Hematology/Anemia FNP Review

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Anemia in children is potentially associated with poorer school performance. A. True B. False

Approximately 90% of the body's erythropoietin is produced by the kidney. A. True B. False

During pregnancy, folic-acid requirements increase twofold to fourfold. A. True B. False

One of the earliest laboratory markers in evolving macrocytic or microcytic anemia is: A. an increase in RBC distribution width (RDW). B. a reduction in measurable hemoglobin. C. a low MCH level. D. an increased platelet count.

Second-line drug intervention in the presence of anaphylaxis should be: A. oral diphenhydramine. B. nebulized albuterol. C. nebulized epinephrine. D. oral prednisone.

The body's normative response to anemia is reticulocytopenia. A. True B. False

The red blood cell content is approximately 90% hemoglobin. A. True B. False

The time to highest blood concentration (Cmax) of epinephrine is shorter when the medication is given: A. intramuscularly in the vastus lateralis. B. subcutaneously in the abdominal wall. C. intramuscularly in the deltoid. D. intramuscularly into the gluteus.

Which of the following plays an essential role in type 1 hypersensitivity? A. Immunoglobulin E B. immunoglobulin A C. immunoglobulin G D. immunoglobulin F

Which tumor marker may detect a tumor of the ovary or testes? A. Alpha fetoprotein B. Carcinoembryonic antigen C. Human chorionic gonadotropin D. Cancer antigen 125

A. Alpha fetoprotein - May be elevated with embryonal cell tumors of the ovary or testis, hepatocellular carcinoma, and choriocarcinoma.

Physiological changes in the immune system of older adults include A. An increase in immunoglobulin A and G antibodies B. A high rate of T-lymphocyte proliferation C. An increase in the number of cytotoxic T cells D. An increase in CD8, which affects regulation of the immune system

A. An increase in immunoglobulin A and G antibodies

Your client, Mr. Jones, has Sjorgen's syndrome. Which treatment do you suggest? A. Artificial tears and chewing sugarless gum B. Frequent rinsing out of the mouth with mouthwash C. Drinking at least one glass of milk per day D. Removing wax from the ears at regular intervals

A. Artificial tears and chewing sugarless gum - Sjorgen's syndrome is a multisystem autoimmune disease characterized by dysfunction of the exocrine glands, specifically notable for dry eyes and dry mouth.

Sara comes today with numerous petechiae on her arms. You know that she is not taking warfarin (Coumadin). What other drugs do you ask her about? A. Aspirin or aspirin compounds B. Antihypertensive agents C. Oral contraceptives D. Anticonvulsants

A. Aspirin or aspirin compounds

Which of the following cancers is associated with Epstein-Barr virus? A. Burkitt's lymphoma B. Kaposi's sarcoma C. Lymphoma D. Adult T-cell leukemia

A. Burkitt's lymphoma - Kaposi's sarcoma is associated with human cytomegalovirus - Lymphoma is associated with the human herpesvirus 6 - Adult T-cell leukemia is associated with the human T-lymphotropic viruses

Clients with AIDS typically experience the neurological symptomatic triad consisting of A. Cognitive, motor, and behavioral changes B. Seizures, paresthesias, and dysesthesias C. Kaposi's sarcoma, cryptococcal meningitis, and depression D. Seizures, depression, and paresthesias

A. Cognitive, motor, and behavioral changes - All are potential symptoms of AIDS, but the key word is neurological.

Which of the following is not an effective strategy to prevent the nausea and vomiting associated with the effects of radiation and chemotherapy? A. Decreasing the amount of liquids B. Eating a soft, bland diet low in fat and sugar C. Relaxation D. Distraction

A. Decreasing the amount of liquids - It is important to maintain an adequate fluid intake to prevent dehydration, which may result in vomiting.

You have a new client, Robert, age 67, who present with a generalized lymphadenopathy. You know that this is indicative of A. Disseminated malignancy, particularly of the hematological system B. Cancer of the liver C. Sjorgen's syndrome D. Pancreatic cancer

A. Disseminated malignancy, particularly of the hematological system - Such as lymphoma or leukemia

A client with HIV infection has a fever of unknown origin (FUO). Which of the following is a possible cause of an FUO in a client with HIV? A. Drug fever B. Upper respiratory infection C. Nothing specific; this is a systemic disease manifestation D. Urinary tract infection

A. Drug fever - A fever of unknown origin in clients with HIV is defined as temperature > 101 on multiple occasions over 4 weeks duration in an outpatient and 3 weeks duration in an inpatient, with an uncertain diagnosis after three appropriate investigations of cultures and the like.

Which is the most abundant immunoglobulin (Ig) found in the blood, lymph, and intestines? A. IgG B. IgA C. IgM D. IgD

A. IgG - IgG is active against bacteria, bacterial toxins, and viruses

When the donor and recipient of a transplant are identical twins, this is referred to as a(n) A. Isograft B. Autograft C. Allograft D. Xenograft

A. Isograft

Sally has HIV infection and asks which method of birth control, other than abstinence, would be best for her. You suggest A. Latex condoms B. The spermicide nonoxynol-9 C. An intrauterine device (IUD) D. An oral contraceptive

A. Latex condoms

Which of the following is a benign neoplasm? A. Leiomyoma B. Osteosarcoma C. Glioma D. Seminoma

A. Leiomyoma - Benign neoplasm of the smooth muscle

Tina, age 2, had a complete blood count (CBC) drawn at her last visit. It indicates that she has a microcytic hypochromic anemia. What should you do now at this visit? A. Obtain a lead level B. Instruct Tina's parents to increase the amount of milk in her diet. C. Start Tina on ferrous sulfate (Feosol) and check the CBC in 6 weeks. D. Recheck the CBC on this visit

A. Obtain a lead level - Provider should always check a lead level before starting iron supplementations in children because an elevated lead level will cause anemia despite a normal iron level.

Despite successful primary prophylaxis, which infection remains a common AIDS-defining diagnosis? A. Pneumocystitis jiroveci pneumonia (PCP) B. Cryptococcosis C. Cryptosporidiosis D. Candidiasis

A. Pneumocystitis jiroveci pneumonia - Before the appearance of AIDS, Pneumocystitis jiroveci pneumonia was a rare disease that immunosuppressed persons and clients with leukemia sometimes developed.

Systemic lupus erythematosus is diagnosed on the basis of A. Positive antinuclear antibody (ANA), malar rash, and photosensitivity B. Positive ANA, weight loss, and night sweats C. Negative ANA, photosensitivity, and renal disease D. Leukopenia, negative ANA, and photosensitivity

A. Positive antinuclear antibody (ANA), malar rash, and photosensitivity

Sue has sickle cell anemia. In regulating her and monitoring her hemoglobin and hematocrit levels, you want to maintain them at A. Slightly below normal B. Strictly at normal C. Slightly above normal D. Around normal with only minor fluctuations

A. Slightly below normal - Clients with sickle cell anemia should have their hemoglobin and hematocrit levels maintained at a level slightly below normal because this protects from some of the vaso-occlusive infarctive complications related to the viscosity characteristics of sickle cell anemia.

