoglobulin produced in response to bacterial and viral infections - Activates the complement system

What should the nurse advise the client to do to help with stomatitis?

- Avoid mouthwashes containing alcohol - avoid tobacco - Use of soft toothbrush - Avoid rough, hot or spicy foods - Removal of dentures unless they're eating

In erythematous areas:

- Avoid t soaps, cosmetics, perfumes, powders, lotions, and ointments -Use only lukewarm water to bathe the area. - Avoid rubbing or scratching the area. -Avoid shaving the area with a straight-edged razor. - Avoid applying hot-water bottles, heating pads, ice, and adhesive tape to the area. - Avoid exposing the area to sunlight or cold weather. - Avoid tight clothing in the area. Use cotton clothing. - aloe vera, or Biafine

allergic dermatitis treatment

- Avoidance of offending material - Aluminum acetate (Burow Solution, Domeboro Powder) or cool water compress - Systemic corticosteroids (prednisone) for 7-10 days - Topical corticosteroids for mild cases - Oral antihistamines to relieve pruritus

instruction for a patient taking antihistamine

- Because antihistamines may produce drowsiness, the patient is cautioned about this and other side effects applicable to the medication. - Operating machinery, driving a car, and performing activities that require intense concentration should be postponed. - The patient is also informed about the dangers of drinking alcohol when taking antihistamines, because they tend to exaggerate the effects of alcohol.

Epicutaneous Immunotherapy

- Because the epidermis is less vascular, there is reduced risk of systemic allergic side effects due to inadvertent intravascular allergen delivery

Hormonal Agents

- Bind to hormone receptor sites that alter cellular growth - block binding of estrogens to receptor sites (antiestrogens) - inhibit RNA synthesis - suppress cytochrome P450 system

How does graft vs host disease present?

- Blistering rash - Diffuse inflammation to the GI tract with massive diarrhea - Hepatomegaly

how to distinguish candidiasis from oral hairy leukoplakia in patients with HIV

- Candidiasis Lesions can be easily scraped off with a tongue depressor or other instrument which is in contrast to lesions associated with oral hairy leukoplakia.

Common variable immunodeficiency (CVID)

- Caused by a variety of genetic abnormalities - resulting in defective ability of immune cells to produce normal amounts of antibodies, resulting in frequent bacterial or viral infections of the upper airway, sinuses, and lungs.

The nurse is administering a sympathomimetic drug to a patient. Whatareas of concern does the nurse have when administering this drug?(Select all that apply.) a. Causes bronchodilation b. Constricts integumentary smooth muscle c. Dilates the muscular vasculature d. Causes bronchoconstrictione. Causes laryngospasm

- Causes bronchodilationb. - Constricts integumentary smooth musclec. - Dilates the muscular vasculature

Arsenic trioxide (Trisenox)

- Causes fragmentation of DNA resulting in cell death - in acute promyelocytic leukemia, it corrects protein changes and changes malignant cells into normal white blood cells.

Irritant contact dermatitis

- Damage to skin because of irritation and loss of epidermoid skin layer - not an allergic reaction. - caused by excessive use of soaps and cleansers, repeated handwashing, inadequate hand drying, mechanical irritation (e.g., sweating, rubbing inside powdered gloves), exposure to chemicals added during the manufacturing of gloves, and alkaline pH of powdered gloves. * benign, and is not life-threatening.

nitrosoureas side effects

- Delayed and cumulative myelosuppressio, especially thrombocytopenia - nausea, vomiting, pulmonary, hepatic and renal damage

If wet desquamation occurs:

- Do not disrupt any blisters that have formed. - Avoid frequent washing of the area. -Report blistering. - Use prescribed creams or ointments - topical antibacterial creams may help to dry a wet wound (e.g., Silvadene cream) - If area weeps, apply a nonadhesive absorbent dressing. - If the area is without drainage, moisture and vapor-permeable dressings, such as hydrocolloids and hydrogels on noninfected areas, have been used in many settings.

HIV Encephalopathy manifestations

- Early manifestations include memory deficits, headache, difficulty concentrating, progressive confusion, psychomotor slowing, apathy, and ataxia. - Later stages include global cognitive impairments, delay in verbal responses, a vacant stare, spastic paraparesis, hyperreflexia, psychosis, hallucinations, tremor, incontinence, seizures, mutism, and death.

Because allergic rhinitis is induced by airborne pollens or molds, it is characterized by the following seasonal occurrences

- Early spring—tree pollen (oak, elm, poplar) - Early summer—grass pollen (Timothy, Redtop) - Early fall—weed pollen (ragweed)

Genotypic and phenotypic resistance assays are used to assess viral strains and inform selection of treatment strategies. Explain

- Genotypic assays detect drug-resistant mutations present in relevant viral genes - phenotypic assays measure the ability of a virus to grow in different concentrations of ART drugs.

irritant dermatitis treatment

- Identification and removal of source of irritation - Application of hydrophilic cream or petrolatum to soothe and protect - Topical corticosteroids and compresses for weeping lesions - Antibiotics for infection and oral antihistamines for pruritus

Antitumor Antibiotics

- Interfere with DNA synthesis by binding DNA - prevent RNA synthesis

Antimetabolites

- Interferes with the biosynthesis of metabolites or nucleic acids necessary for RNA and DNA synthesis; inhibits DNA replication and repair *Cell cycle—specific (S phase)

preventions for patients with antibody deficiency disorders

- Live vaccines are contraindicated

•M- The absence of presence of distant metastasis

- Mx Distant metastasis cannot be assessed - M0 No distant metastasis - M1 Distant metastasis

N- The absence or presence and extent of regional lymph node metastasis

- Nx Regional lymph nodes cannot be assessed - N0 No regional Lymph nodes metastasis - N1,2,3 Increasing involvement of regional lymph nodes

Superior Vena Cava Syndrome (SVCS) clinical manifestations

- Progressive shortness of breath (dyspnea), cough, hoarseness, chest pain, and facial swelling - Edema of the neck, arms, hands, and thorax and reported sensation of skin tightness, difficulty swallowing, and stridor - engorged and distended jugular, temporal, and arm veins - Dilated thoracic vessels causing prominent venous patterns on the chest wall - Increased intracranial pressure

Irritant contact dermatitis treatment

- Referral for diagnostic testing - Avoidance of exposure to irritant - Thorough washing and drying of hands - Use of powder-free gloves with more frequent changes of gloves - Changing glove types - Use of water- or silicone-based moisturizing creams, lotions, or topical barrier agents - Avoidance of oil- or petroleum-based skin agents with latex products, because they cause breakdown of the latex product

Most immune responses to antigens involve both humoral and cellular responses, although one usually predominates. For example, during transplant rejection, the cellular response involving ___ cells predominates, whereas in the bacterial pneumonias and sepsis, the humoral response involving ____ cells plays the dominant protective role

- T cells - B cells

- A person diagnosed with breast cancer has a TNM staging of T2N1M0. What does that mean?

- The person has a larger than normal or extent of a primary tumor 2 out of 4 - one lymph node involved - no distant metastasis.

When the body is invaded or attacked by bacteria, viruses, or other pathogens, it has three means of defense:

- The phagocytic immune response - The humoral or antibody immune response - The cellular immune response

Why do patients who have burns have an increase risk for infection?

- The skin is the first line of defense against organisms - Body loses proteins (immunoglobulins) - Increased cortisol suppresses the immune system

T- The extent of the primary tumor

- Tx Primary tumor cannot be assessed - T0 No evidence of primary tumor - Tis Carcinoma in situ - T1, T2, T3, T4 Increasing size and/or local extent of the primary tumor

Latex allergy

- Type I IgE-mediated immediate -hypersensitivity to plant proteins in natural rubber latex -Severe reactions usually occur shortly after parenteral or mucous membrane exposure. - risk for anaphylaxis - Local swelling, redness, edema, itching, and systemic reactions, including anaphylaxis, occur within minutes after exposure.

Prevent or minimize hair loss through the following:

- Use scalp hypothermia and scalp tourniquets -Cut long hair before treatment. - gently pat dry, and avoid excessive shampooing. - Avoid curling irons, dryers, clips, barrettes, hair sprays, hair dyes, and permanent waves. - Avoid excessive combing or brushing; use wide-toothed comb.

Cancer-Related Anorexia-Cachexia Syndrome

- a complex biologic process that results from a combination of increased energy expenditure and decreased intake - The patient experiences continued weight loss and malnutrition characterized by loss of adipose tissue, visceral protein, and skeletal muscle mass

pre-exposure prophylaxis (PrEP)

- a way for people who do not have HIV but who are at very high risk of getting HIV to prevent HIV infection by taking a pill every day. The pill (brand name Truvada) contains two medicines (tenofovir and emtricitabine) that are used in combination with other medicines to treat HIV.

Severe systemic reactions anaphylactic reaction

- abrupt onset -symptoms progress rapidly to bronchospasm, laryngeal edema, severe dyspnea, cyanosis, and hypotension. - Dysphagia, abdominal cramping, vomiting, diarrhea, and seizures can also occur. - Cardiac arrest and coma may follow.

Indications of extravasation during administration include:

- absence of blood returned from the IV catheter - resistance to flow of IV fluid - burning or pain, swelling, or redness at the site

spleen function

- acts as a filter for blood as part of the immune system - Old red blood cells are recycled in the spleen - platelets and white blood cells are stored there - fight certain kinds of bacteria that cause pneumonia and meningitis

graft-versus-host disease (GVHD)

- an immune response initiated by T lymphocytes of donor tissue against the recipient's tissues (skin, gastrointestinal tract, liver) * an undesirable response

Bone marrow cells proliferate rapidly, and if sites containing bone marrow (e.g., the iliac crest or sternum) are included in the radiation field, ___________, _________ (decreased white blood cells [WBCs]), and ____________ (a decrease in platelets) may result.

- anemia - leukopenia (decreased white blood cells [WBCs]) -thrombocytopenia (a decrease in platelets)

how would you manage nausea and vomiting in a patient?

- antiemetics (give before chemo starts) -serotonin receptor antagonist (e.g., ondansetron) and a corticosteroid (e.g., dexamethasone), given orally or intravenously. - benzodiazepine (e.g., lorazepam) - limit oral intake for a few hours

Patients need to understand the difference between rescue medications for allergy exacerbation and seasonal flares (e.g., ______________) and medications used for allergy control throughout the year (e.g., _______________, __________).

- antihistamines - inhaled corticosteroids, leukotriene modifiers

Screening for symptoms of TB in HIV patient

- asking for cough of any duration - chest radiography is recommended to exclude TB disease in a patient with a positive skin test or interferon-gamma release assays

How are TSA's used clinically?

- assess the extent of the disease - track the course of illness during chemotherapy and relapse

Familial atypical cold urticaria (FACU)

- autosomal dominant condition - inherited from one affected parent -symptoms usually begin at birth within the first 6 months of life

What will the nurse monitor for postoperatively after a tumor removal?

- bleeding, - infection, - wound dehiscence, - fluid and electrolyte imbalances, - pain management.

CREST stands for

- calcinosis (calcium deposits in the tissues) - Raynaud's phenomenon - esophageal hardening and dysfunction -sclerodactyly (scleroderma of the digits) -telangiectasia (capillary dilation that forms a vascular lesion)

Stomatitis is characterized by:

- changes in sensation -mild redness (erythema), and edema or, if severe, by painful ulcerations, bleeding, and secondary infection.

Cancers with these underlying genetic abnormalities include:

- chronic myelogenous leukemia -meningiomas - acute leukemia - retinoblastomas -Wilms tumor

four major signs and symptoms of allergic rhinitis include

- copious amounts of serous - nasal discharge - nasal congestion - sneezing - nose and throat itching.

Hematopoietic Cytokines

- diverse substances produced mainly by bone marrow and WBCs. - They regulate many cellular activities by acting as chemical messengers among cells and as growth factors for blood cells.

Factors that contribute to the severity of radiation dermatitis include:

- dose and form of radiation - inclusion of skin folds in the irradiated area - increased age - the presence of medical comorbidities

Two types of ionizing radiation

- electromagnetic radiation (x-rays and gamma rays) - particulate radiation (electrons, beta particles, protons, neutrons, and alpha particles)

It has been estimated that the primary cause of death for up to 40% of patients diagnosed with RA is cardiovascular disease. The cause of cardiovascular disease in these patients is thought to be due to:

- elevated lipid values, chronic inflammation - dysfunction of the endothelium - abnormal homocysteine levels

Natural Immunity is composed of

- granulocytes (neurophil, eosinophil, basophil) - monocytes - dentric cells - natural killer cells

Some medications may cause bone marrow toxicity leading to decreases in circulating platelets.

- heparin - vancomycin

examples of viruses that cause cancer?

- human papillomavirus (HPV) - hepatitis B virus (HBV) - Epstein-Barr virus (EBV) (Burkitt lymphoma and nasopharyngeal cancer)

Interferons are used to treat ___________ disorders (e.g., multiple sclerosis) and ____________ conditions (e.g., chronic hepatitis).

- immune-related -chronic inflammatory

Vesicants are those agents that, if deposited into the subcutaneous or surrounding tissues (extravasation), cause:

- inflammation - tissue damage - possibly necrosis of tendons, muscles, nerves, and blood vessels.

pathophysiologic features rheumatologic diseases

- inflammation -autoimmunity -degeneration

Carcinogenesis is thought to be a three-step cellular process:

- initiation, - promotion, - progression

HIV Wasting Syndrome

- involuntary loss of more than 10% of one's body weight while having experienced diarrhea or weakness and fever for more than 30 days. - Wasting refers to the loss of muscle mass, although part of the weight loss may also be due to loss of fat.

Latent TB in a person with HIV infection is treated with ____________, supplemented with _____________ to prevent peripheral neuropathy, for 9 months since it has proven efficacy, good tolerability, and infrequent severe toxicity.

- isoniazid (INH) -pyridoxine (Aminoxin)

problems caused by rheumatic diseases include:

- limitations in mobility and activities of daily living - pain, fatigue, altered self-image - sleep disturbances, as well as systemic effects that can lead to organ failure and death.

lipodystrophy syndrome

- loss or absence of fat, or the abnormal distribution of fat in the body, in HIV infection - lipoatrophy (localized subcutaneous fat loss in the face, arms, legs, and buttocks) - lipohypertrophy (central visceral fat [lipomata] accumulation in the abdomen - dorsocervical region [buffalo hump],

Nurses need to reduce the risk for infection. How? by implementing

- neutropenic precautions - avoiding rectal or vaginal procedures - using electric razors - avoid using stagnant water - reduce exposure to sources of infection

correct way to use a condom

- pinch - leave an inch - roll

primary immune deficiency diseases (PIDDs)

- pt is born with it - diagnosed in infancy

SIT immunotherapy instruction for patient

- remain in the primary provider's office for at least 30 minutes after the injection, so that emergency treatment can be given if the patient has a reaction - avoiding rubbing or scratching the injection site - continuing with the series for the period of time required. * patient and family are instructed about emergency treatment of severe allergic symptoms.

For any frequent or prolonged administration of antineoplastic vesicants, ________________, _____________________, or __________________ should be inserted to promote safety during medication administration and reduce problems with access to the circulatory system

- right atrial silastic catheters - implanted venous access devices - peripherally inserted central catheters (PICCs)

Pap test

- start at 21 -Screening should be done every 3 years

chronic side effects Hematopoietic Stem Cell Transplantation

- sterility - pulmonary, cardiac, renal, neurologic, and hepatic dysfunction - osteoporosis - avascular bone necrosis - diabetes - secondary malignancy

Alterations in oral mucosa secondary to radiation therapy in the head and neck region include:

- stomatitis -decreased salivation and xerostomia -change in or loss of taste -mucositis

Hereditary angioedema clinical manifestations

- swelling usually is diffuse - does not itch - is not accompanied by urticaria. - Gastrointestinal edema may cause abdominal pain severe enough to be incapacitating. - attacks last 2 to 4 days and resolve without intervention - can cause respiratory obstruction and asphyxiation

Some chemotherapy agents damage the kidneys because they impair water secretion, leading to:

- syndrome of inappropriate secretion of antidiuretic hormone (SIADH) - decrease renal perfusion - precipitate end products after cell lysis - cause interstitial nephritis

Interpretation of Skin Test Results - A positive reaction:

- urticarial wheal - localized erythema -pseudopodia (irregular projection at the end of a wheal) with associated erythema * is considered indicative of sensitivity to the corresponding antigen.

implanted vascular access device

- used for administration of medications, fluids, blood products, and nutrition. - The self-sealing septum permits repeated puncture by Huber needles without damage or leakage. *for long term use of vesicants

transcriptase-polymerase chain reaction (RT-PCR)

- used to track viral load and response to treatment of HIV infection - detect HIV in high-risk seronegative people before antibodies are measurable, to confirm a positive EIA result - creen neonate

hypersensitivity reactions (HSRs) are a subgroup of adverse drug reactions that are unexpected and associated with mild or progressively worsening signs and symptoms, such as rash, urticaria, fever, hypotension, cardiac instability, dyspnea, wheezing, throat tightness, and syncope. Immediate HSRs appear within ___ hour of an infusion, while delayed HSRs may occur hours afterward.

-1

Early onset of menses before age ___ and delayed onset of menopause after age ____, null parity (never giving birth), and delayed childbirth after age ____ are all associated with an increased risk of breast cancer.

-12 - 55 -30

Screen for cancer: - annual mammogram starting at age ___, colonoscopy at age ___ every 10 years, annual fecal occult blood test at age ____, PSA at age ____, pap smear every ____ years

-40 -50 -50 -50 - at 21 every 3 years

The use of hyperthermia (thermal therapy), which is the generation of temperatures greater than physiologic fever range (greater than _____°C [____°F]), has been used for many years to destroy cancerous tumors.

-41.5 - 106.7

Acute CINV is experienced in the first 24 hours after chemotherapy with a maximal intensity after ___ -____ hours; delayed CINV occurs 24 hours posttreatment and may last as many as ___ days with a maximal intensity 48-72 hours after drug administration

-5-6 -7

The primary neuroreceptors known to be implicated in CINV are:

-5-hydroxytryptamine (5-HT or serotonin) - dopamine receptor

The risk of bleeding increases when the platelet count decreases below ________________. At platelet counts lower than 10,000/mm3 (0.02 × 1012/L), the risk for spontaneous bleeding is increased

-50,000/mm3 (0.05 × 1012/L)

_______ tests detect antibodies, not HIV itself, while antigen and RNA tests directly detect HIV. The updated CDC recommendations

-Antibody

Endometrial

-At the time of menopause, women at average risk should be informed about risks and symptoms of endometrial cancer and encouraged to report any unexpected bleeding or spotting to their physicians.

Helper T cells

-Attacks foreign invaders (antigens) directly - Initiates and augments inflammatory response

humoral immune response

-B lymphocyte -Produces antibodies or immunoglobulins (IgA, IgD, IgE, IgG, IgM)

Two surrogate markers are used routinely to assess immune function and level of HIV viremia:

-CD4+ T-cell count (CD4+ count) - plasma HIV RNA (viral load).

Cancer Vaccines

-Cancer vaccines mobilize the body's immune response to prevent or treat cancer. These vaccines contain either portions of cancer cells alone or portions of cells in combination with other substances (adjuvants) that can augment or boost immune responses.

Second-Generation H1 Antihistamines (Nonsedating)

-Cetirizine (Zyrtec) -Desloratadine (Clarinex) -Loratadine (Alavert, Claritin) -Fexofenadine (Allegra) -Levocetirizine (Xyzal)

First-Generation H1 Antihistamines (Sedating)

-Diphenhydramine (Benadryl) -Chlorpheniramine (Chlor-Trimeton) -Hydroxyzine (Atarax)

primary radiotherapy modalities

-EBRT - brachytherapy (a form of internal radiation) - systemic (radioisotopes) - contact or surface molds.

Biopsy Types

-Excisional biopsy (for small, easily accessible tumors) - Incisional biopsy (operformed if the tumor mass is too large to be removed) - Needle biopsy (is performed to sample suspicious masses that are easily and safely accessible)

Medical Management for primary immune deficiency diseases (PIDDs)

-Hematopoietic stem cell transplantation (HSCT) - Gene therapy - Patients with antibody deficiencies receive regular Ig replacement therapy including both IV immunoglobulin (IVIG) and subcutaneous immunoglobulin (SCIG) to provide functional antibodies

Primary Chemical Mediators

-Histamine -Eosinophil chemotactic factor of anaphylaxis -Platelet-activating factor -Prostaglandins

diagnostic test for primary immune deficiency diseases (PIDDs)

-Laboratory tests (used to identify antibody deficiencies, cellular (T-cell) defects, neutrophil disorders and complement deficiencies) -complete blood cell count - serum Ig levels (IgG, IgM, and IgA) and antibody responses to vaccines

What are the differences between benign and malignant cells?

-Malignant cells invade tissue - Bening are more well differentiate

Prostate

-Men, age 50+ -

Superior Vena Cava Syndrome (SVCS) nursing intervention

-Monitor cardiopulmonary and neurologic status. -Avoid upper extremity venipuncture and blood pressure measurement - instruct patient to avoid tight or restrictive clothing and jewelry on fingers, wrist, and neck. -semi-Fowler position -avoid completely supine or prone position -Promote energy conservation to -administer fluids cautiously to minimize edema. -radiation-related problems such as mucositis with resultant dysphagia (difficulty swallowing) and esophagitis. -Monitor for chemotherapy-related problems, such as myelosuppression.

how to prevent renal toxicity due to chemotherapy?

-Monitoring laboratory values of blood urea nitrogen (BUN), serum creatinine, creatinine clearance, and serum electrolytes - Adequate hydration - diuresis - alkalinization of the urine to prevent formation of uric acid crystals - administration of allopurinol (Zyloprim)

What should the nurse encourage people to do if they believe there has been an exposure to HIV?

-Pre-exposure prophylaxis (PrEP) might be appropriate. - PrEP involves taking one pill containing two HIV medications daily in order to avoid the risk of sexual HIV acquisition in adults and adolescents of age 12 and 754 older - HIV status should be checked every three months to be sure that the person has not become infected. The ultimate goal of PrEP is to reduce the acquisition of HIV infection with its resulting morbidity, mortality, and cost to individuals and society (US Public Health Service,

Cytomegalovirus Retinitis

-Retinitis caused by CMV is a leading cause of blindness in patients with AIDS.

four most common emergencies related to chemotherapy?

-Superior Vena Cava Syndrome (SVCS) -Spinal Cord Compression -Hypercalcemia -Tumor Lysis Syndrome (TLS)

about 70% to 80% of lymphocytes in the blood are ___ cells, and about 10% to 15% are ___ cells

-T -B

several precautionary steps must be observed before skin testing with allergens is performed:

-Testing is not performed during periods of bronchospasm. - Epicutaneous tests (scratch or prick tests) are performed before other testing methods, in an effort to minimize the risk of systemic reaction. - Emergency equipment must be readily available to treat anaphylaxis.

Carcinogenesis: progression

-The mutant, proliferating cells begin to exhibit malignant behavior. These cells begin to accumulate more and more mutations with each division. * angiogenesis occur

Immunotherapy Contraindications

-The use of beta-blocker or angiotensin-converting enzyme inhibitor therapy (may mask early signs of anaphylaxis) - Presence of significant pulmonary or cardiac disease or organ failure - Inability of the patient to recognize or report signs and symptoms of a systemic reaction - Nonadherence of the patient to other therapeutic regimens and nonlikelihood that the patient will adhere to the immunization schedule (often weekly for an indefinite period) - Inability to monitor the patient for at least 30 minutes after administration of immunotherapy - Absence of equipment or adequate personnel to respond to allergic reaction if one occurs

Gene Therapy

-Tumor-directed therapy (introduction of a therapeutic gene (suicide gene) into tumor cells in an attempt to destroy them.) -Active immunotherapy (administration of genes that will invoke the antitumor responses of the immune system) -Adoptive immunotherapy (dministration of genetically altered lymphocytes that are programmed to cause tumor destruction.)

Mild stomatitis (generalized erythema, limited ulcerations, small white patches: Candida) nursing intervention

-Use normal saline mouth rinses every 1-4 hours. -Use soft toothbrush or toothette. -Remove dentures except for meals -Apply water-soluble lip lubricant -Avoid foods that are spicy or hard to chew

Vascular imaging

-Use of contrast agents that are injected into veins or arteries and monitored by fluoroscopy, CT, or MRI imaging in order to assess tumor vasculature. - Used to assess tumor vascularity prior to surgical procedures. Use in assessing the efficacy of antiangiogenesis (preventing new blood vessel formation) drugs is largely investigational *Liver and brain cancers

intravenous immunoglobulin (IVIG) administration

-acute anaphylactic reaction is a potential side effect - hypotensionand signs of anaphyla - administered promptly after opening containerand infused within 4 hours.

acute fatigue vs cancer-related fatigue

-acute fatigue: occurs after an energy-demanding experience - cancer-related fatigue: a distressing persistent, subjective sense of physical, emotional and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning

Hemorrhagic cystitis is a bladder toxicity that can result from cyclophosphamide and ifosfamide therapy. management

-aggressive IV hydration - frequent voiding, and diuresis - Mesna (Mesnex) is a cytoprotectant agent that binds with the toxic metabolites of cyclophosphamide or ifosfamide in the kidneys to prevent hemorrhagic cystitis.

altered skin integrity due to radiation:

-alopecia (hair loss) -erythema and dry desquamation (flaking of skin) -moist or wet desquamation (dermis exposed, skin oozing serous fluid) -ulceration

AlloHSCTs are used primarily for diseases of the__________ and are dependent on the availability of a human leukocyte antigen-matched donor, which greatly limits the number of possible transplants.

-bone marrow *Allogeneic HSCT (AlloHSCT): From a donor

Carcinogenesis: Initiation

-carcinogens cause mutations in the cellular DNA - cells escape apoptosis (programed cell death)

Pneumocystis Pneumonia

-caused by P. jirovecii -a type of infection of the lungs (pneumonia) in people with a weak immune system. - People with a healthy immune system don't usually get infected with PCP.

Carcinogenesis: Promotion

-co-carcinogens) causes proliferation and expansion of initiated cells - leads to the formation of a preneoplastic or benign (noncancerous) lesion.

Complement has three major physiologic functions:

-defending the body against bacterial infection - bridging natural and acquired immunity - disposing of immune complexes and the by-products associated with inflammation

rheumatic diseases

-encompass autoimmune, degenerative, inflammatory, and systemic conditions that affect the joints, muscles, and soft tissues of the body. - most commonly manifest the clinical features of arthritis -

Severe late effects of radiation include:

-fibrosis, atrophy, ulceration, and necrosis * may affect the lungs, heart, central nervous system, and bladder.

peripherally inserted central catheters (PICCs)

-for long term use of vesicants

Measures to avoid bleeding include:

-giving oprelvekin to stimulate platelet production and prevent thrombocytopenia - avoiding trauma, including venipuncture and injections, when possible - using an electric razor for shaving - stop brushing and flossing the teeth.

myelosuppression management

-granulocyte colony-stimulating factor [G-CSF] and granulocyte-macrophage colony-stimulating factor [GM-CSF] -Erythropoietin (EPO) - Interleukin 11 (IL-11)

Uses of Intravenous Immunoglobulin Replacement Therapy (IVIG)

-has been used in primary immunodeficiency diseases (PI), other immune deficiency disorders, and in a variety of inflammatory and autoimmune diseases. - Most immunologists strongly discourage the use of central catheters to administer IVIG due to the increased risk of serious blood infections.

Subcutaneous Immunotherapy

-most common method -serial injection of one or more antigens that are selected in each particular case on the basis of skin testing. -Specific treatment consists of injecting extracts of the allergens that cause symptoms in a particular patient. -patient must be monitored after administration of immunotherapy. - Maintenance booster injections are given at 2- to 4-week intervals for a period of several years,

Myelosuppression due to chemotherapy is predictable. What do we see?

-patients blood counts are lowest 7 to 14 days after chemotherapy has been given -fever associated with neutrophil count less than 1,500 cells/mm3 *Frequent monitoring of blood cell counts is essential

Antibody functions

-phagocyte signaling -antigen clumping -prevention of cell entry -complement protein signaling

lymph nodes function:

-remove foreign material from the lymph system before it enters the bloodstream. - serve as centers for immune cell proliferation - contain immune cells that defend the body's mucosal surfaces against microorganism

Several assessment findings are associated with RA:

-rheumatoid nodules - joint inflammation detected on palpation -bilateral and symmetric stiffness, tenderness, swelling, and temperature changes in the joints.

most common food to cause allergies

-seafood (lobster, shrimp, crab, clams, fish) - peanuts, tree nuts - berries - eggs - wheat - milk - chocolate

Atopy

-state of hypersensitivity to an allergen-allergic -genetic predisposition -asthma, allergic rhinitis, and atopic dermatitis

Oprelvekin (Neumega)

-stimulates platelet production -This drug is used to prevent severe thrombocytopenia and reduce the need for platelet transfusions in adults with nonmyeloid cancer receiving myelosuppressive chemotherapy and are at high risk for thrombocytopenia.

Interleukin 11 (IL-11)

-stimulates the production of megakaryocytes (precursors to platelets) and can be used to prevent and treat severe thrombocytopenia but has had limited use because of toxicities, such as HSR; capillary leak syndrome; pulmonary edema; atrial dysrhythmias; and nausea, vomiting, and diarrhea

Chemotherapy is used primarily to treat _________ disease rather than _________ lesions that are amenable to surgery or radiation.

-systemic -localized

Severe stomatitis (confluent ulcerations with bleeding and white patches covering >25% of oral mucosa) nursing intervention

-tissue samples for culture - ability to chew and swallow,assess gag reflex -place patient on side and irrigate mouth; have suction available. -Remove dentures. - toothette or gauze soaked with solution for cleansing. -water-soluble lip lubricant. -liquid or pureed diet -Monitor for dehydration. -Consult primary provider for use of topical anesthetic, such as dyclonine and diphenhydramine, or viscous lidocaine.

anaphylactoid response

-triggered by non-immunoglobulin E (IgE)-mediated events - This nonallergenic anaphylaxis reaction may occur with medications, food, exercise, or cytotoxic antibody transfusions.

Nursing management during stem cell infusion:

-vital signs and blood oxygen saturation - assessing for adverse effects - providing strategies for symptom control, ongoing support, and patient education.

woman-controlled methods to prevent HIV

-woman-controlled methods -microbicides

IgE antibodies

0.002% of serum antibodies - Appears in serum - Takes part in allergic and some hypersensitivity reactions - Combats parasitic infections

IgD antibodies

0.2 % - Appears in small amounts in serum - Possibly influences B-lymphocyte differentiation, but role is unclear

Creatinine normal range

0.7-1.4 mg/dL (62-124 mcmol/L)

Chronic rhinitis accounts for an average of ____ to ____ missed work days per patient per year

1 to 2

The onset of gradually progressing alopecia and body hair loss associated with targeted therapies generally occurs ___ to ____ months after the start of treatment and may be patchy appearing as temporal or frontal hair loss.

1 to 3

Stereotactic body radiotherapy (SBRT) is delivered with considerably higher treatment fraction doses over a short span of time, usually __ to __ treatment days, in contrast to daily treatments for 5 days per week for 6 to 8 weeks for conventional EBRT.

1 to 5

The acquired immune response is broadly divided into two mechanisms:

1) the cell-mediated response, involving T-cell activation (2) effector mechanisms, involving B-cell maturation and production of antibodies

HIV Wasting Syndrome is defined as the involuntary loss of more than ____% of one's body weight while having experienced diarrhea or weakness and fever for more than ____days.

10 30

GVHD may be acute, occurring within the first ___ days, or chronic, occurring after 100 days

100

Stomatitis affects up to ____% of patients undergoing high-dose chemotherapy with HSCT, ____% of patients with malignancies of the head and neck receiving radiotherapy, and up to ____% of patients receiving standard-dose chemotherapy

100 80 40

Thrombocytopenia, a decrease in the circulating platelet count, is the most common cause of bleeding in patients with cancer and is usually defined as a platelet count less than ______________________________

100,000/mm3 (0.1 × 1012/L).

Educate clients as to signs and symptoms of infection and to report temperature over _______ immediately to the provider

100.4

Placing patient in private room if absolute WBC count <___________/mm3.

1000

about ________% of all cancers worldwide are linked to viral infections

11

Achieving viral suppression requires the use of ART with at least two, and preferably three, active drugs from two or more drug classes and should occur within the first _____ TO ____ weeks of therapy especially if the patient is new to ART

12 to 24

educate on avoiding carcinogens (smoking), limiting alcohol and caloric intake and increasing activity level, using sunscreen with a minimum SPF of ____, limiting sun exposure and using condoms

15

IgA antibodies

15% - Appears in body fluids (blood, saliva, tears, and breast milk, as well as pulmonary, gastrointestinal, prostatic, and vaginal secretions) -Protects against respiratory, gastrointestinal, and genitourinary infections -Prevents absorption of antigens from food -Passes to neonate in breast milk for protection

While monitoring the patient's eosinophil level, the nurse suspects a definite allergic disorder when seeing an eosinophil value of what percentage of the total leukocyte count? 3% to 4% 5% to 10% 15% to 40% 1% to 3%

15% to 40%

What are the normal platelet counts?

150,000-400,000

Normal platelet count

150,000-400,000/mm3

The HIV antibody test, an enzyme immunoassay (EIA), became available in _________, allowing early diagnosis of the infection before the onset of symptoms.

1984

Pathophysiology and associated physical signs of rheumatoid arthritis.

1st. -presentation of antigen to T cell 2nd. -T and B cell proliferation -angiogenesis in synovial lining 3rd. -neutrophil accumulation in synovial fluid -cell proliferation - no cartilage invasion 4th. synovitis -ealsy pannus invasion of cartilage - condrocyte proliferation - laxity of ligament

How is Intradermal testing performed

1st. A 0.5- or 1-mL sterile syringe with a 26/27-gauge intradermal needle is used to inject 0.02 to 0.03 mL of intradermal allergen. 2nd. The needle is inserted with the bevel facing upward and the syringe parallel to the skin. 3rd. The skin is penetrated superficially, and a small amount of the allergen solution is injected to create a bleb (raised area) approximately 5 mm in diameter. 4th. A separate sterile syringe and needle are used for each injection.

Diagnosis of Cancer

1st. Determine presence, extent of tumor 2nd. Identify possible spread (metastasis) of disease or invasion of other body tissues 3rd. Evaluate function of involved, uninvolved body systems, organs 4th. Obtain tissue, cells for analysis, including evaluation of tumor stage, grade

Acute or early toxicities most often begin within ____ weeks of the initiation of treatment occur when normal cells within the treatment area are damaged and cellular death exceeds regeneration.

2

A patient comes to the clinic with pruritus and nasal congestion after eating shrimp for lunch. The nurse is aware that the patient may be having an anaphylactic reaction to the shrimp. These symptoms typically occur within how many hours after exposure? 6 hours 12 hours 24 hours 2 hours

2 hours

Hyperpigmentation, a less severe radiation-associated skin reaction, may develop about __ to __ weeks after the initiation of treatment

2 to 4

If the patient is to undergo SIT immunotherapy, the nurse reinforces the primary provider's explanation regarding the purpose and procedure. Instructions are given regarding the series of injections, which usually are given initially every week and then at ____ to _____ -week intervals.

2- to 4

nonsmokers who live with a smoker have about a ____% to ____% greater risk of developing lung cancer

20% to 30%

A patient received epinephrine in response to an anaphylactic reaction at 10:00 AM. The nurse knows to observe the patient for a "rebound" reaction that may occur as early as: 6:00 PM. 2:00 PM. 4:00 PM. 10:00 PM.

2:00 PM.

Combination estrogen and progesterone therapy is linked to a higher risk of breast cancer. The longer the combined therapy is used, the higher the risk. However, within ____ years of stopping the hormones, the risk returns to that of a woman who never used this therapy.

3

HIV status should be checked every ____ months to be sure that the person has not become infected

3

a patient is infected with HIV after sharing needles with another IVdrug abuser. Upon infection with HIV, the immune system respondsby making antibodies against the virus, usually within how manyweeks after infection?

3 to 12 weeks

antiallergy medication, allergen immunotherapy has the potential to alter the allergic disease course after ____ to ___ years of therapy. Because it may prevent the progression or development of asthma or multiple or additional allergies, it is also considered to be a potential preventive measure

3 to 5

Instruct patients to avoid sunlight through use of protective clothing, use of sun screen with SPF of ____ with physical blockers (zinc oxide, titanium dioxide), or avoidance of direct sun exposure.

30

Anthracyclines (e.g., daunorubicin, doxorubicin) are known to cause irreversible cumulative cardiac toxicities, especially when total dosage reaches ______ mg/m2 and _____ mg/m2, respectively

300 550

Patients should be advised that a "rebound" anaphylactic reaction canoccur ________ hours after an initial attack, even when epinephrinehas been given.

4 to 10

At what age should someone receive a baseline mammogram?

40, unless history of breast cancer, then baseline should be at 30 y/o

Eosinophils, which are granular leukocytes, normally make up 2% to 5% of the total number of WBCs. They can be found in blood, sputum, and nasal secretions. A level greater than___ to ____ is considered abnormal and may be found in patients with allergic disorders

5% to 10%

normal white blood cell count

5,000-10,000

What level of SPF should be used to help prevent skin cancer?

50 SPF

An adequate CD4+ response for most patients on ART is an increase in CD4+ count in the range of _______ to ______ mm3 per year, generally with an accelerated response in the first 3 months

50 to 150

normal CD4 count

500 to 1,500 cells

Primary or acute infection is characterized by high levels of viral replication, widespread dissemination of HIV throughout the body, and destruction of CD4+ T cells, which leads to dramatic drops in CD4+ T-cell counts (normally ______ to ____________)

500 to 1,500 cells/

For certain chemotherapeutic agents, there is a maximum lifetime dose limit that must be adhered to because of the danger of long-term irreversible organ complications (e.g., because of the risk of cardiomyopathy, doxorubicin [Adriamycin] has a cumulative lifetime dose limit of _______ mg/m2).

550

The American College of Rheumatology and the European League Against Rheumatism have collaborated and established new criteria for classifying RA. These criteria are based on a point system where a total score of ___ or greater is required for the diagnosis of RA.

6

Most people have about ____________ to ____________ CD4+ cells/mm3, but a level as low as 500 cells/mm3 can be considered within normal limits.

700 to 1,000

post-exposure prophylaxis (PEP) includes taking antiretroviral medicines as soon as possible, but no more than____ hours (3 days) after possible HIV exposure; two to three drugs are usually prescribed which must be taken for _____ days.

72 28

_____% of all cancer diagnoses are in people 55 years of age or older.

78

set point varies greatly from patient to patient and dictates the subsequent rate of disease progression; on average, ______ to _____ years can pass before a major HIV-related complication develops.

8 to 10

Normal calcium levels

8.5-10.5 mg/dL

Scleroderma starts insidiously with Raynaud's phenomenon and swelling in the hands. Raynaud's phenomenon is observed in _______% of patients with scleroderma and can precede the official scleroderma diagnosis for years

90

The lethal tumor dose is defined as the dose that will eradicate ______% of the tumor yet preserve normal tissue.

95

During a mumps outbreak at a local school, a patient, who is a school teacher, is exposed. She has previously been immunized for mumps. What type of immunity does she possess? A) Acquired immunity B) Natural immunity C) Phagocytic immunity D) Humoral immunity

A (Feedback: Acquired immunity usually develops as a result of prior exposure to an antigen, often through immunization. When the body is attacked by bacteria, viruses, or other pathogens, it has three means of defense. The first line of defense, the phagocytic immune response, involves the WBCs that have the ability to ingest foreign particles. A second protective response is the humoral immune response, which begins when the B lymphocytes transform themselves into plasma cells that manufacture antibodies. The natural immune response system is rapid, nonspecific immunity present at birth.)

Patient teaching regarding infection prevention for the patient with an immunodeficiency includes which of the following guidelines? A) Cook all food thoroughly. B) Refrain from using creams or emollients on skin. C) Maintain contact only with individuals who have recently been vaccinated. D) Take OTC vitamin supplements consistently.

A (Feedback: All foods must be cooked to avoid food-borne illness. The patient should avoid contact with individuals who have recently been ill or vaccinated. The nurse should apply creams and emollients to any dry, chaffed, or cracked skin. Vitamin supplements may or may not be indicated.)

Family members of an immunocompromised patient have asked the nurse why antibiotics are not being given to the patient in order to prevent infection. How should the nurse best respond? A) "Using antibiotics to prevent infections can cause the growth of drug-resistant bacteria." B) "If an antibiotic is given to prevent a bacterial infection, the patient is at risk of a viral infection." C) "Antibiotics can never prevent an infection; they can only cure an infection that is fully developed." D) "Antibiotics cannot resolve infections in people who are immunocompromised."

A (Feedback: Although prophylactic drug treatment effectively prevents some bacterial and fungal infections, it must be used with caution because it has been implicated in the emergence of resistant organisms. Use of antibiotics does not directly increase the risk of viral infections.)

A nurse is preparing to administer a scheduled dose of IVIG to a patient who has a diagnosis of severe combined immunodeficiency disease (SCID). What medication should the nurse administer prior to initiating the infusion? A) Diphenhydramine B) Ibuprofen C) Hydromorphone D) Fentanyl

A (Feedback: Diphenhydramine and acetaminophen are administered 30 minutes prior to an IVIG infusion.)

A patient has undergone treatment for septic shock and received high doses of numerous antibiotics during the course of treatment. When planning the patient's subsequent care, the nurse should be aware of what potential effect on the patient's immune function? A) Bone marrow suppression B) Uncontrolled apoptosis C) Thymus atrophy D) Lymphoma

A (Feedback: Large doses of antibiotics can precipitate bone marrow suppression, affecting immune function. Antibiotics are not noted to cause apoptosis, thymus atrophy, or lymphoma.)

A patient with Wiskott-Aldrich syndrome is admitted to the medical unit. The nurse caring for the patient should prioritize which of the following? A) Protective isolation B) Fresh-frozen plasma administration C) Chest physiotherapy D) Nutritional supplementation

A (Feedback: Patients with Wiskott-Aldrich syndrome (WAS) are at a grave risk for infection; infection prevention is a priority aspect of nursing care. Nutritional supplementation may be necessary, but infection prevention is paramount. Chest physiotherapy and FFP administration are not indicated.)

The nurse is caring for a patient who has a diagnosis of paroxysmal nocturnal hemoglobinuria. When planning this patient's care, the nurse should recognize the patient's heightened risk of what complication? A) Venous thromboembolism B) Acute respiratory distress syndrome (ARDS) C) Myocardial infarction D) Hypertensive urgency

A (Feedback: Patients with paroxysmal nocturnal hemoglobinuriahave a high incidence of life-threatening venous thrombosis, which occurs most commonly in the abdominal and cerebral veins. This health problem is not linked to ARDS, MI, or hypertensive urgency.)

A patient is vigilant in her efforts to "take good care of herself" but is frustrated by her recent history of upper respiratory infections and influenza. What aspect of the patient's lifestyle may have a negative effect on immune response? A) The patient works out at the gym twice daily. B) The patient does not eat red meats. C) The patient takes over-the-counter dietary supplements. D) The patient sleeps approximately 6 hours each night.

A (Feedback: Rigorous exercise or competitive exercise—usually considered a positive lifestyle factor—can be a physiologic stressor and cause negative effects on immune response. The patient's habits around diet and sleep do not present obvious threats to immune function.)

A woman has been diagnosed with breast cancer and is being treated aggressively with a chemotherapeutic regimen. As a result of this regimen, she has an inability to fight infection due to the fact that her bone marrow is unable to produce a sufficient amount of what? A) Lymphocytes B) Cytoblasts C) Antibodies D) Capillaries

A (Feedback: The white blood cells involved in immunity (including lymphocytes) are produced in the bone marrow. Cytoblasts are the protoplasm of the cell outside the nucleus. Antibodies are produced by lymphocytes, but not in the bone marrow. Capillaries are small blood vessels)

A patient's exposure to which of the following microorganisms is most likely to trigger a cellular response? A) Herpes simplex B) Staphylococcus aureus C) Pseudomonas aeruginosa D) Beta hemolytic Streptococcus

A (Feedback: Viral, rather than bacterial antigens, induce a cellular response.)

A patient with an exacerbation of systemic lupus erythematosus (SLE) has been hospitalized on the medical unit. The nurse observes that the patient expresses angerand irritation when her call bell isn't answered immediately. What would be the most appropriate response? A) "You seem like you're feeling angry. Is that something that we could talk about?" B) "Try to remember that stress can make your symptoms worse." C) "Would you like to talk about the problem with the nursing supervisor?" D) "I can see you're angry. I'll come back when you've calmed down."

A (The changes and the unpredictable course of SLE necessitate expert assessment skills and nursing care, as well as sensitivity to the psychological reactions of the patient. Offering to listen to the patient express anger can help the nurse and the patient understand its cause and begin to deal with it. Although stress can exacerbate the symptoms of SLE, telling the patient to calm down doesn't acknowledge her feelings. Ignoring the patient's feelings suggests that the nurse has no interest in what the patient has said. Offering to get the nursing supervisor also does not acknowledge the patient's feelings.)

A nurse is planning the care of a patient who has a long history of chronic pain, which has only recently been diagnosed as fibromyalgia. What nursing diagnosis is most likely to apply to this woman's care needs? A) Ineffective Role Performance Related to Pain B) Risk for Impaired Skin Integrity Related to Myalgia C) Risk for Infection Related to Tissue Alterations D) Unilateral Neglect Related to Neuropathic Pain

A (Typically, patients with fibromyalgia have endured their symptoms for a long period of time. The neuropathic pain accompanying FM can often impair a patient's ability to perform normal roles and functions. Skin integrity is unaffected and the disease has no associated infection risk. Activity limitations may result in neglect, but not of a unilateral nature.)

A patient's decreased mobility is ultimately the result of an autoimmune reaction originating in the synovial tissue, which caused the formation of pannus. This patient has been diagnosed with what health problem? A) Rheumatoid arthritis (RA) B) Systemic lupus erythematosus C) Osteoporosis D) Polymyositis

A (Feedback: In RA, the autoimmune reaction results in phagocytosis, producing enzymes within the joint that break down collagen, cause edema and proliferation of the synovial membrane, and ultimately form pannus. Pannus destroys cartilage and bone. SLE, osteoporosis, and polymyositis do not involve pannus formation.)

A patient has a diagnosis of rheumatoid arthritis and the primary care provider has now prescribed cyclophosphamide (Cytoxan). The nurse's subsequent assessments should address what potential adverse effect? A) Infection B) Acute confusion C) Sedation D) Malignant hyperthermia

A (Feedback: When administering immunosuppressives such as Cytoxan, the nurse should be alert to manifestations of bone marrow suppression and infection. Confusion and sedation are atypical adverse effects. Malignant hyperthermia is a surgical complication and not a possible adverse effect.)

A patient is undergoing diagnostic testing to determine the etiology of recent joint pain. The patient asks the nurse about the difference between osteoarthritis (OA) and rheumatoid arthritis (RA). What is the best response by the nurse? A) "OA is a considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." B) "OA and RA are very similar. OA affects the smaller joints such as the fingers, and RA affects the larger, weight-bearing joints like the knees." C) "OA originates with an infection. RA is a result of your body's cells attacking one another." D) "OA is associated with impaired immune function; RA is a consequence of physical damage."

A - OA is a degenerative arthritis with a noninflammatory etiology, characterized by the loss of cartilage on the articular surfaces of weight-bearing joints, with spur development. - RA is characterized by inflammation of synovial membranes and surrounding structures.

A patient who has been newly diagnosed with systemic lupus erythematosus (SLE) has been admitted to the medical unit. Which of the following nursing diagnoses is the most plausible inclusion in the plan of care? A) Fatigue Related to Anemia B) Risk for Ineffective Tissue Perfusion Related to Venous Thromboembolism C) Acute Confusion Related to Increased Serum Ammonia Levels D) Risk for Ineffective Tissue Perfusion Related to Increased Hematocrit

A Patients with SLE nearly always experience fatigue, which is partly attributable to anemia. Ammonia levels are not affected and hematocrit is typically low, not high. VTE is not one of the central complications of SLE.)

The nurse is preparing to care for a patient who has scleroderma. The nurse refers to resources that describe CREST syndrome. Which of the following is a component of CREST syndrome? A) Raynaud's phenomenon B) Thyroid dysfunction C) Esophageal varices D) Osteopenia

A The "R" in CREST stands for Raynaud's phenomenon.

A nurse is working with a patient with rheumatic disease who is being treated with salicylate therapy. What statement would indicate that the patient is experiencing adverse effects of this drug? A) "I have this ringing in my ears that just won't go away." B) "I feel so foggy in the mornings and it takes me so long to wake up." C) "When I eat a meal that's high in fat, I get really nauseous." D) "I seem to have lost my appetite, which is unusual for me."

A - Tinnitus is associated with salicylate therapy.

An infection control nurse is presenting an inservice reviewing the immune response. The nurse describes the clumping effect that occurs when an antibody acts like a cross-link between two antigens. What process is the nurse explaining? A) Agglutination B) Cellular immune response C) Humoral response D) Phagocytic immune response

A Agglutination refers to the clumping effect occurring when an antibody acts as a cross-link between two antigens. This takes place within the context of the humoral immune response, but is not synonymous with it.

The nurse is providing care for a patient who has multiple sclerosis. The nurse recognizes the autoimmune etiology of this disease and the potential benefits of what treatment? A) Stem cell transplantation B) Serial immunizations C) Immunosuppression D) Genetic engineering

A Clinical trials using stem cells are under way in patients with a variety of disorders having an autoimmune component, including multiple sclerosis. Immunizations and genetic engineering are not used to treat multiple sclerosis. * Immunosuppression would exacerbate symptoms of MS

A patient with a history of dermatitis takes corticosteroids on a regular basis. The nurse should assess the patient for which of the following complications of therapy? A) Immunosuppression B) Agranulocytosis C) Anemia D) Thrombocytopenia

A Corticosteroids such as prednisone can cause immunosuppression. Corticosteroids do not typically cause agranulocytosis, anemia, or low platelet counts.

A home health nurse is caring for a patient who has an immunodeficiency. What is the nurse's priority action to help ensure successful outcomes and a favorable prognosis? A) Encourage the patient and family to be active partners in the management of the immunodeficiency. B) Encourage the patient and family to manage the patient's activity level and activities of daily living effectively. C) Make sure that the patient and family understand the importance of monitoring fluid balance. D) Make sure that the patient and family know how to adjust dosages of the medications used in treatment.

A Encouraging the patient and family to be active partners in the management of the immunodeficiency is the key to successful outcomes and a favorable prognosis. This transcends the patient's activity and functional status. Medications should not be adjusted without consultation from the primary care provider. Fluid balance is not normally a central concern.

A nurse is caring for a 78-year-old patient with a history of osteoarthritis (OA). When planning the patient's care, what goal should the nurse include? A) The patient will express satisfaction with her ability to perform ADLs. B) The patient will recover from OA within 6 months. C) The patient will adhere to the prescribed plan of care. D) The patient will deny signs or symptoms of OA.

A Feedback: Pain management and optimal functional ability are major goals of nursing interventions for OA. Cure is not a possibility and it is unrealistic to expect a complete absence of signs and symptoms. Adherence to the plan of care is highly beneficial, but this is not the priority goal of care.

An HIV-infected patient presents at the clinic for a scheduled CD4+ count. The results of the test are 45 cells/mL, and the nurse recognizes the patient's increased risk for Mycobacterium aviumcomplex (MAC disease). The nurse should anticipate the administration of what drug? A) Azithromycin B) Vancomycin C) Levofloxacin D) Fluconazole

A HIV-infected adults and adolescents should receive chemoprophylaxis against disseminatedMycobacterium avium complex (MAC disease) if they have a CD4+ count less than 50 cells/µL. Azithromycin (Zithromax) or clarithromycin (Biaxin) are the preferred prophylactic agents.

A gardener sustained a deep laceration while working and requires sutures. The patient is asked about the date of her last tetanus shot, which is over 10 years ago. Based on this information, the patient will receive a tetanus immunization. The tetanus injection will allow for the release of what? A) Antibodies B) Antigens C) Cytokines D) Phagocytes

A Immunizations activate the humoral immune response, culminating in antibody production. Antigens are the substances that induce the production of antibodies. Immunizations do not prompt cytokine or phagocyte production

The nurse is caring for a patient with an immunodeficiency who has experienced sudden malaise. The nurse's colleague states, "I'm pretty sure that it's not an infection, because the most recent blood work looks fine." What principle should guide the nurse's response to the colleague? A) Immunodeficient patients will usually exhibit subtle and atypical signs of infection. B) Infections in immunodeficient patients have a slower onset but a more severe course. C) Laboratory blood work is often inaccurate in immunodeficient patients. D) Immunodeficient patients do not develop symptoms of infection.

A Immunodeficient patients often lack the typical objective and subjective signs and symptoms of infection. However, this does not mean that they wholly lack symptoms. Infections do not normally have a slower onset. Blood work may not be a reliable diagnostic tool, but that does not mean that the results are inaccurate.

A nurse is admitting a patient with an immunodeficiency to the medical unit. In planning the care of this patient, the nurse should assess for what common sign of immunodeficiency? A) Chronic diarrhea B) Hyperglycemia C) Rhinorrhea D) Contact dermatitis

A The cardinal symptoms of immunodeficiency include chronic or recurrent severe infections, infections caused by unusual organisms or organisms that are normal body flora, poor response to treatment of infections, and chronic diarrhea.

A nurse is assessing the skin integrity of a patient who has AIDS. When performing this inspection, the nurse should prioritize assessment of what skin surfaces? A) Perianal region and oral mucosa B) Sacral region and lower abdomen C) Scalp and skin over the scapulae D) Axillae and upper thorax

A The nurse should inspect all the patient's skin surfaces and mucous membranes, but the oral mucosa and perianal region are particularly vulnerable to skin breakdown and fungal infection.

Intradermal testing

A 0.5- or 1-mL sterile syringe with a 26/27-gauge intradermal needle is used to inject 0.02 to 0.03 mL of intradermal allergen.

A patient who has developed kidney failure is discussing options with the healthcare provider for treatment. What does the nurse understand that kidney failure is associated with? a. A deficiency in circulating lymphocytes b. A deficiency in phosphorus c. Decreased amount of WBCs d. Increased amount of macrophages

A deficiency in circulating lymphocytes

Atopic allergic disorders are characterized by which of the following? a)An IgA-mediated reaction b)A hereditary predisposition c)Production of a systemic reaction d)A response to physiologic allergens

A hereditary predisposition Explanation: Atopic allergic disorders are characterized by a hereditary predisposition and production of a local reaction to IgE antibodies produced in response to common environmental allergens. Atopic allergic disorders are characterized by a hereditary predisposition and production of a local reaction to IgE antibodies produced in response to common environmental allergens. Atopic and nonatopic allergic disorders are IgE-mediated allergic reactions

Erythropoietin

A hormone produced and released by the kidney that stimulates the production of red blood cells by the bone marrow.

Natural Killer Cells

A type of white blood cell that can kill tumor cells and virus-infected cells; an important component of innate immunity.

An office worker takes a cupcake that contains peanut butter. He begins wheezing, with an inspiratory stridor and air hunger and the occupational health nurse is called to the office. The nurse should recognize that the worker is likely suffering from which type of hypersensitivity? A) Anaphylactic (type 1) B) Cytotoxic (type II) C) Immune complex (type III) D) Delayed-type (type IV)

A) Anaphylactic (type 1) anaphylaxis is characterized by edema in many tissues, including the larynx, and is often accompanied by hypotension, bronchospasm, and cardiovascular collapse in severe cases.

The nurse is providing care for a patient who has experienced a type I hypersensitivity reaction. What condition is an example of such a reaction? A) Anaphylactic reaction after a bee sting B) Skin reaction resulting from adhesive tape C) Myasthenia gravis D) Rheumatoid arthritis

A) Anaphylactic reaction after a bee sting b) is a type IV C) type II D) type III

A school nurse is caring for a child who appears to be having an allergic response. What should be the initial action of the school nurse? A) Assess for signs and symptoms of anaphylaxis. B) Assess for erythema and urticaria. C) Administer an OTC antihistamine. D) Administer epinephrine.

A) Assess for signs and symptoms of anaphylaxis.

A patient has been brought to the emergency department by EMS after being found unresponsive. Rapid assessment reveals anaphylaxis as a potential cause of the patients condition. The care team should attempt to assess for what potential causes of anaphylaxis? Select all that apply. A) Foods B) Medications C) Insect stings D) Autoimmunity E) Environmental pollutants

A) Foods B) Medications C) Insect stings

A patient with multiple food and environmental allergies tells the nurse that he is frustrated and angry about having to be so watchful all the time and wonders if it is really worth it. What would be the nurses best response? A) I can only imagine how you feel. Would you like to talk about it? B) Lets find a quiet spot and Ill teach you a few coping strategies. C) Thats the same way that most patients who have a chronic illness feel. D) Do you think that maybe you could be managing things more efficiently

A) I can only imagine how you feel. Would you like to talk about it?

A patient has been admitted to the emergency department with signs of anaphylaxis following a bee sting. The nurse knows that if this is a true allergic reaction the patient will present with what alteration in laboratory values? A) Increased eosinophils B) Increased neutrophils C) Increased serum albumin D) Decreased blood glucos

A) Increased eosinophils

After the completion of testing, a childs allergies have been attributed to her familys cat. When introducing the family to the principles of avoidance therapy, the nurse should promote what action? A) Removing the cat from the familys home B) Administering OTC antihistamines to the child regularly C) Keeping the cat restricted from the childs bedroom D) Maximizing airflow in the house

A) Removing the cat from the familys home

The nurse is planning the care of a patient who has a diagnosis of atopic dermatitis, which commonly affects both of her hands and forearms. What risk nursing diagnosis should the nurse include in the patients care plan? A) Risk for Disturbed Body Image Related to Skin Lesions B) Risk for Disuse Syndrome Related to Dermatitis C) Risk for Ineffective Role Performance Related to Dermatitis D) Risk for Self-Care Deficit Related to Skin Lesion

A) Risk for Disturbed Body Image Related to Skin Lesions

A nurse has asked the nurse educator if there is any way to predict the severity of a patients anaphylactic reaction. What would be the nurses best response? A) The faster the onset of symptoms, the more severe the reaction. B) The reaction will be about one-third more severe than the patients last reaction to the same antigen. C) There is no way to gauge the severity of a patients anaphylaxis, even if it has occurred repeatedly in the past. D) The reaction will generally be slightly less severe than the last reaction to the same antigen.

A) The faster the onset of symptoms, the more severe the reaction.

A patient has sought care, stating that she developed hives overnight. The nurses inspection confirms the presence of urticaria. What type of allergic hypersensitivity reaction has the patient developed? A) Type I B) Type II C)MType III D) Type IV

A) Type I

A 5-year-old boy has been diagnosed with a severe food allergy. What is an important parameter to address when educating the parents of this child about his allergy and care? A) Wear a medical identification bracelet. B) Know how to use the antihistamine pen. C) Know how to give injections of lidocaine. D) Avoid live attenuated vaccinations.

A) Wear a medical identification bracelet.

A nurse is completing a nutritional status of a patient who has been admitted with AIDS-related complications. What components should the nurse include in this assessment? Select all that apply. A) Serum albumin level B) Weight history C) White blood cell count D) Body mass index E) Blood urea nitrogen (BUN) level

A, B, D, E Nutritional status is assessed by obtaining a dietary history and identifying factors that may interfere with oral intake, such as anorexia, nausea, vomiting, oral pain, or difficulty swallowing. In addition, the patient's ability to purchase and prepare food is assessed. Weight history (i.e., changes over time); anthropometric measurements; and blood urea nitrogen (BUN), serum protein, albumin, and transferrin levels provide objective measurements of nutritional status.

A patient is prescribed telithromycin 800 mg orally for community-acquired pneumonia. Prior to administering the medication, the nurse reviews the patient's laboratory values. Which of the following laboratory values would recommend a reduction in dosage to 400 mg? (Select all that apply.) A. creatinine, 3.3 mg per dL B. alanine aminotransferase, 98 units per L C. aspartate aminotransferase, 60 units per L D. sodium, 145 mEq per L

A, B, and C. The creatinine, alanine aminotransferase, and aspartate aminotransferase are all elevated, indicating diminished renal and hepatic function. It is necessary to reduce the telithromycin dosage in the presence of renal and hepatic impairment.

A patient has been admitted to a medical unit with a diagnosis of polymyalgia rheumatica (PMR). The nurse should be aware of what aspects of PMR? Select all that apply. A) PMR has an association with the genetic marker HLA-DR4. B) Immunoglobulin deposits occur in PMR. C) PMR is considered to be a "wear-and-tear" disease. D) Foods high in purines exacerbate the biochemical processes that occur in PMR. E) PMR occurs predominately in Caucasians.

A,B,E (The underlying mechanism involved with polymyalgia rheumatica is unknown. This disease occurs predominately in Caucasians and often in first-degree relatives. An association with the genetic marker HLA-DR4 suggests a familial predisposition. Immunoglobulin deposits in the walls of inflamed temporal arteries also suggest an autoimmune process. Purines are unrelated and it is not a result of physical degeneration.)

The nurse is applying standard precautions in the care of a patient who has an immunodeficiency. What are key elements of standard precautions? Select all that apply. A) Using appropriate personal protective equipment B) Placing patients in negative-pressure isolation rooms C) Placing patients in positive-pressure isolation rooms D) Using safe injection practices E) Performing hand hygiene

A,D,E (Feedback: Some of the key elements of standard precautions include performing hand hygiene; using appropriate personal protective equipment, depending on the expected type of exposure; and using safe injection practices. Isolation is an infection control strategy but is not a component of standard precautions.)

A teenage boy receives a prescription for erythromycin for an upper respiratory tract infection. He complains that he cannot hear the teacher, who then sends him to the school nurse's office. After assessing the patient's hearing with a tuning fork, the nurse determines that his hearing is diminished. What is the most important nursing intervention? A. The nurse should notify the parents to call the physician; this is an adverse effect of erythromycin. B. The nurse should inform the parents of a physician who specializes in ear, nose, and throat surgery. C. The nurse should instruct the patient to stop taking the erythromycin and his hearing will improve. D. The nurse should call the physician and inform the patient of a change in antibiotics.

A. After the nurse assesses the patient's hearing, it is important to notify the patient's family of the hearing loss and tell the parents to notify the physician, because this is an adverse effect of erythromycin. The nurse does not have the authority to discontinue the erythromycin but needs to play a role in notifying the prescriber of the hearing loss.

In explaining antineoplastic therapy to a family member of a patient who is to receive treatment with a cytotoxic drug, the nurse explains that it... A. damages both malignant and nonmalignant cells B. causes few adverse effects C. stimulates growth of cancer cells D. must be given daily

A. Cytotoxic drugs damage both normal and malignant cells and may cause severe adverse effects. They block or slow cancer cell growth rather than stimulating it. Administration of most of the drugs is cyclical, with cycles of a few days, then a few weeks without the drugs, then a repeat cycle as opposed to daily administration.

Which of the following classes of cephalosporins has the best activity against gram-positive organisms? A. first-generation cephalosporins B. second-generation cephalosporins C. third-generation cephalosporins D. fourth-generation cephalosporins

A. First-generation cephalosporins are primarily effective against gram-positive bacteria. Second-generation cephalosporins are more active against gram-negative bacteria than first-generation drugs. Third-generation cephalosporins further extend the spectrum of activity against gram-negative organisms. Fourth-generation cephalosporins are the broadest of all in spectrum acting against some gram-positive and many gram-negative organisms, including greater stability against degradation by beta-lactamase enzymes.

A woman develops a urinary tract infection following the delivery of an infant. The nurse practitioner is considering prescribing trimethoprim-sulfamethoxazole. What assessment is necessary to make? A. if the woman is breast-feeding B. if the woman has been treated with the medication in the past C. if anyone in her family has a known allergy to the drug D. if she is experiencing hematuria

A. It is important to assess if the woman is breast-feeding. If a fetus or young infant receives a sulfonamide by placental transfer, in breast milk, or by direct administration, the drug displaces bilirubin from binding sites on albumin. As a result, bilirubin may accumulate in the bloodstream (hyperbilirubinemia) and central nervous system (kernicterus), causing life-threatening toxicity.

Hormone inhibitor drugs used in the treatment of cancer are most effective in... A. treating breast or prostate cancer B. preventing hematological malignancies C. treating thyroid and pituitary tumors D. protecting normal cells from cytotoxic drugs

A. Malignant tumors of the breast, uterus, ovary, and prostate are influenced by hormones. Sex hormones act as growth factors in some malignancies. For example, some breast tumors have estrogen receptors, whereas prostate cancer in men grows under stimulation by testosterone. Hormone inhibitors slow the growth of cancer cells stimulated by hormones.

A physician writes an order for gentamicin 7 mg per kg intravenously every 24 hours and ampicillin 500 mg intravenously every 6 hours. The patient has a diagnosis of endocarditis. This is not an ideal antibiotic regimen for endocarditis because... A. it is best to use multiple daily dosing of gentamicin for endocarditis B. the addition of gentamicin to ampicillin increases the risk of treatment failure in endocarditis C. the appropriate single daily dose of gentamicin is 15 mg per kg once daily D. streptomycin is the recommended aminoglycoside for use in endocarditis

A. Once-daily aminoglycoside dosing is contraindicated in patients with endocarditis, and only the conventional dosing regimen should be used. B is incorrect because gentamicin and ampicillin are recommended in endocarditis, and they increase the risk of treatment success, not failure. C is incorrect because the single daily dose of gentamicin is a maximum of 7 mg/kg, not 15 mg/kg, once daily. D is incorrect because streptomycin is not the recommended aminoglycoside for use in endocarditis.

acquired immune deficiency syndrome

AIDS *a syndrome, or range of symptoms, that may develop in time in a person with HIV who does not receive treatment

A mutation of CCR5 that is common in Caucasians, but not other ethnic groups, has been identified. how does this affects these race in HIV?

About 1% of Caucasians lack functional CCR5 and are highly protected against HIV infection even if exposed (although protection is not absolute); about 18% are not markedly protected against infection but, if infected, demonstrate significantly slower rates of disease progression.

Indications of extravasation during administration of vesicant agents include the following:

Absence of blood return from the IV catheter Resistance to flow of IV fluid Burning or pain, swelling, or redness at the site * An extravasation kit should be readily available with emergency equipment and antidote medications

Although natural immunity can often effectively combat infections, many pathogenic microbes have evolved that resist natural immunity. __________ immunity is necessary to defend against these resistant agents.

Acquired

What happens when Natural Immunity is not enough to combat infection?

Acquired Immunity steps in

What does cellular membrane damage result from?

Activation of complement, arrival of killer T cells, and attraction of macrophages

_________ acquired immunity refers to immunologic defenses developed by the person's own body

Active

acude side effects Hematopoietic Stem Cell Transplantation

Acute side effects include alopecia, hemorrhagic cystitis, nausea, vomiting, diarrhea, encephalopathy, pulmonary edema, acute kidney injury, fluid and electrolyte imbalances, and severe mucositis

After receiving a dose of penicillin, a client develops dyspnea and hypotension. The nurse suspects the client is experiencing anaphylactic shock. What should the nurse do first? Administer the antidote for penicillin, as ordered, and continue to monitor the client's vital signs. Insert an indwelling urinary catheter and begin to infuse I.V. fluids, as ordered. Administer epinephrine, as ordered, and prepare to intubate the client, if necessary. Page an anesthesiologist immediately and prepare to intubate the client.

Administer epinephrine, as ordered, and prepare to intubate the client, if necessary.

There is maximum lifetime dosage limits with certain chemo agents due to irreversible organ damage such as with __________ which causes cardiomyopathy.

Adriamycin

what happens after viral set point is reached?

After the viral set point is reached, a chronic stage persists in which the immune system cannot eliminate the virus despite its best efforts.

The nurse is educating a patient with allergic rhinitis about how the condition is induced. What should the nurse include in the education on this topic? Airborne pollens or molds Topical creams or ointments Ingested foods Parenteral medications

Airborne pollens or molds

The nurse is educating a patient with allergic rhinitis about how thecondition is induced. What should the nurse include in the educationon this topic? a. Airborne pollens or molds b. Ingested foods c. Parenteral medications d. Topical creams or ointments

Airborne pollens or molds

The nurse practitioner treating a patient with allergic rhinitis decides pharmacologic therapy would be helpful. Which of the following is she most likely to prescribe? Rhinocort Sudafed Allegra Afrin

Allegra

what is the most common form of respiratory allergy, which is presumed to be mediated by an immediate (type I hypersensitivity) immunologic reaction.

Allergic rhinitis (hay fever, seasonal allergic rhinitis)

Hyper-immunoglobulin E syndrome (HIES)

Also called Job syndrome -Results from mutations in a gene that encodes a signaling module called STAT3 resulting in recurrent bacterial infections of skin and lungs.

Epothilones: ixabepilone (Ixempra) *Cell cycle—specific (M phase)

Alters microtubules and inhibits mitosis

__________ has demonstrated an ability to minimize renal toxicities associated with cisplatin, cyclophosphamide (Cytoxan), and ifosfamide (Ifex) therapy.

Amifostine

Laboratory tests evaluate whether ART is effective for a specific patient. How?

An adequate CD4+ response for most patients on ART is an increase in CD4+ count in the range of 50 to 150 mm3 per year, generally with an accelerated response in the first 3 months

Give me an example of a hereditary gene associated with cancer.

An example would include hereditary breast and ovarian cancer syndrome (BRCA1 and BRCA2).

What is indicative of a viral infection: an increase in the neutrophils or the lymphocytes?

An increase in neutrophils indicates a bacterial infection while an increase in lymphocytes indicate a viral infection (although lymphocytes are also elevated in some bacterial infections as well)

Contact Dermatitis

An inflammation of the skin caused by having contact with certain chemicals or substances; many of these substances are used in cosmetology.

Psoriatic arthritis

An inflammatory arthritis associated with psoriasis of the skin

TNM Classification System

An international system for determining the extent of metastasis and the level of cell differentiation, two important factors in treatment and prognosis of cancer.

Genetic tumor markers (Also called prognostic indicators)

Analysis for the presence of mutations (alterations) in genes found in tumors or body tissues. Assists in diagnosis, selection of treatment, prediction of response to therapy, and risk of progression or recurrence

a clinical response to an immediate (type I hypersensitivity) immunologic reaction between a specific antigen and an antibody. The reaction results from a rapid release of IgE-mediated chemicals, which can induce a severe, life-threatening reaction

Anaphylaxis

The nurse observes diffuse swelling involving the deeper skin layers in a patient who has experienced an allergic reaction. The nurse would correctly document this finding as which of the following? Angioneurotic edema Pitting edema Urticaria Contact dermatitis

Angioneurotic edema

A patient was seen in the clinic for hypertension and received a prescription for a new antihypertensive medication. The patient arrived in the emergency department a few hours after taking the medication with severe angioedema. What medication prescribed may be responsible for the reaction? Beta blocker Vasodilator Angiotensin-converting enzyme (ACE) inhibitor Angiotensin receptor blocker

Angiotensin-converting enzyme (ACE) inhibitor

A patient was seen in the clinic for hypertension and received aprescription for a new antihypertensive medication. The patientarrived in the emergency department a few hours after taking themedication with severe angioedema. What medication prescribed maybe responsible for the reaction? a. Beta blocker b. Angiotensin-converting enzyme (ACE) inhibitor c. Angiotensin receptor blocker d. Vasodilator

Angiotensin-converting enzyme (ACE) inhibitor

The nurse is caring for a patient who has been admitted for the treatment of AIDS. In the morning, the patient tells the nurse that he experienced night sweats and recently coughed up some blood. What is the nurse's most appropriate action? A) Assess the patient for additional signs and symptoms of Kaposi's sarcoma. B) Review the patient's most recent viral load and CD4+ count. C) Place the patient on respiratory isolation and inform the physician. D) Perform oral suctioning to reduce the patient's risk for aspiration.

Ans: C Feedback: These signs and symptoms are suggestive of tuberculosis, not Kaposi's sarcoma; prompt assessment and treatment is necessary. There is no indication of a need for oral suctioning and the patient's blood work will not reflect the onset of this opportunistic infection.

A hospital patient is immunocompromised because of stage 3 HIV infection and the physician has ordered a chest radiograph. How should the nurse most safely facilitate the test? A) Arrange for a portable x-ray machine to be used. B) Have the patient wear a mask to the x-ray department. C) Ensure that the radiology department has been disinfected prior to the test. D) Send the patient to the x-ray department, and have the staff in the department wear masks.

Ans: A Feedback: A patient who is immunocompromised is at an increased risk of contracting nosocomial infections due to suppressed immunity. The safest way the test can be facilitated is to have a portable x-ray machine in the patient's room. This confers more protection than disinfecting the radiology department or using masks.

A patient with HIV infection has begun experiencing severe diarrhea. What is the most appropriate nursing intervention to help alleviate the diarrhea? A) Administer antidiarrheal medications on a scheduled basis, as ordered. B) Encourage the patient to eat three balanced meals and a snack at bedtime. C) Increase the patient's oral fluid intake. D) Encourage the patient to increase his or her activity level.

Ans: A Feedback: Administering antidiarrheal agents on a regular schedule may be more beneficial than administering them on an as-needed basis, provided the patient's diarrhea is not caused by an infectious microorganism. Increased oral fluid may exacerbate diarrhea; IV fluid replacement is often indicated. Small, more frequent meals may be beneficial, and it is unrealistic to increase activity while the patient has frequent diarrhea.

A nurse is planning the care of a patient with AIDS who is admitted to the unit withPneumocystis pneumonia (PCP). Which nursing diagnosis has the highest priority for this patient? A) Ineffective Airway Clearance B) Impaired Oral Mucous Membranes C) Imbalanced Nutrition: Less than Body Requirements D) Activity Intolerance

Ans: A Feedback: Although all these nursing diagnoses are appropriate for a patient with AIDS, Ineffective Airway Clearance is the priority nursing diagnosis for the patient with Pneumocystis pneumonia (PCP). Airway and breathing take top priority over the other listed concerns.

A patient with HIV has a nursing diagnosis of Risk for Impaired Skin Integrity. What nursing intervention best addresses this risk? A) Utilize a pressure-reducing mattress. B) Limit the patient's physical activity. C) Apply antibiotic ointment to dependent skin surfaces. D) Avoid contact with synthetic fabrics.

Ans: A Feedback: Devices such as alternating-pressure mattresses and low-air-loss beds are used to prevent skin breakdown. Activity should be promoted, not limited, and contact with synthetic fabrics does not necessary threaten skin integrity. Antibiotic ointments are not normally used unless there is a break in the skin surface.

Since the emergence of HIV/AIDS, there have been significant changes in epidemiologic trends. Members of what group currently have the greatest risk of contracting HIV? A) Gay, bisexual, and other men who have sex with men B) Recreational drug users C) Blood transfusion recipients D) Health care providers

Ans: A Feedback: Gay, bisexual, and other men who have sex with men remain the population most affected by HIV and account for 2% of the population but 61% of the new infections. This exceeds the incidence among drug users, health care workers, and transfusion recipients.

A clinic nurse is caring for a patient admitted with AIDS. The nurse has assessed that the patient is experiencing a progressive decline in cognitive, behavioral, and motor functions. The nurse recognizes that these symptoms are most likely related to the onset of what complication? A) HIV encephalopathy B) B-cell lymphoma C) Kaposi's sarcoma D) Wasting syndrome

Ans: A Feedback: HIV encephalopathy is a clinical syndrome characterized by a progressive decline in cognitive, behavioral, and motor functions. The other listed complications do not normally have cognitive and behavioral manifestations.

A nurse is addressing the incidence and prevalence of HIV infection among older adults. What principle should guide the nurse's choice of educational interventions? A) Many older adults do not see themselves as being at risk for HIV infection. B) Many older adults are not aware of the difference between HIV and AIDS. C) Older adults tend to have more sex partners than younger adults. D) Older adults have the highest incidence of intravenous drug use.

Ans: A Feedback: It is known that many older adults do not see themselves as being at risk for HIV infection. Knowledge of the relationship between HIV infection and AIDS is not known to affect the incidence of new cases. The statements about sex partners and IV drug use are untrue.

A patient who has AIDS is being treated in the hospital and admits to having periods of extreme anxiety. What would be the most appropriate nursing intervention? A) Teach the patient guided imagery. B) Give the patient more control of her antiretroviral regimen. C) Increase the patient's activity level. D) Collaborate with the patient's physician to obtain an order for hydromorphone.

Ans: A Feedback: Measures such as relaxation and guided imagery may be beneficial because they decrease anxiety, which contributes to weakness and fatigue. Increased activity may be of benefit, but for other patients this may exacerbate feelings of anxiety or loss. Granting the patient control has the potential to reduce anxiety, but the patient is not normally given unilateral control of the ART regimen. Hydromorphone is not used to treat anxiety.

The nurse's plan of care for a patient with stage 3 HIV addresses the diagnosis of Risk for Impaired Skin Integrity Related to Candidiasis. What nursing intervention best addresses this risk? A) Providing thorough oral care before and after meals B) Administering prophylactic antibiotics C) Promoting nutrition and adequate fluid intake D) Applying skin emollients as needed

Ans: A Feedback: Thorough mouth care has the potential to prevent or limit the severity of this infection. Antibiotics are irrelevant because of the fungal etiology. The patient requires adequate food and fluids, but these do not necessarily prevent candidiasis. Skin emollients are not appropriate because candidiasis is usually oral.

The nurse is caring for a patient who is to begin receiving external radiation for a malignant tumor of the neck. While providing patient education, what potential adverse effects should the nurse discuss with the patient? A) Impaired nutritional status B) Cognitive changes C) Diarrhea D) Alopecia

Ans: A Feedback: Alterations in oral mucosa, change and loss of taste, pain, and dysphasia often occur as a result of radiotherapy to the head and neck. The patient is at an increased risk of impaired nutritional status. Radiotherapy does not cause cognitive changes. Diarrhea is not a likely concern for this patient. Radiation only results in alopecia when targeted at the whole brain; radiation of other parts of the body does not lead to hair loss.

A 50-year-old man diagnosed with leukemia will begin chemotherapy. What would the nurse do to combat the most common adverse effects of chemotherapy? A) Administer an antiemetic. B) Administer an antimetabolite. C) Administer a tumor antibiotic. D) Administer an anticoagulant.

Ans: A Feedback: Antiemetics are used to treat nausea and vomiting, the most common adverse effects of chemotherapy. Antihistamines and certain steroids are also used to treat nausea and vomiting. Antimetabolites and tumor antibiotics are classes of chemotherapeutic medications. Anticoagulants slow blood clotting time, thereby helping to prevent thrombi and emboli.

While a patient is receiving IV doxorubicin hydrochloride for the treatment of cancer, the nurse observes swelling and pain at the IV site. The nurse should prioritize what action? A) Stopping the administration of the drug immediately B) Notifying the patients physician C) Continuing the infusion but decreasing the rate D) Applying a warm compress to the infusion site

Ans: A Feedback: Doxorubicin hydrochloride is a chemotherapeutic vesicant that can cause severe tissue damage. The nurse should stop the administration of the drug immediately and then notify the patients physician. Ice can be applied to the site once the drug therapy has stopped.

The clinic nurse is caring for a 42-year-old male oncology patient. He complains of extreme fatigue and weakness after his first week of radiation therapy. Which response by the nurse would best reassure this patient? A) These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory and x-ray studies. B) These symptoms are part of your disease and are an unfortunately inevitable part of living with cancer. C) Try not to be concerned about these symptoms. Every patient feels this way after having radiation therapy. D) Even though it is uncomfortable, this is a good sign. It means that only the cancer cells are dying.

Ans: A Feedback: Fatigue and weakness result from radiation treatment and usually do not represent deterioration or disease progression. The symptoms associated with radiation therapy usually decrease after therapy ends. The symptoms may concern the patient and should not be belittled. Radiation destroys both cancerous and normal cells.

A 16-year-old female patient experiences alopecia resulting from chemotherapy, prompting the nursing diagnoses of disturbed body image and situational low self-esteem. What action by the patient would best indicate that she is meeting the goal of improved body image and self-esteem? A) The patient requests that her family bring her makeup and wig. B) The patient begins to discuss the future with her family. C) The patient reports less disruption from pain and discomfort. D) The patient cries openly when discussing her disease.

Ans: A Feedback: Requesting her wig and makeup indicates that the patient with alopecia is becoming interested in looking her best and that her body image and self-esteem may be improving. The other options may indicate that other nursing goals are being met, but they do not necessarily indicate improved body image and self-esteem.

The home health nurse is performing a home visit for an oncology patient discharged 3 days ago after completing treatment for non-Hodgkin lymphoma. The nurses assessment should include examination for the signs and symptoms of what complication? A) Tumor lysis syndrome (TLS) B) Syndrome of inappropriate antiduretic hormone (SIADH) C) Disseminated intravascular coagulation (DIC) D) Hypercalcemia

Ans: A Feedback: TLS is a potentially fatal complication that occurs spontaneously or more commonly following radiation, biotherapy, or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia, lymphoma, and small cell lung cancer. DIC, SIADH and hypercalcemia are less likely complications following this treatment and diagnosis.

The hospice nurse has just admitted a new patient to the program. What principle guides hospice care? A) Care addresses the needs of the patient as well as the needs of the family. B) Care is focused on the patient centrally and the family peripherally. C) The focus of all aspects of care is solely on the patient. D) The care team prioritizes the patients physical needs and the family is responsible for the patients emotional needs.

Ans: A Feedback: The focus of hospice care is on the family as well as the patient. The family is not solely responsible for the patients emotional well-being

A 60-year-old patient with a diagnosis of prostate cancer is scheduled to have an interstitial implant for high-dose radiation (HDR). What safety measure should the nurse include in this patients subsequent plan of care? A) Limit the time that visitors spend at the patients bedside. B) Teach the patient to perform all aspects of basic care independently. C) Assign male nurses to the patients care whenever possible. D) Situate the patient in a shared room with other patients receiving brachytherapy.

Ans: A Feedback: To limit radiation exposure, visitors should generally not spend more than 30 minutes with the patient. Pregnant nurses or visitors should not be near the patient, but there is no reason to limit care to nurses who are male. All necessary care should be provided to the patient and a single room should be used.

You are caring for a patient who has just been told that her stage IV colon cancer has recurred and metastasized to the liver. The oncologist offers the patient the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer? A) Palliative B) Reconstructive C) Salvage D) Prophylactic

Ans: A Feedback: When cure is not possible, the goals of treatment are to make the patient as comfortable as possible and to promote quality of life as defined by the patient and his or her family. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach. Prophylactic surgery involves removing nonvital tissues or organs that are at increased risk to develop cancer.

A nurse who works in an oncology clinic is assessing a patient who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the patients skin appears yellow. Which blood tests should be done to further explore this clinical sign? A) Liver function tests (LFTs) B) Complete blood count (CBC) C) Platelet count D) Blood urea nitrogen and creatinine

Ans: A Feedback: Yellow skin is a sign of jaundice and the liver is a common organ affected by metastatic disease. An LFT should be done to determine if the liver is functioning. A CBC, platelet count and tests of renal function would not directly assess for liver disease.

A nurse is performing the admission assessment of a patient who has AIDS. What components should the nurse include in this comprehensive assessment? Select all that apply. A) Current medication regimen B) Identification of patient's support system C) Immune system function D) Genetic risk factors for HIV E) History of sexual practices

Ans: A, B, C, E Feedback: Nursing assessment includes numerous focuses, including identification of medication use, support system, immune function and sexual history. HIV does not have a genetic component.

You are caring for an adult patient who has developed a mild oral yeast infection following chemotherapy. What actions should you encourage the patient to perform? Select all that apply. A) Use a lip lubricant. B) Scrub the tongue with a firm-bristled toothbrush. C) Use dental floss every 24 hours. D) Rinse the mouth with normal saline. E) Eat spicy food to aid in eradicating the yeast.

Ans: A, C, D Feedback: Stomatitis is an inflammation of the oral cavity. The patient should be encouraged to brush the teeth with a soft toothbrush after meals, use dental floss every 24 hours, rinse with normal saline, and use a lip lubricant. Mouthwashes and hot foods should be avoided.

The nurse is describing some of the major characteristics of cancer to a patient who has recently received a diagnosis of malignant melanoma. When differentiating between benign and malignant cancer cells, the nurse should explain differences in which of the following aspects? Select all that apply. A) Rate of growth B) Ability to cause death C) Size of cells D) Cell contents E) Ability to spread

Ans: A,B,E Feedback: Benign and malignant cells differ in many cellular growth characteristics, including the method and rate of growth, ability to metastasize or spread, general effects, destruction of tissue, and ability to cause death. Cells come in many sizes, both benign and malignant. Cell contents are basically the same, but they behave differently.

A patient is beginning an antiretroviral drug regimen shortly after being diagnosed with HIV. What nursing action is most likely to increase the likelihood of successful therapy? A) Promoting appropriate use of complementary therapies B) Addressing possible barriers to adherence C) Educating the patient about the pathophysiology of HIV D) Teaching the patient about the need for follow-up blood work

Ans: B Feedback: ART is highly dependent on adherence to treatment, and the nurse should proactively address this. Blood work is necessary, but this will not have a direct bearing on the success or failure of treatment. Complementary therapies are appropriate, but are not the main factor in successful treatment. The patient may or may not benefit from teaching about HIV pathophysiology.

A nurse is performing an admission assessment on a patient with stage 3 HIV. After assessing the patient's gastrointestinal system and analyzing the data, what is most likely to be the priority nursing diagnosis? A) Acute Abdominal Pain B) Diarrhea C) Bowel Incontinence D) Constipation

Ans: B Feedback: Diarrhea is a problem in 50% to 60% of all AIDS patients. As such, this nursing diagnosis is more likely than abdominal pain, incontinence, or constipation, though none of these diagnoses is guaranteed not to apply.

A patient has come into contact with HIV. As a result, HIV glycoproteins have fused with the patient's CD4+ T-cell membranes. This process characterizes what phase in the HIV life cycle? A) Integration B) Attachment C) Cleavage D) Budding

Ans: B Feedback: During the process of attachment, glycoproteins of HIV bind with the host's uninfected CD4+ receptor and chemokine coreceptors, which results in fusion of HIV with the CD4+ T-cell membrane. Integration, cleavage, and budding are steps that are subsequent to this initial phase of the HIV life cycle.

A nurse is assessing a 28-year-old man with HIV who has been admitted with pneumonia. In assessing the patient, which of the following observations takes immediate priority? A) Oral temperature of 100°F B) Tachypnea and restlessness C) Frequent loose stools D) Weight loss of 1 pound since yesterday

Ans: B Feedback: In prioritizing care, the pneumonia would be assessed first by the nurse. Tachypnea and restlessness are symptoms of altered respiratory status and need immediate priority. Weight loss of 1 pound is probably fluid related; frequent loose stools would not take short-term precedence over a temperature or tachypnea and restlessness. An oral temperature of 100°F is not considered a fever and would not be the first issue addressed.

A patient with HIV will be receiving care in the home setting. What aspect of self-care should the nurse emphasize during discharge education? A) Appropriate use of prophylactic antibiotics B) Importance of personal hygiene C) Signs and symptoms of wasting syndrome D) Strategies for adjusting antiretroviral dosages

Ans: B Feedback: Infection control is of high importance in patients living with HIV, thus personal hygiene is paramount. This is a more important topic than signs and symptoms of one specific complication (wasting syndrome). Drug dosages should never be independently adjusted. Prophylactic antibiotics are not normally prescribed unless the patient's CD4 count is below 50.

A patient is in the primary infection stage of HIV. What is true of this patient's current health status? A) The patient's HIV antibodies are successfully, but temporarily, killing the virus. B) The patient is infected with HIV but lacks HIV-specific antibodies. C) The patient's risk for opportunistic infections is at its peak. D) The patient may or may not develop long-standing HIV infection.

Ans: B Feedback: The period from infection with HIV to the development of HIV-specific antibodies is known as primary infection. The virus is not being eradicated and infection is certain. Opportunistic infections emerge much later in the course of the disease.

A public health nurse is preparing an educational campaign to address a recent local increase in the incidence of HIV infection. The nurse should prioritize which of the following interventions? A) Lifestyle actions that improve immune function B) Educational programs that focus on control and prevention C) Appropriate use of standard precautions D) Screening programs for youth and young adults

Ans: B Feedback: Until an effective vaccine is developed, preventing HIV by eliminating and reducing risk behaviors is essential. Educational interventions are the primary means by which behaviors can be influenced. Screening is appropriate, but education is paramount. Enhancing immune function does not prevent HIV infection. Ineffective use of standard precautions apply to very few cases of HIV infection.

A nurse is working with a patient who was diagnosed with HIV several months earlier. The nurse should recognize that a patient with HIV is considered to have AIDS at the point when the CD4+ T-lymphocyte cell count drops below what threshold? A) 75 cells/mm3 of blood B) 200 cells/mm3 of blood C) 325 cells/mm3 of blood D) 450 cells/mm3 of blood

Ans: B Feedback: When CD4+ T-cell levels drop below 200 cells/mm3 of blood, the person is said to have AIDS.