Caroline, an older adult, is homeless and has iron-deficiency anemia. She smokes and drinks when she can and has an ulcer. Which of the following is not one of the risk factors of iron-deficiency anemia? A. Smoking B. Poverty C. Ulcer disease D. Age older than 60

A. Smoking

Your 18 year old client, Mandy, has infectious mononucleosis. What might you expect her blood work to reflect? A. Thrombocytopenia and elevated transaminase B. Elevated white blood cells (WBCs) C. Decreased WBCs D. Decreased serum globulins

A. Thrombocytopenia and elevated transaminase - Infectious mononucleosis is a lymphocytic leukocytosis that may be confused with leukmia and other disorders. The presence of heterophile antibodies (monospot test) in the context of clinical and hematological findings is diagnostic.

a. slightly below normal

Ann has sickle cell anemia. In regulating her and monitoring her hemoglobin and hematocrit levels, you want to maintain them at: a. slightly below normal b. strictly at normal c. slightly above normal d. around normal with only minor fluctuations

c. she will probably have growth hormone problems, in which case she can then begin growth hormone tx

Ann, age 5, is being txed with radiation for cancer. Her mothers asks about the effect radiation will have on Ann's future growth. although she knows that a specialist will be handling Ann's care, her mother asks for your opinion. How do you respond? a. let's worry about the cancer first, then see how her growth is affected b. chemotherapy may affect her future growth, but radiation will not c. she will probably have growth hormone problems, in which case she can then begin growth hormone tx d. that the least of your worries now; everything will turn out ok

A 40-year-old woman with pyelonephritis is taking two mediations: ciprofloxacin and ferrous sulfate (for iron-deficiency anemia). She asks about taking both medications. You advise that: A. she should take the medications with a large glass of water. B. an inactive drug compound is potentially formed if the two medications are taken together. C. she can take the medications together to enhance adherence to therapy. D. the ferrous sulfate potentially slows gastrointestinal motility and results in enhanced ciprofloxacin absorption.

A 68-year-old man who is usually healthy presents with new onset of "huffing and puffing" with exercise for the past 3 weeks. Physical examination reveals conjunctiva pallor and a hemic murmur. Hemogram results are as follows: Hgb = 7.6 g Hct = 20.5% RBC = 2.1 million mm3 MCV = 76 fL MCHC= 28 g/dL RDW = 18.4% Reticulocytes = 1.8% The most likely cause of these finding is: A. poor nutrition. B. occult blood loss. C. malabsorption. D. chronic inflammation.

Common physical examination findings in patients with pernicious anemia include: A. hypoactive bowel sounds. B. stocking-glove neuropathy. C. thin, spoon-shaped nails. D. retinal hemorrhages.

Intervention in anemia of chronic disease most often includes: A. oral vitamin B12. B. treatment of the underlying cause. C. transfusion. D. parenteral iron.

Most of the body's iron is obtained from: A. animal-based food sources. B. recycled iron content from aged red blood cells (RBCs). C. endoplasmic reticulum production. D. vegetable-based food sources.

One month into therapy for pernicious anemia, you wish to check the efficacy of the intervention. The best laboratory test to order at this point is a: A. Schilling test. B. hemoglobin measurement. C. reticulocyte count. D. serum cobalamin.

Pernicious anemia is usually caused by: A. dietary deficiency of vitamin B12. B. lack of production of intrinsic factor by the gastric mucosa. C. RBC enzyme deficiency. D. a combination of micronutrient deficiencies caused by malabsorption.

Risk factors for folate-deficiency anemia include: A. menorrhagia. B. chronic ingestion of overcooked foods. C. use of nonsteroidal antiinflammatory drugs. D. gastric atrophy.

Risk factors for folate-deficiency anemia include: A. menorrhagia. B. chronic ingestion of overcooked foods. C. use of nonsteroidal antiinflammatory drugs. D. gastric atrophy

The body's normative response to anemia is reticulocytopenia. A. True B. False

The use of a systemic corticosteroid in the treatment of anaphylaxis is primarily helpful for: A. treatment of the most acute symptoms. B. minimization of a protracted allergic response. C. prevention of future episodes. D. reducing the risk of fatality associated with the event.

When counseling a patient about the neurological alterations often associated with vitamin B12 deficiency, the NP advises that: A. these usually resolve within days with appropriate therapy. B. if present for longer than 6 months, these changes are occasionally permanent. C. the use of parenteral vitamin B12 therapy is needed to ensure symptom resolution. D. cognitive changes associated with vitamin B12 deficiency are seldom reversible even with appropriate therapy.

When prescribing erythropoietin supplementation, the NP considers that: A. the adrenal glands are its endogenous source. B. the addition of micronutrient supplementation needed for erythropoiesis is advisable. C. its use is as an adjunct in treating thrombocytopenia. D. with its use, the RBC life span is prolonged.

Which of the following conditions is unlikely to result in anemia of chronic disease? A. rheumatoid arthritis B. peripheral vascular disease C. chronic renal insufficiency D. osteomyelitis

Which of the following is most consistent with iron-deficiency anemia? A. low mean corpuscular volume (MCV), normal mean corpuscular hemoglobin (MCH) B. low MCV, low MCH C. low MCV, elevated MCH D. normal MCV, normal MCH

You examine a 47-year-old man who presents with difficulty initiating and maintaining sleep and chronic pharyngeal erythema with the following results on hemogram: Hemoglobin (Hgb) = 15 g Hct = 45% RBC = 4.2 million mm3 MCV = 108 fL MCHC=33.2 g/dL These values are most consistent with: A. pernicious anemia. B. alcohol abuse. C. thalassemia minor. D. Fanconi disease.

You examine a 57-year-old woman with rheumatoid arthritis who is on disease-modifying antirheumatic disease but continues to have poor disease control and find the following results on hemogram: Hgb = 10.5 g Hct = 33% RBC = 3.1 million mm3 MCV = 88 fL MCHC=32.8 g/dL RDW= 12.2% Reticulocytes = 0.8% The laboratory findings are most consistent with: A. pernicious anemia. B. anemia of chronic disease. C. beta-thalassemia minor. D. folate-deficiency anemia.

Your priority in caring for Tom, the aforementioned patient, is to: A. administer a rapidly acting oral antihistamine. B. administer parenteral epinephrine. C. initiate vasopressor therapy. D. administer a parenteral systemic corticosteroid.

Kathy, age 64, is a sun worshipper. She tells you that because she did not get skin cancer in her youth, she certainly will not get it now. How do you respond? A. "You're probably right; if you haven't had it by now, you're probably safe." B. "As you age, you have decreased pigment in your skin, which puts you at more risk." C. "You skin elasticity is decreased, so you have more of a chance of contracting skin cancer as you age." D. "Skin cancer is not dependent on age; anyone can get it."