The public health nurse is presenting a health-promotion class to a group at a local community center. Which intervention most directly addresses the leading cause of cancer deaths in North America? A) Monthly self-breast exams B) Smoking cessation C) Annual colonoscopies D) Monthly testicular exams

Ans: B Feedback: Cancer is second only to cardiovascular disease as a leading cause of death in the United States. Although the numbers of cancer deaths have decreased slightly, more than 570,000 Americans were expected to die from a malignant process in 2011. The leading causes of cancer death in the United States, in order of frequency, are lung, prostate, and colorectal cancer in men and lung, breast, and colorectal cancer in women, so smoking cessation is the health promotion initiative directly related to lung cancer.

The nurse is admitting an oncology patient to the unit prior to surgery. The nurse reads in the electronic health record that the patient has just finished radiation therapy. With knowledge of the consequent health risks, the nurse should prioritize assessments related to what health problem? A) Cognitive deficits B) Impaired wound healing C) Cardiac tamponade D) Tumor lysis syndrome

Ans: B Feedback: Combining other treatment methods, such as radiation and chemotherapy, with surgery contributes to postoperative complications, such as infection, impaired wound healing, altered pulmonary or renal function, and the development of deep vein thrombosis.

A patient with a diagnosis of gastric cancer has been unable to tolerate oral food and fluid intake and her tumor location precludes the use of enteral feeding. What intervention should the nurse identify as best meeting this patients nutritional needs? A) Administration of parenteral feeds via a peripheral IV B) TPN administered via a peripherally inserted central catheter C) Insertion of an NG tube for administration of feeds D) Maintaining NPO status and IV hydration until treatment completion

Ans: B Feedback: If malabsorption is severe, or the cancer involves the upper GI tract, parenteral nutrition may be necessary. TPN is administered by way of a central line, not a peripheral IV. An NG would be contraindicated for this patient. Long-term NPO status would result in malnutrition.

The clinic nurse is caring for a patient whose grandmother and sister have both had breast cancer. She requested a screening test to determine her risk of developing breast cancer and it has come back positive. The patient asks you what she can do to help prevent breast cancer from occurring. What would be your best response? A) Research has shown that eating a healthy diet can provide all the protection you need against breast cancer. B) Research has shown that taking the drug tamoxifen can reduce your chance of breast cancer. C) Research has shown that exercising at least 30 minutes every day can reduce your chance of breast cancer. D) Research has shown that there is little you can do to reduce your risk of breast cancer if you have a genetic predisposition.

Ans: B Feedback: Large-scale breast cancer prevention studies supported by the National Cancer Institute (NCI) indicated that chemoprevention with the medication tamoxifen can reduce the incidence of breast cancer by 50% in women at high risk for breast cancer. A healthy diet and regular exercise are important, but not wholly sufficient preventive measures.

A patients most recent diagnostic imaging has revealed that his lung cancer has metastasized to his bones and liver. What is the most likely mechanism by which the patients cancer cells spread? A) Hematologic spread B) Lymphatic circulation C) Invasion D) Angiogenesis

Ans: B Feedback: Lymph and blood are key mechanisms by which cancer cells spread. Lymphatic spread (the transport of tumor cells through the lymphatic circulation) is the most common mechanism of metastasis.

A patient newly diagnosed with cancer is scheduled to begin chemotherapy treatment and the nurse is providing anticipatory guidance about potential adverse effects. When addressing the most common adverse effect, what should the nurse describe? A) Pruritis (itching) B) Nausea and vomiting C) Altered glucose metabolism D) Confusion

Ans: B Feedback: Nausea and vomiting, the most common side effects of chemotherapy, may persist for as long as 24 to 48 hours after its administration. Antiemetic drugs are frequently prescribed for these patients. Confusion, alterations in glucose metabolism, and pruritis are not common adverse effects.

A nurse is creating a plan of care for an oncology patient and one of the identified nursing diagnoses is risk for infection related to myelosuppression. What intervention addresses the leading cause of infection-related death in oncology patients? A) Encourage several small meals daily. B) Provide skin care to maintain skin integrity. C) Assist the patient with hygiene, as needed. D) Assess the integrity of the patients oral mucosa regularly.

Ans: B Feedback: Nursing care for patients with skin reactions includes maintaining skin integrity, cleansing the skin, promoting comfort, reducing pain, preventing additional trauma, and preventing and managing infection. Malnutrition in oncology patients may be present, but it is not the leading cause of infection-related death. Poor hygiene does not normally cause events that result in death. Broken oral mucosa may be an avenue for infection, but it is not the leading cause of death in an oncology patient.

The nurse is caring for a patient with an advanced stage of breast cancer and the patient has recently learned that her cancer has metastasized. The nurse enters the room and finds the patient struggling to breath and the nurses rapid assessment reveals that the patients jugular veins are distended. The nurse should suspect the development of what oncologic emergency? A) Increased intracranial pressure B) Superior vena cava syndrome (SVCS) C) Spinal cord compression D) Metastatic tumor of the neck

Ans: B Feedback: SVCS occurs when there is gradual or sudden impaired venous drainage giving rise to progressive shortness of breath (dyspnea), cough, hoarseness, chest pain, and facial swelling; edema of the neck, arms, hands, and thorax and reported sensation of skin tightness and difficulty swallowing; as well as possibly engorged and distended jugular, temporal, and arm veins. Increased intracranial pressure may be a part of SVCS, but it is not what is causing the patients symptoms. The scenario does not mention a problem with the patients spinal cord. The scenario says that the cancer has metastasized, but not that it has metastasized to the neck.

A 54-year-old has a diagnosis of breast cancer and is tearfully discussing her diagnosis with the nurse. The patient states, They tell me my cancer is malignant, while my coworkers breast tumor was benign. I just dont understand at all. When preparing a response to this patient, the nurse should be cognizant of what characteristic that distinguishes malignant cells from benign cells of the same tissue type? A) Slow rate of mitosis of cancer cells B) Different proteins in the cell membrane C) Differing size of the cells D) Different molecular structure in the cells

Ans: B Feedback: The cell membrane of malignant cells also contains proteins called tumor-specific antigens (e.g., carcinoembryonic antigen [CEA] and prostate-specific antigen [PSA]), which develop over time as the cells become less differentiated (mature). These proteins distinguish malignant cells from benign cells of the same tissue type.

An oncology nurse educator is providing health education to a patient who has been diagnosed with skin cancer. The patients wife has asked about the differences between normal cells and cancer cells. What characteristic of a cancer cell should the educator cite? A) Malignant cells contain more fibronectin than normal body cells. B) Malignant cells contain proteins called tumor-specific antigens. C) Chromosomes contained in cancer cells are more durable and stable than those of normal cells. D) The nuclei of cancer cells are unusually large, but regularly shaped.

Ans: B Feedback: The cell membranes are altered in cancer cells, which affect fluid movement in and out of the cell. The cell membrane of malignant cells also contains proteins called tumor-specific antigens. Malignant cellular membranes also contain less fibronectin, a cellular cement. Typically, nuclei of cancer cells are large and irregularly shaped (pleomorphism). Fragility of chromosomes is commonly found when cancer cells are analyzed.

A nurse is caring for a patient hospitalized with AIDS. A friend comes to visit the patient and privately asks the nurse about the risk of contracting HIV when visiting the patient. What is the nurse's best response? A) Do you think that you might already have HIV? B) Don't worry. Your immune system is likely very healthy. C) AIDS isn't transmitted by casual contact. D) You can't contract AIDS in a hospital setting.

Ans: C Feedback: AIDS is commonly transmitted by contact with blood and body fluids. Patients, family, and friends must be reassured that HIV is not spread through casual contact. A healthy immune system is not necessarily a protection against HIV. A hospital setting does not necessarily preclude HIV infection.

A nurse would identify that a colleague needs additional instruction on standard precautions when the colleague exhibits which of the following behaviors? A) The nurse wears face protection, gloves, and a gown when irrigating a wound. B) The nurse washes the hands with a waterless antiseptic agent after removing a pair of soiled gloves. C) The nurse puts on a second pair of gloves over soiled gloves while performing a bloody procedure. D) The nurse places a used needle and syringe in the puncture-resistant container without capping the needle.

Ans: C Feedback: Gloves must be changed after contact with materials that may contain high concentration of microorganisms, even when working with the same patient. Each of the other listed actions adheres to standard precautions.

A patient was tested for HIV using enzyme immunoassay (EIA) and results were positive. The nurse should expect the primary care provider to order what test to confirm the EIA test results? A) Another EIA test B) Viral load test C) Western blot test D) CD4/CD8 ratio

Ans: C Feedback: The Western blot test detects antibodies to HIV and is used to confirm the EIA test results. The viral load test measures HIV RNA in the plasma and is not used to confirm EIA test results, but instead to track the progression of the disease process. The CD4/CD8 ratio test evaluates the ratio of CD4 and CD8 cells but is not used to confirm results of EIA testing.

The mother of two young children has been diagnosed with HIV and expresses fear of dying. How should the nurse best respond to the patient? A) Would you like me to have the chaplain come speak with you? B) You'll learn much about the promise of a cure for HIV. C) Can you tell me what concerns you most about dying? D) You need to maintain hope because you may live for several years.

Ans: C Feedback: The nurse can help the patient verbalize feelings and identify resources for support. The nurse should respond with an open-ended question to help the patient to identify fears about being diagnosed with a life-threatening chronic illness. Immediate deferral to spiritual care is not a substitute for engaging with the patient. The nurse should attempt to foster hope, but not in a way that downplays the patient's expressed fears.

A patient with a recent diagnosis of HIV infection expresses an interest in exploring alternative and complementary therapies. How should the nurse best respond? A) Complementary therapies generally have not been approved, so patients are usually discouraged from using them. B) Researchers have not looked at the benefits of alternative therapy for patients with HIV, so we suggest that you stay away from these therapies until there is solid research data available. C) Many patients with HIV use some type of alternative therapy and, as with most health treatments, there are benefits and risks. D) You'll need to meet with your doctor to choose between an alternative approach to treatment and a medical approach.

Ans: C Feedback: The nurse should approach the topic of alternative or complementary therapies from an open-ended, supportive approach, emphasizing the need to communicate with care providers. Complementary therapies and medical treatment are not mutually exclusive, though some contraindications exist. Research supports the efficacy of some forms of complementary and alternative treatment.

A patient's primary infection with HIV has subsided and an equilibrium now exists between HIV levels and the patient's immune response. This physiologic state is known as which of the following? A) Static stage B) Latent stage C) Viral set point D) Window period

Ans: C Feedback: The remaining amount of virus in the body after primary infection is referred to as the viral set point, which results in a steady state of infection that lasts for years. This is not known as the static or latent stage. The window period is the time a person infected with HIV tests negative even though he or she is infected.

The nurse on a bone marrow transplant unit is caring for a patient with cancer who is preparing for HSCT. What is a priority nursing diagnosis for this patient? A) Fatigue related to altered metabolic processes B) Altered nutrition: less than body requirements related to anorexia C) Risk for infection related to altered immunologic response D) Body image disturbance related to weight loss and anorexia

Ans: C Feedback: A priority nursing diagnosis for this patient is risk for infection related to altered immunologic response. Because the patients immunity is suppressed, he or she will be at a high risk for infection. The other listed nursing diagnoses are valid, but they are not as high a priority as is risk for infection.

The school nurse is teaching a nutrition class in the local high school. One student states that he has heard that certain foods can increase the incidence of cancer. The nurse responds, Research has shown that certain foods indeed appear to increase the risk of cancer. Which of the following menu selections would be the best choice for potentially reducing the risks of cancer? A) Smoked salmon and green beans B) Pork chops and fried green tomatoes C) Baked apricot chicken and steamed broccoli D) Liver, onions, and steamed peas

Ans: C Feedback: Fruits and vegetables appear to reduce cancer risk. Salt-cured foods, such as ham and processed meats, as well as red meats, should be limited.

A patient on the oncology unit is receiving carmustine, a chemotherapy agent, and the nurse is aware that a significant side effect of this medication is thrombocytopenia. Which symptom should the nurse assess for in patients at risk for thrombocytopenia? A) Interrupted sleep pattern B) Hot flashes C) Epistaxis (nose bleed) D) Increased weight

Ans: C Feedback: Patients with thrombocytopenia are at risk for bleeding due to decreased platelet counts. Patients with thrombocytopenia do not exhibit interrupted sleep pattern, hot flashes, or increased weight.

An oncology patient has just returned from the postanesthesia care unit after an open hemicolectomy. This patients plan of nursing care should prioritize which of the following? A) Assess the patient hourly for signs of compartment syndrome. B) Assess the patients fine motor skills once per shift. C) Assess the patients wound for dehiscence every 4 hours. D) Maintain the patients head of bed at 45 degrees or more at all times.

Ans: C Feedback: Postoperatively, the nurse assesses the patients responses to the surgery and monitors the patient for possible complications, such as infection, bleeding, thrombophlebitis, wound dehiscence, fluid and electrolyte imbalance, and organ dysfunction. Fine motor skills are unlikely to be affected by surgery and compartment syndrome is a complication of fracture casting, not abdominal surgery. There is no need to maintain a high head of bed.

Traditionally, nurses have been involved with tertiary cancer prevention. However, an increasing emphasis is being placed on both primary and secondary prevention. What would be an example of primary prevention? A) Yearly Pap tests B) Testicular self-examination C) Teaching patients to wear sunscreen D) Screening mammograms

Ans: C Feedback: Primary prevention is concerned with reducing the risks of cancer in healthy people through practices such as use of sunscreen. Secondary prevention involves detection and screening to achieve early diagnosis, as demonstrated by Pap tests, mammograms, and testicular exams.

The nurse is caring for a 39-year-old woman with a family history of breast cancer. She requested a breast tumor marking test and the results have come back positive. As a result, the patient is requesting a bilateral mastectomy. This surgery is an example of what type of oncologic surgery? A) Salvage surgery B) Palliative surgery C) Prophylactic surgery D) Reconstructive surgery

Ans: C Feedback: Prophylactic surgery is used when there is an extensive family history and nonvital tissues are removed. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusion. Reconstructive surgery may follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect.

A public health nurse has formed an interdisciplinary team that is developing an educational program entitled Cancer: The Risks and What You Can Do About Them. Participants will receive information, but the major focus will be screening for relevant cancers. This program is an example of what type of health promotion activity? A) Disease prophylaxis B) Risk reduction C) Secondary prevention D) Tertiary prevention

Ans: C Feedback: Secondary prevention involves screening and early detection activities that seek to identify early stage cancer in individuals who lack signs and symptoms suggestive of cancer. Primary prevention is concerned with reducing the risks of disease through health promotion strategies. Tertiary prevention is the care and rehabilitation of the patient after having been diagnosed with cancer.

A 58-year-old male patient has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray shows carcinoma. The patient is anxious and asks if he can smoke. Which statement by the nurse would be most therapeutic? A) Smoking is the reason you are here. B) The doctor left orders for you not to smoke. C) You are anxious about the surgery. Do you see smoking as helping? D) Smoking is OK right now, but after your surgery it is contraindicated.

Ans: C Feedback: Stating You are anxious about the surgery. Do you see smoking as helping? acknowledges the patients feelings and encourages him to assess his previous behavior. Saying Smoking is the reason you are here belittles the patient. Citing the doctors orders does not address the patients anxiety. Sanctioning smoking would be highly detrimental to this patient.

The hospice nurse is caring for a patient with cancer in her home. The nurse has explained to the patient and the family that the patient is at risk for hypercalcemia and has educated them on that signs and symptoms of this health problem. What else should the nurse teach this patient and family to do to reduce the patients risk of hypercalcemia? A) Stool softeners are contraindicated. B) Laxatives should be taken daily. C) Consume 2 to 4 L of fluid daily. D) Restrict calcium intake.

Ans: C Feedback: The nurse should identify patients at risk for hypercalcemia, assess for signs and symptoms of hypercalcemia, and educate the patient and family. The nurse should teach at-risk patients to recognize and report signs and symptoms of hypercalcemia and encourage patients to consume 2 to 4 L of fluid daily unless contraindicated by existing renal or cardiac disease. Also, the nurse should explain the use of dietary and pharmacologic interventions, such as stool softeners and laxatives for constipation, and advise patients to maintain nutritional intake without restricting normal calcium intake.

The nurse is performing an initial assessment of an older adult resident who has just relocated to the long-term care facility. During the nurses interview with the patient, she admits that she drinks around 20 ounces of vodka every evening. What types of cancer does this put her at risk for? Select all that apply. A) Malignant melanoma B) Brain cancer C) Breast cancer D) Esophageal cancer E) Liver cancer

Ans: C, D, E Feedback: Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate- and nitrite-containing foods, and red and processed meats. Alcohol increases the risk of cancers of the mouth, pharynx, larynx, esophagus, liver, colorectum, and breast.

A patient has been diagnosed with AIDS complicated by chronic diarrhea. What nursing intervention would be appropriate for this patient? A) Position the patient in the high Fowler's position whenever possible. B) Temporarily eliminate animal protein from the patient's diet. C) Make sure the patient eats at least two servings of raw fruit each day. D) Obtain a stool culture to identify possible pathogens.

Ans: D Feedback: A stool culture should be obtained to determine the possible presence of microorganisms that cause diarrhea. Patients should generally avoid raw fruit when having diarrhea. There is no need to avoid animal protein or increase the height of the patient's bed.

A patient's current antiretroviral regimen includes nucleoside reverse transcriptase inhibitors (NRTIs). What dietary counseling will the nurse provide based on the patient's medication regimen? A) Avoid high-fat meals while taking this medication. B) Limit fluid intake to 2 liters a day. C) Limit sodium intake to 2 grams per day. D) Take this medication without regard to meals.

Ans: D Feedback: Many NRTIs exist, but all of them may be safely taken without regard to meals. Protein, fluid, and sodium restrictions play no role in relation to these drugs.

An 18-year-old pregnant female has tested positive for HIV and asks the nurse if her baby is going to be born with HIV. What is the nurse's best response? A) There is no way to know that for certain, but we do know that your baby has a one in four chance of being born with HIV. B) Your physician is likely the best one to ask that question. C) If the baby is HIV positive there is nothing that can be done until it is born, so try your best not to worry about it now. D) It's possible that your baby could contract HIV, either before, during, or after delivery.

Ans: D Feedback: Mother-to-child transmission of HIV-1 is possible and may occur in utero, at the time of delivery, or through breast-feeding. There is no evidence that the infant's risk is 25%. Deferral to the physician is not a substitute for responding appropriately to the patient's concern. Downplaying the patient's concerns is inappropriate.

A 16-year-old has come to the clinic and asks to talk to a nurse. The nurse asks the teen what she needs and the teen responds that she has become sexually active and is concerned about getting HIV. The teen asks the nurse what she can do keep from getting HIV. What would be the nurse's best response? A) There's no way to be sure you won't get HIV except to use condoms correctly. B) Only the correct use of a female condom protects against the transmission of HIV. C) There are new ways of protecting yourself from HIV that are being discovered every day. D) Other than abstinence, only the consistent and correct use of condoms is effective in preventing HIV.

Ans: D Feedback: Other than abstinence, consistent and correct use of condoms is the only effective method to decrease the risk of sexual transmission of HIV infection. Both female and male condoms confer significant protection. New prevention techniques are not commonly discovered, though advances in treatment are constant.

A patient has come into the free clinic asking to be tested for HIV infection. The patient asks the nurse how the test works. The nurse responds that if the testing shows that antibodies to the AIDS virus are present in the blood, this indicates what? A) The patient is immune to HIV. B) The patient's immune system is intact. C) The patient has AIDS-related complications. D) The patient has been infected with HIV.

Ans: D Feedback: Positive test results indicate that antibodies to the AIDS virus are present in the blood. The presence of antibodies does not imply an intact immune system or specific immunity to HIV. This finding does not indicate the presence of AIDS-related complications.

The nurse is addressing condom use in the context of a health promotion workshop. When discussing the correct use of condoms, what should the nurse tell the attendees? A Attach the condom prior to erection. B) A condom may be reused with the same partner if ejaculation has not occurred. C) Use skin lotion as a lubricant if alternatives are unavailable. D) Hold the condom by the cuff upon withdrawal.

Ans: D Feedback: The condom should be unrolled over the hard penis before any kind of sex. The condom should be held by the tip to squeeze out air. Skin lotions, baby oil, petroleum jelly, or cold cream should not be used with condoms because they cause latex deterioration/condom breakage. The condom should be held during withdrawal so it does not come off the penis. Condoms should never be reused.

During the admission assessment of an HIV-positive patient whose CD4+ count has recently fallen, the nurse carefully assesses for signs and symptoms related to opportunistic infections. What is the most common life-threatening infection? A) Salmonella infection B) Mycobacterium tuberculosis C) Clostridium difficile D) Pneumocystis pneumonia

Ans: D Feedback: There are a number of opportunistic infections that can infect individuals with AIDS. The most common life-threatening infection in those living with AIDS is Pneumocystis pneumonia (PCP), caused by P. jiroveci (formerly carinii). Other opportunistic infections may involve Salmonella,Mycobacterium tuberculosis, and Clostridium difficile.

An oncology nurse is contributing to the care of a patient who has failed to respond appreciably to conventional cancer treatments. As a result, the care team is considering the possible use of biologic response modifiers (BRFs). The nurse should know that these achieve a therapeutic effect by what means? A) Promoting the synthesis and release of leukocytes B) Focusing the patients immune system exclusively on the tumor C) Potentiating the effects of chemotherapeutic agents and radiation therapy D) Altering the immunologic relationship between the tumor and the patient

Ans: D Feedback: BRFs alter the immunologic relationship between the tumor and the cancer patient (host) to provide a therapeutic benefit. They do not necessarily increase white cell production or focus the immune system solely on the tumor. BRFs do not potentiate radiotherapy and chemotherapy.

A nurse provides care on a bone marrow transplant unit and is preparing a female patient for a hematopoietic stem cell transplantation (HSCT) the following day. What information should the nurse emphasize to the patients family and friends? A) Your family should likely gather at the bedside in case theres a negative outcome. B) Make sure she doesnt eat any food in the 24 hours before the procedure. C) Wear a hospital gown when you go into the patients room. D) Do not visit if you've had a recent infection.

Ans: D Feedback: Before HSCT, patients are at a high risk for infection, sepsis, and bleeding. Visitors should not visit if they have had a recent illness or vaccination. Gowns should indeed be worn, but this is secondary in importance to avoiding the patients contact with ill visitors. Prolonged fasting is unnecessary. Negative outcomes are possible, but the procedure would not normally be so risky as to require the family to gather at the bedside.

An oncology nurse is caring for a patient who has developed erythema following radiation therapy. What should the nurse instruct the patient to do? A) Periodically apply ice to the area. B) Keep the area cleanly shaven. C) Apply petroleum jelly to the affected area. D) Avoid using soap on the treatment area.

Ans: D Feedback: Care to the affected area must focus on preventing further skin irritation, drying, and damage. Soaps, petroleum ointment, and shaving the area could worsen the erythema. Ice is also contraindicated.

The nurse is caring for a patient has just been given a 6-month prognosis following a diagnosis of extensive stage small-cell lung cancer. The patient states that he would like to die at home, but the team believes that the patients care needs are unable to be met in a home environment. What might you suggest as an alternative? A) Discuss a referral for rehabilitation hospital. B) Panel the patient for a personal care home. C) Discuss a referral for acute care. D) Discuss a referral for hospice care.

Ans: D Feedback: Hospice care can be provided in several settings. Because of the high cost associated with free-standing hospices, care is often delivered by coordinating services provided by both hospitals and the community. The primary goal of hospice care is to provide support to the patient and family. Patients who are referred to hospice care generally have fewer than 6 months to live. Each of the other listed options would be less appropriate for the patients physical and psychosocial needs.

An oncology patient will begin a course of chemotherapy and radiation therapy for the treatment of bone metastases. What is one means by which malignant disease processes transfer cells from one place to another? A) Adhering to primary tumor cells B) Inducing mutation of cells of another organ C) Phagocytizing healthy cells D) Invading healthy host tissues

Ans: D Feedback: Invasion, which refers to the growth of the primary tumor into the surrounding host tissues, occurs in several ways. Malignant cells are less likely to adhere than are normal cells. Malignant cells do not cause healthy cells to mutate. Malignant cells do not eat other cells.

An oncology patient has begun to experience skin reactions to radiation therapy, prompting the nurse to make the diagnosis Impaired Skin Integrity: erythematous reaction to radiation therapy. What intervention best addresses this nursing diagnosis? A) Apply an ice pack or heating pad PRN to relieve pain and pruritis B) Avoid skin contact with water whenever possible C) Apply phototherapy PRN D) Avoid rubbing or scratching the affected area

Ans: D Feedback: Rubbing and or scratching will lead to additional skin irritation, damage, and increased risk of infection. Extremes of hot, cold, and light should be avoided. No need to avoid contact with water.

A 62-year-old woman diagnosed with breast cancer is scheduled for a partial mastectomy. The oncology nurse explained that the surgeon will want to take tissue samples to ensure the disease has not spread to adjacent axillary lymph nodes. The patient has asked if she will have her lymph nodes dissected, like her mother did several years ago. What alternative to lymph node dissection will this patient most likely undergo? A) Lymphadenectomy B) Needle biopsy C) Open biopsy D) Sentinel node biopsy

Ans: D Feedback: Sentinel lymph node biopsy (SLNB), also known as sentinel lymph node mapping, is a minimally invasive surgical approach that, in some instances, has replaced more invasive lymph node dissections (lymphadenectomy) and their associated complications such as lymphedema and delayed healing. SLNB has been widely adopted for regional lymph node staging in selected cases of melanoma and breast cancer.

The nurse is orienting a new nurse to the oncology unit. When reviewing the safe administration of antineoplastic agents, what action should the nurse emphasize? A) Adjust the dose to the patients present symptoms. B) Wash hands with an alcohol-based cleanser following administration. C) Use gloves and a lab coat when preparing the medication. D) Dispose of the antineoplastic wastes in the hazardous waste receptacle.

Ans: D Feedback: The nurse should use surgical gloves and disposable long-sleeved gowns when administering antineoplastic agents. The antineoplastic wastes are disposed of as hazardous materials. Dosages are not adjusted on a short-term basis. Hand and arm hygiene must be performed before and after administering the medication.

_________ and ______________ agents cause the most serious anaphylactic reactions.

Antibiotics and radiocontrast

_____________ defend against foreign invaders in several ways, and the type of defense used depends on the structure and composition of both the antigen and the immunoglobulin.

Antibodies

substance that induces the production of antibodies

Antigen

Stage 1 of HIV infection

Apparent good health continues because CD4+ T-cell levels remain high enough to preserve immune defensive responses, but over time, the number of CD4+ T cells continues to decrease.

Mitotic Spindle Inhibitors

Arrest metaphase by inhibiting mitotic tubular formation (spindle); inhibit DNA and protein synthesis *Cell cycle—specific (M phase)

Taxanes (Paclitaxel, Docetaxel)

Arrest metaphase by inhibiting tubulin depolymerization *Cell cycle—specific (M phase)

disease-modifying antirheumatic drugs (DMARDs) function

As their name suggests, DMARDs have the ability to suppress the autoimmune response; alter disease progression; and stop or decrease further tissue damage on the joints, cartilage, and organs

_________ is defined as the genetic predisposition to mount an IgE response to inhaled or ingested innocuous proteins

Atopy

_____________ disorders tend to be more common in women because estrogen tends to enhance immunity.

Autoimmune

Is the following statement True or False? Autoimmune disorders are more common in women than men.

Autoimmune disorders are more common in women than men.

Which of the following would the nurse prioritize as the most important action for the patient to take to prevent anaphylaxis? Desensitization Carry an emergency kit Avoid potential allergens Wear a medical alert bracelet

Avoid potential allergens

The best treatment for latex allergy includes which of the following? Emergency kit with epinephrine Antihistamines Avoidance of latex-based products Corticosteroids

Avoidance of latex-based products

A patient diagnosed with common variable immune deficiency (CVID) has been admitted to the acute medicine unit. When reviewing this patient's laboratory findings, the nurse should prioritize what values? A) Creatinine and blood urea nitrogen (BUN) B) Hemoglobin and vitamin B12 C) Sodium, potassium and magnesium D) D-dimer and c-reactive protein

B (Feedback: A patient diagnosed with CVID often develops pernicious anemia; the patient's hemoglobin and vitamin B12 levels would be used to assess for this common complication of CVID. None of the other listed blood values directly relates to the signs and complications of CVID.)

A nurse has administered a child's scheduled vaccination for rubella. This vaccination will cause the child to develop which of the following? A) Natural immunity B) Active acquired immunity C) Cellular immunity D) Mild hypersensitivity

B (Feedback: Active acquired immunity usually develops as a result of vaccination or contracting a disease. Natural immunity is present at birth and provides a nonspecific response to any foreign invader. Immunizations do not activate the process of cellular immunity. Hypersensitivity is not an expected outcome of immunization.)

The nurse is admitting a patient to the unit with a diagnosis of ataxia-telangiectasia. The nurse's assessment should reflect the patient's increased risk for what complication? A) Peripheral edema B) Cancer C) Anaphylaxis D) Gastrointestinal bleeds

B (Feedback: Frequent causes of death in patients with ataxia-telangiectasiaare chronic pulmonary disease and malignancy. Peripheral edema, anaphylaxis, and GI bleeding are not noted to be common among patients with ataxia-telangiectasia.)

A nurse is caring for a patient with a phagocytic cell disorder. The patient states, "My specialist says that I will likely be cured after I get my treatment tomorrow." To what treatment is the patient most likely referring? A) Treatment with granulocyte-macrophage colony-stimulating factor (GM-CSF) B) Hematopoietic stem cell transplantation C) Treatment with granulocyte colony-stimulating factor (G-CSF) D) Brachytherapy

B (Feedback: Hematopoietic stem cell transplantation (HSCT), another form of cell therapy, has proven to be a successful curative modality. Treatment with GM-CSF or G-CSF is not curative. Brachytherapy is not a treatment for immunodeficiency.)

A 20-year-old patient with an immunodeficiency is admitted to the unit with an acute episode of upper airway edema. This is the fifth time in the past 3 months that the patient has had such as episode. As the nurse caring for this patient, you know that the patient may have a deficiency of what? A) Interferons B) C1esterase inhibitor C) IgG D) IgA

B (Feedback: Hereditary angioneurotic edema results from the deficiency of C1esterase inhibitor, which opposes the release of inflammatory mediators. The clinical picture of this autosomal dominant disorder includes recurrent attacks of edema. A patient with this diagnosis does not lack interferons, IgG, or IgA.)

A patient was recently exposed to infectious microorganisms and many T lymphocytes are now differentiating into killer T cells. This process characterizes what stage of the immune response? A) Effector B) Proliferation C) Response D) Recognition

B (Feedback: In the proliferation stage, T lymphocytes differentiate into cytotoxic (or killer) T cells, whereas B lymphocytes produce and release antibodies. This does not occur in the response, recognition, or effector stages.)

A 16-year-old has been brought to the emergency department by his parents after falling through the glass of a patio door, suffering a laceration. The nurse caring for this patient knows that the site of the injury will have an invasion of what? A) Interferons B) Phagocytic cells C) Apoptosis D) Cytokines

B (Feedback: Monocytes migrate to injury sites and function as phagocytic cells, engulfing, ingesting, and destroying greater numbers and quantities of foreign bodies or toxins than granulocytes. This occurs in response to the foreign bodies that have invaded the laceration from the dirt on the broken glass. Interferon, one type of biologic response modifier, is a nonspecific viricidal protein that is naturally produced by the body and is capable of activating other components of the immune system. Apoptosis, or programmed cell death, is the body's way of destroying worn out cells such as blood or skin cells or cells that need to be renewed. Cytokines are the various proteins that mediate the immune response. These do not migrate to injury sites.)

The nurse is assessing a client's risk for impaired immune function. What assessment finding should the nurse identify as a risk factor for decreased immunity? A) The patient takes a beta blocker for the treatment of hypertension. B) The patient is under significant psychosocial stress. C) The patient had a pulmonary embolism 18 months ago. D) The patient has a family history of breast cancer.

B (Feedback: Stress is a psychoneuroimmunologic factor that is known to depress the immune response. Use of beta blockers, a family history of cancer, and a prior PE are significant assessment findings, but none represents an immediate threat to immune function.)

A nurse is preparing to discharge a patient with an immunodeficiency. When preparing the patient for self-infusion of IVIG in the home setting, what education should the nurse prioritize? A) Sterile technique for establishing a new IV site B) Signs and symptoms of adverse reactions C) Formulas for calculating daily doses D) Technique for adding medications to the IVIG

B (Feedback: The patient who is to receive IVIG at home will need information about adverse reactions and their management. A patient would not start a new IV site independently and the patient does not calculate changes in dose independently. Medications are not added to IVIG.)

A young couple visits the nurse practitioner stating that they want to start a family. The husband states that his brother died of a severe infection at age 6 months. He says he never knew what was wrong but his mother had him undergo "blood testing" as a child. Based on these statements, what health problem should the nurse practitioner suspect? A) Severe neutropenia B) X-linked agammaglobulinemia C) Drug-induced thrombocytopenia D) Aplastic anemia

B (Feedback: There is no evidence of drug-induced thrombocytopenia or aplastic anemia. The child would have only suffered from severe neutropenia if there was evidence of bacterial or fungal infections. The fact the mother of this individual had him tested for gamma-globulin as a child would indicate that his sibling had X-linked agammaglobulinemia. More than 10% of patients with X-linked agammaglobulinemia are hospitalized for infection at less than 6 months of age. Since the condition is X-linked it is important for the couple to undergo genetic testing.)

A nurse is performing the initial assessment of a patient who has a recent diagnosis of systemic lupus erythematosus (SLE). What skin manifestation would the nurse expect to observe on inspection? A) Petechiae B) Butterfly rash C) Jaundice D) Skin sloughing

B (An acute cutaneous lesion consisting of a butterfly-shaped rash across the bridge of the nose and cheeks occurs in SLE. Petechiae are pinpoint skin hemorrhages, which are not a clinical manifestation of SLE. Patients with SLE do not typically experience jaundice or skin sloughing.)

A patient is admitted with cellulitis and experiences a consequent increase in white blood cell count. The nurse is aware that during the immune response, pathogens are engulfed by white blood cells that ingest foreign particles. What is this process known as? A) Apoptosis B) Phagocytosis C) Antibody response D) Cellular immune response

B (Feedback: During the first mechanism of defense, white blood cells, which have the ability to ingest foreign particles, move to the point of attack, where they engulf and destroy the invading agents. This is known as phagocytosis. The action described is not apoptosis (programmed cell death) or an antibody response. Phagocytosis occurs in the context of the cellular immune response, but it does not constitute the entire cellular response.)

A nurse is assessing a patient for risk factors known to contribute to osteoarthritis. What assessment finding would the nurse interpret as a risk factor? A) The patient has a 30 pack-year smoking history. B) The patient's body mass index is 34 (obese). C) The patient has primary hypertension. D) The patient is 58 years old.

B (Feedback: Risk factors for osteoarthritis include obesity and previous joint damage. Risk factors of OA do not include smoking or hypertension. Incidence increases with age, but a patient who is 58 would not yet face a significantly heightened risk.)

A patient with polymyositisis experiencing challenges with activities of daily living as a result of proximal muscle weakness. What is the most appropriate nursing action? A) Initiate a program of passive range of motion exercises B) Facilitate referrals to occupational and physical therapy C) Administer skeletal muscle relaxants as ordered D) Encourage a progressive program of weight-bearing exercise

B -Patients with polymyositis may have symptoms similar to those of other inflammatory diseases. However, proximal muscle weakness is characteristic, making activities such as hair combing, reaching overhead, and using stairs difficult. - Therefore, use of assistive devices may be recommended, and referral to occupational or physical therapy may be warranted.

A patient with rheumatoid arthritis comes to the clinic complaining of pain in the joint of his right great toe and is eventually diagnosed with gout. When planning teaching for this patient, what management technique should the nurse emphasize? A) Take OTC calcium supplements consistently. B) Restrict consumption of foods high in purines. C) Ensure fluid intake of at least 4 liters per day. D) Restrict weight-bearing on right foot.

B Although severe dietary restriction is not necessary, the nurse should encourage the patient to restrict consumption of foods high in purines, especially organ meats. Calcium supplementation is not necessary and activity should be maintained as tolerated. Increased fluid intake is beneficial, but it is not necessary for the patient to consume more than 4 liters daily.

A nurse is providing care for a patient who has just been diagnosed as being in the early stage of rheumatoid arthritis. The nurse should anticipate the administration of which of the following? A) Hydromorphone (Dilaudid) B) Methotrexate (Rheumatrex) C) Allopurinol (Zyloprim) D) Prednisone

B In the past, a step-wise approach starting with NSAIDs was standard of care. However, evidence clearly documenting the benefits of early DMARD (methotrexate [Rheumatrex], antimalarials, leflunomide [Arava], or sulfasalazine [Azulfidine]) treatment has changed national guidelines for management. Now it is recommended that treatment with the non-biologic DMARDs begin within 3 months of disease onset.

A 21-year-old male has just been diagnosed with a spondyloarthropathy. What will be a priority nursing intervention for this patient? A) Referral for assistive devices B) Teaching about symptom management C) Referral to classes to stop smoking D) Setting up an exercise program

B Major nursing interventions in the spondyloarthropathies are related to symptom management and maintenance of optimal functioning. This is a priority over the use of assistive devices, smoking cessation, and exercise programs, though these topics may be of importance for some patients.

A nurse is providing care for a patient who has a rheumatic disorder. The nurse's comprehensive assessment includes the patient's mood, behavior, LOC, and neurologic status. What is this patient's most likely diagnosis? A) Osteoarthritis (OA) B) Systemic lupus erythematosus (SLE) C) Rheumatoid arthritis (RA) D) Gout

B SLE has a high degree of neurologic involvement, and can result in central nervous system changes. The patient and family members are asked about any behavioral changes, including manifestations of neurosis or psychosis. Signs of depression are noted, as are reports of seizures, chorea, or other central nervous system manifestations.

A nurse is planning patient education for a patient being discharged home with a diagnosis of rheumatoid arthritis. The patient has been prescribed antimalarials for treatment, so the nurse knows to teach the patient to self-monitor for what adverse effect? A) Tinnitus B) Visual changes C) Stomatitis D) Hirsutism

B - Antimalarials may cause visual changes; regular ophthalmologic examinations are necessary. - Tinnitus is associated with salicylate therapy - stomatitis is associated with gold therapy - hirsutism is associated with corticosteroid therapy.

A nurse is explaining the process by which the body removes cells from circulation after they have performed their physiologic function. The nurse is describing what process? A) The cellular immune response B) Apoptosis C) Phagocytosis D) Opsonization

B - Apoptosis, or programmed cell death, is the body's way of destroying worn out cells such as blood or skin cells or cells that need to be renewed.

A man was scratched by an old tool and developed a virulent staphylococcus infection. In the course of the man's immune response, circulating lymphocytes containing the antigenic message returned to the nearest lymph node. During what stage of the immune response did this occur? A) Recognition stage B) Proliferation stage C) Response stage D) Effector stage

B - The recognition stage of antigens as foreign by the immune system is the initiating event in any immune response. The body must first recognize invaders as foreign before it can react to them. - In the proliferation stage, the circulating lymphocyte containing the antigenic message returns to the nearest lymph node. Once in the node, the sensitized lymphocyte stimulates some of the resident dormant T and B lymphocytes to enlarge, divide, and proliferate. - In the response stage, the differentiated lymphocytes function either in a humoral or a cellular capacity. - In the effector stage, either the antibody of the humoral response or the cytotoxic (killer) T cell of the cellular response reaches and connects with the antigen on the surface of the foreign invader.

The nurse should recognize a patient's risk for impaired immune function if the patient has undergone surgical removal of which of the following? A) Thyroid gland B) Spleen C) Kidney D) Pancreas

B A history of surgical removal of the spleen, lymph nodes, or thymus may place the patient at risk for impaired immune function. Removal of the thyroid, kidney, or pancreas would not directly lead to impairment of the immune system.

A hospital nurse has experienced percutaneous exposure to an HIV-positive patient's blood as a result of a needlestick injury. The nurse has informed the supervisor and identified the patient. What action should the nurse take next? A) Flush the wound site with chlorhexidine. B) Report to the emergency department or employee health department. C) Apply a hydrocolloid dressing to the wound site. D) Follow up with the nurse's primary care provider.

B After initiating the emergency reporting system, the nurse should report as quickly as possible to the employee health services, the emergency department, or other designated treatment facility.

A patient has just been told by his physician that he has scleroderma. The physician tells the patient that he is going to order some tests to assess for systemic involvement. The nurse knows that priority systems to be assessed include what? A) Hepatic B) Gastrointestinal C) Genitourinary D) Neurologic

B Assessment of systemic involvement with scleroderma requires a systems review with special attention to gastrointestinal, pulmonary, renal, and cardiac systems.

A patient is undergoing testing to determine the overall function of her immune system. What test can be performed to evaluate the functioning of the patient's cellular immune system? A) Immunoglobulin testing B) Delayed hypersensitivity skin test C) Specific antibody response D) Total serum globulin assessment

B Cellular (cell-mediated) immunity tests include the delayed hypersensitivity skin test, since this immune response is specifically dependent on the cellular immune response. Each of the other listed tests assesses functioning of the humoral immune system.

A 6-month-old infant has been diagnosed with X-linked agammaglobulinemia and the parents do not understand why their baby did not develop an infection during the first months of life. The nurse should describe what phenomenon? A) Cell-mediated immunity in infants B) Passive acquired immunity C) Phagocytosis D) Opsonization

B Infants with X-linked agammaglobulinemia usually become symptomatic after the natural loss of maternally transmitted immunoglobulins (passive acquired immunity), which occurs at about 5 to 6 months of age.

A patient who has AIDS has been admitted for the treatment of Kaposi's sarcoma. What nursing diagnosis should the nurse associate with this complication of AIDS? A) Risk for Disuse Syndrome Related to Kaposi's Sarcoma B) Impaired Skin Integrity Related to Kaposi's Sarcoma C) Diarrhea Related to Kaposi's Sarcoma D) Impaired Swallowing Related to Kaposi's Sarcoma

B Kaposi's sarcoma (KS) is a disease that involves the endothelial layer of blood and lymphatic vessels. This malignancy does not directly affect swallowing or bowel motility and it does not constitute a risk for disuse syndrome.

A nurse is caring for a patient who has an immunodeficiency. What assessment finding should prompt the nurse to consider the possibility that the patient is developing an infection? A) Uncharacteristic aggression B) Persistent diarrhea C) Pruritis (itching) D) Constipation

B Persistent diarrhea is among the varied signs and symptoms that may suggest infection in an immunocompromised patient. Aggression, pruritis, and constipation are less suggestive of an infectious etiology.

A nurse has created a plan of care for an immunodeficient patient, specifying that care providers take the patient's pulse and respiratory rate for a full minute. What is the rationale for this aspect of care? A) Respirations affect heart rate in immunodeficient patients. B) These patients' blunted inflammatory responses can cause subtle changes in status. C) Hemodynamic instability is one of the main complications of immunodeficiency. D) Immunodeficient patients are prone to ventricular tachycardia and atrial fibrillation.

B Pulse rate and respiratory rate should be counted for a full minute, because subtle changes can signal deterioration in the patient's clinical status. The rationale for this action is not because of the relationship between heart rate and respirations. These patients do not have a greatly increased risk of hemodynamic instability or dysrhythmias.

A patient with rheumatic disease is complaining of stomatitis. The nurse caring for the patient should further assess the patient for the adverse effects of what medications? A) Corticosteroids B) Gold-containing compounds C) Antimalarials D) Salicylate therapy

B Stomatitis is an adverse effect that is associated with gold therapy. Steroids, antimalarials, and salicylates do not normally have this adverse effect.

A nurse is explaining how the humoral and cellular immune responses should be seen as interacting parts of the broader immune system rather than as independent and unrelated processes. What aspect of immune function best demonstrates this? A) The movement of B cells in and out of lymph nodes B) The interactions that occur between T cells and B cells C) The differentiation between different types of T cells D) The universal role of the complement system

B T cells interact closely with B cells, indicating that humoral and cellular immune responses are not separate, unrelated processes, but rather branches of the immune response that interact. Movement of B cells does not clearly show the presence of a unified immune system. The differentiation between types of T cells and the role of the complement system do not directly suggest a single immune system.

A nurse has admitted a patient diagnosed with severe combined immunodeficiency disease (SCID) to the unit. The patient's orders include IVIG. How will the patient's dose of IVIG be determined? A) The patient will receive 25 to 50 mg/kg of body weight. B) The dose will be determined by the patient's response. C) The dose will be determined by body surface area. D) The patient will receive a one-time bolus followed by 100- to 150-mg doses.

B The optimal dosage of IVIG is determined by the patient's response. In most instances, an IV dose of 200 to 800 mg/kg of body weight is administered.