B. "As you age, you have decreased pigment in your skin, which puts you at more risk."

Samantha is being given platelets because of acute leukemia. One "pack" of platelets should raise her count by how much? A. 2,000-4,000 mm3 B. 5,000-8,000 mm3 C. 9,000-12,000 mm3 D. About 15,000 mm3

B. 5,000-8,000 mm3 - One pack equals about 50ml.

Select a statement that is true about the erythrocyte sedimentation rate (ESR). A. It is a very specific indicator of inflammation B. A rise in the ESR is a normal part of aging C. It is useful in detecting pancreatic cancer D. It is diagnostic for rheumatoid arthritis

B. A rise in the ESR is a normal part of aging - The ESR is a very nonspecific indicator of inflammation and is often elevated in inflammatory musculoskeletal conditions; it is not, however, diagnostic for rheumatoid arthritis.

Sam is being worked up for pancreatic cancer. He states that the doctor wants to put a "scope" in and inject dye into his ducts. He wants to know more about this. What procedure is he referring to? A. Percutaneous transhepatic cholangiography B. An endoscopic retrograde cholangiopancreatography C. An angiography D. An upper gastrointestinal (GI) series

B. An endoscopic retrograde cholangiopancreatography - An endoscope is inserted via the mouth and passed by the stomach and into the small intestine, where the dye is injected into the pancreatic ducts and x-rays are taken to determine if any obstruction is apparent.

Some pharmacological adjuncts to analgesics in clients with uncontrolled cancer pain include A. Anticonvulsants and tricyclic antidepressants B. Anticonvulsants, tricyclic antidepressants, and corticosteroids C. Selective serotonin receptor inhibitors D. Benzodiazepines

B. Anticonvulsants, tricyclic antidepressants, and corticosteroids - Pain that is poorly controlled with opioids and NSAIDs is often neuropathic in nature, meaning that it is a result of direct nerve injury, such as nerve compression

Sickle cell anemia is an autosomal recessive disorder caused by the hemoglobin S gene. An abnormal hemoglobin leads to chronic hemolytic anemia with numerous clinical manifestations and becomes a chronic multisystem disease, with death from organ failure, usually between ages 40 and 50. The hemoglobin S gene is carried by A. Approximately 4% of the U.S. population B. Approximately 8% of American blacks C. Approximately 4% of Latinos D. Approximately 12% of Native Americans

B. Approximately 8% of American blacks - The hemoglobin S gene is carried by approximately 8% of American blacks and 1 birth in 400 in American blacks will produce a child with sickle cell.

Tobacco has been linked to which of the following types of cancer? A. Colon cancer B. Bladder cancer C. Prostate cancer D. Cervical cancer

B. Bladder cancer - Tobacco use has been linked to an increased risk for bladder, pancreatic, laryngeal, esophageal, oropharyngeal, and some types of gastric cancer.

Samual, age 5, is receiving radiation therapy for his acute lymphocytic leukemia. He is at increased risk of developing which type of cancer as a secondary malignancy when he becomes an adult? A. Chronic lymphocytic leukemia B. Brain tumor C. Liver cancer D. Esophageal cancer

B. Brain tumor

Which bone tumor arises from cartilage and is usually located in the pelvis, femur, proximal humerus, or ribs? A. Osteosarcoma B. Chondrosarcoma C. Ewing's sarcoma D. Fibrosarcoma

B. Chondrosarcoma - It is the second most common bone malignancy, seen most frequently in men between ages 30 and 60.

Which of the following increases the risk of pancreatic cancer? A. A high-carbohydrate diet B. Cigarette smoking, diabetes, and a high-fat diet C. Diabetes and lack of activity D. Yo-yo dieting

B. Cigarette smoking, diabetes, and a high-fat diet

Julia asks how smoking increases the risk for folic acid deficiency. You respond that smoking A. Causes small-vessel disease and constricts all vessels that transport essential nutrients. B. Decreases the vitamin C absorption C. Affects the liver's ability to store folic acid D. Causes nausea, thereby inhibiting the appetite and ingestion of foods rich in folic acid

B. Decrease the vitamin C absorption - Vitamin C is necessary for folic acid absorption

Which of the following white blood cell types is elevated in parasitic infections, hypersensitivity reactions, and autoimmune disorders? A. Neutrophils B. Eosinophils C. Basophils D. Monocytes

B. Eosinophils

The three most common signs and symptoms of primary HIV infection are A. Weight loss, pharyngitis, and fatigue B. Fever, fatigue, and pharyngitis C. Night sweats, rash, and headache D. Myalgias, fatigue, and fever

B. Fever, fatigue, and pharyngitis

Which of the following is a genotoxic carcinogen? A. Vinyl chloride polymers B. Chemotherapy drugs C. Asbestos D. Wood and leather dust

B. Genotoxic carcinogens directly alter DNA and cause mutations

Which of the following is an X-linked recessive disorder commonly seen in African American men? A. Sickle cell anemia B. Glucose-6-phosphate dehydrogenase deficiency C. Pyruvate kinase deficiency D. Bernard-Soulier syndrome

B. Glucose-6-phosphate dehydrogenase deficiency - It is an enzyme defect that causes episodic hemolytic anemia because of the decreased ability of red blood cells to deal with oxidative stresses.

A platelet count less than 150,000/mm3 may indicate A. Possible hemorrhage B. Hypersplenism C. Polycythemia vera D. Malignancy

B. Hypersplenism - As well as possible bone marrow failure or accelerated consumption of platelets

Jill has just been given a diagnosis of HIV infection and has a normal initial Pap test. When do the Centers for Disease Control and Prevention (CDC) guidelines state that she should have a repeat Pap test? A. In 3 months B. In 6 months C. In 1 year D. She should have a colposcopy every year rather than a Pap test

B. In 6 months - CDC recommends that if a woman infected with HIV has a normal initial Pap test, then a second evaluation should be done in 6 moths to reduce the likelihood of a false-negative initial test.

What is the earliest visual sign of oral and pharyngeal squamous cell carcinoma? A. Leukoplakia B. Mucosal erythroplasia C. Loss of sensation in the tongue D. Difficulty chewing or swallowing

B. Mucosal erythroplasia - Red inflammatory lesions. Leukoplakia (thickened white patches of the tongue or mucous membranes) is the most common premalignant lesion.