A patient with HIV is admitted to the hospital because of chronic severe diarrhea. The nurse caring for this patient should expect the physician to order what drug for the management of the patient's diarrhea? A) Zithromax B) Sandostatin C) Levaquin D) Biaxin

B Therapy with octreotide acetate (Sandostatin), a synthetic analogue of somatostatin, has been shown to be effective in managing chronic severe diarrhea. *Somatostatin inhibits many physiologic functions, including gastrointestinal motility and intestinal secretion of water and electrolytes.

lymphocyte cells that are important in producing circulating antibodies

B cells

these cells are important for producing a humoral immune response

B cells

A nurse knows of several patients who have achieved adequate control of their allergy symptoms using over-the-counter antihistamines. Antihistamines would be contraindicated in the care of which patient? A) A patient who has previously been treated for tuberculosis B) A pregnant woman at 30 weeks gestation C) A patient who is on estrogen-replacement therapy D) A patient with a severe allergy to eggs

B) A pregnant woman at 30 weeks gestation

A child has been transported to the emergency department (ED) after a severe allergic reaction. The ED nurse is evaluating the patients respiratory status. How should the nurse evaluate the patients respiratory status? Select all that apply. A) Facilitate lung function testing. B) Assess breath sounds. C) Measure the childs oxygen saturation by oximeter. D) Monitor the childs respiratory pattern. E) Assess the childs respiratory rate.

B) Assess breath sounds. C) Measure the childs oxygen saturation by oximeter. D) Monitor the childs respiratory pattern. E) Assess the childs respiratory rate.

The nurse in an allergy clinic is educating a new patient about the pathology of the patients health problem. What response should the nurse describe as a possible consequence of histamine release? A) Constriction of small venules B) Contraction of bronchial smooth muscle C) Dilation of large blood vessels D) Decreased secretions from gastric and mucosal cells

B) Contraction of bronchial smooth muscle - H1 receptors are found predominantly on bronchiolar and vascular smooth muscle cells

A patient is receiving a transfusion of packed red blood cells. Shortly after initiation of the transfusion, the patient begins to exhibit signs and symptoms of a transfusion reaction. The patient is suffering from which type of hypersensitivity? A) Anaphylactic (type 1) B) Cytotoxic (type II) C) Immunecomplex (type III) D) Delayed type (type IV)

B) Cytotoxic (type II) occurs when the system mistakenly identifies a normal constituent of the body as foreign. This reaction may be the result of a cross-reacting antibody, possibly leading to cell and tissue damage.

A patient has a documented history of allergies presents to the clinic. She states that she is frustrated by her chronic nasal congestion, anosmia (inability to smell) and inability to concentrate. The nurse should identify which of the following nursing diagnoses? A) Deficient Knowledge of Self-Care Practices Related to Allergies B) Ineffective Individual Coping with Chronicity of Condition and Need for Environmental Modification C) Acute Confusion Related to Cognitive Effects of Allergic Rhinitis D) Disturbed Body Image Related to Sequelae of Allergic Rhinitis

B) Ineffective Individual Coping with Chronicity of Condition and Need for Environmental Modification

A patient is learning about his new diagnosis of asthma with the asthma nurse. What medication has the ability to prevent the onset of acute asthma exacerbations? A) Diphenhydramine (Benadryl) B) Montelukast (Singulair) C) Albuterol sulfate (Ventolin) D) Epinephrine

B) Montelukast (Singulair) Leukotriene modifiers, such as zafirlukast (Accolate) and montelukast (Singulair), block the synthesis or action of leukotrienes and prevent the signs and symptoms associated with asthma

A patient is brought to the emergency department (ED) in a state of anaphylaxis. What is the ED nurses priority for care? A) Monitor the patients level of consciousness. B) Protect the patients airway. C) Provide psychosocial support. D) Administer medications as ordered.

B) Protect the patients airway.

A patient was prescribed an oral antibiotic for the treatment of sinusitis. The patient has now stopped, stating she developed a rash shortly after taking the first dose of the drug. What is the nurses most appropriate response? A) Encourage the woman to continue with the medication while monitoring her skin condition closely. B) Refer the woman to her primary care provider to have the medication changed. C) Arrange for the woman to go to the nearest emergency department. D) Encourage the woman to take an OTC antihistamine with each dose of the antibiotic.

B) Refer the woman to her primary care provider to have the medication changed.

A nurse at an allergy clinic is providing education for a patient starting immunotherapy for the treatment of allergies. What education should the nurse prioritize? A) The importance of scheduling appointments for the same time each month B) The importance of keeping appointments for desensitization procedures C) The importance of avoiding antihistamines for the duration of treatment D) The importance of keeping a diary of reactions to the immunotherapy

B) The importance of keeping appointments for desensitization procedures

A child has been diagnosed with a severe walnut allergy after suffering an anaphylactic reaction. What is a priority for health education? A) The need to begin immunotherapy as soon as possible B) The need for the parents to carry an epinephrine pen C) The need to vigilantly maintain the childs immunization status D) The need for the child to avoid all foods that have a high potential for allergies

B) The need for the parents to carry an epinephrine pen

A patient with severe environmental allergies is scheduled for an immunotherapy injection. What should be included in teaching the patient about this treatment? A) The patient will be given a low dose of epinephrine before the treatment. B) The patient will remain in the clinic to be monitored for 30 minutes following the injection. C) Therapeutic failure occurs if the symptoms to the allergen do not decrease after 3 months. D) The allergen will be administered by the peripheral intravenous route.

B) The patient will remain in the clinic to be monitored for 30 minutes following the injection.

A patients decline in respiratory and renal function has been attributed to Goodpasture syndrome, which is a type II hypersensitivity reaction. What pathologic process underlies the patients health problem? A) Antigens have bound to antibodies and formed inappropriate immune complexes. B) The patients body has mistakenly identified a normal constituent of the body as foreign. C) Sensitized T cells have caused cell and tissue damage. D) Mast cells have released histamines that directly cause cell lysis.

B) The patients body has mistakenly identified a normal constituent of the body as foreign. - In Goodpasture syndrome, it generates antibodies against lung and renal tissue, producing lung damage and kidney injury

A nurse is caring for a teenage girl who has had an anaphylactic reaction after a bee sting. The nurse is providing patient teaching prior to the patients discharge. In the event of an anaphylactic reaction, the nurse informs the patient that she should self-administer epinephrine in what site? A) Forearm B) Thigh C) Deltoid muscle D) Abdomen

B) Thigh

In acute renal failure, doses of which of the following antibiotics must be reduced? (Check all that apply.) A. nafcillin B. cefazolin C. meropenem D. aztreonam

B, C, and D. Cefazolin, meropenem, and aztreonam all rely on renal clearance, and their dosages must be reduced in acute renal failure. The elimination of nafcillin does not entirely rely on renal clearance, because it is 60% metabolized by the liver.

A patient has been admitted with a phagocytic cell disorder and the nurse is reviewing the most common health problems that accompany these disorders. The nurse should identify which of the following? Select all that apply. A) Inflammatory bowel disease B) Chronic otitis media C) Cutaneous abscesses D) Pneumonia E) Cognitive deficits

B,C,D (Feedback: Patients with phagocytic cell disorders experience recurrent cutaneous abscesses, chronic eczema, bronchitis, pneumonia, chronic otitis media, and sinusitis. Irritable bowel syndrome and cognitive deficits are atypical.)

A nurse is caring for a patient who is suspected of having giant cell arteritis (GCA). What laboratory tests are most useful in diagnosing this rheumatic disorder? Select all that apply. A) Erythrocyte count B) Erythrocyte sedimentation rate C) Creatinine clearance D) C-reactive protein E) D-dimer

B,D (Feedback: Simultaneous elevation in the ESR and CRP have a sensitivity of 88% and a specificity of 98% in making the diagnosis of GCA when coupled with clinical findings. Erythrocyte counts, creatinine clearance, and D-dimer are not diagnostically useful.)

A woman is to receive amoxicillin-clavulanate (Augmentin) 500 mg PO every 8 hours for bronchitis. The nurse retrieves two 250-mg tablets from the medication cart. This is incorrect for which of the following reasons? A. The amount of sulbactam in amoxicillin-clavulanate 250 mg is 62.5 mg per tablet, twice the intended amount. B. This provides twice the intended dose of clavulanate. C. The 250-mg tablets have less absorption than the 500-mg tablets. D. Administration of amoxicillin-clavulanate is only intravenous, so selecting tablets means that the wrong drug is being administered.

B. Amoxicillin-clavulanate (Augmentin) is an orally administered combination product containing the antibiotic amoxicillin and the beta-lactamase inhibitor clavulanate. It is available in 250-, 500-, and 875-mg tablets; each of which contains 125 mg of clavulanate. Administering two 250-mg tablets of Augmentin provides an overdosage (250 mg) of clavulanate.

A nurse working in the neurointensive care unit is caring for a patient with a head injury who has been experiencing seizures and now has pneumonia caused by Pseudomonas aeruginosa. The physician has prescribed imipenem 1 g IV every 6 hours plus gentamicin for the pneumonia. Before administering the antibiotics, the nurse should do which of the following? A. Avoid mixing the imipenem and gentamicin in the same IV bag to prevent inactivation of the gentamicin. B. Remind the physician of the patient's seizures and inquire whether a different antibiotic might be safer. C. Suggest to the physician that imipenem is used to treat gram-positive infections and will not be effective in this patient. D. Set the infusion pump to deliver the imipenem over 15 minutes.

B. An adverse effect of imipenem is central nervous system toxicity including seizures, which is undesirable for this patient with a head injury and seizure activity. Although imipenem may be given concomitantly with gentamicin, mixing these drugs together in the same IV fluid inactivates the gentamicin. Imipenem is a broad-spectrum antibiotic that should be infused over 40 to 60 minutes.

A nurse reading a patient's chart notices that the patient is scheduled to receive ciprofloxacin 500 mg PO at 9:00 AM. The medication administration record also indicates that Maalox 30 mL PO and hydrochlorothiazide 25 mg PO are due at 9:00 AM. The nurse should... A. administer all the medications as scheduled B. hold the Maalox until 11:00 AM C. ask the physician to discontinue hydrochlorothiazide because of increased risk of ototoxicity D. administer the Maalox and ciprofloxacin but hold the hydrochlorothiazide

B. Ciprofloxacin can chelate with cations, and iron, multivitamins, calcium, magnesium, aluminum salts, and sucralfate may significantly reduce the absorption of ciprofloxacin. Therefore, ciprofloxacin should be taken 2 hours before or 6 hours after administration of the other agents. A is incorrect because Maalox impairs the absorption of ciprofloxacin. C is incorrect because loop diuretics, not thiazide diuretics, potentiate the effects of nephrotoxicity. D is incorrect because of the interaction with Maalox and ciprofloxacin. Thiazide diuretics do not interact with ciprofloxacin like loop diuretics do.

A critically ill patient is receiving gentamicin 1.5 mg per kg intravenously every 8 hours. The patient has recently stopped making urine, and the most recent laboratory results indicate that the patient's creatinine level has risen from a normal value of 0.8 mg per dL to 3.6 mg per dL. At the next scheduled time for administration of gentamicin, the nurse should A. administer half the prescribed dose B. hold the gentamicin and notify the physician C. administer gentamicin as prescribed D. draw a blood sample for testing the gentamicin trough level before the dose and then administer as prescribed

B. Gentamicin is excreted via the kidneys, and alterations in renal function may cause nephrotoxicity. Possible nephrotoxicity is a well-known adverse effect of gentamicin, and in this case, the nurse should notify the physician. A and C are incorrect because the patient could be experiencing renal impairment, and giving more gentamicin, even half the dose, may still cause drug toxicity and nephrotoxicity. D is incorrect because gentamicin could be contributing to the renal impairment. Although obtaining a trough level might help evaluate the gentamicin regimen, the nurse should not administer the drug until he or she discusses it with the physician.

A vesicant antineoplastic drug does which of the following? A. It causes minor skin irritation. B. It causes extensive tissue damage. C. It requires administration only through a central IV line. D. It requires deep intramuscular injection if diluted with normal saline.

B. Leakage of a vesicant drug into tissues surrounding the venipuncture site can cause severe tissue damage, which should be prevented if possible. Drug administration is often at a peripheral IV site, although it may occur via central line. Intramuscular administration is never appropriate.

A priority nursing diagnosis to include in the care plan for a patient receiving cytotoxic chemotherapy is... A. Risk for Impaired Skin Integrity B. Risk for Injury: Infection C. Body Image Disturbance related to alopecia D. Ineffective Family Coping

B. Most cytotoxic antineoplastic drugs suppress bone marrow function, including production of white blood cells that normally fight infectious microorganisms. Although impaired skin integrity, body image disturbance, and ineffective family coping may also be appropriate nursing diagnoses for particular patients, they are not as important as the risk of infection.

A patient is admitted to the emergency department following opening an envelope containing a substance that experts have identified as anthrax. Which of the following medications is administered? A. tetracycline B. doxycycline C. amoxicillin-clavulanic acid combination D. neomycin

B. Patients who are asymptomatic receive doxycycline or ciprofloxacin for 60 days following exposure to anthrax.

A cardiac surgeon orders cefazolin 1 g IV "on call" to the operating room for a patient scheduled for a heart valve replacement. The surgery is scheduled for 7:00 AM the next morning. What is the rationale for giving the antibiotic at 6:30 AM? The last dose was administered more than 8 hours ago. A. The cefazolin must be given 60 minutes before the procedure for legal reasons. B. The cefazolin must be given within 60 minutes before the first skin incision to reach therapeutic concentrations. C. The cefazolin trough level will be checked at 6:00 AM, which would allow the level to come back before administration of the "on call" dose. D. The last dose was administered yesterday.

B. Research has demonstrated that antibiotics must be present in the patient when the first skin incision to provide the most protection against infections acquired during surgery. That means that most antibiotics are ideally given no more than 1 hour before, not after, the first skin incision.

Which of the following adverse effects of telithromycin indicates a superinfection? A. diarrhea B. bloody diarrhea C. nausea D. vomiting

B. The development of bloody diarrhea is a symptom of pseudomembranous colitis, which is a superinfection.

A female patient with chronic lymphocytic leukemia is beginning to receive an oral cyclophosphamide. The nurse instructs the patient that the best way to take the drug is... A. with food B. on an empty stomach C. at bedtime D. one hour after a meal

B. The nurse tells the patient to take the oral cyclophosphamide on an empty stomach. If severe gastrointestinal upset occurs, she should take the drug with food.

A man is receiving treatment for a Mycoplasma pneumoniae infection. He says that drinking orange juice hurts his mouth. What priority assessment should the nurse make? A. Assess the patient's fecal output for signs and symptoms of diarrhea. B. Assess the patient's mouth for signs of candidal infection. C. Assess the patient's lung sounds for rales or rhonchi. D. Assess the patient's intake and output.

B. When a patient complains of mouth pain and difficulty swallowing when taking an antiinfective agent such as tetracycline, it is necessary to inspect the patient's mouth for white patchy areas. These areas indicate Candida albicans, a superinfection of the mouth.

A nurse is applying silver sulfadiazine (Silvadene) to a child's burns. Which of the following nursing actions is most important when applying the medication? A. providing pain medication B. using sterile gloves C. giving the child a bath D. teaching the parent to apply the medication

B. When applying silver sulfadiazine (Silvadene) to a burned area, it is important to wear sterile gloves.

A physician has ordered sulfisoxazole for a woman with a urinary tract infection. The nurse has asked the patient about whether she takes any over-the-counter medications. The patient reports that she regularly takes St. John's wort as a mood elevator. Which of the following patient teaching interventions is most important? A. Taking St. John's wort and sulfisoxazole results in no known interactions. B. Sulfisoxazole combined with St. John's wort leads to an increased therapeutic effect of the sulfisoxazole. C. Sulfisoxazole has a decreased effect when given with St. John's wort. D. When given in combination, sulfisoxazole and St. John's wort result in manic tendencies.

B. When taken concurrently with sulfisoxazole, St. John's wort enhances the effects of the sulfisoxazole.

patient must be monitored after administration of immunotherapy. Why?

Because of the risk of anaphylaxis, injections should not be given by a lay person or by the patient. The patient must remain in the office or clinic for at least 30 minutes after the injection and is observed for possible systemic symptoms.

A nurse comes to the employee health center for evaluation and is diagnosed with allergic contact dermatitis related to latex. Which of the following would the nurse most likely exhibit? Rhinitis Angioedema Blistering Laryngeal edema

Blistering

How is HIV transmitted?

Bodily fluids -Blood -Semen -Vaginal fluid -Breast milk

Alkylating Agents

Bond with DNA, RNA, and protein molecules leading to impaired DNA replication, RNA transcription, and cell functioning * all resulting in cell death

Topoisomerase I Inhibitors side effects

Bone marrow suppression, diarrhea, nausea, vomiting, flulike symptoms (topotecan), rash (etoposide), hepatotoxicity (teniposide)

Alkylating agents common Side Effects:

Bone marrow suppression, nausea, vomiting, cystitis (cyclophosphamide, ifosfamide), stomatitis, alopecia, gonadal suppression, renal toxicity (cisplatin), and development of secondary malignancies

Throbbing and aching pain

Bone metastasis

__________________ is the placement of radioactive sources within or immediately next to the cancer site in order to provide a highly targeted, intense dose of radiation beyond a dose that is usually provided by EBRT. In addition, this form of radiation delivery helps to spare exposure to normal surrounding tissue.

Brachytherapy

A patient's recent diagnostic testing included a total lymphocyte count. The results of this test will allow the care team to gauge what aspect of the patient's immunity? A) Humoral immune function B) Antigen recognition C) Cell-mediated immune function D) Antibody production

C (Feedback: A total lymphocyte count is a test used to determine cellular immune function. It is not normally used for testing humoral immune function and the associated antigen-antibody.)

The nurse knows that the response of natural immunity is enhanced by processes that are inherent in the physical and chemical barriers of the body. What is a chemical barrier that enhances the response of natural immunity? A) Cell cytoplasm B) Interstitial fluid C) Gastric secretions D) Cerebrospinal fluid

C (Feedback: Chemical barriers, such as mucus, acidic gastric secretions, enzymes in tears and saliva, and substances in sebaceous and sweat secretions, act in a nonspecific way to destroy invading bacteria and fungi. Not all body fluids are chemical barriers, however. Cell cytoplasm, interstitial fluid, and CSF are not normally categorized as chemical barriers to infection.)

A nurse is reviewing a patient's medication administration record in an effort to identify drugs that may contribute to the patient's recent immunosuppression. What drug is most likely to have this effect? A) An antibiotic B) A nonsteroidal anti-inflammatory drug (NSAID) C) An antineoplastic D) An antiretroviral

C (Feedback: Chemotherapy affects bone marrow function, destroying cells that contribute to an effective immune response and resulting in immunosuppression. Antibiotics in large doses cause bone marrow suppression, but antineoplastic drugs have the most pronounced immunosuppressive effect. NSAIDs and antiretrovirals do not normally have this effect.)

A nurse caring for a patient who has an immunosuppressive disorder knows that continual monitoring of the patient is critical. What is the primary rationale behind the need for continual monitoring? A) So that the patient's functional needs can be met immediately B) So that medications can be given as ordered and signs of adverse reactions noted C) So that early signs of impending infection can be detected and treated D) So that the nurse's documentation can be thorough and accurate

C (Feedback: Continual monitoring of the patient's condition is critical, so that early signs of impending infection may be detected and treated before they seriously compromise the patient's status. Continual monitoring is not primarily motivated by the patient's functional needs or medication schedule. The nurse's documentation is important, but less than infection control.)

A patient's primary immunodeficiency disease is characterized by the inability of white blood cells to initiate an inflammatory response to infectious organisms. What is this patient's most likely diagnosis? A) Chronic granulomatous disease B) Wiskott-Aldrich syndrome C) Hyperimmunoglobulinemia E syndrome D) Common variable immunodeficiency

C (Feedback: In one rare type of phagocytic disorder, hyperimmunoglobulinemia E syndrome (formerly known as Job syndrome), white blood cells cannot initiate an inflammatory response to infectious organisms. The other listed health problems do not have this pathology.)

A teenager is diagnosed with cellulitis of the right knee and fails to respond to oral antibiotics. He then develops osteomyelitis of the right knee, prompting a detailed diagnostic workup that reveals a phagocytic disorder. This patient faces an increased risk of what complication? A) Thrombocytopenia B) HIV/AIDS C) Neutropenia D) Hemophilia

C (Feedback: Patients with phagocytic cell disorders may develop severe neutropenia. None of the other listed health problems is a common complication of phagocytic disorders.)

The nurse educator is differentiating primary immunodeficiency diseases from secondary immunodeficiencies. What is the defining characteristic of primary immunodeficiency diseases? A) They require IVIG as treatment. B) They are the result of intrauterine infection. C) They have a genetic origin. D) They are communicable.

C (Feedback: Primary immunodeficiency diseases are genetic in origin and result from intrinsic defects in the cells of the immune system. Primary immunodeficiency diseases do not always need IVIG as treatment, and they are not communicable. Primary immunodeficiencies do not result from intrauterine infection.)

A home health nurse will soon begin administering IVIG to a new patient on a regular basis. What teaching should the nurse provide to the patient? A) The need for a sterile home environment B) Complementary alternatives to IVIG C) Expected benefits and outcomes of the treatment D) Technique for managing and monitoring daily fluid intake

C (Feedback: The patient who is to receive IVIG at home will need information about the expected benefits and outcomes of the treatment as well as expected adverse reactions and their management. The home environment cannot be sterile and complementary alternatives to IVIG have not been identified. Fluid management is not a central concern.)

A nurse is caring for a patient who has had a severe antigen/antibody reaction. The nurse knows that the portion of the antigen that is involved in binding with the antibody is called what? A) Antibody lock B) Antigenic sequence C) Antigenic determinant D) Antibody channel

C (Feedback: The portion of the antigen involved in binding with the antibody is referred to as the antigenic determinant. This portion is not known as an antibody lock, antigenic sequence, or antibody channel.)

The nurse is working with the interdisciplinary team to care for a patient who has recently been diagnosed with severe combined immunodeficiency disease (SCID). What treatment is likely of most benefit to this patient? A) Combined radiotherapy and chemotherapy B) Antibiotic therapy C) Hematopoietic stem cell transplantation (HSCT) D) Treatment with colony-stimulating factors (CSFs)

C (Feedback: Treatment options for SCID include stem cell and bone marrow transplantation, but HSCT is the definitive therapy for the disease and supersedes the importance of antibiotics. CSFs, radiation therapy, and chemotherapy are not indicated.)

A nurse is performing the health history and physical assessment of a patient who has a diagnosis of rheumatoid arthritis (RA). What assessment finding is most consistent with the clinical presentation of RA? A) Cool joints with decreased range of motion B) Signs of systemic infection C) Joint stiffness, especially in the morning D) Visible atrophy of the knee and shoulder joints

C (In addition to joint pain and swelling, another classic sign of RA is joint stiffness, especially in the morning. Joints are typically swollen, not atrophied, and systemic infection does not accompany the disease. Joints are often warm rather than cool.)

A patient with SLE asks the nurse why she has to come to the office so often for "check-ups." What would be the nurse's best response? A) "Taking care of you in the best way involves seeing you face to face." B) "Taking care of you in the best way involves making sure you are taking your medication the way it is ordered." C) "Taking care of you in the best way involves monitoring your disease activity and how well the prescribed treatment is working." D) "Taking care of you in the best way involves drawing blood work every month."

C (The goals of treatment include preventing progressive loss of organ function, reducing the likelihood of acute disease, minimizing disease-related disabilities, and preventing complications from therapy. Management of SLE involves regular monitoring to assess disease activity and therapeutic effectiveness. Stating the benefit of face-to-face interaction does not answer the patient's question. Blood work is not necessarily drawn monthly and assessing medication adherence is not the sole purpose of visits.)

A clinic nurse is caring for a patient with suspected gout. While explaining the pathophysiology of gout to the patient, the nurse should describe which of the following? A) Autoimmune processes in the joints B) Chronic metabolic acidosis C) Increased uric acid levels D) Unstable serum calcium levels

C (Feedback: Gout is caused by hyperuricemia (increased serum uric acid). Gout is not categorized as an autoimmune disease and it does not result from metabolic acidosis or unstable serum calcium levels.)

A patient with rheumatoid arthritis comes into the clinic for a routine check-up. On assessment the nurse notes that the patient appears to have lost some of her ability to function since her last office visit. Which of the following is the most appropriate action? A) Arrange a family meeting in order to explore assisted living options. B) Refer the patient to a support group. C) Arrange for the patient to be assessed in her home environment. D) Refer the patient to social work.

C Assessment in the patient's home setting can often reveal more meaningful data than an assessment in the health care setting.

A clinic nurse is caring for a patient diagnosed with rheumatoid arthritis (RA). The patient tells the nurse that she has not been taking her medication because she usually cannot remove the childproof medication lids. How can the nurse best facilitate the patient's adherence to her medication regimen? A) Encourage the patient to store the bottles with their tops removed. B) Have a trusted family member take over the management of the patient's medication regimen. C) Encourage her to have her pharmacy replace the tops with alternatives that are easier to open. D) Have the patient approach her primary care provider to explore medication alternatives.

C The patient's pharmacy will likely be able to facilitate a practical solution that preserves the patient's independence while still fostering adherence to treatment.

A patient is responding to a microbial invasion and the patient's differentiated lymphocytes have begun to function in either a humoral or a cellular capacity. During what stage of the immune response does this occur? A) The recognition stage B) The effector stage C) The response stage D) The proliferation stage

C - In the response stage, the differentiated lymphocytes function in either a humoral or a cellular capacity. - In the effector stage, either the antibody of the humoral response or the cytotoxic (killer) T cell of the cellular response reaches and connects with the antigen on the surface of the foreign invader. - In the recognition stage, the recognition of antigens as foreign, or non-self, by the immune system is the initiating event in any immune response. - During the proliferation stage the circulating lymphocytes containing the antigenic message return to the nearest lymph node.)

A patient with cystic fibrosis has received a double lung transplant and is now experiencing signs of rejection. What is the immune response that predominates in this situation? A) Humoral B) Nonspecific C) Cellular D) Mitigated

C - Most immune responses to antigens involve both humoral and cellular responses, although only one predominates. - During transplantation rejection, the cellular response predominates over the humoral response.

A patient with AIDS is admitted to the hospital with AIDS-related wasting syndrome and AIDS-related anorexia. What drug has been found to promote significant weight gain in AIDS patients by increasing body fat stores? A) Advera B) Momordicacharantia C) Megestrol D) Ranitidine

C -Megestrol acetate (Megace), a synthetic oral progesterone preparation, promotes significant weight gain. In patients with HIV infection, it increases body weight primarily by increasing body fat stores.

A nurse is educating a patient with gout about lifestyle modifications that can help control the signs and symptoms of the disease. What recommendation should the nurse make? A) Ensuring adequate rest B) Limiting exposure to sunlight C) Limiting intake of alcohol D) Smoking cessation

C Alcohol and red meat can precipitate an acute exacerbation of gout. Each of the other listed actions is consistent with good health, but none directly addresses the factors that exacerbate gout.

A gerontologic nurse is caring for an older adult patient who has a diagnosis of pneumonia. What age-related change increases older adults' susceptibility to respiratory infections? A) Atrophy of the thymus B) Bronchial stenosis C) Impaired ciliary action D) Decreased diaphragmatic muscle tone

C As a consequence of impaired ciliary action due to exposure to smoke and environmental toxins, older adults are vulnerable to lung infections.

A nurse is admitting an adolescent patient with a diagnosis of ataxia-telangiectasis. Which of the following nursing diagnoses should the nurse include in the patient's plan of care? A) Fatigue Related to Pernicious Anemia B) Risk for Constipation Related to Decreased Gastric Motility C) Risk for Falls Due to Loss of Muscle Coordination D) Disturbed Kinesthetic Sensory Perception Related to Vascular Changes

C Ataxia-telangiectasia is an autosomal recessive neurodegenerative disorder characterized by cerebellar ataxia (loss of muscle coordination), telangiectasia (vascular lesions caused by dilated blood vessels), and immune deficiency. Decreased coordination is likely to constitute a risk for falls. The patient does not characteristically lose tactile sensation or experience pernicious anemia or constipation.

Diagnostic testing has revealed a deficiency in the function of a patient's complement system. This patient is likely to have an impaired ability to do which of the following? A) Protecting the body against viral infection B) Marking the parameters of the immune response C) Bridging natural and acquired immunity D) Collecting immune complexes during inflammation

C Complement has three major physiologic functions: defending the body against bacterial infection, bridging natural and acquired immunity, and disposing of immune complexes and the byproducts associated with inflammation. Complement does not mark the parameters of the immune response; complement does not collect immune complexes during inflammation.

A patient's current immune response involves the direct destruction of foreign microorganisms. This aspect of the immune response may be performed by what cells? A) Suppressor T cells B) Memory T cells C) Cytotoxic T cells D) Complement T cells

C Cytotoxic T cells (also called CD8 + cells) participate in the destruction of foreign organisms. Memory T cells and suppressor T cells do not perform this role in the immune response. The complement system does not exist as a type of T cell.

A nurse is admitting a patient who exhibits signs and symptoms of a nutritional deficit. Inadequate intake of what nutrient increases a patient's susceptibility to infection? A) Vitamin B12 B) Unsaturated fats C) Proteins D) Complex carbohydrates

C Depletion of protein reserves results in atrophy of lymphoid tissues, depression of antibody response, reduction in the number of circulating T cells, and impaired phagocytic function. As a result, the patient has an increased susceptibility to infection.

A patient with a diagnosis of primary immunodeficiency informs the nurse that he has been experiencing a new onset of a dry cough and occasional shortness of breath. After determining that the patient's vital signs are within reference ranges, what action should the nurse take? A) Administer a nebulized bronchodilator. B) Perform oral suctioning. C) Assess the patient for signs and symptoms of infection. D) Teach the patient deep breathing and coughing exercises.

C Dyspnea and cough are among the many signs and symptoms that may suggest infection in an immunocompromised patient. There is no indication for suctioning or the use of nebulizers. Deep breathing and coughing exercises do not address the patient's complaints or the likely etiology.

A patient with systemic lupus erythematosus (SLE) is preparing for discharge. The nurse knows that the patient has understood health education when the patient makes what statement? A) "I'll make sure I get enough exposure to sunlight to keep up my vitamin D levels." B) "I'll try to be as physically active as possible between flare-ups." C) "I'll make sure to monitor my body temperature on a regular basis." D) "I'll stop taking my steroids when I get relief from my symptoms."

C Fever can signal an exacerbation and should be reported to the physician. Sunlight and other sources of ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of SLE. Patients should be encouraged to pace activities and plan rest periods.

A patient with a diagnosis of common variable immunodeficiency begins to develop thick, sticky, tenacious sputum. The patient has a history of episodes of pneumonia at least one time per year for the last 10 years. What does the nurse suspect the patient is developing? A) Pulmonary edema B) A pulmonary neoplasm C) Bronchiectasis D) Emphysema

C Frequent respiratory tract infections in patients with CVID typically lead to chronic progressive bronchiectasis and pulmonary failure. Pulmonary edema is often a result of vascular insufficiency. A patient suffering from CVID is likely to develop gastric cancer, not lung cancer. The patient is not at risk for emphysema.

A nurse is planning the assessment of a patient who is exhibiting signs and symptoms of an autoimmune disorder. The nurse should be aware that the incidence and prevalence of autoimmune diseases is known to be higher among what group? A) Young adults B) Native Americans C) Women D) Hispanics

C Many autoimmune diseases have a higher incidence in females than in males, a phenomenon believed to be correlated with sex hormones.

A patient with SLE has come to the clinic for a routine check-up. When auscultating the patient's apical heart rate, the nurse notes the presence of a distinct "scratching" sound. What is the nurse's most appropriate action? A) Reposition the patient and auscultate posteriorly. B) Document the presence of S3 and monitor the patient closely. C) Inform the primary care provider that a friction rub may be present. D) Inform the primary care provider that the patient may have pneumonia.

C Patients with SLE are susceptible to developing a pericardial friction rub, possibly associated with myocarditis and accompanying pleural effusions; this warrants prompt medical follow-up.

A patient requires ongoing treatment and infection-control precautions because of an inherited deficit in immune function. The nurse should recognize that this patient most likely has what type of immune disorder? A) A primary immune deficiency B) A gammopathy C) An autoimmune disorder D) A rheumatic disorder

C Primary immune deficiency results from improper development of immune cells or tissues. These disorders are usually congenital or inherited. Autoimmune disorders are less likely to have a genetic component, though some have a genetic component. Overproduction of immunoglobulins is the hallmark of gammopathies. Rheumatic disorders do not normally involve impaired immune function

The nurse care plan for a patient with AIDS includes the diagnosis of Risk for Impaired Skin Integrity. What nursing intervention should be included in the plan of care? A) Maximize the patient's fluid intake. B) Provide total parenteral nutrition (TPN). C) Keep the patient's bed linens free of wrinkles. D) Provide the patient with snug clothing at all times.

C Skin surfaces are protected from friction and rubbing by keeping bed linens free of wrinkles and avoiding tight or restrictive clothing. Fluid intake should be adequate, and must be monitored, but maximizing fluid intake is not a goal. TPN is a nutritional intervention of last resort.

An immunocompromised patient is being treated in the hospital. The nurse's assessment reveals that the patient's submandibular lymph nodes are swollen, a finding that represents a change from the previous day. What is the nurse's most appropriate action? A) Administer a PRN dose of acetaminophen as ordered. B) Monitor the patient's vital signs q2h for the next 24 hours. C) Inform the patient's primary care provider of this finding. D) Implement standard precautions in the patient's care.

C Swollen lymph nodes are suggestive of infection and warrant prompt medical assessment and treatment.

A junior nursing student is having an observation day in the operating room. Early in the day, the student tells the OR nurse that her eyes are swelling and she is having trouble breathing. What should the nurse suspect? A) Cytotoxic reaction due to contact with the powder in the gloves B) Immune complex reaction due to contact with anesthetic gases C) Anaphylaxis due to a latex allergy D) Delayed reaction due to exposure to cleaning products

C) Anaphylaxis due to a latex allergy

A nurse is aware of the need to assess patients risks for anaphylaxis. What health care procedure constitutes the highest risk for anaphylaxis? A) Administration of the measles-mumps-rubella (MMR) vaccine B) Rapid administration of intravenous fluids C) Computed tomography with contrast solution D) Administration of nebulized bronchodilators

C) Computed tomography with contrast solution

A child is undergoing testing for food allergies after experiencing unexplained signs and symptoms of hypersensitivity. What food items would the nurse inform the parents are common allergens? A) Citrus fruits and rice B) Root vegetables and tomatoes C) Eggs and wheat D) Hard cheeses and vegetable oils

C) Eggs and wheat

A patient has presented with signs and symptoms that are consistent with contact dermatitis. What aspect of care should the nurse prioritize when working with this patient? A) Promoting adequate perfusion in affected regions B) Promoting safe use of topical antihistamines C) Identifying the offending agent, if possible D) Teaching the patient to safely use an EpiPen

C) Identifying the offending agent, if possible

A nurse has included the nursing diagnosis of Risk for Latex Allergy Response in a patients plan of care. The presence of what chronic health problem would most likely prompt this diagnosis? A) Herpes simplex B) HIV C) Spina bifida D) Hypogammaglobulinemia

C) Spina bifida

A patient has been living with seasonal allergies for many years, but does not take antihistamines, stating, When I was young I used to take antihistamines, but they always put me to sleep. How should the nurse best respond? A) Newer antihistamines are combined with a stimulant that offsets drowsiness. B) Most people find that they develop a tolerance to sedation after a few months. C) The newer antihistamines are different than in years past, and cause less sedation. D) Have you considered taking them at bedtime instead of in the morning?

C) The newer antihistamines are different than in years past, and cause less sedation.

A nurse is creating a teaching plan for a patient who has a recent diagnosis of scleroderma. What topics should the nurse address during health education? Select all that apply. A) Surgical treatment options B) The importance of weight loss C) Managing Raynaud's-type symptoms D) Smoking cessation E) The importance of vigilant skin care

C,D,E Patient teaching for the patient with scleroderma focuses on management of Raynaud's phenomenon, smoking cessation, and meticulous skin care. Surgical treatment options do not exist and weight loss is not a central concern.

A man had rheumatic fever as a child. He has an appointment for a tooth extraction. His dentist prescribes which of the following medications prior to the extraction? A. chloramphenicol B. vancomycin C. clarithromycin D. digoxin

C. Clarithromycin is the prophylactic drug of choice for patients who are predisposed to cardiac endocarditis. Patients who have had rheumatic fever are at risk for the development of this infectious cardiac condition.

A patient is admitted to the critical care unit with a diagnosis of Legionnaire's disease. Based on your knowledge of pharmacology, which medication is the drug of choice to treat the infection? A. azithromycin B. clarithromycin C. erythromycin D. vancomycin

C. Parenteral erythromycin is the drug of choice for the treatment of Legionnaire's disease.

A patient from a nursing home arrives at the emergency department with acute pyelonephritis. The physician prescribes ciprofloxacin 500 mg PO twice daily. The patient has a history of seizures and bradycardia. The nurse should... A. counsel the patient's caregiver to avoid administering the ciprofloxacin with the patient's anticonvulsant B. ask the physician to check blood levels of the patient's anticonvulsant(s) before giving the first dose of ciprofloxacin C. call the patient's seizure and dysrhythmia history to the physician's attention and inquire whether another type of antibiotic might be selected D. counsel the patient's caregiver to discontinue the ciprofloxacin after the patient's fever is gone

C. The addition of ciprofloxacin has led to documented drug interactions with anticonvulsants and antidysrhythmics, and the prescriber should choose an alternative if possible. A is incorrect because the patient needs to take the anticonvulsant for seizures as well as an antibiotic for pyelonephritis. Altering the administration schedule may precipitate seizures. B is incorrect because even if levels are obtained, it is the concurrent administration ciprofloxacin that can alter the levels of the anticonvulsant. In addition, an interaction with the antidysrhythmic agent may prolong the QT interval. D is incorrect because all antibiotics should be taken for the entire duration of therapy, even if the patient feels better or the fever is gone.

A college student is seen in the campus health center with a sore throat. Examination of the throat reveals redness and swelling but no sign of infection. Which of the following is an accurate description of the inflammatory process? A. A granuloma will develop if the inflammation is unresolved. B. The student is not at risk for the development of an infection. C. There is an influx of leukocytes to the throat. D. Scarring will result from phagocytic action.

C. The presence of inflammation initiates the influx of leukocytes to the area of inflammation to assist in tissue repair.

A physician has ordered intravenous sulfamethoxazole with trimethoprim. How should the nurse administer the medication? A. in 500 mL of 0.45% normal saline B. in 150 mL of 10% dextrose and water C. in 125 mL of 5% dextrose and water D. in 125 mL of 5% dextrose and 0.45% normal saline

C. When administering sulfamethoxazole and trimethoprim intravenously, it is necessary to dilute the medication in 125 mL of 5% dextrose and water.

During stage 0, which is also known as acute/recent infection, most varieties of HIV-1 use the chemokine cell receptor molecule for entry to T cells in addition to the CD4+ receptor, which suggests that the R5 variant is preferred to a different variant (CXCR4) but the preferred coreceptor can shift over the course of infection.

CCR5 (R5 virus)

All viruses target specific cells. HIV targets cells with _________ receptors, which are expressed on the surface of T lymphocytes, monocytes, dendritic cells, and brain microglia.

CD4+

Testing for latent TB at the time of HIV diagnosis should be routine, regardless of an individual's risk of TB exposure. Individuals with negative diagnostic tests for latent TB who have stage 3 HIV infection should be retested once their _____ count increases due to ART.

CD4+

The __________ count serves as the major laboratory indicator of immune function and prophylaxis for opportunistic infections, and is the strongest predictor of subsequent disease progression and survival

CD4+

The ________ serves as the major laboratory indicator of immunefunction and prophylaxis for opportunistic infections, and is the strongest predictor of subsequent disease progression and survival

CD4+ count

Mature T cells (T lymphocytes) are composed of two major subpopulations that are defined by cell surface receptors of ________ or __________

CD4+ or CD8+.

Why does the immunocompromised client have an increased incidence of cancer?

Cancer develops when the immune system fails to recognize and destroy abnormal cells--Therefore patients who are immunocompromised have an increased incidence of cancer

In women with early-stage HIV infection, ____________________ usually presents the same as in women without HIV infection, with white adherent vaginal discharge associated with mucosal burning and itching of mild-to-moderate severity and sporadic recurrences

Candida vulvovaginitis

characterized by painless, creamy white, plaque-like lesions that can occur on the buccal surface, hard or soft palate, oropharyngeal mucosa, or tongue surface.

Candidiasis

Account for 80-90% of all cancers

Carcinoma

Carcinoembryonic antigen

Carcinomas of the colon, pancreas, lung, stomach, and heart

Autoimmune polyglandular syndrome type 1

Causes a diverse range of symptoms, including autoimmunity against different types of organs and candidiasis, a fungal infection caused by Candida yeast.

The nurse is administering a sympathomimetic drug to a patient. What areas of concern does the nurse have when administering this drug? (Select all that apply.) Constricts integumentary smooth muscle Causes laryngospasm Causes bronchoconstriction Dilates the muscular vasculature Causes bronchodilation

Causes bronchodilation Constricts integumentary smooth muscle Dilates the muscular vasculature

Why is cefazolin the drug of choice for his cardiac pacemaker procedure?

Cefazolin is the drug of choice for surgical prophylaxis in most surgical procedures.

Use of chemicals or chemotherapy applied directly to tissue to cause destruction

Chemosurgery

___________ involves the use of antineoplastic drugs in an attempt to destroy cancer cells by interfering with cellular functions, including replication and DNA repair

Chemotherapy

leucovorin (Wellcovorin)

Chemotherapy modulating agent *Adjunct Chemotherapeutic Agents

The nurse is evaluating the plan of care for a client with an allergic disorder who has a nursing diagnosis of deficient knowledge related to measures for allergy control. Which of the following would indicate to the nurse that the outcome has been met? Client demonstrates appropriate coping strategies for dealing with a chronic disorder. Client identifies methods for reducing exposure risk to allergens. Client states the need for coughing and deep breathing. Client reports an absence of symptoms associated with the allergy.

Client identifies methods for reducing exposure risk to allergens. Explanation: For the nursing diagnosis of deficient knowledge, the client's ability to identify methods for reducing the risk of allergen exposure indicates that the outcome has been met. The statment about coughing and deep breathing and an absence of symptoms would be appropriate for evaluating the nursing diagnosis of ineffective breathing pattern. Positive coping strategies would be an appropriate outcome for a nursing diagnosis of ineffective coping.

Immediate hypersensitivity, a type I allergic reaction manifestation:

Clinical manifestations have a rapid onset and can include urticaria, wheezing, dyspnea, laryngeal edema, bronchospasm, tachycardia, angioedema, hypotension, and cardiac arrest.

Progressive Multifocal Leukoencephalopathy Clinical manifestations

Clinical manifestations often begin with mental confusion and rapidly progress to include blindness, aphasia, muscle weakness, paresis (partial or complete paralysis), and death

A condition characterized by redness, itching, and large, blisterlike wheals on skin that is exposed to cold.

Cold Urticaria

What is complement, how is it formed, and how does it function?

Complement is a term used to describe circulating plasma proteins that are made in the liver and activated when an antibody couples with an antigen. Complement defends the body against bacterial infection, bridges natural and acquired immunity, and disposes of immune complexes and byproducts associated with inflammation.

What laboratory test should the nurse review first to identify antibodydeficiencies?

Complete blood count with manual differential should always be analyzed first

Use of narrow-beam x-ray to scan successive layers of tissue for a cross-sectional view

Computed tomography (CT) scan

__________________, a type IV delayed hypersensitivity reaction, is an acute or chronic skin condition caused by contact with an exogenous substance that elicits an allergic response.

Contact dermatitis

approach for managing CINV

Corticosteroids, phenothiazines, sedatives, and histamines are helpful * especially when used in combination with serotonin blockers to provide antiemetic protection

A client with allergic rhinitis is prescribed a mast cell stabilizer. Which of the following would the nurse expect to be used? Diphenhydramine Cromolyn sodium Certirizine Zafirlukast

Cromolyn sodium

Use of liquid nitrogen or a very cold probe to freeze tissue and cause cell destruction

Cryoablation * Cervical, prostate, and rectal cancers

Which of the following is the most frequent route of exposure to a latex allergy? a)Parenteral b)Inhalation c)Cutaneous d)Mucosal

Cutaneous Explanation: Routes of exposure to latex products can be cutaneous, percutaneous, mucosal, parenteral, or aerosol. Allergic reactions are more likely with parenteral or mucous membrane exposure but can also occur with cutaneous contact or inhalation. The most frequent source of exposure is cutaneous, which usually involves the wearing of natural latex gloves.

first manifestation of kaposi sarcoma?