In teaching your client about the American Cancer Society's CAUTION model, which identifies signs of many cancers, you teach her that the N stands for A. Night sweats B. Nagging cough C. Nausea and vomiting D. Noxious odor

B. Nagging cough - Or hoarseness

Pernicious anemia is a result of A. Not enough folic acid B. Not enough intrinsic factor C. Not enough Vitamin D D. Not enough iron

B. Not enough intrinsic factor

Pernicious anemia is a result of A. Not enough folic acid B. Not enough intrinsic factor C. Not enough Vitamin D D. Not enough iron

B. Not enough intrinsic factor. - Pernicious anemia is a result of the parietal cells of the stomach lining failing to secrete enough intrinsic factor to ensure intestinal absorption of Vitamin B12.

Stu, age 49, has slightly reduced hemoglobin and hematocrit readings. What is your next action after you ask him about his diet? A. Repeat the laboratory tests B. Perform a fecal occult blood test C. Start him on an iron preparation D. Start him on folic acid

B. Perform a fecal occult blood test - Tests for fecal occult blood in the stools should be done on all clients suspected of having iron-deficiency anemia.

Which of the following is not an inherited condition that causes hemolytic anemia? A. Hereditary spherocytosis B. Pernicious anemia C. Glucose-6-phosphate dehydrogenase deficiency D. Sickle cell anemia

B. Pernicious anemia - Caused by an inadequate absorption of vitamin B12. Symptoms develop slowly and subtly and may not be recognized right away.

The T in the TNM staging system refers to A. Tolerance B. Primary tumor C. Tumor marker D. Turgor

B. Primary tumor - N is for regional lymph nodes, and M is for distant metastasis

rare autosomal recessive intrinsic platelet disorder causing bleeding

Bernard-Soulier syndrome is a

A 48-year-old woman developed iron-deficiency anemia after excessive perimenopausal bleeding, successfully treated by endometrial ablation. Her hematocrit (Hct) level is 25%, and she is taking iron therapy. At 5 days into therapy, one possible observed change in laboratory parameters would include: A. a correction of mean cell volume. B. an 8% increase in Hct level. C. reticulocytosis. D. a correction in ferritin level.

A healthy 34-year-old man asks whether he should take an iron supplement. You respond that: A. this is a prudent measure to ensure health. B. iron-deficiency anemia is a common problem in men of his age. C. use of an iron supplement in the absence of a documented deficiency can lead to iatrogenic iron overload. D. excess iron is easily excreted.

A woman who is planning a pregnancy should increase her intake of which of the following to minimize the risk of neural tube defect in the fetus? A. iron B. niacin C. folic acid D. vitamin C

An increase in the normal variation of RBC size is known as: A. poikilocytosis. B. granulation. C. anisocytosis. D. basophilic stippling.

In health, the ratio of hemoglobin to hematocrit is usually: A. 1:1. B. 1:2. C. 1:3. D. 1:4.

In the first weeks of anemia therapy with parenteral vitamin B12 in a 68-year-old woman with hypertension who is taking a thiazide diuretic, the patient should be carefully monitored for: A. hypernatremia. B. dehydration. C. hypokalemia. D. acidemia.

Of the following medications, which is least likely to be implicated as a trigger for anaphylaxis? A. ibuprofen B. amoxicillin C. acetaminophen D. aspirin

Poikilocytosis refers to alterations in a red blood cells: A. thickness. B. color. C. shape. D. size.

Results of hemogram in a person with anemia of chronic disease include: A. microcytosis. B. anisocytosis. C. reticulocytopenia. D. macrocytosis.

The most common clinical manifestation of systemic anaphylaxis typically is: A. dizziness. B. airway obstruction. C. urticaria. D. gastrointestinal upset.

Tom is a 19-year-old man who presents with sudden onset of edema of the lips and face and a sensation of "throat tightness and shortness of breath" after a bee sting. Physical examination reveals inspiratory and expiratory wheezing. Blood pressure is 78/44 mm Hg, heart rate is 102 bpm, and respiratory rate is 24/min. His clinical presentation is most consistent with the diagnosis of: A. urticaria. B. angioedema. C. anaphylaxis. D. reactive airway disease.

When the cause of a macrocytic anemia is uncertain, the most commonly recommended additional testing includes which of the following? A. haptoglobin and reticulocyte count. B. Schilling test and gastric biopsy. C. methylmalonic acid and homocysteine. D. transferrin and prealbumin.

Which of the following is not consistent with anemia of chronic disease (ACD)? A. NL RDW B. NL MCHC C. Hct less than 24% D. NL to slightly elevated serum ferritin

Which of the following is the best advice on taking ferrous sulfate to enhance iron absorption? A. "Take with other medications." B. "Take on a full stomach." C. "Take on an empty stomach." D. "Do not take with vitamin C."

You examine a 22-year-old woman of Asian ancestry. She has no presenting complaint. Hemogram results are as follows: Hgb = 9.1 g (normal 12 to 14 g) Hct = 28% (normal 36% to 42%) RBC = 5 million mm3 (normal 3.2 to 4.3 million mm3) MCV = 68 fL (normal 80 to 96 fL) MCHC=33.2 g/dL (normal 32-36 d/dL) RBC distribution width (RDW) = 13% (normal ≤15%). Reticulocytes = 1.5% This is most consistent with the laboratory assessment of: A. iron-deficiency anemia. B. Cooley anemia. C. alpha-thalassemia minor. D. hemoglobin Barts.

Allie, age 5, is being treated with radiation for cancer. Her mother asks about the effect radiation will have on Allie's future growth. Although she knows that a specialist will be handling Allie's care, her mother asks for your opinion. How do you respond? A. "Let's worry about the cancer first, then see how her growth is affected." B. "Chemotherapy may effect her futur growth, but not radiation." C. "She will probably have growth hormone problems, in which case she can then begin growth hormone therapy." D. That's the least of your worries now; everything will turn out ok."

C. "She will probably have growth hormone problems, in which case she can then begin growth hormone therapy."

Mandy's 16 year old daughter has hepatitis A. Which of the following statements made by Mandy indicates that she understands the teaching you've just completed? A. "I guess she needs to be hospitalized until she's recovered." B. "We'll keep her at home with strict isolation precautions." C. "We'll stop at the store and buy plastic eating utensils." D. "We'll stop at the drugstore and pick up prescription medications immediately."

C. "We'll stop at the store and buy plastic eating utensils." - Clients with Hepatitis A should have separate eating and drinking utensils or use disposable ones.

Maria asks if being overweight predisposes her to cancer. How do you respond? A. "No, you have the came risk as a normal-weight individual." B. "You have less of a risk of cancer than normal-weight individuals because you have protein stores to combat mutant cells." C. "Yes, you have an increased risk of hormone-dependent cancers because of your obesity." D. "Yes, you have an increased risk because you have many more cells in all the organs of your body."

C. "Yes, you have an increased risk of hormone-dependent cancers because of your obesity." - Because of excessive body fat. Sex hormones are synthesized from fat, and obese people have excessive amounts of the hormones that feed hormone-dependent malignancies such as cancer of the breast, bowel, ovary, endometrium, and prostate.