Cutaneous signs may be the first manifestation of HIV; they can appear anywhere on the body and are usually brownish pink to deep purple.

substances produced primarily by cells of the immune system to enhance or suppress the production and functioning of components of the immune system, are used to treat cancer or the adverse effects of some cancer treatments.

Cytokines

CD8+ cells

Cytotoxic T cells

The nurse is completing a focused assessment addressing a patient's immune function. What should the nurse prioritize in the physical assessment? A) Percussion of the patient's abdomen B) Palpation of the patient's liver C) Auscultation of the patient's apical heart rate D) Palpation of the patient's lymph nodes

D (Feedback: During the assessment of immune function, the anterior and posterior cervical, supraclavicular, axillary, and inguinal lymph nodes are palpated for enlargement. If palpable nodes are detected, their location, size, consistency, and reports of tenderness on palpation are noted. Because of the central role of lymph nodes in the immune system, they are prioritized over the heart, liver, and abdomen, even though these would be assessed.)

A nurse educator is explaining that patients with primary immunodeficiencies are living longer than in past decades because of advances in medical treatment. This increased longevity is associated with an increased risk of what? A) Chronic obstructive pulmonary disease B) Dementia C) Pulmonary fibrosis D) Cancer

D (Feedback: Advances in medical treatment have meant that patients with primary immunodeficiencies live longer, thus increasing their overall risk of developing cancer. It does not mean that they are at increased risk of COPD, dementia, or pulmonary fibrosis.)

A patient who has received a heart transplant is taking cyclosporine, an immunosuppressant. What should the nurse emphasize during health education about infection prevention? A) Eat a high-calorie, high-protein diet. B) Limit physical activity in order to conserve energy. C) Take prophylactic antibiotics as ordered. D) Perform frequent handwashing.

D (Feedback: Hand hygiene is imperative in infection control. A well-balanced diet is important, but for most patients this is secondary to hygiene as an infection-control measure. Prophylactic antibiotics are not normally used. Limiting physical activity will not protect the patient from infection.)

A nurse is planning the care of a patient who requires immunosuppression to ensure engraftment of depleted bone marrow during a transplantation procedure. What is the most important component of infection control in the care of this patient? A) Administration of IVIG B) Antibiotic administration C) Appropriate use of gloves and goggles D) Thorough and consistent hand hygiene

D (Feedback: Hand hygiene is usually considered the most important aspect of infection control. IVIG and antibiotics are not considered infection control measures, though they enhance resistance to infection and treat infection. Gloves and goggles are sometimes indicated but are less effective than hand hygiene.)

A nursing student is giving a report on the immune system. What function of cytokines should the student describe? A) Determining whether a cell is foreign B) Determining if lymphokines will be activated C) Determining whether the T cells will remain in the nodes and retain a memory of the antigen D) Determining whether the immune response will be the production of antibodies or a cell-mediated response

D (Feedback: Separate subpopulations of helper T cells produce different types of cytokines and determine whether the immune response will be the production of antibodies or a cell-mediated immune response. Cytokines do not determine whether cells are foreign, determine if lymphokines will be activated, or determine the role of memory T cells.)

The nurse is preparing to administer IVIG to a patient who has an immunodeficiency. What nursing guideline should the nurse apply? A) Do not exceed an infusion rate of 300 mL/hr. B) Slow the infusion rate if the patient exhibits signs of a transfusion reaction. C) Weigh the patient immediately after the infusion is complete. D) Administer pretreatment medications as ordered 30 minutes prior to infusion.

D (Feedback: The nurse should administer pretreatment acetaminophen and diphenhydramine as prescribed 30 minutes before the start of the infusion. The patient should be weighed prior to the treatment and the IV infusion rate should not exceed 200 mL/hour. The nurse should stop the transfusion in the event of any signs of a reaction.)

A home health nurse is reinforcing health education with a patient who is immunosuppressed and his family. What statement best suggests that the patient has understood the nurse's teaching? A) "My family needs to understand when I can go get the seasonal flu shot." B) "I need to know how to treat my infections in a home setting." C) "I need to understand how to give my platelet transfusions." D) "My family needs to understand that I'll probably need lifelong treatment."

D (Feedback: The patient must be made aware that all health-related instructions are lifelong. Immunizations may be contraindicated and infection usually requires inpatient treatment. Platelet transfusions are not indicated for most patients who have immunodeficiencies.)

The home health nurse is assessing a patient who is immunosuppressed following a liver transplant. What is the most essential teaching for this patient and the family? A) How to promote immune function through nutrition B) The importance of maintaining the patient's vaccination status C) How to choose antibiotics based on the patient's symptoms D) The need to report any slight changes in the patient's health status

D (Feedback: They must be informed of the need for continuous monitoring for subtle changes in the patient's physical health status and of the importance of seeking immediate health care if changes are detected. Nutrition is important, but infection control is the priority. Patients and families do not choose antibiotics independently. Vaccinations are often contraindicated in immunocompromised patients.)

The parents of a 1-month-old infant bring their child to the pediatrician with symptoms of congestive heart failure. The infant is ultimately diagnosed with DiGeorge syndrome. What will prolong this infant's survival? A) Stem cell transplantation B) Long-term antibiotics C) Chemotherapy D) Thymus gland transplantation

D (Feedback: Transplantation of fetal thymus, postnatal thymus, or human leukocyte antigen (HLA)-matched bone marrow has been used for permanent reconstitution of T-cell immunity in infants with DiGeorge syndrome. Antibiotics and chemotherapy do not address the etiology of the infant's disease. Stem cell transplantation is not a common treatment modality.)

A patient is suspected of having rheumatoid arthritis and her diagnostic regimen includes aspiration of synovial fluid from the knee for a definitive diagnosis. The nurse knows that which of the following procedures will be involved? A) Angiography B) Myelography C) Paracentesis D) Arthocentesis

D (Arthrocentesis involves needle aspiration of synovial fluid. Angiography is an x-ray study of circulation with a contrast agent injected into a selected artery. Myelography is an x-ray of the spinal subarachnoid space taken after the injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture. Paracentesis is removal of fluid (ascites) from the peritoneal cavity through a small surgical incision or puncture made through the abdominal wall under sterile conditions.)

A patient is being treated for cancer and the nurse has identified the nursing diagnosis of Risk for Infection Due to Protein Losses. Protein losses inhibit immune response in which of the following ways? A) Causing apoptosis of cytokines B) Increasing interferon production C) Causing CD4+ cells to mutate D) Depressing antibody response

D (Feedback: Depletion of protein reserves results in atrophy of lymphoid tissues, depression of antibody response, reduction in the number of circulating T cells, and impaired phagocytic function. This specific nutritional deficit does not cause T-cell mutation, an increase in the production of interferons, or apoptosis of cytokines.)

A clinic nurse is caring for a patient newly diagnosed with fibromyalgia. When developing a care plan for this patient, what would be a priority nursing diagnosis for this patient? A) Impaired Urinary Elimination Related to Neuropathy B) Altered Nutrition Related to Impaired Absorption C) Disturbed Sleep Pattern Related to CNS Stimulation D) Fatigue Related to Pain

D (Feedback: Fibromyalgia is characterized by fatigue, generalized muscle aching, and stiffness. Impaired urinary elimination is not a common manifestation of the disease. Altered nutrition and disturbed sleep pattern are potential nursing diagnoses, but are not the priority.)

A nurse is assessing a patient with rheumatoid arthritis. The patient expresses his intent to pursue complementary and alternative therapies. What fact should underlie the nurse's response to the patient? A) New evidence shows CAM to be as effective as medical treatment. B) CAM therapies negate many of the benefits of medications. C) CAM therapies typically do more harm than good. D) Evidence shows minimal benefits from most CAM therapies.

D A recent systematic review of complementary and alternative medicine (CAM) examined the efficacy of herbal medicine, acupuncture, Tai chi and biofeedback for the treatment of rheumatoid arthritis and osteoarthritis. Although acupuncture treatment for pain management showed some promise, in all modalities the evidence was ambiguous. There is not enough evidence of the effectiveness of CAM and more rigorous research is needed.

A patient's rheumatoid arthritis (RA) has failed to respond appreciably to first-line treatments and the primary care provider has added prednisone to the patient's drug regimen. What principle will guide this aspect of the patient's treatment? A) The patient will need daily blood testing for the duration of treatment. B) The patient must stop all other drugs 72 hours before starting prednisone. C) The drug should be used at the highest dose the patient can tolerate. D) The drug should be used for as short a time as possible.

D Corticosteroids are used for shortest duration and at lowest dose possible to minimize adverse effects.

A patient is diagnosed with giant cell arteritis (GCA) and is placed on corticosteroids. A concern for this patient is that he will stop taking the medication as soon as he starts to feel better. Why must the nurse emphasize the need for continued adherence to the prescribed medication? A) To avoid complications such as venous thromboembolism B) To avoid the progression to osteoporosis C) To avoid the progression of GCA to degenerative joint disease D) To avoid complications such as blindness

D The nurse must emphasize to the patient the need for continued adherence to the prescribed medication regimen to avoid complications of giant cell arteritis, such as blindness.

IVIG has been ordered for the treatment of a patient with an immunodeficiency. Which of the following actions should the nurse perform before administering this blood product? A) Ensure that the patient has a patent central line. B) Ensure that the IVIG is appropriately mixed with normal saline. C) Administer furosemide before IVIG to prevent hypervolemia. D) Weigh the patient before administration to verify the correct dose.

D The nurse should obtain height and weight before treatment to verify accurate dosing. IVIG can be administered through a peripheral line. Diuretics are not normally given prior to administration, and IVIG is not mixed with normal saline.

A community health nurse is performing a visit to the home of a patient who has a history of rheumatoid arthritis (RA). On what aspect of the patient's health should the nurse focus most closely during the visit? A) The patient's understanding of rheumatoid arthritis B) The patient's risk for cardiopulmonary complications C) The patient's social support system D) The patient's functional status

D The patient's functional status is a central focus of home assessment of the patient with RA. The nurse may also address the patient's understanding of the disease, complications, and social support, but the patient's level of function and quality of life is a primary concern.

A nurse is providing care for a patient who has a recent diagnosis of giant cell arteritis (GCA). What aspect of physical assessment should the nurse prioritize? A) Assessment for subtle signs of bleeding disorders B) Assessment of the metatarsal joints and phalangeal joints C) Assessment for thoracic pain that is exacerbated by activity D) Assessment for headaches and jaw pain

D - Assessment of the patient with GCA focuses on musculoskeletal tenderness, weakness, and decreased function. - Careful attention should be directed toward assessing the head (for changes in vision, headaches, and jaw claudication).

Allopurinol (Zyloprim) has been ordered for a patient receiving treatment for gout. The nurse caring for this patient knows to assess the patient for bone marrow suppression, which may be manifested by which of the following diagnostic findings? A) Hyperuricemia B) Increased erythrocyte sedimentation rate C) Elevated serum creatinine D) Decreased platelets

D - Thrombocytopenia occurs in bone marrow suppression. - Hyperuricemia occurs in gout, but is not caused by bone marrow suppression. - Increased erythrocyte sedimentation rate may occur from inflammation associated with gout, but is not related to bone marrow suppression. - An elevated serum creatinine level may indicate renal damage, but this is not associated with the use of allopurinol.

A neonate exhibited some preliminary signs of infection, but the infant's condition resolved spontaneously prior to discharge home from the hospital. This infant's recovery was most likely due to what type of immunity? A) Cytokine immunity B) Specific immunity C) Active acquired immunity D) Nonspecific immunity

D -Natural immunity, or nonspecific immunity, is present at birth. - Active acquired or specific immunity develops after birth. - Cytokines are proteins that mediate the immune response; they are not a type of immunity.

A patient's injury has initiated an immune response that involves inflammation. What are the first cells to arrive at a site of inflammation? A) Eosinophils B) Red blood cells C) Lymphocytes D) Neutrophils

D -Neutrophils are the first cells to arrive at the site where inflammation occurs. -Eosinophils increase in number during allergic reactions and stress responses, but are not always present during inflammation. RBCs do not migrate during an immune response. -Lymphocytes become active but do not migrate to the site of inflammation.

A nurse's plan of care for a patient with rheumatoid arthritis includes several exercise-based interventions. Exercises for patients with rheumatoid disorders should have which of the following goals? A) Maximize range of motion while minimizing exertion B) Increase joint size and strength C) Limit energy output in order to preserve strength for healing D) Preserve and increase range of motion while limiting joint stress

D Exercise is vital to the management of rheumatic disorders. Goals should be preserving and promoting mobility and joint function while limiting stress on the joint and possible damage. Cardiovascular exertion should remain within age-based limits and individual ability, but it is not a goal to minimize exertion. Increasing joint size is not a valid goal.

A nurse is planning a patient's care and is relating it to normal immune response. During what stage of the immune response should the nurse know that antibodies or cytotoxic T cells combine and destroy the invading microbes? A) Recognition stage B) Proliferation stage C) Response stage D) Effector stage

D In the effector stage, either the antibody of the humoral response or the cytotoxic (killer) T cell of the cellular response reaches and couples with the antigen on the surface of the foreign invader. The coupling initiates a series of events that in most instances results in total destruction of the invading microbes or the complete neutralization of the toxin.

A nurse is providing health education regarding self-care to a patient with an immunodeficiency. What teaching point should the nurse emphasize? A) The importance of aggressive treatment of acne B) The importance of avoiding alcohol-based cleansers C) The need to keep fingernails and toenails closely trimmed D) The need for thorough oral hygiene

D Many patients develop oral manifestations and need education about promoting good dental hygiene to diminish the oral discomfort and complications that frequently result in inadequate nutritional intake. Alcohol cleansers do not necessarily need to be avoided and nail care is not a central concern.

A nurse has admitted a patient who has been diagnosed with urosepsis. What immune response predominates in sepsis? A) Mitigated B) Nonspecific C) Cellular D) Humoral

D Most immune responses to antigens involve both humoral and cellular responses, although only one predominates. For example, during transplantation rejection, the cellular response predominates, whereas in the bacterial pneumonias and sepsis, the humoral response plays the dominant role. Neither mitigated nor nonspecific cell response is noted in this situation.

A 40-year-old woman was diagnosed with Raynaud's phenomenon several years earlier and has sought care because of a progressive worsening of her symptoms. The patient also states that many of her skin surfaces are "stiff, like the skin is being stretched from all directions." The nurse should recognize the need for medical referral for the assessment of what health problem? A) Giant cell arteritis (GCA) B) Fibromyalgia (FM) C) Rheumatoid arthritis (RA) D) Scleroderma

D Scleroderma starts insidiously with Raynaud's phenomenon and swelling in the hands. Later, the skin and the subcutaneous tissues become increasingly hard and rigid and cannot be pinched up from the underlying structures.

A nurse is reviewing the immune system before planning an immunocompromised patient's care. How should the nurse characterize the humoral immune response? A) Specialized cells recognize and ingest cells that are recognized as foreign. B) T lymphocytes are assisted by cytokines to fight infection. C) Lymphocytesare stimulated to become cells that attack microbes directly. D) Antibodies are made by B lymphocytes in response to a specific antigen.

D The humoral response is characterized by the production of antibodies by B lymphocytes in response to a specific antigen. Phagocytosis and direct attack on microbes occur in the context of the cellular immune response.

A patient is being treated for bacterial pneumonia. In the first stages of illness, the patient's dyspnea was accompanied by a high fever. Currently, the patient claims to be feeling better and is afebrile. The patient is most likely in which stage of the immune response? A) Recognition stage B) Proliferation stage C) Response stage D) Effector stage

D The immune response culminates with the effector stage, during which offending microorganisms are killed by the various actions of the immune system. The patient's improvement in health status is likely the result of this final stage in the immune response.

Which of the following individuals would be the most appropriate candidate for immunotherapy? A) A patient who had an anaphylactic reaction to an insect sting B) A child with allergies to eggs and dairy C) A patient who has had a positive tuberculin skin test D) A patient with severe allergies to grass and tree pollen

D) A patient with severe allergies to grass and tree pollen -This type of therapy provides an adjunct to symptomatic pharmacologic therapy and can be used when avoidance of allergens is NOT possible.

An adolescent patients history of skin hyperreactivity and inflammation has been attributed to atopic dermatitis. The nurse should recognize that this patient consequently faces an increased risk of what health problem? A) Bronchitis B) Systemic lupus erythematosus (SLE) C) Rheumatoid arthritis D) Asthma

D) Asthma

A nurse is preparing a patient for allergy skin testing. Which of the following precautionary steps is most important for the nurse to follow? A) The patient must not have received an immunization within 7 days. B) The nurse should administer albuterol 30 to 45 minutes prior to the test. C) Prophylactic epinephrine should be administered before the test. D) Emergency equipment should be readily available.

D) Emergency equipment should be readily available -before skin testing with allergens is performed: * Testing is not performed during periods of bronchospasm. * Epicutaneous tests (scratch or prick tests) are performed before other testing methods, in an effort to minimize the risk of systemic reaction. * Emergency equipment must be readily available to treat anaphylaxis.

A patient with a family history of allergies has suffered an allergic response based on a genetic predisposition. This atopic response is usually mediated by what immunoglobulin? A) Immunoglobulin A B) Immunoglobulin M C) Immunoglobulin G D) Immunoglobulin E

D) Immunoglobulin E

The nurse is creating a care plan for a patient suffering from allergic rhinitis. Which of the following outcomes should the nurse identify? A) Appropriate use of prophylactic antibiotics B) Safe injection of corticosteroids C) Improved skin integrity D) Improved coping with lifestyle modifications

D) Improved coping with lifestyle modifications

A patient has developed severe contact dermatitis with burning, itching, cracking, and peeling of the skin on her hands. What should the nurse teach the patient to do? A) Wear powdered latex gloves when in public. B) Wash her hands with antibacterial soap every few hours. C) Maintain room temperature at 75F to 80F whenever possible. D) Keep her hands well-moisturized at all times.

D) Keep her hands well-moisturized at all times.

The nurse is providing health education to the parents of a toddler who has been diagnosed with food allergies. What should the nurse teach this family about the childs health problem? A) Food allergies are a life-long condition, but most families adjust quite well to the necessary lifestyle changes. B) Consistent use of over-the-counter antihistamines can often help a child overcome food allergies. C) Make sure that you carry a steroid inhaler with you at all times, especially when you eat in restaurants D) Many children outgrow their food allergies in a few years if they avoid the offending foods.

D) Many children outgrow their food allergies in a few years if they avoid the offending foods.

A nurse is caring for a patient who has allergic rhinitis. What intervention would be most likely to help the patient meet the goal of improved breathing pattern? A) Teach the patient to take deep breaths and cough frequently. B) Use antihistamines daily throughout the year. C) Teach the patient to seek medical attention at the first sign of an allergic reaction. D) Modify the environment to reduce the severity of allergic symptoms.

D) Modify the environment to reduce the severity of allergic symptoms.

The nurse is providing care for a patient who has a diagnosis of hereditary angioedema. When planning this patients care, what nursing diagnosis should be prioritized? A) Risk for Infection Related to Skin Sloughing B) Risk for Acute Pain Related to Loss of Skin Integrity C) Risk for Impaired Skin Integrity Related to Cutaneous Lesions D) Risk for Impaired Gas Exchange Related to Airway Obstruction

D) Risk for Impaired Gas Exchange Related to Airway Obstruction

A patient who is scheduled for a skin test informs the nurse that he has been taking corticosteroids to help control his allergy symptoms. What nursing intervention should the nurse implement? A) The patient should take his corticosteroids regularly prior to testing. B) The patient should only be tested for grass, mold, and dust initially. C) The nurse should have an emergency cart available in case of anaphylaxis during the test. D) The patients test should be cancelled until he is off his corticosteroids.

D) The patients test should be cancelled until he is off his corticosteroids.

A nurse practitioner has prescribed nitrofurantoin (Macrodantin) for a woman with a urinary tract infection. Which of the following cardiovascular adverse effects is this patient at risk for developing? A. inverted T wave B. widened QRS C. premature ventricular contraction (PVC) D. bundle branch block

D. Bundle branch block and changes in the ST and T waves are cardiac-related adverse effects of nitrofurantoin.

A parent of a high school student calls the school nurse regarding her daughter's crying. The parent states that this behavior is unusual for her daughter. Which of the following medications contributes to changes in behavior? A. metronidazole B. naproxen sodium C. vitamin C D. erythromycin

D. Changes in behavior with crying or laughing is an adverse effect of erythromycin.

A sputum specimen report from the laboratory states, "Contamination with typical oral flora." Which interpretation is correct? A. Bacteria in the mouth are growing in the lungs. B. The normal flora has become pathogenic. C. The patient has a pulmonary infection. D. The sputum from the lungs has mixed with bacteria in the mouth.

D. Normal or typical flora refers to microbe that normally resides in a body region. When the sputum specimen was obtained, a relatively large amount of oral secretions were expectorated into the specimen container taking with it normal flora from the mouth. To avoid this, the nurse will have the patient rinse the mouth out well prior to collecting a sputum specimen and will give clear instructions to the patient to cough deeply in order to obtain a specimen of pulmonary secretions rather than oral secretions.

An outpatient has just received a prescription for ciprofloxacin 500 mg PO twice daily for acute bronchitis. The nurse should teach the patient... A. not to take ciprofloxacin with a meal B. to restrict fluid intake to avoid fluid overload C. to take ciprofloxacin with an antacid (e.g., Tums) to decrease the chance of stomach upset D. to avoid prolonged exposure to sunlight

D. Photosensitivity may occur with exposure to direct or indirect sunlight; therefore, the patient should avoid prolonged exposure to the sun. Sunscreens do not prevent photosensitivity reactions. A is incorrect because patients may take ciprofloxacin with food to avoid gastrointestinal upset. B is incorrect because adequate fluid intake should accompany a ciprofloxacin dose to prevent drug crystals from forming in the urinary tract. C is incorrect because ciprofloxacin interacts with antacids, resulting in impaired ciprofloxacin absorption.

The nurse would prepare for what type of adverse effect in a client receiving imipenem-cilastatin who has a creatinine clearance =20 mL/min? A. Elevated liver function tests B. Rash C. Respiratory distress D. Seizure activity

D. Seizure activity risk also increases because the drug is excreted by the kidneys and this client's renal function is decreased. The nurse should prepare for possible seizure.

A patient receiving tetracycline should receive the following instruction regarding the medication? A. Take tetracycline with food. B. Take tetracycline in combination with antacids. C. Take the first dose and then obtain a test known as culture and sensitivity. D. Take tetracycline with a full glass of water.

D. Tetracycline should be taken with a full glass of water.

Torsade de pointes is a lengthened QT interval. Which of the following medications combined with telithromycin results in this condition? A. acetaminophen B. naproxen sodium C. regular insulin D. ciprofloxacin

D. The combination of ciprofloxacin and telithromycin leads to a prolonged QT wave.

When administering a sulfonamide, which of the following interventions is most effective in decreasing crystalluria? A. administering 8 ounces of cranberry juice B. providing a full liquid diet during the course of drug therapy C. inserting a Foley catheter for the measurement of an accurate intake and output D. providing a minimum of 2000 mL of fluid per day

D. To prevent crystalluria, it is essential that patients receive 2000 mL of fluids in a 24-hour period.

The nurse is caring for a client who has an indwelling Foley catheter. What nursing interventions will help prevent a urinary tract infection in this client? (Select all that apply.) A. Disconnect the catheter system to drain the urine from the drainage bag. B. Irrigate the Foley catheter three times a day. C. Leave the catheter in for at least 3 weeks. D. Keep the urinary drainage bag below the level of the client's bladder. E. Perform perineal care frequently.

D. and E. "Irrigate the Foley catheter three times a day" The sterility of the catheter/collection apparatus should not be broken unless there is a specific physician order to do so. Routine irrigation is not done.

Liver and kidney monitoring is recommended for most ___________ therapy because it can cause elevation of the liver enzymes and can also affect kidney function.

DMARD

After infecting individuals, DNA viruses insert a part of their own _______near the infected cell genes causing cell division. The newly formed cells that now carry viral DNA lack normal controls on growth

DNA

Replicating cells are most vulnerable to the disruptive effects of radiation, during _________ and _________, i.e., early S, G2, and M phases of the cell cycle. Therefore, those body tissues that undergo frequent cell division are most sensitive to radiation therapy.

DNA synthesis and mitosis

Glycosylation disorders with immune deficiency

Defects in glycosylation, which refers to the attachment of sugars to proteins; can disrupt the immune system resulting in immune deficiency.

Immune deficiencies primary

Deficiency results from improper development of immune cells or tissues; usually congenital or inherited

Immune deficiencies Secondary

Deficiency results from some interference with an already developed immune system; usually acquired later in life

Allergic contact dermatitis

Delayed hypersensitivity (type IV) reaction. Usually affects only area in contact with latex; reaction is usually to chemical additives used in the manufacturing process rather than to latex itself.

a patients receiving thoracic irradiation for lung cancer may experience acute esophageal irritation—associated chest pain and dysphagia. why this happens?

Depending on the targeted region, any portion of the gastrointestinal mucosa may be involved, causing mucositis (inflammation of the lining of the mouth, throat, and gastrointestinal tract)

what happens if someone is depleted of protein?

Depletion of protein reserves results in atrophy of lymphoid tissues, depression of antibody response, reduction in the number of circulating T cells, and impaired phagocytic function.

This disorder is the leading cause of fatal anaphylaxis, comprising 43% of deaths from anaphylaxis.

Dermatitis Medicamentosa (Drug Reactions)

________________, a type I hypersensitivity disorder, is the term applied to skin rashes associated with certain medications.

Dermatitis medicamentosa

A client with an allergic disorder calls the nurse and asks what treatment is available for allergic disorders. The nurse explains to the client that there is more than one treatment available. What treatments would the nurse tell the client about? Sublingual-swallow immunotherapy (SLIT) Desensitization Sublingual-topical immunotherapy (STIT) Resensitization

Desensitization Explanation: Desensitization is another option. Desensitization is a form of immunotherapy in which a person receives weekly or twice-weekly injections of dilute but increasingly higher concentrations of an allergen without interruption. SLIT is a form of desensitization therapy. Options C and D are distractors for this question.

Cryptococcus Neoformans Diagnosis

Diagnosis is confirmed by CSF analysis

HIV-1 differentiation assay

Differentiates HIV-1 from HIV-2

______________disease refers to a group of systemic disorders that are chronic in nature and are characterized by diffuse inflammation and degeneration in the connective tissues.

Diffuse connective tissue

The nurse is preparing to administer a medication that has an affinityfor H1 receptors. Which medication would the nurse administer? a. Diphenhydramine b. Omeprazole c. Cimetidine d. Ranitidine

Diphenhydramine

The nurse is preparing to administer a medication that has an affinity for H1 receptors. Which medication would the nurse administer? a)Ranitidine (Zantac) b)Diphenhydramine (Benadryl) c)Omeprazole (Prilosec) d) Cimetidine (Tagamet)

Diphenhydramine (Benadryl) Explanation: Certain medications are categorized by their action at these receptors. Diphenhydramine (Benadryl) is an example of an antihistamine, a medication that displays an affinity for H1 receptors. Cimetidine (Tagamet) and ranitidine (Zantac) target H2 receptors to inhibit gastric secretions in peptic ulcer disease.

Endoscopy

Direct visualization of a body cavity or passageway by insertion of an endoscope into a body cavity or opening; allows tissue biopsy, fluid aspiration, and excision of small tumors. Used for diagnostic and therapeutic purposes

When assessing the skin of a client with allergic contact dermatitis, the nurse would most likley expect to find irritation at which area? Plantar aspects of the feet Lower arms Ankles Dorsal aspect of the hand

Dorsal aspect of the hand

_________ is the ability of pathogens to withstand the effects of medications that should be toxic to them.

Drug resistance

Vesicants

Drugs capable of causing pain, inflammation and blistering of skin, underlying flesh and structures leading to tissue death & necrosis

A patient is experiencing an allergic reaction after receiving a dose ofpenicillin. What should the nurse look for in the patient's initialassessment? a. Dyspnea, bronchospasm, and/or laryngeal edema b. Hypotension and tachycardia c. The presence and location of pruritus d. The severity of cutaneous warmth and flushing

Dyspnea, bronchospasm, and/or laryngeal edema

When a patient experiences an allergic reaction, the nurse should initially assess for:

Dyspnea, bronchospasm, and/or laryngeal edema. Explanation: Initial nursing assessment and intervention needs to be directed toward evaluating breathing and maintaining an open airway.

Most immediate HSRs are immunoglobulin ____________-mediated reaction—an allergic reaction.

E (IgE)

______ is a test that detects and measures antibodies in your blood. This test can be used to determine if you have antibodies related to certain infectious conditions.

EIA -also called ELISA

A patient has a sensitivity to ragweed and tells the nurse that it comesat the same time every year. When does the patient typically notice thesymptoms? a. Early spring b. Early fall c. Summer d. Midwinter

Early fall

A nurse practitioner working in an allergy clinic is treating a patient who is allergic to ragweed. She advises the patient to expect an increase in symptoms during which of the following seasons? Early fall Late spring Early summer Early spring

Early fall Explanation: Ragweed has a seasonal occurrence in early fall. Tree pollen and mold spores occur in the spring. Rose and grass pollen occur in the summer.

The nurse is caring for an older adult patient hospitalized with cellulitis of the right lower extremity. Why is it imperative that the nurse continually assess the physical and emotional status of this patient? a. Older patients are at risk of developing dementia b. The patient will not respond to the antibiotic treatment as well as a younger patient would c. Early recognition and management of factors influencing immuneresponse may decrease morbidity and mortality d. Older adult patients develop depression and suicidal tendencieswhen they are faced with chronic illness

Early recognition and management of factors influencing immuneresponse may decrease morbidity and mortality

Use of an electric current to destroy tumor cells

Electrosurgery *Basal and squamous cell skin cancers

Injected allergens are used for "hyposensitization" and may produce systemic reactions that can be harmful. Which of the following medications should be on hand in case of an adverse reaction? Epinephrine Pyribenzamine Phenergan hydrochloride Dramamine

Epinephrine Explanation: Although severe systemic reactions occur in less than 1% of patients, the risk for potentially fatal anaphylaxis exists. It tends to occur at the beginning of the treatment cycle. Because of this risk, epinephrine should be immediately available.

How is epinephrine administered?

Epinephrine, in a 1:1000 dilution, is given subcutaneously in the upper extremity or thigh and may be followed by a continuous intravenous infusion.

Erythrocyte count

Erythrocyte count

This approach not only provides the pathologist with the entire tissue specimen for the determination of stage and grade but also decreases the chance of seeding tumor cells (disseminating cancer cells throughout surrounding tissues).

Excisional biopsy

humoral and cellular immune responses DON'T interact with eachother

FALSE! T cells interact closely with B cells, indicating that humoral and cellular immune responses are not separate, unrelated processes but rather are branches of the immune response that interact.

it is possible to erradique 100% of a tumor

FALSE! Eradication of 100% of the tumor is almost impossible; the goal of treatment is eradication of enough of the tumor so that the remaining malignant cells can be destroyed by the body's immune system

HIV disease progression is classified from less to more severe;once a case is classified into a surveillance severity stage, it can be reclassified into a less severe stage if the CD4+ T-lymphocytes increase. true/false

FALSE! once a case is classified into a surveillance severity stage, it cannot be reclassified into a less severe stage even if the CD4+ T-lymphocytes increase, which often occurs when a person receives ART.

nonlatex condoms will protect an patient that is allergic to latex agains HIV.

FALSE!! Nonlatex condoms made of natural materials such as lambskin are available for people with latex allergy but will not protect against HIV infection.

When signs and symptoms of HSR occur, the medication should be reduced

FALSE!! When signs and symptoms of HSR occur, the medication should be discontinued immediately and emergency procedures initiated.

TWO people with HIV can have sex without worrying of trasmission because they are already infected.

FALSE!!! Avoid having unprotected sex with another HIV-seropositive person. Cross-infection with that person's HIV can increase the severity of infection. *Take ART regularly to achieve viral suppression.

weakness and fatigue due to radiation represent deterioration or progression of disease. TRUE OR FALSE?

FALSE. *If systemic symptoms, such as weakness and fatigue, occur, the nurse explains that these symptoms are a result of the treatment and do NOT represent deterioration or progression of the disease.

Immunotherapy is safe during pregnancy

False! Immunotherapy should not be initiated during pregnancy; for patients who have been receiving immunotherapy before pregnancy, the dosage should not be increased during pregnancy.

nurse must administer IV vesicants in peripheral veins

False. •Treatment should neverbe administered in peripheral veins involving the hand or wrist.

Hypercalcemia Clinical Manifestations

Fatigue, weakness, confusion, decreased level of responsiveness, hyporeflexia, nausea, vomiting, constipation, ileus, polyuria (excessive urination), polydipsia (excessive thirst), dehydration, and dysrhythmias

A health care provider prescribed Flonase, an intranasal corticosteroid, for a patient with a severe case of allergic rhinitis. The nurse told the patient that there is a delayed response to full benefits from the drug. The patient took his first dose on February 2. The patient should expect that the drug will be fully effective no later than: February 12. February 9. February 15. February 6.

February 15.

Nursing students are reviewing various medications that can be used to treat allergic disorders. The students demonstrate understanding of the information when they identify which of the following as an intranasal corticosteroid? a)Fexofenadine b)Fluticasone c)Zileuton d)Cromolyn sodium

Fluticasone Explanation: Fluticasone is an example of an intranasal corticosteroid. Cromolyn sodium is a mast cell stabilizer. Zileuton is a leukotriene-receptor inhibitor. Fexofenadine is a second-generation antihistamine.

cell cycle RNA and protein synthesis occurs

G1 phase

-premitotic phase - DNA synthesis is complete, mitotic spindle forms

G2 phase

________ therapy includes approaches that correct genetic defects, manipulate genes to induce tumor cell destruction, or assist the body's immune defenses in the hope of preventing or combating disease.

Gene

most common form of inflammatory arthritis.

Gout

tumor Grading

Grading: classification of tumor cells

_________________ a major cause of morbidity and mortality in 30% to 50% of the allogeneic transplant population, occurs when the donor lymphocytes initiate an immune response against the recipient's tissues (skin, gastrointestinal tract, liver) during the beginning of engraftmen.The donor cells view the recipient's tissues as foreign or immunologically different from what they recognize as "self" in the donor.

Graft-versus-host disease

According to nursing research by Campbell et al., about 65% of patients identified with anaphylaxis who were seen in the emergency department were discharged to home. Of those 65%, one-third were prescribed self-injectable epinephrine. Patient teaching for use of an EpiPen must be included with discharge instructions. Select all the teaching points that apply. Grasp the EpiPen with the black tip pointing downward. Jab firmly at a 45 degree angle to get maximum penetration. Hold for 5 seconds and massage injection area for 5 seconds. Call 911 before injecting epinephrine. Form a fist around the unit. Hold black tip near outer thigh.

Grasp the EpiPen with the black tip pointing downward. Form a fist around the unit. Hold black tip near outer thigh.

human immune deficiency virus

HIV - HIV is a virus that attacks a type of white blood cell called a CD4 cell in the body's immune system. It reduces the body's ability to fight infection and illness. The body can fight off many viruses, but some of them can never be completely removed once they are present. HIV is one of these. * treatment with antiretroviral therapy can minimize the effect of the virus by slowing or halting its progression.

_______ infection has been best managed as a chronic disease, most appropriately in an outpatient care setting, whereas _______ may involve acute conditions that require hospitalization

HIV AIDS

two forms of HIV

HIV-1 and HIV-2

Which of the following terms refers to an incomplete antigen? Allergen Antibody Hapten Antigen

Hapten Explanation: A hapten is an incomplete antigen. An allergen is a substance that causes manifestations of allergy. An antigen is a substance that induces the production of antibodies. An antibody is a protein substance developed by the body in response to and interacting with a specific antigen.

__________________ is one bacterium identified as a significant cause of gastric cancer

Helicobacter pylori

CD4+ cells

Helper T cells that carry the CD4 protein antigen on their surface. HIV binds to CD4 and infects and kills T cells bearing this protein. AIDS patients have an inadequate number of CD4+ cells

What would the nurse assess for bleeding/sepsis which are major complications following HSCT until engraftment occurs?

Hematopoietic Stem Cell Transplantation -Petechiae - Ecchymosis - Fever - Hypotension - Chills - Coffee ground emesis - Abdominal distention

The nurse is evaluating a patient's complete blood cell count and differential (CBC and diff) along with the serum immunoglobulin E (IgE) level. Which of the following results might indicate that the patient has an allergic disorder? a)Low white blood cells b) Low eosinophil level c) High neutrophils d) High IgE level

High IgE level Explanation: High total IgE levels and/or a high percentage of eosinophils may indicate an allergic disorder. However, normal IgE levels do not exclude the diagnosis of an allergic disorder. The level of neutrophils and white blood cell counts are not impacted by allergic disorders.

Which of the following body substances causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle? Serotonin Prostaglandin Bradykinin Histamine

Histamine

__________ is the major mediator of allergic reactions in the nasal mucosa.

Histamine

Which of the following is a primary chemical mediator of hypersensitivity? a)Serotonin b)Histamine c)Heparin d)Bradykinin

Histamine Explanation: Histamine is a primary chemical mediator of hypersensitivity. Secondary mediators include serotonin, heparin, and bradykinin.

AIDS-Related Lymphomas

Hodgkin lymphoma and non-Hodgkin lymphoma

_________ causes venereal warts and is a risk factor for cervical intraepithelial neoplasia, a cellular change that is frequently a precursor to cervical cancer.

Human papillomavirus (HPV)

The most common serious allergic reactions to insect stings are from the ______________ family, which includes bees, ants, wasps, and yellow jackets

Hymenoptera

__________ is a potentially life-threatening metabolic abnormality resulting when the calcium released from the bones is more than the kidneys can excrete or the bones can reabsorb.

Hypercalcemia

Body produces inappropriate or exaggerated responses to specific antigens

Hypersensitivity

Dermatitis medicamentosa

Hypersensitivity reaction to a drug.

how is Hyperthermia use with chemotherapy

Hyperthermia is thought to alter cellular membrane permeability when used with chemotherapy, allowing for an increased uptake of the chemotherapeutic agent.

Tumors that do not clearly resemble the tissue of origin in structure or function are described as poorly differentiated or undifferentiated and are assigned grade _____.

IV

Photodynamic therapy

IV administration of a light-sensitizing agent (hematoporphyrin derivative [HPD]) that is taken up by cancer cells, followed by exposure to laser light within 24-48 hours; causes cancer cell death

Cytotoxic Antineoplastic Drugs administration

IV injection or infusion.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Ibuprofen (Motrin) Meloxicam (Mobic) Celecoxib (Celebrex)

patient receiving subcutaneous Immunotherapy must remain in the clinic for at least 30 minutes after the injection and is observed for possible systemic symptoms. What happens if a large, local swelling develops?

If a large, local swelling develops at the injection site, the next dose should not be increased, because this may be a warning sign of a possible systemic reaction

The body can produce five different types of immunoglobulin (Ig). Each of the five types, or classes, is identified by a specific letter of the alphabet:

IgA, IgD, IgE, IgG, and IgM.

A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated? a)IgG b)IgE c)IgA d)IgB

IgE Explanation: Immunoglobulin E (IgE) is involved with an allergic reaction. IgA combines with antigens and activates complement. IgB coats the surface of B lymphocytes. IgG is the principal immunoglobulin formed in response to most infectious agents

______________ allergy, a type I hypersensitivity reaction, occurs in about 2% of the adult population; it is thought to occur in people who have a genetic predisposition combined with exposure to allergens early in life through the gastrointestinal or respiratory tract or nasal mucosa.

IgE-mediated food

There are several types of reactions to latex. The nurse knows to be most concerned about laryngeal edema with the following reaction: Allergic contact. IgG antibodies. Irritant contact. IgE-mediated hypersensitivity.

IgE-mediated hypersensitivity.

Enhances phagocytosis

IgG

- Appears in serum and tissues (interstitial fluid) - Assumes a major role in bloodborne and tissue - infections Activates the complement system - Enhances phagocytosis Crosses the placent

IgG (75% of Total Immunoglobulin)

The nurse should be alert to the possibility of __________, especially in the 3-month period after treatment with ART is initiated, because this syndrome is associated with significant morbidity and patients often require hospital admission.

Immune Reconstitution Inflammatory Syndrome (IRIS)

ACQUIRED IMMUNE DEFICIENCY

Immune deficiency can be acquired due to: - medical treatment such as chemotherapy - infection from agents such as human immune deficiency virus (HIV).

________ results from rapid restoration of organism-specific immuneresponses to infections that cause either the deterioration of a treatedinfection or new presentation of a subclinical infection.

Immune reconstitution inflammatory syndrome (IRIS)

Hyper-immunoglobulin M (hyper-IgM) syndromes

Immune system fails to produce normal IgA, IgG, and IgE antibodies but can produce normal or elevated IgM. Infants usually develop severe respiratory infections.

How do you know if your patient is immunodeficient?

Immunodeficiency is marked by frequent infections that could be severe, infection from organisms that do not typically cause a problem, poor treatment response and chronic diarrhea

__________ , also referred to as allergy vaccine therapy, involves the administration of gradually increasing quantities of specific allergens to the patient until a dose is reached that is effective in reducing disease severity from natural exposure.

Immunotherapy

what occurs during an allergic reaction?

In allergic reactions, the body encounters allergens that are types of antigens, usually proteins that the body's defenses recognize as foreign, and a series of events occurs in an attempt to render the invaders harmless, destroy them, and remove them from the body.

What is the difference between the pathophysiology of inflammatoryrheumatic disease and that of degenerative rheumatic disease?

In inflammatory rheumatic disease, the inflammation occurs as the result of an immune response. Newly formed synovial tissue is infiltrated with inflammatory cells (pannus formation), and joint degeneration occurs as a secondary process. In degenerative rheumatic disease, synovitis results from mechanical irritation. A secondary inflammation occurs.

nursing management in patient receiving EBRT?

In patients receiving EBRT, the nurse assesses the patient's skin regularly throughout the course of treatment.

In men, the leading causes of cancer are lung, prostate and colorectal. What about women?

In women it's lung followed by breast and colorectal

Topoisomerase I Inhibitors

Induce breaks in the DNA strand by binding to enzyme topoisomerase, preventing cells from dividing *Cell cycle—specific (S phase)

What is the patient at risk for if the spleen is removed?

Infection * spleen acts like a filter

Impaired bone marrow proliferation would place the patient at increased risk for what?

Infection and bleeding

Progressive Multifocal Leukoencephalopathy

Infection of immunosuppressed patients (AIDS, transplants, leukemics) caused by reactivation of JC virus. Progressive course to death within months. - demyelinating CNS disorder that affects the oligodendroglia. -

Miscellaneous Agents

Inhibits protein, DNA, and RNA synthesis

The nurse is caring for a client who is being treated with intracavitary brachytherapy. What should the nurse do if the aid assists the client to the bathroom?

Instruct on the importance of maintaining bedrest for this patient

The nurse observes the LPN instruct a family member who is visiting a patient receiving brachytherapy that visits are only allowed for 1 hour. What should the nurse do?

Instruct that visits should be limited to 30 minutes

how to prevent infection as a complication of chemotherapy?

Instruct the patient to avoid exposure to infection by avoiding crowds, anyone with a known infection, and contact with fresh flowers, soil, animals, or animal excrement. Frequent and thorough hand hygiene by the patient and everyone involved in his or her care is necessary to reduce exposure to pathogenic microorganisms.

_____ radiation includes localized implantation or systemic radionuclide administration

Internal

The nurse working in an allergy clinic is preparing to administer skin testing to a patient. Which of the following routes is the safest for the nurse to use to administer the solution? Subcutaneous Intramuscular Intravenous Intradermal

Intradermal Explanation: The intradermal route is the correct route of administration for skin testing and therefore a safe route. Another safe route is epicutaneous. The type of skin testing being performed determines whether the nurse will administer the solution via the epicutaneous or intradermal route.

Which of the following is a mast cell stabilizer used in the treatment of allergic rhinitis? Intranasal cromolyn sodium (NasalCrom) Tetrahydrozoline hydrochloride (Visine) Pseudoephedrine hydrochloride (Sudafed) Oxymetazoline hydrochloride (Afrin)

Intranasal cromolyn sodium (NasalCrom)

__________ radiation can directly break the strands of the DNA helix, leading to cell death.It can also indirectly damage DNA through the formation of free radicals. If the DNA cannot be repaired, the cell may die immediately or may initiate apoptosis

Ionizing

Sharp, throbbing pain

Ischemia *Kaposi's sarcoma

A patient with an acute exacerbation of arthritis is temporarilyconfined to bed. What position can the nurse recommend to preventflexion deformities? a. Prone b. Semi-Fowler's c. Side-lying with pillows supporting the shoulders and legs d. Supine with pillows under the knees

It is best for the client with rheumatoid arthritis to lie prone several times daily to prevent hip flexion contracture.

Sjögren's syndrome

It is one of the most common autoimmune disorders

What is a vesicant?

It is the agent that is deposited into the subcutaneous or surrounding tissues causes the damage and possibly necrosis of tendons, muscles, nerves, and blood vessels.

After teaching a client how to self-administer epinephrine, the nurse determines that the teaching plan has been successful when the client demonstrates which of the following? a)Maintains pressure on the auto-injector for about 30 seconds after insertion b)Jabs the autoinjector into the outer thigh at a 90-degree angle c) Avoids massaging the injection site after administration d)Pushes down on the grey release cap to administer the medication

Jabs the autoinjector into the outer thigh at a 90-degree angle Explanation: To self-administer epinephrine, the client should remove the autoinjector from its carrying tube, grasp the unit with the black tip (injectiing end) pointed downward, form a fist around the device, and remove the gray safety release cap. Then the client should hold the black tip near the outer thigh and swing and jab firmly into the outer thigh at a 90-degree angle until a click is heard. Next, the client should hold the device firmly in place for about 10 seconds, remove the device, and massage the site for about 10 seconds.

Patients with acquired immune deficiency syndrome (AIDS) have an increased incidence of what cancer ________________

Kaposi sarcoma

cancerous condition starting as purple or brown papules on the lower extremities that spreads through the skin to the lymph nodes and internal organs; frequently seen with AIDS

Kaposi sarcoma

Those with HIV/AIDS are at greater risk of developing certain cancers. Which are:

Kaposi sarcoma, lymphoma, and invasive cervical cancer

nonatopic disorders

Lack the genetic component and organ specificity of the atopic disorders * Latex allergy

Use of light and energy aimed at an exact tissue location and depth to vaporize cancer cells (also referred to as photocoagulation or photoablation)

Laser surgery

_________ effects (approximately 6 months to years after treatment) of radiation therapy may occur in body tissues that were in the field of radiation. These effects are chronic, usually a result of permanent damage to tissues, loss of elasticity, and changes secondary to a decreased vascular supply.

Late

_____________, a compound similar to folic acid, helps fluorouracil bind with an enzyme inside of cancer cells and enhances the ability of fluorouracil to remain in the intracellular environment.

Leucovorin

patient taking Methotrexate is exexperiencing significant toxicity, including severe bone marrow suppression, mucositis, diarrhea and liver, and lung and kidney damage, can occur. What drug would the nurse administer to help with these symptoms?

Leucovorin helps to prevent or lessen these toxicities.

fat redistribution syndrome

Lipodystrophy is a problem with the way your body makes, uses, and stores fat. It's also called fat redistribution.

right atrial silastic catheters

Long-term silastic catheters, inserted into the right atrium via a jugular vein * to prevent Extravasation of vesicants

warts, hypogammaglobulinemia, infections, and myelokathexis syndrome (WHIMS)

Low levels of white blood cells, especially neutrophils, which predispose to frequent infections and persistent warts.

Cytotoxic T (killer T)

Lyses cells infected with virus; plays a role in graft rejection

Use of magnetic fields and radiofrequency signals to create sectioned images of various body structures

Magnetic resonance imaging (MRI)

provocative test disadvantages

Major disadvantages of this type of testing are the limitation of one antigen per session and the risk of producing severe symptoms, particularly bronchospasm, in patients with asthma.

Use of x-ray images of the breast

Mammography

_______________ cells, which are located in the skin and mucous membranes, play a major role in IgE-mediated immediate hypersensitivity.

Mast

Leukemia

May involve various cell lines produced in the bone marrow *

Colorectal

Men and women, ages 50+

____________ is a cytoprotectant agent that binds with the toxic metabolites of cyclophosphamide or ifosfamide in the kidneys to prevent hemorrhagic cystitis.

Mesna (Mesnex)

Creatinine

Metabolic waste excreted through the kidneys

A nurse is reviewing the dietary history of a client who has experienced anaphylaxis. Which of the following would the nurse identify as a common cause of anaplhylaxis? Select all that apply? Shrimp Chicken Beef Eggs Milk

Milk Eggs Shrimp

duplicated chromosomes separate and cell division occurs in what phase?

Mitosis

The clinic nurse is caring for a client with an allergic disorder who has received the first sensitizing dose of a new drug. Now, the client is given a second dose. What nursing action is most important at this stage of transition? a)Assess the client for reduced urine output. b)Monitor the client for reactions. c)Assess the client for reduced appetite. d)Monitor the client for increased heart rate.

Monitor the client for reactions. Explanation: Monitoring the client is necessary when a second dose of a new drug is administered because reactions may follow the first sensitizing dose. Although it is important to ensure the client's comfort, it is not essential to assess the client for changes in urine output, appetite, or heart rate.

Radioimmunoconjugates

Monoclonal antibodies are labeled with a radioisotope and injected IV into the patient; the antibodies that aggregate at the tumor site are visualized with scanners

Cytotoxic Antineoplastic Drugs

Most of these drugs kill malignant cells by interfering with cell replication, with the supply and use of nutrients (e.g., amino acids, purines, pyrimidines), or with the genetic materials in the cell nucleus (DNA or RNA).

_______, a common side effect of radiation and some types of chemotherapy, refers to an inflammatory process involving the mucous membranes of the oral cavity and the gastrointestinal tract.

Mucositis

NF-kB Essential modifier (NEMO) mutations

Mutations in the NEMO gene cannot "turn on" other genes especially those involved in inflammation and the immune response and are, therefore, highly susceptible to infections with mycobacteria.

Histamine release in anaphylaxis causes which of the following? Nasal congestion Feeling of impending doom Urinary urgency Stomach cramps

Nasal congestion

A 6-year-old experienced an allergic reaction to shellfish. The nurse practitioner gave the mother a booklet that includes teaching points about food allergies. The nurse reminded the mother to be vigilant for mild systemic reactions such as: Wheezing and coughing. Nasal congestion and sneezing. Shortness of breath. Bronchospasm.

Nasal congestion and sneezing.

________________, which is nonspecific, provides a broad spectrum of defense against and resistance to infection. It is considered the first line of host defense following antigen exposure, because it protects the host without remembering prior contact with an infectious agent

Natural Immunity

_________________ (polymorphonuclear leukocytes) are the first cells to arrive at the site where inflammation occurs.

Neutrophils

Which leukocytes are the first to arrive at the site of inflammation? A. Basophils B. Eosinophils C. Monocytes D. Neutrophils

Neutrophils arrive first at a site where inflammation occurs.

___________ has the oldest and largest HIV epidemic in the Western world and could serve as a future model for other locales.

New York City

Autoimmunity

Normal protective immune response paradoxically turns against or attacks the body, leading to tissue damage

a patient with AIDS is having a recurrence of 10 to 12 loose stools a day, what medication may help this patient with controlling the chronic diarrhea? a. Octreotide b. rifaximin (xifaxan) c. bismuth subsalicylate (pepto bismol) d. atropine diphenoxylate (lomotil)

Octreotide

A patient has had a "stuffy nose" and obtained Afrin nasal spray.What education should the nurse provide to the patient in order toprevent "rebound congestion"? a. Be sure to use the Afrin for at least 10 days to ensure thestuffiness is gone b. Use the medication every 4 hours to prevent congestion fromrecurring c. Drink plenty of fluids d. Only use the Afrin for 3 to 4 days once every 12 hours

Only use the Afrin for 3 to 4 days once every 12 hours

A patient has had a "stuffy nose" and obtained Afrin nasal spray. What education should the nurse provide to the patient in order to prevent "rebound congestion"? a)Use the medication every 4 hours to prevent congestion from recurring. b)Drink plenty of fluids. c)Be sure to use the Afrin for at least 10 days to ensure the stuffiness is gone. d)Only use the Afrin for 3 to 4 days once every 12 hours.

Only use the Afrin for 3 to 4 days once every 12 hours. Explanation: Adrenergic agents, which are vasoconstrictors of mucosal vessels, are used topically in nasal (Afrin) and ophthalmic (Alphagan P) formulations in addition to the oral route (pseudoephedrine [Sudafed]) (Karch, 2012). The topical route (drops and sprays) causes fewer side effects than oral administration; however, the use of drops and sprays should be limited to a few days to avoid rebound congestion.

Most common form of cancer of the bone

Osteosarcoma

___________ (abnormally high concentrations) of host suppressor T lymphocytes induced through the release of cytokines by malignant cells is thought to down-regulate the immune response, thus permitting uncontrolled cell growth

Overexpression

Gammopathies

Overproduction of immunoglobulins

The most common symptom of rheumatic disease that causes a patient to seek medical attention is ________

PAIN

symptoms rheumatic diseases

PAIN, joint swelling, limited movement, stiffness, weakness, and FATIGUE.

Some cancer cells have been found to have altered cell membranes that interfere with APC binding and presentation to T lymphocytes. Tumors can also express molecules that induce T-lymphocyte anergy or tolerance such as ___________.

PD-1 ligand *These molecules bind to PD-1 proteins on T lymphocytes and either block the killing of the tumor or induce cell death in the lymphocyte.

______________, an IV-administered synthetic form of human keratinocyte growth factor, is beneficial in the prevention of stomatitis in patients with hematologic malignancies who are preparing for HSCT

Palifermin (Kepivance)

___________ radiation therapy is used to relieve the symptoms of locally advanced or metastatic disease, especially when the cancer has spread to the brain, bone, or soft tissue, or to treat oncologic emergencies, such as superior vena cava syndrome, bronchial airway obstruction, or spinal cord compression.

Palliative

______________ is a serious complication that arises during successful ART in patients with HIV-TB co-infection who are receiving TB treatment.

Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS)

_____________ acquired immunity is temporary immunity transmitted from a source outside the body that has developed immunity through previous disease or immunization

Passive

Patients with RA CBC results

Patients may exhibit anemia, and platelets may be elevated due to the inflammatory process

_________ and ________ allergies are responsible for the most severe food allergy reactions.

Peanut and tree nut (e.g., cashew, walnut)

Which of the following allergies is responsible for most severe food allergy reactions? Seafood Berries Peanuts Seeds

Peanuts

___________ is the most common medication to cause anaphylaxis.

Penicillin

A nurse is preparing a presentation to a local commununity group about allergic disorders. Which medication would the nurse include as the most common cause of anaphylaxis? a)Penicillin b)Iodine contrast agent c) Morphine d) Aspirin

Penicillin Explanation: Although aspirin, morphine (an opioid) and radiocontrast agents such as iodine can cause anaphylaxis, penicillin is the most comon cause of anaphylaxis, accounting for about 75% of fatal anaphylactic reactions in the United States each year.

What is the most common cause of anaphylaxis? a)NSAIDs b)Radiocontrast agent c)Penicillin d)Opioids

Penicillin Explanation: Penicillin is the most common cause of anaphylaxis, accounting for about 75% of fatal anaphylactic reactions in the United States each year. Opioids, NSAIDs, and radiocontrast agents are some of the medications that are frequently reported as causing anaphylaxis.

most common medications to cause dermatitis medicamentosa?

Penicillin, cephalosporin, and sulfonamide antibiotics are most commonly implicated

The cardiac system is also commonly affected in SLE. _____________ is the most common cardiac manifestation.Patients may present with substernal chest pain that is aggravated by movement or inspiration.

Pericarditis

Gynecological Manifestations of AIDS

Persistent candidiasis, vaginitis, cervical dysplasia, neoplasia. Pelvic inflammatory disease (PID)

What are some common signs of thrombocytopenia?

Petechiae and ecchymosis

Chronic granulomatous disease (CGD)

Phagocytes are unable to kill certain bacteria and fungi resulting in increased susceptibility to infections.

Leukocyte adhesion deficiency (LAD)

Phagocytes are unable to move to the site of an infection resulting in an inability to fight pathogens resulting in recurrent, life-threatening infections and poor wound healing.

Which type of contact dermatitis requires light exposure in addition to allergen contact? Allergic Irritant Phototoxic Photoallergic

Photoallergic

A patient with HIV develops a nonproductive cough, shortness ofbreath, a fever of 101°F, and an O2 saturation of 92%. What infectioncaused by Pneumocystis jiroveci does the nurse know could occurwith this patient? a. Mycobacterium avium complex (MAC) b. Pneumocystis pneumonia c. Tuberculosis d. Community-acquired pneumonia

Pneumocystis pneumonia

Tumor Lysis Syndrome (TLS)

Potentially fatal complication that occurs spontaneously or more commonly following radiation, biotherapy, or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia, lymphoma, and small cell lung cancer. *leads to rapidly induced electrolyte imbalances

Which of the following interventions is the single most important aspect for the patient at risk for anaphylaxis? Use of antihistamines Wearing of medical alert bracelet Prevention Desensitization

Prevention

Wiskott-Aldrich syndrome (WAS)

Problems with B and T cells and platelets resulting in prolonged episodes of bleeding, recurrent bacterial and fungal infections and increased risk of cancers and autoimmune diseases.

Superior Vena Cava Syndrome (SVCS)

Progressive occlusion of the superior vena cava that leads to venous distention of upper extremities and head * If untreated, SVCS may lead to cerebral anoxia laryngeal edema, bronchial obstruction, and death.

_____ therapy, a form of external radiation, permits treatment of deep tumors in close proximity to critical structures, such as the heart or major blood vessels.

Proton

___________ therapy is another approach to EBRT. It utilizes high linear energy transfer (LET) in the form of charged protons generated by a large magnetic unit called a cyclotron.

Proton

This type of testing is helpful in identifying clinically significant allergens in patients who have a large number of positive tests.

Provocative Testing

this test involves the direct administration of the suspected allergen to the sensitive tissue, such as the conjunctiva, nasal or bronchial mucosa, or gastrointestinal tract (by ingestion of the allergen), with observation of target organ response.

Provocative Testing

Polymyositis first symptoms

Proximal muscle weakness is typically the first symptom. Muscle weakness is usually symmetric and diffuse.

most consistent features of atopic dermatitis?

Pruritus and hyperirritability of the skin are the most consistent features of atopic dermatitis and are related to large amounts of histamine in the skin.

Deformities of the hands (e.g., ulnar deviation and swan neck deformity) and feet are common in

RA

Heberden's and Bouchard's nodes

RA

Diffuse Connective Tissue Diseases INCLUDE:

RA, SLE, scleroderma, polymyositis, Sjögren's syndrome, polymyalgia rheumatica (PMR), and giant cell arteritis (GCA).

The nurse working in the ED is asked to explain allergy testing to a patient who experienced an allergic reaction to an unknown allergen. Which test indicates the quantity of allergen necessary to evoke an allergic reaction? Intradermal test Provocative testing RAST Scratch test

RAST Explanation: RAST is a radioimmunoassay that measures allergen-specific IgE. The RAST indicates the quantity of allergen necessary to evoke an allergic reaction. Provocative testing involves the direct administration of the suspected allergen to the sensitive tissue, such as the conjunctiva. The scratch test does not indicate the quantity of allergen.

Nurses must recognize the differences among common laboratory tests used to diagnose and assess HIV infection and guide therapy. For example, the EIA is a diagnostic screening test that determines the presence of antibodies to HIV. The _______ test, which measures viral load, is used along with the ______ count, which indicates the level of immune dysfunction, to assess the stage and severity of HIV infection. It is important to assess the extent of damage to the immune system before initiation of ART and/or prophylactic treatment for opportunistic infections.

RT-PCR CD4+

RA is a systemic disease with multiple extra-articular features. Most common are fever, weight loss, fatigue, anemia, lymph node enlargement, and ____________ phenomenon (cold- and stress-induced vasospasm causing episodes of digital blanching or cyanosis).

Raynaud's

__________ of antigens as foreign, or non-self, by the immune system is the initiating event in any immune response. Recognition involves the use of lymph nodes and lymphocytes for surveillance.

Recognition

In a streptococcal throat infection, for example, the streptococcal organism gains access to the mucous membranes of the throat. A circulating lymphocyte moving through the tissues of the throat comes in contact with the organism. The lymphocyte recognizes the antigens on the microbe as different (non-self) and the streptococcal organism as antigenic (foreign). this is an example of what stage of the 4 stages in immune response?

Recognition Stage

A client has been taking a decongestant for allergic rhinitis. During a follow-up visit, which finding suggests that the decongestant has been effective? a)Increased tearing b)Headache c)Reduced sneezing d)Increased salivation

Reduced sneezing Explanation: Decongestants relieve congestion and sneezing and reduce labored respirations. When effective, decongestants dry the mucous membranes; therefore, the client shouldn't experience increased salivation or tearing. Because decongestants alleviate congestion, they also relieve headaches, which may be caused by congestion.

A patient with a history of anaphylactic reactions to insect stings has just been stung by a wasp. The patient is going to self-administer his EpiPen. Place the steps in the correct order that he would follow. Use all options. 1 Call the emergency medical response number (911) 2 Remove the gray safety-release cap 3 Jab the black tip into the outer thigh 4 Massage the injection area

Remove the gray safety-release cap Jab the black tip into the outer thigh Massage the injection area Call the emergency medical response number (911)

Non-dividing cells capable of future proliferation are the least sensitive to antineoplastic medications and consequently are potentially dangerous. However, the non-dividing cells must be destroyed to eradicate the disease. How are these cell destroyed?

Repeated cycles of chemotherapy or sequencing of multiple chemotherapeutic agents is used to achieve more tumor cell destruction by destroying the non-dividing tumor cells as they begin active cell division

photo allergic reaction

Resembles allergic dermatitis but requires light exposure in addition to allergen contact to produce immunologic reactivity

Phototoxic dermatitis

Resembles the irritant type but requires sun and a chemical in combination to damage the epidermis

when is recommendable to do resistance testing in patients in HIV care?

Resistance testing in persons who are chronically infected is recommended at the time of entry into HIV care.

allergic dermatitis

Results from contact of skin and allergenic substance; has a sensitization period of 10-14 days

irritant dermatitis

Results from contact with a substance that chemically or physically damages the skin on a nonimmunologic basis; occurs after first exposure to irritant or repeated exposures to milder irritants over an extended time

CARD9 Deficiency

Results in susceptibility to fungal infections such as candidiasis; fungi are usually present on the skin; does not cause severe problems in healthy people.

An infant is born to a mother who had no prenatal care during her pregnancy. What type of hypersensitivity reaction does the nurse understand may have occurred? a)Bacterial endocarditis b)Rh-hemolytic disease c)Lupus erythematosus d) Rheumatoid arthritis

Rh-hemolytic disease Explanation: A type II hypersensitivity, or cytotoxic, reaction, which involves binding either the IgG or IgM antibody to a cell-bound antigen, may lead to eventual cell and tissue damage. The reaction is the result of mistaken identity when the system identifies a normal constituent of the body as foreign and activates the complement cascade. Examples of type II reactions are myasthenia gravis, Goodpasture syndrome, pernicious anemia, hemolytic disease of the newborn, transfusion reaction, and thrombocytopenia.

Cigarette smoking is one modifiable risk factor that has been shown to be highly related to __________

Rheumatoid Arthritis

What is another disease process that methotrexate is used for?

Rheumatoid Arthritis

A client comes to the clinic reporting nasal congestion and states, "I've been using an over-the-counter nasal spray that seemed to help at first, but then I got even more congested than before I started the medication. I continued the nasal spray, but it seems to be worse." The nurse suspects which of the following? Tolerance to the medication Drug overdose Development of a new allergy Rhinitis medicamentosa

Rhinitis medicamentosa

- These catherer is inserted into the subclavian vein and advanced until its tip lies in the superior vena cava just above the right atrium. - The proximal end is then tunneled from the entry site through the subcutaneous tissue of the chest wall and brought out through an exit site on the chest. * The Dacron cuff anchors the catheter in place and serves as a barrier to infection.

Right atrial catheter

Dacron cuff anchors

Right atrial catheter. * anchors the catheter in place and serves as a barrier to infection.

cell cycle-specific agents destroy cells that are actively reproducing by means of the cell cycle; most affect cells in the _____ phase by interfering with DNA and RNA synthesis.

S

DNA synthesis occurs during

S phase of interphase

Facial lipoatrophy

SIDE EFFECT OF ART

safety precaution HIV patients

STANDARD PRECAUTIONS - Use new gloves for every patient. - Wear protective eye wear, masks or face shields (with safety glasses or goggles) during procedures likely to generate droplets of blood or body fluids. * In general, protective eye wear, masks and clothing are not needed for routine care of AIDS virus-infected persons.

CREST syndrome

Scleroderma

in this disease the skin and subcutaneous tissues become increasingly hard and rigid and cannot be pinched up from the underlying structures. Wrinkles and lines are obliterated. The skin is dry because sweat secretion over the involved region is suppressed. The extremities stiffen and lose mobility

Scleroderma

At which level of prevention are screenings done?

Secondary

____________ prevention involves screening and early detection activities that seek to identify precancerous lesions and early-stage cancer in individuals who lack signs and symptoms of cancer.

Secondary

A patient asks the nurse if it would be all right to take an over-the-counter antihistamine for the treatment of a rash. What should the nurse educate the patient is a major side effect of antihistamines? Sedation Palpitations Anorexia Diarrhea

Sedation

______________, also known as sentinel lymph node mapping, is a minimally invasive surgical approach that in many instances has replaced more invasive lymph node dissections (lymphadenectomy) and the associated complications such as lymphedema and delayed healing.

Sentinel lymph node biopsy (SLNB) *has been widely adopted for regional lymph node staging in selected cases of melanoma and breast cancer

A patient with a history of allergies comes to the clinic for an evaluation. The following laboratory test findings are recorded in a patient's medical record: Total serum IgE levels: 2.8 mg/mL White blood cell count: 5,100/cu mm Eosinophil count: 4% Erythrocyte sedimentation rate: 20 mm/h The nurse identifies which result as suggesting an allergic reaction? Serum IgE level Erythrocyte sedimentation rate White blood cell count Eosinophil count

Serum IgE level

A client with rheumatoid arthritis has infiltration of the lacrimal and salivary glands with lymphocytes as a result of the disease. What does the nurse understand that this clinical manifestation is? a) Sicca syndrome b) Episcleritis c) Cataracts d) Glaucoma

Sicca syndrome Explanation: Sicca syndrome is a condition of dry eyes and dry mouth that can result from infiltration of the lacrimal and salivary glands with lymphocytes. Episcleritis is an inflammatory condition of the connective tissue between the sclera and conjunctiva. Glaucoma results from increased intraocular pressure, and cataracts are a clouding of the lens in the eye. pg.1072

HIV in older adults

Signs of HIV/AIDS can be mistaken for the aches and pains of normal aging. Older adults might be coping with other diseases common to aging that can mask the signs of HIV/AIDS.

__________ syndrome is a systemic autoimmune disease that progressively affects the lacrimal and salivary glands of the body. More than 90% of patients affected are women, and the onset tends to begin between 35 and 50 years of age

Sjögren's

________ testing is considered the most accurate confirmation of allergy

Skin

If the body fails to recognize the TAAs on cancer cells or the function of the APCs is impaired, the immune response is not stimulated. how?

Some cancer cells have been found to have altered cell membranes that interfere with APC binding and presentation to T lymphocytes.

It is generally recommended that herbal products not be used with antiretroviral medications. ______________ may decrease blood levels of some anti-HIV medications and make them less effective; echinacea should be avoided because it may stimulate viral replication.

St. John's wort

when stage 2 occurs in HIV?

Stage 2 occurs when CD4+ T-lymphocyte cells are between 200 and 499

So then, why do we stage and grade tumors?

Staging of a tumor is done to communicate the size of the tumor, if lymph nodes are involved, and if there is metastasis

The key goal of ART

Standard antiretroviral therapy (ART) * to achieve and maintain durable viral suppression.

what is produced in the bone marrow?

Stem cell ( which produces WBC, RBC, platelets)

_______________ is another form of EBRT that uses higher doses of radiation to penetrate very deeply into the body to control deep-seated tumors that cannot be treated by other approaches such as surgery.

Stereotactic body radiotherapy (SBRT)

__________, a form of mucositis, is an inflammatory process of the mouth, including the mucosa and tissues surrounding the teeth.

Stomatitis

Biologic Response Modifiers

Substances produced by normal cells that block tumor growth or stimulate the immune system to fight cancer.

classic symptoms of RA

Symmetric joint pain swelling warmth erythema lack of function

stem cells continuously migrate from the bone marrow to the thymus gland, where they develop into ____ cells.

T

cells that are important for producing a cellular immune response

T cells

how T cells attack foreign invaders in comparison to B cells

T cells attack foreign invaders directly rather than by producing antibodies.

Cellular immune response

T lymphocyte -Helper T -Suppressor T -Memory T -Cytotoxic T (killer T)

In the inflammatory process in rheumatic diseases, a triggering eventstarts the process by activating ________

T lymphocytes

Tumor-associated antigens (TAAs) are found on the membranes of many cancer cells. TAAs are processed by antigen-presenting cells (APCs) and are presented to _____________ that recognize the antigen-bearing cells as foreign.

T lymphocytes

Viral rather than bacterial antigens induce a cellular response. This response is manifested by the increasing number of _______________ (lymphocytosis) seen in the blood tests of people with viral illnesses such as infectious mononucleosis.

T lymphocytes

TNM Classification System T= N= M=

T= The extent of the primary tumor N= The absence or presence and extent of regional lymph node metastasis M= The absence or presence of distant metastasis

Although patients may or may not react to the first infusion of a chemotherapy agent, repeated exposure increases the likelihood of a hypersensitivity reactions (HSRs)

TRUE

Deformities of RA differ from those seen with osteoarthritis (OA), such as Heberden's and Bouchard's nodes.

TRUE

If extravasation is suspected, the medication administration is stopped immediately.

TRUE

A patient is taking nonsteroidal anti-inflammatory drugs (NSAIDs)for the treatment of osteoarthritis. What education should the nursegive the patient about the medication? a. Take the medication on an empty stomach in order to increaseeffectiveness b. Since the medication is able to be obtained over the counter, it hasfew side effects c. Take the medication with food to avoid stomach upset

Take the medication with food to avoid stomach upset

Improved screening, diagnosis, and treatment approaches have led to an estimated 14.5 million cancer survivors in the United States . __________ prevention efforts focus on monitoring for and preventing recurrence of the primary cancer as well as screening for the development of second malignancies in cancer survivors.

Tertiary

HIV-1 nucleic acid amplification test

Tests directly for virus

HIV-1/HIV-2 immunoassay

Tests for both HIV-1 and antibodies

HIV/1-HIV-2 antigen/antibody combination immunoassay

Tests for both antibody and virus for both HIV-1 and HIV-2

Azathioprine (Imuran) has been prescribed for the client with severe rheumatoid arthritis. The dose prescribed is 2 mg/kg/day orally in two divided doses. The medication available is a 50-mg scored tablet. The client weighs 110 pounds. How many milligrams will the nurse prepare per dose for the client?

The client weighs 50 kg (110 lbs/2.2 lbs per kg). The client will receive 100 milligrams per day (50 kg x 2 milligrams/kg). The medication is to be given in two divided doses or 50 mg per dose. pg.1060

A client being treated for an allergy has been prescribed antihistamines. The Kardex of this client reads as follows: Age: 32; Profession: Carpenter; Lifestyle & diet: Lives alone, average smoker, nonalcoholic, no food preferences, practices yoga; Medical history: Suffers from hay fever, recent urinary tract infection that has been treated successfully. What information from the Kardex is likely to have the greatest implication in educating the client about antihistamine administration? The client's age The client's medical history The client's smoking habit The client's profession

The client's profession

A patient is receiving gold sodium thiomalate for the treatment ofrheumatoid arthritis (RA). What does the nurse understand about theaction of this compound?

The drug inhibits T- and B-cell activity

first line of defense against microbial invaders?

The epithelial cells that coat the skin and make up the lining of the respiratory, gastrointestinal, and genitourinary tracts

The nurse is conducting a community education program on allergies and anaphylactic reactions. The nurse determines that the participants understand the education when they make which of the following statements about anaphylaxis? Systemic reactions include urticaria and angioedema. Anaphylactoid (anaphylaxislike) reactions are commonly fatal. The most common food item causing anaphylaxis is chocolate. The most common cause of anaphylaxis is penicillin.

The most common cause of anaphylaxis is penicillin.

The nurse teaches the patient with allergies about anaphylaxis including which of the following statements? Anaphylactoid (anaphylaxis-like) reactions are commonly fatal. The most common cause of anaphylaxis is penicillin. The most common food item causing anaphylaxis is chocolate. Systemic reactions include urticaria and angioedema.

The most common cause of anaphylaxis is penicillin.

Before administrating this medication, what factors should the nurse assess?

The nurse should assess the time of the surgery (the drug should be given 30-60 minutes prior), the patient's understanding of the need to receive the antibiotic, the patient's kidney function (by reviewing blood urea nitrogen and creatinine), and the patency of the IV line (the drug could cause thrombophlebitis).

Tim Fox, a 42-year-old man with a history of mild renal insufficiency, has received a diagnosis of Hodgkin's disease. He has completed a course of radiation therapy and is preparing to begin adjuvant chemotherapy, with a drug regimen that includes doxorubicin, bleomycin, vinblastine, and dacarbazine. Mr. Fox asks the nurse why he has to take so many different chemotherapeutic drugs. How should the nurse respond?

The nurse should explain that combination drug therapy is used in cancer treatment because it is more effective, less toxic, and less likely to cause drug resistance.

What education should the nurse provide to the patient taking long-term corticosteroids? Corticosteroids are relatively safe drugs with very few side effects. The patient should take the medication only as needed and not take it unnecessarily. The patient should not stop taking the medication abruptly and should be weaned off of the medication. The patient should discontinue using the drug immediately if weight gain is observed.

The patient should not stop taking the medication abruptly and should be weaned off of the medication.

Immunotherapy therapeutic failure

Therapeutic failure is evident when a patient does not experience a decrease of symptoms within 12 to 24 months, fails to develop increased tolerance to known allergens, and cannot decrease the use of medications to reduce symptoms.

how to manage chronic diarrhea?

Therapy with octreotide acetate (Sandostatin), a synthetic analog of somatostatin, has been shown to effectively manage chronic severe diarrhea.

Why did the nurse ask the patient about a penicillin allergy with the administration of a cephalosporin?

There is a potential for cross-reactivity with patients that have a severe penicillin allergy due to the common beta-lactam ring.

Continuous infusion of vesicants that takes longer than 1 hour or are given frequently are given only via a central line, such as a right atrial silastic catheter, implanted venous access device, or PICC. Why?

These long-term venous access devices promote safety during medication administration and reduce problems with repeated access to the circulatory system

those body tissues that undergo frequent cell division are most sensitive to radiation therapy.

These tissues include bone marrow, lymphatic tissue, epithelium of the gastrointestinal tract, hair follicles, and gonads.

Which of the following statements describes the clinical manifestations of a delayed hypersensitivity (type IV) allergic reaction to latex? They occur within minutes after exposure to latex. They may worsen when hand lotion is applied before donning latex gloves. They can be eliminated by changing glove brands or using powder-free gloves. They are localized to the area of exposure, usually the back of the hands.

They are localized to the area of exposure, usually the back of the hands.

Most microbial infections induce an inflammatory response mediated by T cells and cytokines which, in excess, can cause tissue damage.Therefore, regulatory mechanisms must be in place to suppress or halt the immune response. which are these regulatory mechanism?

This is mainly achieved by the production of cytokines and transformation of growth factor that inhibit macrophage activation. * In some cases, T-cell activation is so acute that these mechanisms fail, and pathology develops.

Clinical manifestations of inadequate erythropoiesis include anemia. This result in a decrease in what?

This results in a decrease in the oxygen-carrying capacity of blood and consequently a decreased oxygen availability to the tissues

A patient arrives at the clinic and reports a very sore throat as well asa fever. A rapid strep test returns a positive result and the patient isgiven a prescription for an antibiotic. How did the streptococcalorganism gain access to the patient to cause this infection? a. Through the mucous membranes of the throat b. Through the skin c. Breathing in airborne dust d. From being outside in the cold weather and decreasing resistance

Through the mucous membranes of the throat

Positron emission tomography (PET)

Through the use of a tracer, provides black-and-white or color-coded images of the biologic activity of a particular area, rather than its structure. Used in detection of cancer or its response to treatment

_________ is the mechanism by which the immune system is programmed to eliminate foreign substances such as microbes, toxins, and cellular mutations but maintains the ability to accept self-antigens

Tolerance

a condition that occurs when a large number of cancer cells die within a short period, releasing their contents in to the blood.

Tumor lysis syndrome (TLS)

When tumors do not possess _________that label them as foreign, the immune response is not alerted. This allows the tumor to grow too large to be managed by normal immune mechanisms.

Tumor-associated antigens (TAAs; also called tumor cell antigens)

These molecules bind to PD-1 proteins on T lymphocytes and either block the killing of the tumor or induce cell death in the lymphocyte.

Tumors can express molecules that induce T-lymphocyte anergy or tolerance such as PD-1 ligand

High-frequency sound waves echoing off body tissues are converted electronically into images; used to assess tissues deep within the body

Ultrasonography (ultrasound)

Autoimmune lymphoproliferative syndrome (ALPS)

Unusually high numbers of lymphocytes accumulate in the lymph nodes, liver, and spleen leading to enlargement of those organs. * Causes numerous autoimmune problems including low levels of red blood cells, platelets, and neutrophils.

A nurse is preparing a discharge teaching plan for a client with atopic dermatitis. Which instruction should the nurse include in her teaching plan? Keep the thermostat above 75° F (23.9° C). Wear only synthetic fabrics. Bathe only three times per week. Use a topical skin moisturizer daily.

Use a topical skin moisturizer daily. Explanation: The nurse should instruct the client to use a topical skin moisturizer daily to help keep the skin hydrated. Likewise, the client should be encouraged to bathe daily. To minimize irritation, the client should wear only cotton fabrics. The client should maintain a room temperature between 68° F (20° C) and 72° F (22.2° C).

when placing a patient that wanted to go to the bathroom (not allowed) back to bed the radioactive device falls to the floor. What should the nurse do?

Use long forceps to pick up the device and place it in a lead container *keep a lead container in the room in case a radioactive device dislodges

Which of the following is a contraindication for immunotherapy? Allergic asthma Allergic rhinitis Conjunctivitis Use of a beta-blocker

Use of a beta-blocker

Fluoroscopy

Use of x-rays that identify contrasts in body tissue densities; may involve the use of contrast agents

Radiofrequency ablation (RFA)

Uses localized application of thermal energy that destroys cancer cells through heat: temperatures exceed 50°C (122°F)

___________ is a better predictor of the risk of HIV disease progression than the CD4+ count. The lower the __________, the longer the time to AIDS diagnosis and the longer the survival time.

Viral load viral load

what is the most important indicator of response to ART?

Viral load should be measured at baseline and on a regular basis thereafter because viral load is the most important indicator of response to ART.

The CDC estimates that only 36% of the people living with HIV in the United States are prescribed ART and that among these individuals, only 76% have suppressed viral loads

Viral loads are often not suppressed because the patient is not adhering to the treatment plan.

A client is scheduled to begin immunotherapy. The nurse would explain that the client will receive injections initially at which interval Monthly Weekly Daily Bi-monthly

Weekly

Warburg effect

When cancer cells utilize an increase amount of glucose, even in the presence of oxygen

Nonspecific Biologic Response Modifiers

When injected into the patient, these agents serve as antigens that stimulate an immune response. The hope is that the stimulated immune system will then eradicate malignant cells.

Purine rich foods

Whole grain breads and cereals, oatmeal, wheat germ, wheat bran, meat gravies, fresh and saltwater fish, beans, organ meats, mushrooms, green peas, spinach, asparagus, cauliflower, and baker's and brewer's yeast are all high in purine. Lentils, which are beans, are a rich source of purines.

A patient who suffered severe partial thickness burns to the face and trunk is at risk for depletion of essential proteins and immunoglobulins. The stressors associated with this patient's major injury have caused what immune process to occur? a. Cortisol is released from the adrenal cortex, which contributes to immunosuppression b. Circulating lymphocytes will cause lymph node enlargement and altered lymph drainage c. T lymphocytes are stimulated and produce antibodies d. With the help of macrophages, B lymphocytes recognize the antigen of a foreign invader

With the help of macrophages, B lymphocytes recognize the antigen of a foreign invader

Mammography

Women should undergo regular screening mammography starting at age 40 years

Zinc deficiency in particular has been linked to the development of a number of diseases. Whats the role of zinc?

Zinc plays an important role in homeostasis, immune function, and apoptosis, among other functions

________________ (Tylenol) may be appropriate and worth trying before other medications that pose a greater chance of side effects. NSAIDs can be used; however, studies report that long-term use of NSAIDs can increase the risks of peptic ulcers, hemorrhage and cardiovascular toxicity.

a Nonnarcotic analgesic antipyretic -Acetaminophen

enzyme immunoassay (EIA)

a blood test that can determine the presence of antibodies to HIV in the blood or saliva; a variant of this test is called enzyme-linked immunosorbent assay (ELISA)

osteophyte

a bony outgrowth or protuberance; bone spur

Antiretroviral therapy (ART)

a combination of several medications prescribed for people who are HIV-positive to delay the onset of AIDS

cachexia

a condition of physical wasting away due to the loss of weight and muscle mass that occurs in patients with diseases such as advanced cancer or AIDS

Insulin-allergic patients with diabetes and those who are allergic to penicillin may require desensitization. Desensitization is based on controlled anaphylaxis, with a gradual release of mediators.

a conditioning technique designed to gradually reduce anxiety about a particular object or situation

Carcinoma

a malignant tumor that occurs in epithelial tissue

apoptosis:

a normal cell mechanism of programmed cell death

The oncology nurse is giving chemotherapy to a client in a short stay area. The client confides that they are very depressed. The nurse recognizes depression as which of the following?

a normal reaction to the diagnosis of cancer

HIV becomes AIDS when

a person's white blood cell count is so low 200 or below, it leaves their immune system defenseless

complement cascade

a precise sequence of events, usually triggered by antigen-antibody complexes, in which each component of the complement system is activated in turn

Amphoteric

a substance that can act as both an acid and a base

immune reconstitution inflammatory syndrome (IRIS):

a syndrome that results from rapid restoration of pathogen-specific immune responses to opportunistic infections

EIA test

a test that screens for the presence of HIV antibodies in the blood

Optimal viral suppression is defined generally as

a viral load persistently below the level of detection (HIV RNA less than 20 to 75 copies/mL, depending on the assay used).

Radioactive iodine (I-131)

a widely used form of systemic brachytherapy that is the primary treatment for thyroid cancer

A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process? a) "It will get better and worse again." b) "It will never get any better than it is right now." c) "When it clears up, it will never come back." d) "I'll definitely need surgery for this."

a) "It will get better and worse again." Explanation: The client demonstrates understanding of rheumatoid arthritis if he expresses that it's an unpredictable disease characterized by periods of exacerbation and remission. There's no cure for rheumatoid arthritis, but symptoms can be managed. Surgery may be indicated in some cases. pg.1062

A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis? a) "My finger joints are oddly shaped." b) "I have pain in my hands." c) "My legs feel weak." d) "I have trouble with my balance."

a) "My finger joints are oddly shaped." Explanation: Joint abnormalities are the most obvious manifestations of rheumatoid arthritis. A systemic disease, rheumatoid arthritis attacks all connective tissue. Although muscle weakness may occur from limited use of the joint where the muscle attaches, such weakness isn't the most obvious sign of rheumatoid arthritis; also, it occurs only after joint abnormalities arise. Subcutaneous nodules in the hands, although common in rheumatoid arthritis, are painless. The disease may cause gait disturbances, but these follow joint abnormalities. pg.1066

The nurse is teaching a patient about her rheumatic disease. What statement best helps to explain "autoimmunity"? a) "Your symptoms are a result of your body attacking itself." b) "You are not immune to the disease causing the symptoms." c) "You have inherited your parent's immunity to the disease." d) "You have antigens to the disease, but it they do not prevent the disease."

a) "Your symptoms are a result of your body attacking itself." Correct Explanation: In autoimmunity, the body mistakes its own tissue for foreign tissue and begins to attack it. Symptoms develop as the body destroys tissue. The body is in effect "attacking itself." The other statements do not explain autoimmunity. pg.1055

Which client is most likely to develop systemic lupus erythematosus (SLE)? a) A 27-year-old black female b) A 25-year-old white male c) A 35-year-old Hispanic male d) A 25-year-old Jewish female

a) A 27-year-old black female Explanation: SLE strikes nearly 10 times as many women as men and is most common in women between ages 15 and 40. SLE affects more black women than white women; its incidence is about 1 in every 250 black women, compared to 1 in every 700 white women. pg.1069

The nurse is caring for a client with rheumatoid arthritis who suffers with chronic pain in the hands. When would be the best time for the nurse to perform range-of-motion exercises? a) After the client has had a warm paraffin hand bath b) First thing in the morning when the client wakes c) After the client has a diagnostic test d) After cool compresses have been applied to the hands

a) After the client has had a warm paraffin hand bath Explanation: Whether resting or moving, clients in this stage of the disease have considerable chronic pain, which typically is worse in the morning after a night's rest. Warmth helps decrease the symptoms of pain and will be the best time to perform range of motion exercises. pg.1056

Of the following, which drug is not used in the treatment of rheumatoid arthritis? a) Allopurinol (Zyloprim) b) Adalimumab (Humira) c) Methotrexate (Rheumatrex) d) Etanercept (Enbrel

a) Allopurinol (Zyloprim) Explanation: Allopurinol (Zyloprim) is used in the treatment of gout. Etanercept (Enbrel), adalimumab (Humira), and methotrexate (Rheumatrex) are all used in the treatment of rheumatoid arthritis. pg.1079

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. Which of the following would the nurse expect to find? a) Elevated erythrocyte sedimentation rate b) Increased albumin levels c) Increased red blood cell count d) Increased C4 complement

a) Elevated erythrocyte sedimentation rate Explanation: The erythrocyte sedimentation rate (ESR) may be elevated, particularly as the disease progresses. ESR shows inflammation associated with RA. Red blood cell count and C4 complement component are decreased. Serum protein electrophoresis may disclose increased levels of gamma and alpha globulin but decreased albumin. pg.1058

A client with rheumatoid arthritis is prescribed a tumor necrosis factor (TNF)-alpha inhibitor. Which of the following might be prescribed? a) Etanercept b) Celecoxib c) Diclofenac d) Indomethacin

a) Etanercept Explanation: Etanercept is an example of a tumor necrosis factor (TNF)-alpha inhibitor used to treat rheumatoid arthritis. Diclofenac and indomethacin are nonsteroidal anti-inflammatory drugs (NSAIDs). Celecoxib is a cyclooxygenase-2 (COX-2) inhibitor. pg.1061

Which of the following suggests to the nurse that the client with systemic lupus erythematous is having renal involvement? a) Hypertension b) Chest pain c) Behavioral changes d) Decreased cognitive ability

a) Hypertension Explanation: Hypertension is suggestive of renal damage in the client with systemic lupus erythematous. pg.1070

A patient with rheumatoid arthritis is complaining of joint pain. What intervention is a priority to assist the patient? a) Nonsteroidal anti-inflammatory drugs (NSAIDs) b) Opioid therapy c) Surgery d) Ice packs

a) Nonsteroidal anti-inflammatory drugs (NSAIDs) Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of treatment for rheumatoid arthritis pain. They help to decrease inflammation in the joints. Heat is used to relieve pain rather than ice packs. Paraffin baths may also help. Surgery is reserved for joint replacement when the joint is no longer functional. It is not an intervention specific to relieving pain. pg.1056

A patient is seen in the office for complaints of joint pain, swelling, and a low-grade fever. What blood studies does the nurse know are consistent with a positive diagnosis of RA? (Select all that apply.) a) Positive antinuclear antibody (ANA) b) Positive C-reactive protein (CRP) c) Aspartate aminotransferase (AST) and alanine transaminase (ALT) levels of 7 units/L d) Red blood cell (RBC) count of <4.0 million/mcL e) Red blood cell (RBC) count of >4.0 million/mcL

a) Positive antinuclear antibody (ANA) b) Positive C-reactive protein (CRP) d) Red blood cell (RBC) count of <4.0 million/mcL Explanation: Several assessment findings are associated with RA: rheumatoid nodules, joint inflammation detected on palpation, and laboratory findings. The history and physical examination focuses on manifestations such as bilateral and symmetric stiffness, tenderness, swelling, and temperature changes in the joints. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) tend to be significantly elevated in the acute phases of RA and are therefore useful in monitoring active disease and disease progression. The red blood cell count and C4 complement component are decreased. Antinuclear antibody (ANA) test results may also be positive. pg.1066

Which of the following clinical manifestations would the nurse expect to find in a client who has had rheumatoid arthritis for several years? a) Small joint involvement b) Asymmetric joint involvement c) Bouchard's nodes d) Obesity

a) Small joint involvement Explanation: Clinical manifestations of rheumatoid arthritis are usually bilateral and symmetrical and include small joint involvement and joint stiffness in the morning. Other systemic manifestations occur. pg.1065

A physician orders corticosteroids for a child with systemic lupus erythematosus (SLE). The nurse knows that the purpose of corticosteroid therapy for this child is to: a) combat inflammation. b) prevent platelet aggregation. c) promote diuresis. d) prevent infection.

a) combat inflammation. Explanation: Corticosteroids are used to combat inflammation in a child with SLE. To prevent infection, the physician would order antibiotics. Aspirin is used to prevent platelet aggregation. Diuretics, not corticosteroids, promote diuresis. pg.1071

An older adult patient who is postmenopausal informs the nurse thatshe believes she has developed another urinary tract infection (UTI).What risk factors do female patients in this age group have to increasethe incidence of UTIs? (Select all that apply.) a. Residual urine b. Urinary incontinence c. Estrogen deficiency d. Decreased function of the thyroid gland e. Dry mucous membranes of the vagina

a, b, c postmenopausal females are at a greater risk for urinary tract infections due to residual urine, urinary incontinence, and estrogen deficiency

A patient is admitted for the treatment of a primary immunodeficiency and intravenous immunoglobulin (IVIG) is ordered. What should the nurse monitor for as a potential adverse effect of IVIG administration? A) Anaphylaxis B) Hypertension C) Hypothermia D) Joint pain

a. Potential adverse effects of an IVIG infusion include hypotension, flank pain, chills, and tightness in chest, terminating with a slightly elevated body temperature and anaphylactic reaction. Hypertension, hypothermia, and joint pain are not usual adverse effects of IVIG.