Joan had a modified mastectomy with radiation therapy 10 years ago. She asks when she can have her blood pressure or needle sticks taken in the affected arm. How do you respond? A. "If it's been 10 years and you've had no problems, you can discontinue those precautions." B. "Because you didn't have a radical mastectomy, you can do those things now." C. "You must observe these precautions forever." D. "As long as you do limb exercises and have established collateral drainage, you can discontinue these precautions."

C. "You must observe these precautions forever." - Lymphadema may occur many years after a mastectomy (whether radical or modified) or radiation therapy on the affected side.

Sandra, age 19, is pregnant. She is complaining of breathlessness, tiredness, and weakness and is pale. After diagnosing anemia, you order medication and tell her to take it A. Only with meals because it can be irritating to the stomach B. In the morning if she experiences morning sickness C. 1 hour before eating or between meals D. At bedtime

C. 1 hour before eating or between meals - Sandra's symptoms indicate anemia, which is probably caused by a poor diet. She probably has an iron and folic acid deficiency.

Sickle cell anemia affects African Americans. Approximately 1 in 400 African Americans in the United States has sickle cell disease (SCD). Advances in treatment have been made, but life expectancy is still limited. The mean survival time for men with the disease is approximately A. 24 years B. 34 years C. 42 years D. 52 years

C. 42 years - 42 for men and 48 for women

Screening infants for anemia should occur at what age? A. 6 months B. No screening is recommended C. 9 months D. 12 months

C. 9 months - The cutoff points for a diagnosis of anema at this age are a hemoglobin below 11g/dl or a hematocrit below 33%.

The "gold standard" for definitive dianosis of sickle cell anemia is A. A reticulocyte count B. The sickle cell test C. A hemoglobin electrophoresis D. A peripheral blood smear

C. A hemoglobin electrophoresis - Test that determines the presence of hemoglobin S

Mindy, age 6, recently was discharged from the hospital after a sickle cell crisis. You are teaching her parents to be alert to the manifestations of splenic sequestration and tell them to be alert to A. Vomiting and diarrhea B. Decreased mental acuity C. Abdominal pain, pallor, and tachycardia D. Abdominal pain and vomiting

C. Abdominal pain, pallor, and tachycardia - These are all manifestations of splenic sequestrations

Marsha states that a relative is having a carcinoembryonic antigen (CEA) test done to detect some type of cancer. She wants to know what kind. You tell her a CEA is performed to detect A. Adenocarcinoma of the prostate B. Medullary cancer of the thyroid C. Adenocarcinomas of the colon, lung, breast, ovary, stomach and pancreas D. Multiple myeloma

C. Adenocarcinomas of the colon, lung, breast, ovary, stomach and pancreas

What is the most significant reason why alcohol use is discouraged in persons with HIV infection or AIDS? A. Alcohol interferes with the pharmacokinetics of most AIDS drugs B. Filling up on empty calories of alcohol replaces the desire for food. C. Alcohol decreases the ability of persons to adhere to a prescribed medical regimen D. If clients become addicted to alcohol, when AIDS advances, they will become addicted to pain killers

C. Alcohol decreases the ability of persons to adhere to a prescribed medical regimen.

The primary reason for newborn screening for sickle cell disease is to A. Present the parents with the option for genetic screening in the future B. Test siblings if it is proved that the newborn has sickle cell disease C. Allow for the prevention of septicemia with prophylactic medication D. Prevent a sickle cell crisis

C. Allow for the prevention of septicemia with prophylactic medication - Prophylactic medication (penicillin) and prompt clinical intervention for infection and future crises.

Which of the following laboratory studies is used to determine if a client has had hepatitis? A. Serum protein B. Protein electrophoresis C. Antibody testing D. Globulin levels

C. Antibody testing - Antibody titers evaluate antibody-mediated responses.

The placement of a high dose of radioactive material directly into a malignant tumor and giving a lower dose to the normal tissues is referred to as A. Radiotherapy B. Teletherapy C. Brachytherapy D. Ionization therapy

C. Brachytherapy - Also referred to as internal, interstitial, or intracavitary radiation.

Fecal occult blood testing (FOBT) is most effective in identifying A. Cancers in the right colon B. Polyps C. Cancers in the sigmoid colon D. Cancers in the transverse colon

C. Cancers in the sigmoid colon

Which type of leukemia produces symptoms with an insidious onset including weakness, fatigue, massive lymphadenopathy, pruritic vesicular skin lesions, anemia, and thrombocytopenia? A. Acute lymphocytic leukemia B. Acute myelogenous leukemia C. Chronic lymphocytic leukemia D. Chronic myelogenous leukemia

C. Chronic lymphocytic leukemia

The first choice of therapy for a client who is positive for HIV and has oral candidiasis is A. Fluconazole (Diflucan) 100mg PO QD B. Ketoconazole (Nizoral) 200mg PO QD C. Clotrimazole troches (10mg) five times daily or nystatin (Mycostatin) suspension 500,000-1,000,000 units three to five times daily D. Griseofulvin (Grisactin) 500mg BID

C. Clotrimazole troches (10mg) five times daily or nystatin (Mycostatin) suspension 500,000-1,000,000 units three to five times daily - Because of the common recurrence of oral candidiasis and increased rates of drug resistance, systemic fungicides, such as fluconazole, ketoconazole, and griseofulvin, should be reserved for severe cases, such as esophageal candidiasis and clients with dysphagia.

Before initiating cancer therapy, the first crucial step is to A. Stage the disease B. Define the goals of therapy C. Confirm the diagnosis using tissue biopsy D. Choose a treatment plan from the many therapeutic options

C. Confirm the diagnosis using tissue biopsy

Robin has HIV infection and is having a problem with massive diarrhea. You suspect the cause is A. Cryptococcosis B. Toxoplasmosis C. Cryptosporidiosis D. Cytomegalovirus

C. Cryptosporidiosis - When patients with HIV infection have massive diarrhea, a protozoa of the cryptosporidium genus is the most likely cause.

Mrs. Jameson complains of unilateral blurry vision and partial blindness in the left eye. On physical examination, you find decreased peripheral vision on her left side. Funduscopic examination reveals cotton-wool spots. Your most likely diagnosis is A. Cryptococcosis B. Toxoplasmosis C. Cytomegalovirus infection D. Herpes simplex virus infection

C. Cytomegalovirus infection - Classic S&S include cotton-wool spots (cottage cheese and ketchup appearance), hemorrhage, and exudates on funduscopic examination

Which is the best serum test to perform to spot an iron-deficiency anemia early before it progresses to full-blown anemia? A. Hemoglobin B. Hematocrit C. Ferritin D. Reticulocytes

C. Ferritin - A serum measurement of ferritin, the body's iron-storing protein, can tell exactly how much iron is on hand in the body.