A patient is being placed on a purine-restricted diet. What food shouldbe suggested by the nurse? a. Dairy products b. Organ meats c. Raw vegetables d. Shellfish

a. Dairy products

The nurse is performing a physical assessment for a patient at the clinic and palpates enlarged inguinal lymph nodes on the left. What should the nurse document? (Select all that apply.) a. Location b. Size c. Consistency d. Reports of tenderness e. Temperature

a. Location b. Size c. Consistency d. Reports of tenderness

A patient is seen in the office for reports of joint pain, swelling, and alow-grade fever. What blood studies does the nurse know areconsistent with a positive diagnosis of RA? (Select all that apply.) a. Positive C-reactive protein (CRP) b. Positive antinuclear antibody (ANA) c. Red blood cell (RBC) count of <4.0 million/mcL d. Serum complement level (C3) of >130 mg/dL e. Aspartate aminotransferase (AST) and alanine transaminase(ALT) levels of 7 units/L

a. Positive C-reactive protein (CRP) b. Positive antinuclear antibody (ANA) d. Serum complement level (C3) of >130 mg/dL

A patient is diagnosed with pneumocystis pneumonia (PCP). What medication does the nurse anticipate educating the patient about for treatment? a. TMP-SMZ (Bactrim) b. Cephalexin (Keflex) c. Azithromycin (Zithromax) d. Garamycin (Gentamicin)

a. TMP-SMZ (Bactrim)

The nurse is caring for a patient in the hospital who is receiving avitamin D supplement. What does the nurse understand is theimportance of supplementation with this vitamin? (Select all thatapply.) a. Vitamin D deficiency is associated with increased risk of commoncancers b. Vitamin D deficiency is associated with increased risk ofautoimmune disease c. Vitamin D deficiency is associated with increased risk ofcongenital anomalies d. Vitamin D deficiency is associated with increased risk ofinflammatory disorders e. Vitamin D deficiency is associated with increased risk of celiacdisease

a. Vitamin D deficiency is associated with increased risk of common cancers b. Vitamin D deficiency is associated with increased risk of autoimmune disease d. Vitamin D deficiency is associated with increased risk of inflammatory disorders

hypersensitivity:

abnormal heightened reaction to a stimulus of any kind

neutropenia

abnormally low absolute neutrophil count

tophi

accumulation of crystalline deposits in articular surfaces, bones, soft tissue, and cartilage

A vaccine or prior exposure to a disease provides _______ immunity since your immune system will actively generate antibodies in response to the antigen.

active

After cancer chemotherapy, a client experiences nausea and vomiting. The nurse should assign highest priority to which intervention?

administering metoclopramide and dexamethasone as ordered

advantage of proton therapy

advantage of proton therapy is that it is capable of delivering its high-energy dose to a deep-seated tumor, with decreased doses of radiation to the tissues in front of the tumor while virtually no energy exits through the patient's healthy tissue behind the tumor

One antibody can act as a cross-link between two antigens, causing them to bind or clump together. This clumping effect, referred to as __________ helps clear the body of the invading organism by facilitating phagocytosis.

agglutination

clumping effect occurring when an antibody acts as a cross-link between two antigens

agglutination

Hemorrhagic cystitis is a bladder toxicity that can result from certain chemo drugs and can lead to life-threatening hemorrhage. So nurses need to protect the bladder by

aggressive IV hydration, frequent avoiding, and diuresis

substance that causes manifestations of allergy

allergen

An _________ reaction is a manifestation of tissue injury resulting from interaction between an antigen and an antibody.

allergic

E (IgE)-mediated reaction

allergic reaction

IgE function

allergic reactions

In _______________, the body encounters allergens that are types of antigens, usually proteins that the body's defenses recognize as foreign, and a series of events occurs in an attempt to render the invaders harmless, destroy them, and remove them from the body.

allergic reactions

four types of contact dermatitis

allergic, irritant, phototoxic, and photo allergic

what happens if an immune response is overly robust or misdirected?

allergies, asthma, or autoimmune disease results

inappropriate and often harmful immune system response to substances that are normally harmless

allergy

One medication, ______________, is occasionally used in patients with head and neck cancers to reduce acute and chronic xerostomia while preserving antitumor efficacy of the necessary radiation doses

amifostine (Ethyol)

Cryptococcal Meningitis

among patients with HIV infection most commonly occurs as a subacute meningitis or meningoencephalitis with fever, malaise, and headache.

viral set point

amount of virus present in the blood after the initial burst of viremia and the immune response that follows

The nurse is conducting a screening for familial predisposition to cancer. Which element should the nurse note as a possible indication of hereditary cancer syndrome?

an aunt and uncle diagnosed with cancer

polyurethane female condom

an effective contraceptive, provides a physical barrier that prevents exposure to genital secretions containing HIV, such as semen and vaginal fluid, and is inserted by the woman

whats an allergy?

an inappropriate and often harmful response of the immune system to normally harmless substances, called allergens (dust, weeds, pollen, dander)

Tumor marker identification

analysis of substances fund in body—tissues, blood, or other body fluids that are made by the tumor or by the body in response to the tumor

serologic testing algorithm for recent HIV seroconversion (STARHS)

analyzes HIV-positive blood samples to determine whether an HIV infection is recent or has been ongoing.

Closely resembling anaphylaxis is an _______________ reaction, which is caused by the release of mast cell and basophil mediators triggered by non-immunoglobulin E (IgE)-mediated events.

anaphylactoid

rapid clinical response to an immediate immunologic reaction between a specific antigen and antibody

anaphylaxis

The degree of _________ (a pattern of growth in which cells lack normal characteristics and differ in shape and organization with respect to their cells of origin) is associated with increased malignant potential.

anaplasia

angioneurotic edema example

angioedema

Among the many causes of _____________ in patients with cancer are alterations in taste, manifested by increased salty, sour, and metallic taste sensations, and altered responses to sweet and bitter flavors.

anorexia

Immune Reconstitution Inflammatory Syndrome (IRIS) treatment

anti-inflammatory medications such as cortisone.

_______________ are large proteins, called immunoglobulins, that consist of two subunits, each containing a light and a heavy peptide chain held together by a chemical link composed of disulfide bonds.

antibody

a protein substance developed by the body in response to and interacting with a specific antigen

antibody

protein substance developed by the body in response to and interacting with a specific antigen

antibody

There are three types of HIV diagnostic tests:

antibody tests antigen/antibody tests nucleic acid (RNA) tests.

A client complains of sporadic epigastric pain, yellow skin, nausea, vomiting, weight loss, and fatigue. Suspecting gallbladder disease, the physician orders a diagnostic workup, which reveals gallbladder cancer. Which nursing diagnosis is appropriate for this client?

anticipatory grieving

The structural part of the invading or attacking organism that is responsible for stimulating antibody production is called an _____or an immunogen

antigen

substance that induces the production of antibodies

antigen

TAAs are processed by

antigen-presenting cells (APCs)

the portion of the antigen involved in binding with the antibody is referred to as the ____________

antigenic determinant

epitope

any component of an antigen molecule that functions as an antigenetic determinant by permitting the attachment of certain antibodies

____________, which refers to reduced, self-initiated, cognitive, emotional, and behavioral activity, is also commonly reported among those living with a diagnosis of HIV with rates as high as 65%

apathy

colony stimulating factors

are a group of naturally occurring glycoprotein cytokines that regulate production, differentiation, survival, and activation of hematopoietic cells

Microbicides

are gels, films, or suppositories that can kill or neutralize viruses and bacteria; vaginal and rectal microbicides are being researched to see if they can prevent sexual transmission of HIV.

Intracavitary radioisotopes

are used to treat gynecologic cancers.

RA inflammatory processes have also been implicated in ___________stiffness and endothelial dysfunction. It is now believed that cardiovascular risks are similar to the risks of patients with diabetes. Therefore, cardiovascular risk assessment should be included in the patient's physical assessment

arterial wall

inflammation of a joint

arthritis

assessment of body change distress (ABCD) questionnaire

assesses subjective report of bodily changes and body dissatisfaction and the impact of bodily changes on psychosocial variables, quality of life, and HIV self-care behaviors

Women who have SLE are also at risk for early-onset _____________, making them much more likely to suffer myocardial infarction or stroke.

atherosclerosis

There are two types of IgE-mediated allergic reactions:

atopic and nonatopic disorders.

a type I immediate hypersensitivity disorder characterized by inflammation and hyper reactivity of the skin. The term is used synonymously with atopic eczema

atopic dermatitis

type I hypersensitivity involving inflammation of the skin evidenced by itching, redness, and a variety of skin lesions

atopic dermatitis

Nurses should be aware that atopic dermatitis is often linked in a process called the _____________ that often leads to asthma, allergic rhinitis, or food allergy.

atopic march

The immune system's recognition of one's own cells or tissues as "foreign" rather than as self is the basis of many ____________ disorders

autoimmune

____________ diseases are a leading cause of death by disease in females of reproductive age

autoimmune

A hallmark of rheumatologic diseases is ____________, where the body mistakenly recognizes its own tissue as a foreign antigen. It leads to destruction of tissue via the inflammatory process, along with chronic and long-standing pain.

autoimmunity

Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client?

autologous

A client receiving external radiation to the left thorax to treat lung cancer has a nursing diagnosis of Risk for impaired skin integrity. Which intervention should be part of this client's care plan?

avoiding using soap on the irradiated areas

The nurse is teaching the client newly diagnosed with systemic lupus erythematous about the condition. Which statement by the client indicates teaching was effective? a) "I do not need to make any changes in my diet." b) "I should avoid prolonged sun exposure." c) "My energy level will gradually increase over time." d) "My medications will ultimately correct my problem."

b) "I should avoid prolonged sun exposure." Explanation: Prolonged exposure to sun and ultraviolet light can cause exacerbations and disease progression. pg.1072

A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan? a) "Exposure to sunlight will help control skin rashes." b) "Monitor your body temperature." c) "Corticosteroids may be stopped when symptoms are relieved." d) "There are no activity limitations between flare-ups."

b) "Monitor your body temperature." Explanation: The nurse should instruct the client to monitor body temperature. Fever can signal an exacerbation and should be reported to the physician. Sunlight and other sources of ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of SLE. Clients should be encouraged to pace activities and plan rest periods. Corticosteroids must be gradually tapered because they can suppress the function of the adrenal gland. Abruptly stopping corticosteroids can cause adrenal insufficiency, a potentially life-threatening situation. pg.1071

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be? a) Performing meticulous skin care b) Administering ordered analgesics and monitoring their effects c) Providing comprehensive client teaching; including symptoms of the disorder, treatment options, and expected outcomes d) Supplying adaptive devices, such as a zipper-pull, easy-to-open beverage cartons, lightweight cups, and unpackaged silverware

b) Administering ordered analgesics and monitoring their effects Explanation: An acute exacerbation of rheumatoid arthritis can be very painful, and the nurse should make pain management her priority. Client teaching, skin care, and supplying adaptive devices are important, but these actions don't not take priority over pain management. pg.1066

Which of the following refers to fixation of a joint? a) Synovitis b) Ankylosis c) Pannus d) Articulations

b) Ankylosis Explanation: Fixation of a joint, called ankylosis, eliminates friction, but at the drastic cost of immobility. Inflammation is manifested in the joints as synovitis. Pannus has a destructive effect on the adjacent cartilage and bone. Articulations are joints. pg.1078

A patient is prescribed a DMARD that is successful in the treatment of RA but has side effects, including retinal eye changes. What medication does the nurse anticipate educating the patient about? a) Azathioprine (Imuran) b) Hydroxychloroquine (Plaquenil) c) Aurothioglucose (Solganal) d) Diclofenac (Voltaren)

b) Hydroxychloroquine (Plaquenil) Explanation: The DMARD hydroxychloroquine (Plaquenil) is associated with visual changes, GI upset, skin rash, headaches, photosensitivity, and bleaching of hair. The nurse should emphasize the need for ophthalmologic examinations (every 6-12 months). pg.1060

The immune abnormalities that characterize systemic lupus erythematosus (SLE) include which of the following? Select all that apply. a) Autoantibodies immune complexes b) Susceptibility c) Damage d) Abnormal innate and adaptive immune responses e) Inflammation

b) Susceptibility d) Abnormal innate and adaptive immune responses a) Autoantibodies immune complexes e) Inflammation c) Damage Explanation: The immune abnormalities that characterize SLE occur in five phases: susceptibility, abnormal innate and adaptive immune responses, autoantibodies immune complexes, inflammation, and damage.

An older adult has developed a sacral pressure ulcer. What should thenurse assess in order to ensure adequate wound healing and prevent poor outcomes for this patient? (Select all that apply.) a. The patient's ability to perform self wound care b. Nutritional status c. Caloric intake d. Quality of food ingested e. The amount of carbohydrates the patient ingests

b, c, d

A patient with HIV has been on antiretroviral therapy (ART) for 6months. The patient comes to the clinic with home medications, andthe nurse observes that there are too many pills in the container.Which factors are associated with nonadherence to ART? (Select allthat apply.) a. Lives alone b. Active substance abuse c. Taking other medication d. Depression e. Lack of social support

b, d, e

A patient is hospitalized with a severe case of gout. The patient hasgross swelling of the large toe and rates pain a 10 out of 10. With adiagnosis of gout, what should the laboratory results reveal? a. Glucosuria b. Hyperuricemia c. Hyperproteinuria d. Ketonuria

b. Hyperuricemia occurs when there's too much uric acid in your blood. High uric acid levels can lead to several diseases, including a painful type of arthritis called gout.

The nursing instructor is discussing the development of human immune deficiency virus (HIV) disease with the students. Whatshould the instructor inform the class about helper T cells? a. They are activated on recognition of antigens and stimulate the rest of the immune system b. They attack the antigen directly by altering the cell membrane and causing cell lysis c. They have the ability to decrease B-cell production d. They are responsible for recognizing antigens from previous

b. They attack the antigen directly by altering the cell membrane and causing cell lysis

The ___________ is the most suitable area of the body for skin testing because it permits the performance of many tests.

back

Resistance to hyperthermia may develop during the treatment. why?

because cells adapt to repeated thermal insult.

The nurse informs and reminds the patient of the importance of keeping appointments for desensitization procedures. Why?

because dosages are usually adjusted on a weekly basis, and missed appointments may interfere with the dosage adjustment.

patient with mucositis should brush the teeth after meals and at bedtime with a soft toothbrush and floss once daily. Stop brushing and flossing if the platelet count drops below 20,000/mm3. WHY?

because gingival bleeding is likely.

Hyperthermia and radiation therapy are thought to work well together. Why?

because hypoxic tumor cells and cells in the S phase of the cell cycle are more sensitive to heat than radiation, and the addition of heat damages tumor cells so that they cannot repair themselves after radiation therapy.

The use of hand lotion before donning latex gloves can worsen the symptoms of an allergic reaction to latex. Why?

because lotions may leach latex proteins from the gloves, thus increasing skin exposure and the risk of developing true allergic reactions

Stomatitis is commonly associated with some chemotherapy agents. Why?

because of the rapid turnover of epithelium that lines the oral cavity.

Body tissues most affected by radiation are those that normally proliferate rapidly, such as the skin, the epithelial lining of the gastrointestinal tract, and the bone marrow. Why is this?

because radiation targets ALL rapidly growing cells

The updated CDC recommendations (2014b) tests for HIV antigens and HIV nucleic acid. Why?

because studies from populations at high risk for HIV demonstrated that antibody testing alone might miss a considerable percentage of HIV infections detectable by virologic tests, especially during stage 0.

Blood tests can detect HIV infection sooner after exposure than oral fluid tests. Why?

because the level of antibody in blood is higher than it is in oral fluid.

Why are live vaccines contradicted in patients with antibody deficiency disorders?

because the patient is incapable of generating antibodies and the live substance in the vaccine can cause disease

Why are live vaccines contraindicated in patients with antibodydeficiency disorders?

because the patient is incapable of generating antibodies, and the live substance in the vaccine can cause disease

Initially, there is a period during which those who are HIV positive test negative on the HIV antibody blood test, although they are infected and highly infectious. Why?

because their viral loads are very high

Hematopoietic and immune blood cells originate in bone marrow in stem cells, which are often called pluripotent stem cells. Why are they called like that?

because they are capable of becoming different types of cells.

Sarcoma

begin in the bones and in the soft (also called connective) tissues

Hematopoiesis

blood cell formation

Which should a nurse thoroughly evaluate before a bone marrow transplant (BMT) procedure?

blood studies

White blood cells (WBCs) involved in immunity are primarilyproduced in the

bone marrow

Thrombocytopenia often results from _________________after certain types of chemotherapy and radiation therapy and with tumor infiltration of the bone marrow.

bone marrow depression

The immune system is essentially composed of ________, ________,and ________.

bone marrow, lymphoid tissue, white blood cells

subchondral bone

bony plate that supports the articular cartilage

a substance that stimulates nerve fibers and causes pain

bradykinin

HIV Encephalopathy

brain disease and dementia occurring with AIDS

how to prevent dislodgment of intracavity low-dose radiation?

by maintaining the client on bed rest, and a private room, provide low residue diet it's, give antidiarrheal agents to prevent bowel movements, log roll to prevent dislodgment of device and insert a Foley

how granulocytes fight invasion by foreign bodies or toxins?

by releasing cell mediators, such as histamine, bradykinin, and prostaglandins, and by engulfing the foreign bodies or toxins.

A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. She asks which of the tests ordered will determine if she is positive for the disorder. Which statement by the nurse is most accurate? a) "You should discuss that matter with your physician." b) "Tell me more about your concerns about this potential diagnosis." c) "The diagnosis won't be based on the findings of a single test but by combining all data found." d) "SLE is a very serious systemic disorder."

c) "The diagnosis won't be based on the findings of a single test but by combining all data found." Explanation: There is no single test available to diagnose SLE. Therefore, the nurse should inform the client that diagnosis is based on combining the findings from the physical assessment and the laboratory tests results. Advising the client to speak with the physician, stating that SLE is a serious systemic disorder, and asking the client to express her feelings about the potential diagnosis don't answer the client's question. pg.1070

A physician orders tests to determine if a client has systemic lupus erythematosus (SLE). Which test result helps to confirm an SLE diagnosis? a) Increased total serum complement levels b) Negative antinuclear antibody test c) An above-normal anti-deoxyribonucleic acid (DNA) test d) Negative lupus erythematosus cell test

c) An above-normal anti-deoxyribonucleic acid (DNA) test Explanation: Laboratory results specific for SLE include an above-normal anti-DNA test, a positive antinuclear antibody test, and a positive lupus erythematosus cell test. Because the anti-DNA test rarely is positive in other diseases, this test is important in diagnosing SLE. (The anti-DNA antibody level may be depressed in clients who are in remission from SLE.) Decreased total serum complement levels indicate active SLE. pg.1070

Which of the following classifications are considered antiarthritic drugs? Select all that apply. a) Disease-modifying antirheumatics (DMARDs) b) Diuretics c) Anti-inflammatory d) Muscle relaxants e) Glucocorticoids

c) Anti-inflammatory a) Disease-modifying antirheumatics (DMARDs) e) Glucocorticoids Explanation: Antiarthritic drugs fall into three major groups: nonsteroidal anti-inflammatory drugs (NSAIDs), DMARDs, and glucocorticoids. Diuretics and muscle relaxants are not antiarthritic drugs. pg.1056

Which of the following would be consistent with the diagnosis of rheumatoid arthritis? a) Increased C4 complement component b) Increased red blood cell count c) Cloudy synovial fluid d) Decreased ESR

c) Cloudy synovial fluid Explanation: In a patient with rheumatoid arthritis, Arthrocentesis shows synovial fluid that is cloudy, milky, or dark yellow and contains numerous inflammatory components, such as leukocytes and complement. pg.1066

The client with rheumatoid arthritis has a red blood cell count of 3.2 cells/cu mm. Which nursing diagnosis has the highest priority for the client? a) Self-care deficit: Bathing b) Ineffective airway clearance c) Fatigue d) Risk for infection

c) Fatigue Explanation: Low red blood cell count can be related to inadequate nutrition. Insufficient RBC levels compromise the oxygen-carrying capacity of the blood, which can lead to fatigue. pg.1063

Ms. Wilson is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). You are teaching her and her family information about managing her disease. All of the following would be included, except? a) Avoid sunlight and ultraviolet radiation. b) Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing. c) If you have problems with a medication, you may stop it until your next physician visit. d) Pace activities.

c) If you have problems with a medication, you may stop it until your next physician visit. Explanation: Take medications exactly as directed and do not stop the medication if symptoms are relieved unless advised to do so by the physician. Sunlight tends to exacerbate the disease. Because fatigue is a major issue, allow for adequate rest, along with regular activity to promote mobility and prevent joint stiffness. Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing. pg.1072

A patient is receiving gold sodium thiomalate (Myochrysine) for the treatment of RA. What does the nurse understand about the action of this compound? a) Inhibits DNA synthesis b) Inhibits lysosomal enzymes c) Inhibits T- and B-cell activity d) Inhibits platelet aggregation

c) Inhibits T- and B-cell activity Explanation: Gold sodium thiolmalate (Myochrysine) inhibits T- and B-cell activity, thereby suppressing synovitis during the active stage of rheumatoid disease. pg.1060

Which of the following points should be included in the medication-teaching plan for a patient taking adalimumab (Humira)? a) The medication is administered IM. b) The medication is given at room temperature. c) It is important to monitor for injection site reactions. d) The patient should continue taking the medication if fever occurs.

c) It is important to monitor for injection site reactions. Explanation: It is important to monitor for injection site reactions. The medication is injected subcutaneously and must be refrigerated. The medication should be withheld if fever occurs. pg.1061

Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)? a) Disease-modifying antirheumatic drugs (DMARDS) b) Glucocorticoids c) Nonsteroidal anti-inflammatory drugs (NSAIDs) d) Tumor necrosis factor (TNF) blockers

c) Nonsteroidal anti-inflammatory drugs (NSAIDs) Explanation: In most patients NSAIDs usually are the first choice in the treatment of RA. The use of traditional NSAIDs and salicylates inhibit the production of prostaglandins and provide anti-inflammatory effects as well as analgesic. In RA, if joint symptoms persist despite use of NSAIDs, the second major drug group known as DMARDs is initiated early in the disease. TNF blockers interfere with the action of tumor necrosis factor (TNF). Oral glucocorticoids, such as prednisone and prednisolone, are indicated for patients with generalized symptoms. pg.1056

Which diagnostic study finding is decreased in patients diagnosed with rheumatoid arthritis? a) Uric acid b) Creatinine c) Red blood cell count d) Erythrocyte sedimentation rate (ESR)

c) Red blood cell count Explanation: There is a decreased red blood cell count in patients diagnosed with rheumatic diseases. ESR increases inflammatory connective tissue disease. Uric acid is increased in gout. Increased creatinine may indicate renal damage in SLE, scleroderma, and polyarteritis. pg.1066

The client with rheumatoid arthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care? a) Reports decreased joint pain b) Reports ability to perform ADLs c) Reports increased fatigue d) Shows a weight gain of 2 pounds

c) Reports increased fatigue Explanation: Fatigue is common with rheumatoid arthritis. Finding a balance between activity and rest is an essential part of the therapeutic regimen. pg.1063

A client is diagnosed with systemic lupus erythematosus (SLE). Which of the following would be most appropriate for the nurse to use to evaluate the client's stage of disease? a) Auscultate the client's lung sounds. b) Observe the client's gait. c) Review the client's medical record. d) Inspect the client's mouth.

c) Review the client's medical record. Explanation: The nurse evaluates the stage of SLE and plans appropriate interventions by reviewing the medical record and diagnostic findings of the client. The stage of the disease cannot be established by observing the client's gait, inspecting the client's mouth, or auscultating the client's lung sounds. pg.1070

The nurse is performing discharge teaching for a patient with rheumatoid arthritis. What teachings are priorities for the patient? Select all that apply. a) Dressing changes b) Narcotic safety c) Safe exercise d) Medication dosages and side effects e) Assistive devices

c) Safe exercise d) Medication dosages and side effects e) Assistive devices Correct Explanation: The patient who is being discharged to home needs information on how to exercise safely to maintain joint mobility. Medication doses and side effects are always an essential part of discharge teaching. Assistive devices, such as splints or even walkers and canes, may assist the patient to care safely for him- or herself. Narcotics are not commonly used and there would be no reason for dressings. pg.671

After teaching a group of students about systemic lupus erythematosus, the instructor determines that the teaching was successful when the students state which of the following? a) The symptoms are primarily localized to the skin but may involve the joints. b) This disorder is more common in men in their thirties and forties than in women. c) The belief is that it is an autoimmune disorder with an unknown trigger. d) It has very specific manifestations that make diagnosis relatively easy.

c) The belief is that it is an autoimmune disorder with an unknown trigger. Explanation: Systemic lupus erythematosus is believed to be an autoimmune disorder but the triggering mechanism is not known. The disorder is more common in women than in men, most with the disorder in the 3rd or 4th decade of life. The disease is considered the "great imitator" because the clinical signs resemble many other conditions. SLE is a diffuse connective tissue disease that affects multiple body systems. pg.1069

Antineoplastic hormone inhibitor drugs used in the treatment of cancer... A. are highly cytotoxic to both cancer cells and normal cells B. target specific antigens or vital processes of cancer cells C. slow the growth of some cancer cells d. protect normal cells from cytotoxic drugs

c. Hormone inhibitor drugs slow the growth of cancer cells that are stimulated by hormones. They are not cytotoxic. They cause less damage to normal cells than cytotoxic chemotherapy; however, the drugs may still cause serious adverse effects. They do not target specific antigens or vital processes of cancer cells. Biologic drugs do not have protective effects on normal cells.

A patient is prescribed a DMARD that is successful in the treatmentof rheumatoid arthritis (RA) but has side effects, including retinal eyechanges. What medication does the nurse anticipate educating thepatient about? a. Azathioprine b. Diclofenac c. Hydroxychloroquine d. Aurothioglucose

c. Hydroxychloroquine - Administer concurrently with NSAIDs. - Assess for visual changes, GI upset, skin rash, headaches, photosensitivity, bleaching of hair. - Emphasize need for ophthalmologic examinations (every 6-12 months).

Kaposi sarcoma trasmission

can be transmitted via sexual contact and non-sexual routes, such as transfusion of contaminated blood and tissues transplants, or via saliva contact.

viral set point how long can it last?

can last for years and is inversely correlated with disease prognosis. The higher the viral set point, the poorer the prognosis.

What's the second leading cause of death?

cancer

a group of disorders characterized by abnormal cell proliferation, in which cells ignore growth-regulating signals in the surrounding environment

cancer

targeted therapies

cancer treatments that seek to minimize the negative effects on healthy tissues by disrupting specific cancer cell functions (such as malignant transformation), metabolism, communication pathways, processes for growth and metastasis, and genetic coding

Persistent, recurrent vaginal _________may be the first sign of HIV infection in women.

candidiasis

A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: TIS, N0, M0. What does this classification mean?

carcinoma in situ, nor abnormal regional lymph nodes, no evidence of distant metastasis

COX-2 enzyme blockers are less likely to cause gastric irritation and ulceration than other NSAIDs; however, they are associated with increased risk of __________ disease and must be used with caution

cardiovascular

how to prevent bleeding as a complication of chemotherapy?

caused by thrombocytopenia and may occur spontaneously or with minor trauma. Precautions should be instituted if the platelet count drops to 50,000/mm3 or below.

Chemotherapeutic agents may be classified by their mechanism of action in relation to the cell cycle. Agents that exert their maximal effect during specific phases of the cell cycle are termed ______________ agents.

cell cycle-specific

The T lymphocytes are primarily responsible for ________ immunity.

cellular

the immune system's third line of defense, involving the attack of pathogens by T cells

cellular immune response

Facial wasting

characterized as a sinking of the cheeks, eyes, and temples caused by the loss of fat tissue under the skin * SIDE EFFECT OF ART

A nurse visits the employee health department because of mild itching and a rash on both hands. During the assessment interview, the employee health nurse should focus on: chemical and latex glove use. medication allergies. laundry detergent or bath soap changes. life stressors the nurse may be experiencing.

chemical and latex glove use.

carcinogens

chemicals, physical factors, and other agents that cause cancer

Each time a tumor is exposed to ___________, a percentage of the tumor cells (20% to 99%, depending on dosage and agent) are destroyed. Repeated doses of chemotherapy are necessary over a prolonged period to achieve regression of the tumor.

chemotherapy

the use of medications to kill tumor cells by interfering with cellular functions and reproduction

chemotherapy

A cancer client makes the following statement to the nurse: "I guess I will tell my doctor to forego the chemotherapy. I do not want to be throwing up all the time. I would rather die."Which of the following facts supports the use of chemotherapy for this client?

chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects

The experience of ________________________ (CINV) may affect quality of life, psychological status, nutrition, fluid and electrolyte status, functional ability, compliance with treatment, and utilization of health care resources

chemotherapy-induced nausea and vomiting

Fibromyalgia

chronic pain syndrome that involves chronic fatigue, generalized muscle aching, stiffness, sleep disturbances, and functional impairment. I

The _____ of the respiratory tract, along with coughing and sneezing responses, filter and clear pathogens from the upper respiratory tract before they can invade the body further.

cilia

HIV encephalopathy

clinical syndrome characterized by a progressive decline in cognitive, behavioral, and motor functions

A client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last 2 cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia?

closely observe the client's skin for petechiae and bruising

The rheumatoid arthritis (RA) reaction produces enzymes that breakdown ________.

collagen

allogeneic transplantation

comes from the donor other than the patient

Mycobacterium avium Complex

common opportunistic infection that typically occurs in patients with CD4+ T-lymphocyte (CD4+) cell counts less than 50 cells/ mm3.

Pneumocystis pneumonia (PCP):

common opportunistic lung infection; pathogen implicated is most commonly a fungus

series of enzymatic proteins in the serum that, when activated, destroy bacteria and other cells

complement

two groups of antigens

complete protein antigens and low-molecular-weight substances

immunoregulation

complex system of checks and balances that regulates or controls immune responses

angioneurotic edema:

condition characterized by urticaria and diffuse swelling of the deeper layers of the skin (i.e., angioedema)

DiGeorge syndrome

congenital absence of the thymus gland

Two examples of a type IV hypersensitivity reaction (occurs 24 to 72hours after exposure)

contact dermatitis, latex allergy

Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth?

control

the most efficient immunologic responses occur when the antibody and antigen fit like a lock and key. Poor fit can occur with an antibody that was produced in response to a different antigen. This phenomenon is known as ____________________.

cross-reactivity

in acute rheumatic fever, the antibody produced against Streptococcus pyogenes in the upper respiratory tract may cross-react with the patient's heart tissue, leading to heart valve damage. this is an example of what?

cross-reactivity. * The most efficient immunologic responses occur when the antibody and antigen fit like a lock and key.Poor fit can occur with an antibody that was produced in response to a different antigen. This phenomenon is known as cross-reactivity.

generic term for nonantibody proteins that act as intercellular mediators, as in the generation of immune response

cytokines

The cellular response stimulates the resident lymphocytes to become cells that attack microbes directly rather than through the action of antibodies. These transformed lymphocytes are known as _______________ T cells.

cytotoxic (killer)

lymphocytes that lyse cells infected with virus; also play a role in graft rejection

cytotoxic T cells

A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? a) "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints." b) "OA is more common in women. RA is more common in men." c) "OA affects joints on both sides of the body. RA is usually unilateral." d) "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

d) "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." Explanation: OA is a degenerative arthritis, characterized by the loss of cartilage on the articular surfaces of weight-bearing joints with spur development. RA is characterized by inflammation of synovial membranes and surrounding structures. OA may occur in one hip or knee and not the other, whereas RA commonly affects the same joints bilaterally. RA is more common in women; OA affects both sexes equally. pg.1075

A client diagnosed with arthritis doesn't want to take medications. Physical therapy and occupational therapy have been consulted for nonpharmacologic measures to control pain. What might physical and occupational therapy include in the care plan to help control this client's pain? a) Acupuncture b) Cold therapy c) Heat therapy and nonsteroidal anti-inflammatory medications (NSAIDs) d) An exercise routine that includes range-of-motion (ROM) exercises

d) An exercise routine that includes range-of-motion (ROM) exercises Explanation: Physical and occupational therapy will most likely develop an exercise routine that includes ROM exercises to control the client's pain. Acupuncture may help relieve the client's pain; however, it isn't within the scope of practice for physical and occupational therapists. Heat therapy may help the client, but it's coupled with NSAIDs in this option, which goes against the client's wishes. Cold therapy aggravates joint stiffness and causes pain. pg.1067

Which of the following procedures involves a surgical fusion of the joint? a) Synovectomy b) Tenorrhaphy c) Osteotomy d) Arthrodesis

d) Arthrodesis Explanation: An arthrodesis is a surgical fusion of the joint. Synovectomy is the excision of the synovial membrane. Tenorrhaphy is the suturing of a tendon. An osteotomy alters the distribution of the weight within the joint. pg.1067

A nurse assesses a client in the physician's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? a) Photosensitivity, polyarthralgia, and painful mucous membrane ulcers b) Weight gain, hypervigilance, hypothermia, and edema of the legs c) Hypothermia, weight gain, lethargy, and edema of the arms d) Facial erythema, pericarditis, pleuritis, fever, and weight loss

d) Facial erythema, pericarditis, pleuritis, fever, and weight loss Explanation: An autoimmune disorder characterized by chronic inflammation of the connective tissues, SLE causes fever, weight loss, malaise, fatigue, skin rashes, and polyarthralgia. Nearly half of clients with SLE have facial erythema, (the classic butterfly rash). SLE also may cause profuse proteinuria (excretion of more than 0.5 g/day of protein), pleuritis, pericarditis, photosensitivity, and painless mucous membrane ulcers. Weight gain, hypervigilance, hypothermia, and edema of the legs and arms don't suggest SLE. pg.1070

After teaching a class comparing rheumatoid arthritis and osteoarthritis, the instructor determines that the teaching was successful when the students identify which of the following as characteristic of osteoarthritis? a) Swan neck deformity b) Ulnar deviation c) Boutonniere deformity d) Heberden nodes

d) Heberden nodes Explanation: Heberden nodes are a characteristic finding of osteoarthritis. Swan neck deformity, boutonniere deformity, and ulnar deviation are characteristic of rheumatoid arthritis. pg.1066

The client asks the nurse about types of exercise that do not stress the joints. Which of the following would be an inappropriate type of exercise for the nurse to include in the teaching plan? a) T'ai chi b) Yoga c) Pilates d) Jogging

d) Jogging Explanation: Jogging would be an inappropriate type of exercise, as it is a high impact, jarring type of exercise. pg.1077

A client with rheumatoid arthritis has experienced increasing pain and progressing inflammation of the hands and feet. What would be the expected goal of the likely prescribed treatment regimen? a) Eradicating pain b) Promoting sleep c) Eliminating deformities d) Minimizing damage

d) Minimizing damage Explanation: Although RA cannot be cured, much can be done to minimize damage. Treatment goals include decreasing joint inflammation before bony ankylosis occurs, relieving discomfort, preventing or correcting deformities, and maintaining or restoring function of affected structures. Early treatment leads to the best results. pg.1066

A client has had several diagnostic tests to determine if he has systemic lupus erythematosus (SLE). What result is very specific indicator of this diagnosis? a) Positive Anti-Sm antibodies b) Positive ANA titre c) Elevated ESR d) Positive Anti-dsDNA antibody test

d) Positive Anti-dsDNA antibody test Explanation: Anti-double-stranded DNA (anti-dsDNA) antibody test is a test that shows high titers of antibodies against native DNA. This is very specific for SLE because this test is not positive for other autoimmune disorders. Anti-Smith (anti-Sm) antibodies are specific for SLE, but are found in only 20% to 30% of clients with SLE. ANA titre shows the presence of an autoimmune disease but is not specific to SLE. The other lab studies may also indicate multisystem involvement. pg.1071

A patient with an acute exacerbation of arthritis is temporarily confined to bed. What position can the nurse recommend to prevent flexion deformities? a) Supine with pillows under the knees b) Semi-Fowler's c) Side-lying with pillows supporting the shoulders and legs d) Prone

d) Prone Explanation: It is best for the patient with rheumatoid arthritis to lie prone several times daily to prevent hip flexion contracture.

The nurse knows that a patient who presents with the symptom of "blanching of fingers on exposure to cold" would be assessed for what rheumatic disease? a) Reiter's syndrome b) Ankylosing spondylitis c) Sjögren's syndrome d) Raynaud's phenomenon

d) Raynaud's phenomenon Explanation: Blanching of fingers on exposure to cold is associated with Raynaud's phenomenon. pg.1057

A patient comes to the clinic with an inflamed wrist. How should thenurse splint the joint to immobilize it? a. Slight dorsiflexion b. Extension c. Hyperextension d. Internal rotation

d) Slight dorsiflexion Devices such as braces, splints, and assistive devices for ambulation (e.g., canes, crutches, walkers) ease pain by limiting movement or stress from putting weight on painful joints. Acutely inflamed joints can be rested by applying splints to limit motion. Splints also support the joint to relieve spasm.

A patient comes to the clinic with an inflamed wrist. How should the nurse splint the joint to immobilize it? a) Extension b) Internal rotation c) Hyperextension d) Slight dorsiflexion

d) Slight dorsiflexion Explanation: Devices such as braces, splints, and assistive devices for ambulation (e.g., canes, crutches, walkers) ease pain by limiting movement or stress from putting weight on painful joints. Acutely inflamed joints can be rested by applying splints to limit motion. Splints also support the joint to relieve spasm. pg.1056

A patient has a serum study that is positive for the rheumatoid factor. What does the nurse understand is the significance of this test result? a) Specific for RA b) Diagnostic for Sjögren's syndrome c) Diagnostic for SLE d) Suggestive of RA

d) Suggestive of RA Explanation: Rheumatoid factor is present in about 80% of patients with RA, but its presence alone is not diagnostic of RA, and its absence does not rule out the diagnosis. pg.1066

The nurse is gathering objective data for a client at the clinic complaining of arthritic pain in the hands. The nurse observes that the fingers are hyperextended at the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. What does the nurse recognize this deformity as? a) Ulnar deviation b) Boutonnière deformity c) Rheumatoid nodules d) Swan neck deformity

d) Swan neck deformity Explanation: A swan neck deformity is a hyperextension of the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. A Boutonnière deformity is a persistent flexion of the proximal interphalangeal joint with hyperextension of the distal interphalangeal joint. Ulnar deviation is when the fingers are deviating laterally toward the ulna. A rheumatoid nodule is a subcutaneous nodule. pg.1066

A patient is on ART for the treatment of HIV. What does the nursedetermine would be an adequate CD4+ count to determine theeffectiveness of treatment for a patient per year? a. 1 mm3 to 10 mm3 b. 10 mm3 to 20 mm3 c. 20 mm3 to 45 mm3 d. 50 mm3 to 150 mm3

d. 50 mm3 to 150 mm3

A patient is suspected of having myositis. The nurse prepares thepatient for what procedure that will confirm the diagnosis? a. Bone scan b. Computed tomography (CT) c. Magnetic resonance imaging (MRI) d. Muscle biopsy

d. Muscle biopsy - An electromyogram is performed to rule out degenerative muscle disease. - A muscle biopsy may reveal inflammatory infiltrate in the tissue. - Serum studies indicate increased muscle enzyme activity.

A patient has a serum study that is positive for the rheumatoid factor.What does the nurse understand is the significance of this test result? a. The test results are diagnostic for Sjögren syndrome b. The test results are diagnostic for systemic lupus erythematosus c. The test results are specific for rheumatoid arthritis d. The test results are suggestive of rheumatoid arthritis

d. The test results are suggestive of rheumatoid arthritis

The nurse is monitoring the patient's CD4 and cell count for increase or decrease in viral load. An increase in the CD4 count indicates a ________ in viral load and the ability to fight viral infections. I

decrease

Anorexia may occur because patients develop early satiety after eating only a small amount of food. This sense of fullness occurs secondary to:

decrease in digestive enzymes, abnormalities in the metabolism of glucose and triglycerides, and prolonged stimulation of gastric volume receptors, which convey the feeling of being full

thrombocytopenia

decrease in the number of circulating platelets * associated with the potential for bleeding

petechiae and ecchymoses, are early indicators of ______________________. Early detection promotes early intervention.

decreasing platelet levels *Thrombocytopenia

pancytopenia

deficiency of all types of blood cells

neutropenia.

deficiency of neutrophils

radiation ______ occur along a continuum ranging from erythema and dry desquamation (flaking of skin) to moist or wet desquamation (dermis exposed, skin oozing serous fluid) to, potentially, ulceration.

dermatitis

-lysis

destruction

ELISA test

detects anti-HIV antibodies; Western blot given as follow-up

Tumor Staging

determines size of tumor, existence of metastasis TNM T: extent of primary tumor N: lymph node involvement M: extent of metastasis

Patients who have neutropenia are at risk for what problem?

developing sever infections

Prenatal exposure to _________________ (a synthetic form of the female hormone estrogen) has long been recognized as a risk factor for clear cell adenocarcinoma of the lower genital tract.

diethylstilbestrol

erythema:

diffuse redness of the skin

peripheral neuropathy

disorder characterized by sensory loss, pain, muscle weakness, and wasting of muscles in the hands or legs and feet

peripheral neuropathy:

disorder characterized by sensory loss, pain, muscle weakness, and wasting of muscles in the hands or legs and feet

antibody differentiation tests

distinguishes HIV-1 from antibodies

xerostomia

dry mouth

The nurse is evaluating the client's risk for cancer and recommends changes when the client states she

eats red meat such as steaks or hamburgers every day

TB in individuals with advanced immune deficiency can be rapidly progressive and fatal if treatment is delayed and such patients often have smear-negative sputum specimens. Therefore, after collection of available specimens for culture and molecular diagnostic tests what is done?

empiric treatment for TB is warranted in patients with clinical and radiographic presentation suggestive of HIV-related TB.

You are an oncology nurse caring for a client who tells you that their tastes have changed. They go on to say that "meat tastes bad". What is a nursing intervention to increase protein intake for a client with taste changes?

encourage cheese and sandwiches

What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen?

encourage fluid intake to dilute the urine

A side-effect of chemotherapy is renal damage. To prevent this, the nurse should:

encourage fluid intake, if possible, to dilute the urine

Cancers of the breast, prostate, and uterus are thought to depend on ____________ hormonal levels for growth.

endogenous

Tumor growth may be promoted by disturbances in hormonal balance, either by the body's own (_____________) hormone production or by administration of _________ hormones.

endogenous exogenous

A cluster of symptoms referred to as ____________ syndrome may occur during the neutrophil recovery phase in both allogeneic and autologous transplants. Clinical features of this syndrome vary widely but may include noninfectious fever associated with skin rash, weight gain, diarrhea, and pulmonary infiltrates, with improvement noted after the initiation of corticosteroid therapy rather than antibiotic therapy

engraftment

The initial medication of choice for a severe allergic reaction is________, administered ________.

epinephrine, in a 1:1000 dilution given subcutaneously

Common symptoms of irritant dermatitis

erythema and pruritus.

extravasation:

escape of blood from the blood vessel into the tissue

Women who take _________ after menopause appear to have an increased risk of ovarian cancer.

estrogen

A patient will be having an endoscopic procedure with a diagnostic biopsy. What type of biopsy does the nurse explain will remove an entire piece of suspicious tissue?

excisional biopsy

A patient with uterine cancer is being treated with internal radiation therapy. What would the nurse's priority responsibility be for this patient?

explain to the patient that she will continue to emit radiation while the implant is in place

Allergen desensitization

exposure to pollen, dust, dander to develop tolerance *is primarily used to treat IgE-mediated diseases by injections of allergen extracts.

hysical factors associated with carcinogenesis include:

exposure to sunlight, radiation, chronic irritation or inflammation, tobacco carcinogens, industrial chemicals and asbestos.