Maurice is an intravenous drug abuser with chronic hepatitis B (HBV). The development of which type of hepatitis poses the greatest risk to a client with HBV? A. Hepatitis A B. Hepatitis C C. Hepatitis D D. Hepatitis E

C. Hepatitis D

When Judy tells you that she has hemophilia, you know that A. Both of her parents also have the disease B. Her maternal grandfather probably had the disease and it skipped a generation C. Her father had the disease and her mother was a carrier D. Her mother had the disease

C. Her father had the disease and her mother was a carrier - Hemophilia is a classic example of an X-linked recessive disease and, as a rule, only males are affected. In rare instances, female carriers are clinically affected if their normal X chromosomes are disproportionately inactivated.

Prostate cancer is associated with which of the following viruses? A. Herpes simplex virus types 1 and 2 B. Human herpesvirus 6 C. Human cytomegalovirus D. Human T-lymphotropic viruses

C. Human cytomegalovirus

Pregnant women may be prone to thrombophilias, which may be inherited or acquired. Which of the following is an example of a factor that predisposes pregnant women to acquired thrombophilic states in pregnancy? A. Factor V Leiden B. Homocystine C. Immobilization and malignancy D. Protein S and protein C

C. Immobilization and malignancy

Which hypersensitivity reaction results in a skin test that is erythematous with edema within 3-8 hours? A. Anaphylactic reaction B. Cytotoxic reaction C. Immune complex-mediated reaction D. Delayed hypersensitivity reaction

C. Immune complex-mediated reaction - May result from serum sickness, systemic lupus erythematosus, or rheumatoid arthritis

Jimmy is a 6 month old with newly diagnosed sickle cell disease. His mother brings him to the clinic for a well-baby visit. Which of the following should you do on this visit? A. Tell the parents that Jimmy will not be immunized because of his diagnosis B. Tell the parents that Jimmy should not go to day care C. Immunize Jimmy with diptheria, tetanus, and pertussis. Haemophilus influenzae type B (HIB); hepatitis B (HBV); and poliomyelitis vaccines D. Immunize Jimmy with measles, mumps, and rubella; HIB, HBV vaccines only

C. Immunize Jimmy with diptheria, tetanus, and pertussis. Haemophilus influenzae type B (HIB); hepatitis B (HBV); and poliomyelitis vaccines - Children with sickle cell disease should receive all the standard well-baby care, but in addition to the standard immunizations, they should receive the pneumococcal vaccine at age 2 years

Your client, Jackson, has decreased lymphocytes. You suspect A. Bacterial infection B. Viral infection C. Immunodeficiency D. Parasitic infection

C. Immunodeficiency - A decrease in lymphocytes would be most consistent with immunodeficiency disorders, long-term corticosteroid therapy, or debilitating diseases such as Hodgkin's lymphoma or lupus erythematosus - Lymphocytes are increased primarily in viral infections and only occasionally in bacterial infections. - Eosinophils are elevated in parasitic infections such as malaria, trichinosis, and ascariasis

Jan is having biological therapy for her pancreatic cancer. What kind of treatment is this? A. Surgery B. Radiation therapy C. Immunotherapy D. Chemotherapy

C. Immunotherapy - Uses the body's natural ability (immune system) to fight disease or to protect the body from adverse effects of treatment.

How often should you order a complete blood count for your client? A. Routinely B. Before dental work C. In the case of infection D. If she is pregnant

C. In the case of infection

Thalassemia is caused by A. Blood loss B. Impaired production of all blood-forming elements C. Increased destruction of red blood cells D. Autoimmune antibodies

C. Increased destruction of red blood cells - Caused by decreased synthesis of hemoglobin and malformation of red blood cells that increases their hemolysis.

Lorie, age 29, appears with the following signs: pale conjunctiva and nailbeds, tachycardia, heart murmur, cheilosis, stomatitis, splenomegaly, koilonychia, and glossitis. What do you suspect? A. Vitamin B12 deficiency B. Folate deficiency C. Iron-deficiency anemia D. Chronic fatigue syndrome

C. Iron-deficiency anemia - Classic signs of iron-deficiency anemia

The Center for Disease Control and Prevention's definition of AIDS includes the presence of which of the following disorders, with or without laboratory evidence of HIV infection? A. Pneumonia in clients younger than age 60 B. Dementia in clients younger than age 60 C. Kaposi's sarcoma in clients younger than age 60 D. Primary brain lymphoma in clients older than age 60

C. Kaposi's sarcoma in clients younger than age 60 - Kaposi's sarcoma in a client younger than age 60 is considered conclusive evidence of AIDS according to CDC.

Multiple myeloma is a plasma cell malignancy in which the bone marrow is replaced, and there is bone destruction and paraprotein formation. Myeloma is a disease of older adults overall (median age at presentation, 65 years). Common presenting symptoms include A. Nausea and vomiting and chronic cough B. Fatigue and splenomegaly C. Lower back pain and hypercalcemia D. Nausea and vomiting and fatigue

C. Lower back pain and hypercalcemia - Bone pain is a common presenting symptom, most frequently manifested as low back pain or pain in the rib, and may present as a pathological fracture, especially in the femoral neck. Hypercalcemia is often present related to the leakage of calcium occurring from bone destruction.

You are examining Joseph, age 9 months, and note a palpable right supraclavicular node. You know that this finding is suspicious for A. Candidiasis B. Cryptococcosis C. Lymphoma of the mediastinum D. Abdominal malignancy

C. Lymphoma of the mediastinum - Palpable supraclavicular lymph nodes are not normal in infants, children or adults. A right sided palpable node is more commonly associated with lymphoma of the mediastinum, whereas a palpable left-sided node is more commonly associated with an abdominal malignancy

When a neonate is initially protected against measles, mumps, and rubella because the mother is immune, this is an example of which type of immunity? A. Natural active B. Artificial active C. Natural passive D. Artificial passive

C. Natural passive

Julie's brother has chronic lymphatic leukemia. She overheard that he was in stage IV and asks what this means. According to the Rai classification system, stage IV is a stage A. At which the lymphocytes are greater than 10,000mm3 B. With an absolute lymphocytosis, in which the client may live 7-10 years or more C. Of thrombocytopenia, in which the life expectancy may be only 2 years D. Of anemia

C. Of thrombocytopenia, in which the life expectancy may be only 2 years

Which of the following indicates that Jim, a 32 year old client with AIDS, has oropharyngeal candidiasis? A. Small vesicles B. Fissured, white, thickened plaques C. Removable white plaques D. Flat-topped papules with thin, bluish-white spiderweb lines

C. Removable white plaques

A client with HIV infection has a CD4 count of 305 and an HIV RNA level of 13,549. The client is asymptomatic. What is your course of action? A. Negotiate with your client a time to start therapy B. Recheck the laboratory results in 1 month. If the counts remain like this, start treatment. C. Start therapy now because the client's CD4 count is less than 500 and the HIV RNA level is greater than 10,000. D. Wait to start therapy until the client becomes asymptomatic

C. Start therapy now because the client's CD4 count is less than 500 and the HIV RNA level is greater than 10,000. - Regardless of being asymptomatic, CDC recommends starting treatment in a patient with CD4 less than 500 and HIV RNA levels greater than 10,000

Which of the following situations might precipitate a sickle cell crisis in an infant? A. Taking the infant to visit a relative B. Hepatitis B immunization C. Taking the infant to a home Miami Dolphins football game D. Having the infant sleep on its back

C. Taking the infant to a home Miami Dolphins football game - Certain precautions must be taken for infants with sickle cell disease to prevent vaso-occlusive crisis. Any activity or situation that would cause dehydration should be avoided. An example is sitting in a stroller in the heat for any length of time.

What is the meaning of the term "shift to the left" or "left shift"? A. This indicates a rise in basophils B. This indicates a rise in monocytes C. This indicates a rise in neutrophils D. This indicates a rise in lymphocytes

C. This indicates a rise in neutrophils - An elevated WBC count and a relative increase in segmented and band neutrophils. Usually seen in acute bacterial infections, it indicates clinically that the body is responding to an acute need before the neutrophils can fully mature in the bone marrow.

a. smoking

Candy, an older adult, is homeless and has iron-deficiency anemia. She smokes and drinks when she can and has an ulcer. Which of the following is not one of the risk factors of iron-deficiency anemia? a. smoking b. poverty c. ulcer disease d. age older than 60

b. as you age, you have decreased pigment in your skin, which puts you at more risk

Cathy, age 64, is a sun worshipper. She tells you that because she did not get skin cancer in her youth, she certainly will not get it now. How do you respond? a. you are probably right; if you haven't had it by now, you are probably safe b. as you age, you have decreased pigment in your skin, which puts you at more risk c. your skin elasticity is decreased, so you have more of a chance of contracting skin cancer as you age d. skin cancer is not dependent on age; anyone can get it

A person with latex allergy also often has a cross-allergy to all of the following except: A. banana. B. avocado. C. kiwi. D. romaine lettuce.

Erythropoietin is a glycoprotein that influences a stem cell to become a: A. lymphocyte. B. platelet. C. neutrophil. D. red blood cell.

Folate-deficiency anemia causes which of the following changes in the RBC indices? A. microcytic, normochromic B. normocytic, normochromic C. microcytic, hypochromic D. macrocytic, normochromic

In children younger than age 6 years, accidental overdose of iron-containing products is: A. easily treated. B. a source of significant GI upset. C. worrisome but rarely causes significant harm. D. a leading cause of fatal poisoning in the age group.

Increased risks for fatal reactions from anaphylaxis include all of the following except: A. personal history of asthma. B. delay in administering epinephrine C. age in the teen years. D. delay in administering antihistamines.

Pernicious anemia causes which of the following changes in the RBC indices? A. microcytic, normochromic B. normocytic, normochromic C. microcytic, hypochromic D. macrocytic, normochromic

Which of the following food-based allergies is likely to be found in adults and children? A. milk B. egg C. soy D. peanut

Which of the following is true regarding anaphylaxis? A. Adults usually do not develop new anaphylaxis triggers such as food allergies. B. Peanuts are the primary food that can cause a severe allergic reaction. C. Future anaphylactic reactions will become increasingly more severe. D. Trace amounts of an allergen in a food can cause a severe anaphylactic reaction.

Worldwide, which of the following is the most common type of anemia? A. pernicious anemia B. folate-deficiency anemia C. anemia of chronic disease D. iron-deficiency anemia

You examine a 27-year-old woman with menorrhagia who is otherwise well and note the following results on hemogram: Hgb = 10.1 g Hct = 32% RBC = 2.9 million mm 3 MCV = 72 fL MCHC=28.2 g/dL RDW = 18.9% Physical examination is likely to include: A. conjunctiva pallor. B. hemic murmur. C. tachycardia. D. no specific anemia-related findings.

Shelley has esophageal cancer and asks you if alcohol played a part in its development. How do you respond? A. "Your cancer was caused by your cigarette smoking, nothing else." B. "Alcohol is also a carcinogen." C. "Alcohol directly alters the DNA and causes mutations." D. "Alcohol modifies the metabolism of carcinogens in the esophagus and increases their effectiveness."

D. "Alcohol modifies the metabolism of carcinogens in the esophagus and increases their effectiveness."

Nancy recently had a mastectomy and refuses to look at the site. Her husband does all the dressing changes. When she comes into the office for a postoperative checkup, what would you say to her? A. "You'll look at it when you're ready." B. "You must look at it today." C. "Everything's going to be ok. It looks fine." D. "You have to accept this eventually; just glance at it today."

D. "You have to accept this eventually, just glance at it today." - You'll look at it when you're ready may mean that she will never be ready. It is better to take a matter of fact approach and attempt to have her at least glance at it.

Barbie, age 27, had her spleen removed after an automobile accident. You are seeing her in the office for the first time since her discharge from the hospital. She asks you how her surgery will affect her in the future. How do you respond? A. "Your red blood cell production will be slowed." B. "Your lymphatic system may have difficulty transporting lymph fluid to the blood vessels." C. "You'll have difficulty storing the nutritional agents needed to make red blood cells." D. "You may have difficulty salvaging iron from old red blood cells for use."

D. "You may have difficulty salvaging iron from old red blood cells for use."

Skip, age 4, is brought in to the office by his mother. His symptoms are pallor, fatigue, bleeding, fever, bone pain, adenopathy, arthralgias, and hepatosplenomegaly. You refer him to a specialist to perform to confirm a diagnosis? A. An enzyme-linked immunosorbent assay B. A monospot test C. A prothrombin time, partial thromboplastin time, bleeding time, complete blood count, and peripheral smear D. A bone marrow spear

D. A bone marrow smear

Macrocytic normochromic anemias are caused by A. Acute blood loss B. An infection or tumor C. A nutritional deficiency of iron D. A deficiency of folic acid

D. A deficiency of folic acid - Cell size is large and irregular.

Under which of the following circumstances is the reticulocyte count elevated? A. Aplastic anemia B. Iron-deficiency anemias C. Poisonings D. Acute blood loss

D. Acute blood loss - The reticulocyte count indicates the percentage of newly maturing red blood cells released into the circulating blood from the bone marrow.

Which ethnic group has the highest overall cancer incidence rate? A. Native Americans B. Asian and Pacific Islanders C. Hispanics D. African Americans

D. African Americans

A loss of DNA control over differentiation that occurs in response to adverse conditions is referred to as A. Hyperplasia B. Metaplasia C. Anaplasia D. Dysplasia

D. Dysplasia - Dysplastic cells show an abnormal degree of variation in size, shape and appearance and a disturbance in the usual arrangement.