Intravenously given chemotherapy agents are additionally classified by their potential to damage tissue if they inadvertently leak from a vein into surrounding tissue, termed __________

extravasation

The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action?

extravasation

HIV can be transmitted by casual contact

false

Is the following statement True or False? Patients receiving low-dose radiation (brachytherapy) can have their significant others stay with them in the hospital

false

someone with a tumor shouldn't worry about getting cancer

false! tumors can start growing and become malignant

hypersensitivity refers to allergic reactions

false, it includes allergic reactions, but also is an excessive or aberrant immune response to ANY type of stimulus

radiation affect all parts of body

false, radiation therapy is localized treatment, and only the tissues that are within the treatment field are affected.

cytokines act by blocking receptors on target cells?

false. they BIND to receptors on target cells

Systemic side effects are commonly experienced by patients receiving radiation therapy. These include:

fatigue, malaise, and anorexia

Cryptococcal meningitis is characterized by symptoms:

fever, headache, malaise, stiff neck, nausea, vomiting, mental status changes, and seizures.

Immune Reconstitution Inflammatory Syndrome (IRIS) is characterized by:

fever, respiratory and/or abdominal symptoms, and worsening of the clinical manifestations of an opportunistic infection or the appearance of new manifestations.

During the ____ stage of HIV infection, the patient may be asymptomatic or may exhibit various signs and symptoms such as fatigue or skin rash.

first

During the ________ decade, progress was associated with the recognition and treatment of opportunistic diseases and introduction of prophylaxis against opportunistic infection

first

foods that a patient with allergies should avoid?

fish, nuts, eggs, chocolate

ankylosis

fixation or immobility of a joint

implanted venous access devices

for long term use of vesicants

Capsaicin (Zostrix)

for rheumatic diseases made from hot pepper - Instruct patient to apply sparingly - avoid areas of open skin - avoid contact with eyes and mucous membranes. - Wash hands carefully after application. - Assess for local skin irritation.

In external-beam radiation therapy (EBRT), the total radiation dose is delivered over several weeks in daily doses called ___________.

fractions

Immune Reconstitution Inflammatory Syndrome

from rapid restoration of organism-specific immune responses to infections that cause either the deterioration of a treated infection or new presentation of a subclinical infection. *occurs during the initial months after beginning ART

emerging technology designed to enable replacement of missing or defective genes

genetic engineering

colony-stimulating factors (granulocyte colony-stimulating factor [G-CSF] and granulocyte-macrophage colony-stimulating factor [GM-CSF])

given after chemotherapy to stimulate the bone marrow to produce WBCs, especially neutrophils, at an accelerated rate, thus decreasing the duration of neutropenia.

These tumors tend to be more aggressive, less responsive to treatment, and associated with a poorer prognosis as compared to well-differentiated, grade I tumors.

grade IV

_____________ is the pathologic classification of tumor cells. Grading systems seek to define the type of tissue from which the tumor originated and the degree to which the tumor cells retain the functional and histologic characteristics of the tissue of origin (differentiation).

grading

identification of the type of tissue from which the tumor originated and the degree to which the tumor cells retain the functional and structural characteristics of the tissue of origin

grading

The nurse is working with a client who has had an allohematopoietic stem cell transplant (HSCT). The nurse notices a diffuse rash and diarrhea. The nurse contacts the physician to report that the client has symptoms of

graft-versus-host disease

An advantage of AlloHSCT is that the transplanted cells should not be immunologically tolerant of a patient's malignancy and should cause a lethal _______________ in which the donor cells recognize the malignant cells and act to eliminate them.

graft-versus-tumor effect

angiogenesis

growth of new blood vessels that allow cancer cells to grow

alopecia

hair loss

Low-molecular-weight substances, such as medications, function as _______________ (incomplete antigens), binding to tissue or serum proteins to produce a carrier complex that initiates an antibody response.

hapten

scleroderma

hardening of the skin

primary prevention of cancer

health promotion and risk reduction strategies

Many of the antiretroviral agents may cause fat redistribution syndrome and metabolic alterations such as dyslipidemia and insulin resistance, which put the patient at risk for early-onset _______ disease and ______.

heart diabetes.

The physician recommends that parents have their daughter vaccinated with HPV vaccine. What is this vaccine for?

help prevent cervical cancer

lymphocytes that attack foreign invaders (antigens) directly

helper T cells

what conditions trigger erythropoietin production?

hemorrhage, anemia, chronic obstructive pulmonary disease, and high altitude.

During the first 30 days after the conditioning regimen, AlloHSCT patients are at risk for developing ________________________ (HSOS) (previously referred to as veno-oclusive disease) related to chemotherapy-induced inflammation of the sinusoidal epithelium.

hepatic sinusoidal obstructive syndrome

Adverse effects associated with all HIV treatment regimens include:

hepatotoxicity, nephrotoxicity, and osteopenia, along with increased risk of cardiovascular disease and myocardial infarction

Radiation sensitivity is enhanced in tumors that are smaller in size and that contain cells that are rapidly dividing (_______________) and poorly differentiated (no longer resembling the tissue of origin).

highly proliferative

substance in the body that causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle

histamine:

urticaria

hives

Erythropoietin (EPO)

hormone secreted by the kidney to stimulate the production of red blood cells by bone marrow

A large group of genes, called _____________ genes, has been linked to the immune response and the development of multiple rheumatologic diseases

human leukocyte antigen (HLA)

Complete protein antigens, such as animal dander, pollen, and horse serum, stimulate a complete _______ response.

humoral

The ______________ response is characterized by the production of antibodies by B lymphocytes in response to a specific antigen.

humoral

the immune system's second line of defense; often termed the antibody response

humoral immune response

Five disorders of common, primary immunodeficiencies are

humoral immunity, T-cell defects, combined B- and T-cell defects, phagocytic disorders, complement production

When malignant cells are killed (tumor lysis syndrome), intracellular contents are released into the bloodstream. This leads to which of the following? Select all that apply.

hyperkalemia, hyperuricemia, heyperphosphatemia

Potential adverse effects of an IVIG infusion include

hypotension, flank pain, chills, and tightness in chest, terminating with a slightly elevated body temperature and anaphylactic reaction.

Cells in the brain, especially in the ________________, can recognize prostaglandins, interferons, and interleukins, as well as histamine and serotonin, all of which are released during the inflammatory process.

hypothalamus

Syngeneic trasplant

identical twin

opportunistic infection

illness caused by various organisms, some of which usually do not cause disease in people with normal immune systems

the coordinated response of the components of the immune system to a foreign agent or organism

immune response

Enlargement of the lymph nodes in the neck in conjunction with a sore throat is one example of the ____________________

immune response.

the collection of organs, cells, tissues, and molecules that mediate the immune response

immune system

the body's specific protective response to a foreign agent or organism; resistance to disease, specifically infectious diseases

immunity

Antibodies formed by lymphocytes and plasma cells in response to animmunogenic stimulus are called

immunoglobulins

Antibodies that are formed by lymphocytes and plasma cells in response to an immunogenic stimulus constitute a group of serum proteins called _________

immunoglobulins

a family of closely related proteins capable of acting as antibodies

immunoglobulins

Lymphopenia indicates

immunologic abnormality

hapten

incomplete antigen

Seborrheic dermatitis

indurated, diffuse, scaly rash involving the scalp and face. *HIV

What does an elevated neutrophil count signal?

infection

Indwelling or subcutaneous venous access devices require consistent nursing care. Complications include:

infection and thrombosis

Redness, swelling, tenderness, purulent drainage, fever and chills, and an elevated white blood cell count are classic signs of __________

infection.

degenerative rheumatic diseases

inflammation also occurs, but as a secondary process.

Polymyositis

inflammation of many muscles

mucositis

inflammation of the lining of the mouth, throat, and gastrointestinal tract often associated with cancer therapies

stomatitis

inflammation of the oral tissues, often associated with some chemotherapeutic agents and radiation therapy to the head and neck region

WBC count is normal except with ________

inflammation or infection

Immune system response to HIV infection in the CNS includes:

inflammation, atrophy, demyelination, degeneration, and necrosis.

The _____________ response is a major function of the natural immune system that is elicited in response to tissue injury or invading organisms.

inflammatory

Parenterally administered drugs

injecting directly into the body, bypassing the skin and mucous membranes

For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan?

inspecting the skin for petechiae once every shift

Physical barriers to infection

intact skin, mucous membranes, and cilia of the respiratory tract, which prevent pathogens from gaining access to the body.

wasting syndrome

involuntary weight loss consisting of both lean and fat body mass

Fine-needle aspiration (FNA) biopsy

involves aspirating cells rather than intact tissue through a needle that is guided into a suspected diseased area. This type of specimen can only be analyzed by cytological examination (viewing only cells, not tissue).

angioneurotic edema

involves the deeper layers of the skin, resulting in more diffuse swelling rather than the discrete lesions characteristic of hives. It is manifested by non-pruritic, brawny, non-pitting edema with well-defined margins and erythema similar to urticaria

Intraluminal HDR brachytherapy

involves the insertion of catheters or hollow tubes into the lumens of organs so that the radioisotope can be delivered as close to the tumor bed as possible.

Systemic radiotherapy

involves the intravenous (IV) administration of a therapeutic radioactive isotope targeted to a specific tumor.

The primary advantage of HDR brachytherapy ?

is that treatment time is shorter, there is reduced exposure to personnel, and the procedure can be performed on an outpatient basis over several days.

Treatment of suspected TB in individuals with HIV infection is the same as for those who are HIV uninfected and should include an initial four-drug combination of:

isoniazid, rifampin (Rifadin), pyrazinamide, and ethambutol (Etibi)

What does the nurse understand is the rationale for administering allopurinol for a patient receiving chemotherapy?

it lowers serum and uric acid levels

The nurse is caring for a client undergoing an incisional biopsy. Which statement does the nurse understand to be true about an incisional biopsy?

it removes a wedge of tissue for diagnosis

What are the clinical manifestations of degenerative joint disease(osteoarthritis [OA])?

joint pain, stiffness, and functional impairmen

extravasation

leakage of intravenous medication from the veins into the subcutaneous tissues

In certain regimens, additional medications are given with chemotherapy agents to enhance activity or protect normal cells from injury. For example, ____________ is often given with fluorouracil (5-FU) to treat colorectal cancer.

leucovorin (Wellcovorin)

a group of chemical mediators that initiate the inflammatory response

leukotrienes

Secondary Chemical Mediators

leukotrienes, bradykinin, serotonin

radiation therapy is _________treatment, and only the tissues that are within the treatment field are affected.

localized

IgE-producing cells are found in:

located in the respiratory and intestinal mucosa.

HIV-1 nucleic acid tests

looks for the virus RNA directly

Anorexia

loss of appetite

The gastrointestinal manifestations of HIV infection and AIDS include:

loss of appetite, nausea, vomiting, oral and esophageal candidiasis, and chronic diarrhea

Congenital neutropenia syndromes

low levels of neutrophils from birth.

nadir

lowest point of white blood cell depression after therapy that has toxic effects on the bone marrow

leading causes of cancer death in women?

lung, breast, and colorectal cancer in women.

leading causes of cancer death in men?

lung, prostate, and colorectal cancer

T cells

lymphocyte cells that can cause graft rejection, kill foreign cells, or suppress production of antibodies

Lymph nodes are widely distributed internally throughout the body and in the circulating blood, as well as externally near the body's surfaces. They continuously discharge small ___________ into the bloodstream.

lymphocytes

The primary cells responsible for recognition of foreign antigens are

lymphocytes

Null Lymphocytes

lymphocytes that destroy antigens already coated with the antibody

substances released by sensitized lymphocytes when they come in contact with specific antigens

lymphokines

The most common malignancies treated with AuHSCT include ____________ and _____________

lymphoma and multiple myeloma

- T cells secrete substances that direct the flow of cell activity, destroy target cells, and stimulate the ____________. The ____________present the antigens to the T cells and initiate the immune response.

macrophages macrophages

Kaposi sarcoma

malignancy that involves the epithelial layer of blood and lymphatic vessels

having cells or processes that are characteristic of cancer

malignant

Lymphoma

malignant tumor of lymph nodes and lymph tissue * Non-Hodgkin lymphoma * Hodgkin lymphoma

connective tissue cells that contain heparin and histamine in their granules

mast cells

Two or more IgE molecules bind together to an allergen and trigger ____________ or _____________ to release chemical mediators, such as histamine, serotonin, kinins, slow-reacting substances of anaphylaxis, and the neutrophil factor, which produces allergic skin reactions, asthma, and hay fever.

mast cells or basophils

increase creatinine

may indicate kidney damage in SLE, scleroderma, and polyarteritis

viral load test

measures the quantity of HIV RNA or DNA in the blood

anaphylactoid response may occur with:

medications, food, exercise, or cytotoxic antibody transfusions.

cells that are responsible for recognizing antigens from previous exposure and mounting an immune response

memory cells

spread of cancer cells from the primary tumor to distant sites

metastasis

Synovial fluid from an inflamed joint is characteristically ________,________, and ________

milky, cloudy, dark yellow

The advantages of minimally invasive approaches:

minimization of surgical trauma, decreased blood loss, decreased incidence of wound infection and other complications associated with surgery, decreased surgical time and requirement for anesthesia, decreased postoperative pain and limited mobility, and shorter periods of recovery

WBCs that function as phagocytes are called

monocytes

as an effect chemotherapy, the entire gastrointestinal tract is susceptible to _________ (inflammation of the mouth, throat, and gastrointestinal tract) with diarrhea.

mucositis

chemical barriers to infection

mucus, acidic gastric secretions, enzymes in tears and saliva, and substances in sebaceous and sweat secretions, act in a nonspecific way to destroy invading bacteria and fungi.

primary immune deficiency diseases (PIDDs) Major signs and symptoms

multiple infections despite aggressive treatment, infections with unusual or opportunistic organisms, failure to thrive or poor growth, and a positive family history

Suppressor T lymphocytes normally assist in regulating lymphocyte production and diminishing immune responses (i.e., antibody production) when they are no longer required. Low levels of antibodies and high levels of suppressor cells have been found in patients with multiple ________, which is a cancer associated with hypogammaglobulinemia (low amounts of serum antibodies).

myeloma

Many chemotherapy agents cause some degree of _________________(depression of bone marrow function), resulting in decreased WBCs (leukopenia), granulocytes (neutropenia), red blood cells (RBCs) (anemia), and platelets (thrombocytopenia) and increased risk of infection and bleeding.

myelosuppression

The ______ is the lowest ANC following chemotherapy, targeted therapy, or radiation therapy that suppresses bone marrow function.

nadir

A deficient immune system response that is congenital in origin wouldbe classified as a ________ disorder

natural deficiency

lymphocytes that defend against microorganisms and malignant cells

natural killer (NK) cells

Several mechanisms are responsible for the occurrence of __________ and _________, including activation of multiple receptors found in the vomiting center of the medulla, the chemoreceptor trigger zone, the gastrointestinal tract, the pharynx, and the cerebral cortex

nausea and vomiting

most common side effects of chemotherapy are _______ and ________, which may persist for 24 to 48 hours

nausea and vomiting *delayed nausea and vomiting may occur up to 1 week after administration

Cancerous cells, described as malignant neoplasms, demonstrate uncontrolled cell growth that follows no physiologic demand ________

neoplasia

colony-stimulating factors (granulocyte colony-stimulating factor [G-CSF] and granulocyte-macrophage colony-stimulating factor [GM-CSF])—can be given after chemotherapy to stimulate the bone marrow to produce WBCs, especially neutrophils, at an accelerated rate, thus decreasing the duration of ________________

neutropenia.

The leukocytes that arrive first at a site where inflammation occurs are

neutrophils

A client with ovarian cancer is ordered hydroxyurea (Hydrea), an antimetabolite drug. Antimetabolites are a diverse group of antineoplastic agents that interfere with various metabolic actions of the cell. The mechanism of action of antimetabolites interferes with

normal cellular processes during the S phase of the cell cycle

____________, a subpopulation of lymphocytes, destroy antigens already coated with antibody. These cells have special receptor sites on their surface that allow them to connect with the end of antibodies; this is known as antibody-dependent, cell-mediated cytotoxicity.

null lymphocytes

lymphocytes that destroy antigens already coated with the antibody

null lymphocytes

Early Signs of Thrombocytopenia

observe keenly for petechiae and ecchymoses, which are early indicators of decreasing platelet levels. Early detection promotes early intervention.

field or study of cancer

oncology

Prostate HDR therapy

one form of interstitial brachytherapy, in which radioactive strands or wires are placed, while the patient is under anesthesia, into hollow catheters that have been inserted in the perineum close to the prostate gland

Most allergic reactions are either type___ or type ____ hypersensitivity reactions.

one or 4

Interferons

one type of biologic response modifier, is a nonspecific viricidal protein that is naturally produced by the body and is capable of activating other components of the immune system.

Mycobacterium avium complex (MAC)

opportunistic infection caused by mycobacterial organisms that commonly causes a respiratory illness but can also infect other body systems

progressive multifocal leukoencephalopathy:

opportunistic infection that infects brain tissue and causes damage to the brain and spinal cord

In this process, the antigen-antibody molecule is coated with a sticky substance that also facilitates phagocytosis.

opsonization

what should the nurse do is extravasation is suspected?

othe medication administration is stopped immediately

most common symptom in the rheumatic diseases is ______

pain.

______ surgery is performed in an attempt to relieve complications of surgery

palliative

Majority of chemotherapy drugs causes myelosuppression or depression of bone marrow functioning. This results in ____________and increases the risk for infection, bleeding and fatigue

pancytopenia

Screening for allergies before a medication is prescribed or first given is an important preventive measure. A careful history of any sensitivity to suspected antigens must be obtained before administering any medication, particularly in _________ form, because this route is associated with the most severe anaphylaxis.

parenteral

in dermatitis medicamentosa All routes of administration are potentially fatal, but drugs given _________ incur the greatest risk.

parenterally

anaplasia

pattern of growth in which cells lack normal characteristics and differ in shape and organization with respect to their cells of origin; usually, anaplastic cells are malignant

The most common cause of anaphylaxis, accounting for 75% of fatalreactions in the United States, is

penicillin

the most common neurologic symptom at any stage of HIV infection.

peripheral neuropathy

The antibodies prepare the antigens so that the ________cells of the blood and the tissues can dispose of them.

phagocytic

Monocytes are the first to arrive on the scene and function as _________engulfing, ingesting, and destroying greater numbers and quantities of foreign bodies or toxins than granulocytes do

phagocytic cells

cells that engulf, ingest, and destroy foreign bodies or toxins

phagocytic cells

The body's first line of defense is the

phagocytic immune response

the immune system's first line of defense, involving white blood cells that have the ability to ingest foreign particles

phagocytic immune response

Somatostatin inhibits

physiologic functions, including gastrointestinal motility and intestinal secretion of water and electrolytes.

a sensitive laboratory technique that can detect and quantify HIV in a person's blood or lymph nodes

polymerase chain reaction

a patient has difficulty combing the hair, reaching overhead, and using stairs

polymyositis

how to prevent Graft-versus-host disease

prevent GVHD, patients receive immunosuppressant drugs, such as cyclosporine (Sandimmune), methotrexate, tacrolimus (Prograf), or mycophenolate mofetil (MMF).

Once the diagnosis of RA is made, treatment should begin with either a nonbiologic or biologic DMARD. The goal of using DMARD therapy is

preventing inflammation and joint damage.

pre-exposure prophylaxis (PrEP):

prevention method for HIV-negative people who are at high risk of HIV infection; involves taking a specific combination of HIV medicines daily; use with condoms and other prevention tools.

The methods of skin testing include

prick skin tests, scratch tests, and intradermal skin testing

an example of ___________ prevention is the use of immunization to reduce the risk of cancer through prevention of infections associated with cancer. The HPV vaccine is recommended to prevent cervical and head and neck cancers.

primary

The period from infection with HIV to the development of HIV-specific antibodies is known as ______________ OR ______________ (previously known as the window period) and is part of stage 0

primary infection or acute HIV infection

external radiation

process of administering radiation to the patient via a radiation machine located outside the body * external-beam radiation therapy (EBRT) *Stereotactic body radiotherapy (SBRT) *Proton therapy

staging

process of determining the extent of disease, including tumor size and spread or metastasis to distant sites

carcinogenesis

process of transforming normal cells into malignant cells

B cells function

produce antibodies

Erythropoiesis

production of red blood cells

apoptosis

programmed cell death

Actively ___________ cells within a tumor are the most sensitive to chemotherapy (the ratio of dividing cells to resting cells is referred to as the growth fraction).

proliferating

During the ________ stage of an immune response, lymphocytesinterfere with disease by picking up specific antigens from organismsto alter their function

proliferation

pannus

proliferation of newly formed synovial tissue infiltrated with inflammatory cells

type of surgery being done when lesions that are removed are likely to develop into cancer is called ____________

prophylactic

unsaturated fatty acids that have a wide assortment of biologic activity

prostaglandins

interferons

proteins formed when cells are exposed to viral or foreign agents; capable of activating other components of the immune system

Complement System

proteins in the blood that help antibodies kill their target * made in liver

cytokines

proteins that can be produced by leukocytes that are vital to regulation of hematopoiesis, apoptosis, and immune responses

the use of ionizing radiation to kill malignant cells

radiation therapy

Slower-growing tissues and tissues at rest (e.g., muscle, cartilage, nervous system, and connective tissues) are relatively ____________ (less sensitive to the effects of radiation).

radioresistant

A _____________ tumor is one that can be destroyed by a dose of radiation that still allows for cell repair and regeneration in the surrounding normal tissue.

radiosensitive

Ataxia Telangiectasia

rare childhood disease. It affects the brain and other parts of the body. - Ataxia refers to uncoordinated movements, such as walking. - Telangiectasias are enlarged blood vessels (capillaries) just below the surface of the skin.

severe combined immune deficiency (SCID)

rare, life-threatening disorders caused by mutations in different genes involved in development and function of T and B cells; infants appear healthy at birth but are highly susceptible to severe infections.

autoimmunity

reaction of immune response to one's own tissues

rhinitis medicamentosa

rebound nasal congestion commonly associated with overuse of over-the-counter nasal decongestants

There are four well-defined stages in an immune response:

recognition, proliferation, response, and effector

Goals of immunotherapy

reducing the level of circulating IgE, increasing the level of blocking antibody IgG, and reducing mediator cell sensitivity.

atopy

refers to IgE-mediated diseases, such as allergic rhinitis, that have a genetic component.

arthroplasty

replacement of a joint

a virus that carries genetic material in ribonucleic acid (RNA) instead of DNA and contains reverse transcriptase

retrovirus

numerous disorders affecting skeletal muscles, bones, cartilage, ligaments, tendons, and joints

rheumatic diseases

a systemic autoimmune disease with symmetric arthritic manifestations and multiple extra-articular features

rheumatoid arthritis

After topical application of the medication, a rebound period occurs in which the nasal mucous membranes become more edematous and congested than they were before the medication was used. Such a reaction encourages the use of more medication, and a cyclic pattern results.

rhinitis medicamentosa

In ________________, the rebound reaction from the overuse of sympathomimetic nose drops or sprays worsens the congestion, causing the patient to use more of the medication and thus leads to more nasal congestion. This condition should not be confused with a patient developing tolerance to the drug.

rhinitis medicamentosa

The patient must be aware of the effects caused by overuse of the sympathomimetic agents in nose drops or sprays, because a condition referred to as _____________________ may result.

rhinitis medicamentosa

Immediate hypersensitivity, a type I allergic reaction, is mediated by the IgE mast cell system. Symptoms can include:

rhinitis, conjunctivitis, asthma, and anaphylaxis.

A patient developed an infection while on vacation in CentralAmerica and is now taking the antibiotic chloramphenicol. What should the patient be monitored for when taking this drug? a. Eosinophilia b. Neutropenia c. Aplastic anemia d. Hypoprothrombinemia

risk for Leukopenia, aplastic anemia

The _______ decade witnessed progress in the development of highly active antiretroviral drug therapies (HAART) as well as continuing progress in the treatment of opportunistic infections.

second

chemical mediator that acts as a potent vasoconstrictor and bronchoconstrictor

serotonin

In cases of doubt about the validity of the skin tests, a _______________ test or a provocative challenge test may be performed.

serum-specific IgE

The _______________________, formerly known as RAST, is an automated test performed on blood samples by a pathology laboratory. As the name suggests, it detects free antigen-specific IgE in serum as opposed to antigen-specific IgE bound to mast cells in the skin

serum-specific IgE test

Primary immunodeficiencies predispose people to three conditions:

severe infections, autoimmunity, cancer

What type of clinical manifestations does a patient with polymyalgia rheumatic (PMR) present with?

severe proximal muscle discomfort with mild joint swelling. Severe aching in the neck, shoulder, and pelvic muscles is common. Stiffness, noticeable most often in the morning and after periods of inactivity, can become so severe that patients struggle putting on a coat or combing their hair.

Nitrosoureas

similar to alkylating agents * cross the blood-brain barrier

Correlation of a positive ________ test with a positive allergy ________ is an indication for immunotherapy if the allergen cannot be avoided.

skin history

Extravasation of a vesicant could result in tissue necrosis. How can the nurse prevent these?

so never use the hand or wrist and prevent extravasation by confirming patency of the intravenous device

immunity is the body's ________ protective response to a foreign agent or organism.

specific

The ______ plays important roles in regard to red blood cells (erythrocytes) and the immune system. It removes old red blood cells and holds a reserve of blood, which can be valuable in case of hemorrhagic shock, and also recycles iron.

spleen

The nurse is educating the patient with gout about ways to preventreoccurrence of an attack. What foods should the nurse encourage thepatient to avoid? a. Baked chicken b. Steak c. Asparagus d. Pineapple

steak - Both alcohol and consumption of a large meal, especially with red meat, can lead to increases in free fatty acid concentrations; they also are implicated as triggers to acute gout attacks

precursors of all blood cells; reside primarily in bone marrow

stem cells

Adrenergic Agents

stimulate the sympathetic nervous system and induce symptoms characteristic of the fight-or-flight response *vasoconstrictors of mucosal vessels,

Erythropoietin (EPO) drug

stimulates RBC production, thus decreasing the symptoms of treatment-induced chronic anemia and reducing the need for blood transfusions.

Immunomodulators

stimulating the immune system to fight against cancer cells - Interferons, colony-stimulating factors, and monoclonal antibodies (MoAbs) are examples of agents used to help enhance the immune system

Anorexia, nausea, vomiting, and diarrhea may occur if the _________ or _________ is in the radiation field.

stomach or colon *Depending on the targeted region, any portion of the gastrointestinal mucosa may be involved, causing mucositis

A client with a brain tumor is undergoing radiation and chemotherapy for treatment of cancer. The client has recently reported swelling in the gums, tongue, and lips. Which is the most likely cause of these symptoms?

stomatitis

Risk factors and comorbidities associated with __________ include poor oral hygiene, general debilitation, existing dental disease, prior irradiation to the head and neck region, impaired salivary gland function, the use of other medications that dry mucous membranes,myelosuppression (bone marrow depression), advanced age, tobacco use, previous stomatoxic chemotherapy, diminished renal function, and impaired nutritional status

stomatitis

inflammation of the mouth

stomatitis

Patients who suspect that a new rash may be caused by a drug allergy (newly prescribed medications, especially antibiotics such as penicillin or sulfa medications). pt should do what?

stop taking the medication immediately and contact their prescribing clinician, who will determine whether the medication and the rash are related.

immunopathology

study of diseases resulting in dysfunctions within the immune system

Discuss the assessment findings for a patient who has developedPneumocystis pneumonia (PCP).

subacute onset of progressive dyspnea, fever, nonproductive cough, and chest discomfort that worsens within days to weeks. In mild cases, pulmonary examination usually is normal at rest. With exertion, tachypnea, tachycardia, and diffuse dry (cellophane) rales may be auscultated. Oral thrush is a common coinfection. Fever is apparent in most cases and may be the predominant symptom. Hypoxemia is the most characteristic laboratory abnormality, along with elevated lactate dehydrogenase levels

vesicant

substance that can cause inflammation, damage, and necrosis with extravasation from blood vessels and contact with tissues

Cytokines

substances produced primarily by cells of the immune system to enhance production and functioning of components of the immune system

stem cell infusion adverse efects

such as fever, chills, shortness of breath, chest pain, cutaneous reactions, nausea, vomiting, hypotension or hypertension, tachycardia, anxiety, and taste changes

total Serum Immunoglobulin E Levels

support the diagnosis of allergic disease.

myelosuppression

suppression of the blood cell-producing function of the bone marrow

lymphocytes that decrease B-cell activity to a level at which the immune system is compatible with life

suppressor T cells

In humans, transformed cells arise on a regular basis, but are recognized by _________ cells of the immune system that destroy them before cell growth becomes uncontrolled (immune surveillance).

surveillance

Delayed hypersensitivity to latex is characterized by

symptoms of contact dermatitis, including vesicular skin lesions, papules, pruritus, edema, erythema, and crusting and thickening of the skin. *These symptoms usually appear on the back of the hands.

In RA, the autoimmune reaction primarily occurs in the ________.

synovial tissue

Type III hypersensitivity reactions involve the binding of antibodies toantigens. List two possible results: ________ and ________

systemic lupus erythematosus, rheumatoid arthritis, serum sickness

Post-Exposure Prophylaxis for Health Care Providers

taking antiretroviral medicines as soon as possible, but no more than 72 hours (3 days) after possible HIV exposure; two to three drugs are usually prescribed which must be taken for 28 days.

post-exposure prophylaxis (PEP):

taking antiretroviral medicines as soon as possible, but no more than 72 hours (3 days) after possible HIV exposure; two to three drugs are usually prescribed which must be taken for 28 days.

atopy:

term often used to describe immunoglobulin E-mediated diseases (i.e., atopic dermatitis, asthma, and allergic rhinitis) with a genetic component

B lymphocytes mature in ___________ before entering the bloodstream,

the bone marrow

Some antibodies assist in the removal of offending organisms through opsonization. What does this mean?

the coating of antigen-antibody molecules with a sticky substance to facilitate phagocytosis

opsonization

the coating of antigen-antibody molecules with a sticky substance to facilitate phagocytosis

Gastrointestinal symptoms may be related to __________

the direct inflammatory effect of HIV on the cells lining the intestines.

graft-versus-tumor effect:

the donor immune cell response against the malignancy * a desirable response

immunosenescence

the gradual deterioration of the immune system brought on by the aging process

Keep condoms cool and dry. Never use skin lotions, baby oil, petroleum jelly, or cold cream as lubricants. Why?

the oil in these products will cause the latex condom to break. Products made with water (such as K-Y jelly or glycerin) are safer to use.

Prostaglandins are primary chemical mediators that respond to astimulus by contracting smooth muscle and increasing capillarypermeability. This response causes ________

the pain and fever seen with inflammatory responses

The dosage of chemotherapeutic agents is based primarily on:

the patient's total body surface area, weight, previous exposure and response to chemotherapy or radiation therapy, and function of major organ systems.

atopic march

the presence of atopic characteristics, events, or conditions that develop into more permanent disease

The major signal for erythropoietin production is a decreased oxygen level detected by ________________________

the proximal tubule cells in the kidneys.

for those patients who are thrombocytopenic the nurse should avoid:

the rectal route for medication administration as well as IM injections

antigenic determinant

the specific area of an antigen that binds with an antibody combining site and determines the specificity of the antigen-antibody reaction

A 36-year-old man is receiving three different chemotherapeutic agents for Hodgkin's disease. The nurse explains to the client that the three drugs are given over an extended period because:

the three drugs have synergistic effect and act on the cancer cells with different mechanisms

brachytherapy

the use of radioactive materials in contact with or implanted into the tissues to be treateddelivery of radiation therapy through internal implants placed inside or adjacent to the tumor

The _____ decade has focused on issues of preventing new infections, adherence to antiretroviral therapy (ART), development of second- generation combination medications that affect different stages of the viral life cycle, and continued need for an effective vaccine.

third

Corticosteroids and antihistamines, including over-the-counter allergy medications should be stop 48 to 96 hours before testing. Why?

this drugs suppress skin test reactivity

T lymphocytes mature in the _______________, where they differentiate into cells with various functions

thymus

Patients who receive high-dose or long-term corticosteroid therapy must be cautioned not to stop taking the medication suddenly. Doses are tapered when discontinuing this medication. Why?

to avoid adrenal insufficiency.

A client with metastatic pancreatic cancer underwent surgery to remove a malignant tumor in the pancreas. Despite the tumor being removed, the physician informs the client that chemotherapy must be started. Why might the physician opt for chemotherapy?

to prevent metastasis

what is the ultimate goal of PrEP?

to reduce the acquisition of HIV infection with its resulting morbidity, mortality, and cost to individuals and society

Whats the overall goal of ART?

to suppress HIV replication to a level below which drug-resistant mutations do not emerge

cryotherapy

topical application of oral ice during infusions

absolute neutrophil count (ANC)

total number of WBC's x percentage of neutrophils

What are the two major components of antiretroviral therapy (ART)resistance?

transmission of drug resistant HIV at the time of initial infection and selective drug resistance in patients who are receiving nonsuppressive regimens.

The nurse is caring for a patient who has evidence of wet desquamation. The patient wants to open the blisters. What should the nurse do?

treat wet desquamation by leaving blisters in tact and notifying primary care provider, avoid frequent washing of area because of increased irritation, obtain an order for a cream or ointment (such as Aquaphor or silver Silvadene) and use a non-adhesive pad over the area

75% of all cancers in the US are related to environmental and lifestyle factors

true

A negative response on a skin test cannot be interpreted as an absence of sensitivity to an allergen. Such a response may occur with insufficient sensitivity of the test or with the use of an inappropriate allergen in testing.

true

Acquired immunity is the type response that allows the body to respond to pathogens either actively or passive

true

All patients with any form of cold urticaria should carry an auto-injectable epinephrine device for emergency use because hives can progress to anaphylaxis.

true

CD4 cells (helper T cells) stimulate the immune system and help to destroy organisms

true

COX-2 medications block the enzyme involved in inflammation (COX-2) while leaving intact the enzyme involved in protecting the stomach lining (COX-1).

true

DMARDs have been found to halt the progression of bone loss and destruction and can induce remission

true

Decongestants can cause an increase in blood pressure; therefore, patients with a history of hypertension should be cautioned about long-term use of any medication that contains decongestants

true

Fatigue is one of the most frequent and distressing symptoms experienced by patients receiving cancer therapy. Patients report that fatigue persists and interferes with activities of daily living for months to years after the completion of treatment

true

Hormonal changes related to the female reproductive cycle are also associated with cancer incidence.

true

If an immune response fails to develop and clear an antigen sufficiently, the host is considered to be immunocompromised or immunodeficient.

true

If the radiation is delivered when most tumor cells are cycling through the cell cycle, the number of cancer cells destroyed (cell kill) is maximal.

true

In general, women are two to nine times more commonly affected by rheumatologic diseases than men

true

In the event of signs and symptoms suggestive of anaphylaxis, emergency medications and equipment must be available for immediate use.

true

Increased numbers of pregnancies are associated with a decreased incidence of breast, endometrial, and ovarian cancers.

true

Iron and the immune system are linked in homeostasis and pathology, thus making it essential for maximum function

true

Malignant neoplasms invade other tissues (metastasis) and branch off while benign tumors do not metastasize

true

Methotrexate contributes to folic acid deficiency and results in cell death

true

One of the dangers of food allergens is that they may be hidden in other foods and not apparent to people who are susceptible to the allergen.

true

Patients with HIV-TB co-infection with low CD4+ counts who start ART are at high risk of developing TB-IRIS.

true

Patients with RA frequently experience anorexia, weight loss, and anemia.

true

Patients with neutropenia are at increased risk for developing severe infections despite substantial advances in supportive care.

true

Rheumatoid factor is present in about 70% to 80% of patients with RA, but its presence alone is not diagnostic of RA, and its absence does not rule out the diagnosis.

true

Simplifying treatment regimens and decreasing the number of medications that must be taken each day increase patients' adherence to therapy.

true

TB disease can develop in the lungs as well as in extrapulmonary sites such as the central nervous system (CNS), bone, pericardium, stomach, peritoneum, and scrotum and initial diagnostic testing is directed at the anatomic site of symptoms or signs, such as the lungs, lymph nodes, and cerebrospinal fluid.

true

The nurse should be aware that no NSAIDs, not even the COX-2 inhibitors, prevent erosions or alter disease progression and, consequently, are medications useful only for symptom relief.

true

The ongoing nature of most rheumatic diseases makes it important to maintain and, when possible, improve joint mobility and overall functional status.

true

The reduction in T cells increases the risk for opportunistic infections

true

The use of injectable dyes and nuclear medicine imaging can help identify the sentinel lymph node or the initial lymph node to which the primary tumor and surrounding tissue drain.

true

There are more than 100 types of rheumatic diseases.

true

There is evidence that passive smoke may be linked with childhood leukemia and cancers of the larynx, pharynx, brain, bladder, rectum, stomach, and breast

true

Through the process of immune surveillance, an intact immune system usually has the ability to recognize and combat cancer cells through multiple, interacting cells and actions of the innate, humoral, and cellular components of the immune system

true

Transplant recipients who receive immunosuppressive therapy to prevent rejection of the transplanted organ have an increased incidence of cancer

true

Treatment approaches are not initiated until the diagnosis of cancer has been confirmed and staging and grading have been completed.

true

Tumor markers (for example CEA, CA 125) are monitored to help determine the effectiveness of chemotherapy

true

Until engraftment of the new marrow occurs, the patient is at high risk for death from sepsis and bleeding.

true

Vesicant chemotherapy should never be given in peripheral veins involving the hand or wrist. Peripheral administration is permitted for short-duration infusions only, and placement of the venipuncture site should be on the forearm area using a soft, plastic catheter.

true

When latex male condoms are used consistently and correctly during vaginal or anal intercourse, they are highly effective in preventing the sexual transmission of HIV.

true

When the immune system fails to identify and stop the growth of transformed cells, a tumor can develop and progress.

true

in Immunotherapy, because the injection of an allergen may induce systemic reactions, such injections are given only in a setting where epinephrine is immediately available (i.e., primary provider's office, clinic).

true

there is insufficient evidence that maternal diet during pregnancy or lactation affects the development of food allergies later in life

true

Grade I tumor

tumor cells well differentiated

radiosensitive tumor

tumor in which radiation can cause the death of cells without serious damage to surrounding tissue

A ___________ is a biomarker found in blood, urine, or body tissues that can be elevated by the presence of one or more types of cancer. There are many different tumor markers, each indicative of a particular disease process, and they are used in oncology to help detect the presence of cancer

tumor marker

Myeloma

tumor of the bone marrow

The client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse?

tumor pressure against normal tissues

staging determines the size of the tumor, the existence of local invasion, lymph node involvement, and distant metastasis. Several systems exist for classifying the anatomic extent of disease. The _______________ is one system used to describe many solid tumors

tumor, nodes, and metastasis (TNM) system

urticaria:

type I hypersensitive allergic reaction of the skin that is characterized by the sudden appearance of edematous, pink or red wheals of variable size from 2 to 4 mm, and general pruritus.

atopic dermatitis

type I hypersensitivity involving inflammation of the skin evidenced by itching, redness, and a variety of skin lesions

neoplasia

uncontrolled cell growth that follows no physiologic demand * cancer

tumor-specific antigen

unique protein on cell surface of tumors; measurement helps to track the extent of cancer as malignant cells mature and become less differentiated

___________ (hives) is a type I hypersensitive allergic reaction of the skin that is characterized by the sudden appearance of edematous, pink or red wheals of variable size from 2 to 4 mm, and general pruritus.

urticaria

Your client is receiving radiation therapy. The client asks you about oral hygiene. What advice regarding oral hygiene should you offer?

use a soft toothbrush and avoid an electronic toothbrush

Palifermin (Kepivance)

use for stomatitis * promotes epithelial cell repair and accelerated replacement of cells in the mouth and gastrointestinal tract.

Interstitial HDR implants

used in treating such malignancies as prostate, pancreatic, or breast cancer, may be temporary or permanent, depending on the site and radioisotope used.

Nuclear medicine imaging

uses IV injection or ingestion of radioisotope substances followed by imaging of tissues that have concentrated the radioisotopes

precision medicine

using advances in research, technology, and policies to develop individualized plans of care to prevent and treat diseas

autologous transplant

using some of the patient's own bone marrow that was harvested before treatment began

People who are allergic to insect venom may require _______________________, which is used as a control measure and not a cure.

venom immunotherapy

herpes zoster

viral disease affecting the peripheral nerves, characterized by painful blisters that spread over the skin following the affected nerves, usually unilateral; also known as shingles *HIV

Molluscum contagiosum

viral infection characterized by deforming plaque formation. HIV

__________ test use target amplification methods to quantify HIV RNA or DNA levels in the plasma

viral load test

The amount of virus in the body after the initial immune response subsides is referred to as the _____________, which results in an equilibrium between HIV levels and the immune response that may be elicited.

viral set point

atopic dermatitis medical treatment for itching?

wearing cotton fabrics; washing with a mild detergent; humidifying dry heat in winter; maintaining room temperature at 20°C to 22.2°C (68°F to 72°F); using antihistamines such as diphenhydramine; and avoiding animals, dust, sprays, and perfumes.

AIDS-Related Lymphomas symptoms:

weight loss, night sweats, and fever.

when does the immunologic inflammatory process begins?

when antigens are presented to T lymphocytes, leading to a proliferation of T and B cells.

Stage 3 of HIV

when the count drops below 200 cells/mm3 of blood and at this point, the person is considered to have AIDS for surveillance purposes.

What substances are a part of Natural Immunity?

white blood cells, an inflammatory response and chemicals

Anaphylactic reactions produce a clinical syndrome that affects multiple organ systems. Reactions may be categorized as mild, moderate, or severe. The time from the exposure to the antigen to the onset of symptoms is a good indicator of the severity of the reaction. Why?

—the faster the onset, the more severe the reaction.

Brachytherapy safety precautions

• private room •post appropriate notices about radiation safety precautions •staff members meter badges •pregnant staff members not assigned to the patient's care •prohibit visits by children or pregnant visitors •visits 30 minutes a day • 6 foot distance from the radiation source

What primary prevention measures should the nurses educate patients on to reduce the risks of disease?

•Avoid known carcinogens •Increase physical activity •Smoking cessation •Decrease caloric and alcoholic intake

What happens if the antibody is produced in response to one antigen but is able to react with another similar antigen?

•Cross-reactivity occurs ex. Antibodies to Strep pyogenes may also react to the heart tissue (this occurs with Rheumatic Fever)

How do the treatment options differ? - cure - control - palliation

•Cure: complete eradication of the malignancy •Control: prolonged survival and containment of cancer cell growth •Palliation: relief of symptoms associated with the malignancy and improvement of quality of life

Give me some examples of dietary substances that are known to be carcinogenic.

•Fats, •alcohol, •salt cured or smoked meats, •nitrate and nitrite containing foods, •red and processed meats. •Alcohol intake

Port-A-Cath's

•For frequent or prolonged administration vesicants

Immunodeficiency disorders may be caused by a defect in, or a deficiency of:

•Immunodeficiency disorders may be caused by a defect in, or a deficiency of: - phagocytic cells, -B lymphocytes, -T lymphocytes, -complement system.

What happens when a patient has neutropenia (low neutrophil counts)?

•Increased risk for infection, since they are missing a key component of the immune system

What are the early indicators of decreasing platelet levels?

•Petechiae •Ecchymosis

What are the two types of lymphocytes?

•T cells •B cells

During a viral illness like mononucleosis the nurse anticipates a predominate increase in B or T cells?

•T cells since viruses induce a cellular response (B cells dominate in bacterial infections)

What type of precautions should be used when providing care to a patient who requires immunosuppression to prevent infection?

•Universal or standard precautions

What are the systemic effects associated with radiation therapy?

•fatigue, •malaise, •anorexia. •loss of elasticity, •permanent damage to tissues, •changes secondary to a decreased vascular supply. •fibrosis, •atrophy •ulceration •necrosis.