Health maintenance in adults with sickle cell anemia includes which of the following? A. Early sterilization should be performed to prevent transmission of the disease B. Administer hepatitis A vaccine C. Avoid use of oral contraceptives because of increased risk of clotting D. Give folic acid 1mg PO daily

D. Give folic acid 1mg PO daily

One major approach to cancer prevention is A. Colonoscopy B. New drug trials C. Pap smears for women of all ages D. Host modification

D. Host modification - The three major approaches to cancer prevention are education, regulation, and host modification. Host modification refers to increasing knowledge about cancer genetics.

An increase of which immunoglobulin (Ig) signifies atopic disorders such as allergic rhinitis, allergic asthma, atopic dermatitis, and parasitic infection? A. IgG B. IgM C. IgA D. IgE

D. IgE

Your client, Shirley, has an elevated mean cell volume (MCV). What should you be considering in terms of diagnosis? A. Iron-deficiency anemia B. Hemolytic anemias C. Lead poisoning D. Liver disease

D. Liver disease - MCV indicates the average size of individual RBCs. MCV is elevated in megaloblastic anemias, liver disease, and some drugs

Bladder cancer can be detected early by A. An annual urine culture B. A bladder tumor marker blood test C. An annual cystoscopy D. None of the above, there is no early detection

D. None of the above, there is no early detection

Sherri's blood work return with a decreased mean cell volume (MCV) and a decreased mean cellular hemoglobin concentration (MCHC). What should you do next? A. Order a serum iron and total iron binding capacity (TIBC) B. Order a serum ferritin C. Order a serum folate level D. Order a serum iron, TIBC, and serum ferritin level

D. Order a serum iron, TIBC, and serum ferritin level - A decreased MCV and MCHC is indicative of a microcytic, hypochromic anemia.

Frank, a 66 year old white male who is on diuretic therapy, presents with an elevated hematocrit. He also has splenomegaly on examination, as well as subjective complaints of blurred vision, fatigue, headache, and tinnitus. You suspect A. Multiple myeloma B. Waldenstrom's macroglobulinemia C. Dehydration related to use of diuretics D. Polycythemia vera

D. Polycythemia vera - An elevated hematocrit due to contracted plasma volume, rather than increased red blood cell mass, may be due to diuretic use or may occur without obvious cause.

The test in which a small, radioactive tracer dose of cyanocobalamin is given by mouth an then a 24 hour urine sample is collected and assayed for radioactivity is the A. Coombs' test B. Oligonucleotide probe test C. Spherocytic test D. Schilling test

D. Shilling test

Your client, Ms. Jones, has an elevated platelet count. You suspect A. Systemic lupus erythematosus B. Infectious mononucleosis C. Disseminated intravascular coagulation (DIC) D. Splenectomy

D. Splenectomy - Increased platelet count is seen in myeloproliferative leukemias, polycythemia vera, and status post splenectomy

Which cancer can be cured with chemotherapy alone? A. Breast cancer B. Malignant melanoma C. Bladder cancer D. Testicular cancer

D. Testicular cancer

What is the mechanism of action of steroid hormones in cancer chemotherapy? A. They interfere with DNA or RNA synthesis B. They interfere with DNA replication by attacking DNA synthesis throughout the cell cycle C. They inhibit protein synthesis D. They alter the host environment for cell growth

D. They alter the host environment for cell growth

Prophylaxis for the first episode of Pneumocystitis jiroveci pneumonia in an adult or adolescent client infected with HIV is A. Isoniazid (Nydrazid) 300mg PO and pyridoxine (Vitamin B6 [Beesix] 50mg PO QD for 12 days B. Clarithromycin (Biaxin) 500mg PO BID for 2 weeks C. Rifampin (Rimactane) 600mg PO QD for 12 months D. Trimethoprim-sulfamethoxazole (TMP-SMZ) (Bactrim) DS 1 tablet PO QD for 10 days

D. Trimethoprim-sulfamethoxazole (TMP-SMZ) (Bactrim) DS 1 tablet PO QD for 10 days

You suspect that your new client Doug has hepatitis C, although he is asymptomatic at this point in time. Your suspicion is based on his medical history, which includes which of the following factors that has been identified as a red flag for this disease? A. Lactose intolerance B. Frequent sore throats and upper respiratory infections C. A history of mononucleosis at age 17 D. Unsafe sexual behaviors

D. Unsafe sexual behaviors

A metastatic tumor from below the diaphragm is suspected when you palpate which of the following nodes in the left supraclavicular space? A. Wringer's node B. Sims' node C. Wiskott-Aldrich node D. Virchow's node

D. Virchow's node - Virchow's node is an enlarged left supraclavicular node usually infiltrated with a metastatic tumor from below the diaphragm, especially of gastrointestinal origin

Antibodies (inhibitors) directed against factor VIII can arise spontaneously in a number of situations. These include A. Clients who have mitral regurgitation B. As sequelae to a strep infection C. Clients on antibiotics D. Women who are several weeks postpartum after a normal labor and delivery

D. Women who are several weeks postpartum after a normal labor and delivery

b. decreases vitamin C absorption

Jane asks how smoking increases the risk for folic acid deficiency. You respond that smoking: a. causes small vessel disease and constricts all vessels that transport essential nutrients b. decreases vitamin C absorption c. affects the liver's ability to store folic acid d. causes nausea, thereby inhibiting the appetite and ingestion of food rich in folic acid

c. you must observe these precautions forever

Janice had a modified mastectomy with radiation tx 10 years ago. She asks when she can have her blood pressure or needle sticks taken in the affected arm. How do you respond? a. if its been 10 yrs and you've had no problems,you can discontinue those precautions b. because you didn't have a radical mastectomy, you can do those things now c. you must observe these precautions forever d. as long as you do limb exercises and have established collateral drainage, you can discontinue these precautions

c. immunotherapy

Janice is having biological therapy for her pancreatic cancer. What kind of tx is this? a. surgery b. radiation therapy c. immunotherapy d. chemotherapy

b. 6 months

Jill has just been given a dx of HIV infection and has a normal initial Pap test. When do the CDC guidelines state that she should have a repeat Pap smear? a. 3 months b. 6 months c. one year d. she should have a colposcopy every yr rather than an Pap smear

d. polycythemia vera

Jim, a 66 y/o white male who is on diuretic tx, presents with an elevated hematocrit. He also has splenomegaly on exam, as well as subjective c/o of blurred vision, fatigue, headache, and tinnitus. You suspect: a. multiple myeloma b. Waldenstrom's macroglobulinemia c. dehydration related to the diuretics d. polycythemia vera

c. immunize John with diphtheria, tetanus, and pertussis; Haemophilus influenzae type b (HIB); hepatitis B (HBV); and poliomyelitis vaccines

John is a 6 month old with newly dx sickle cell disease. His mother brings him to the clinic for a well-baby visit. Which of the following should you do on this visit? a. tell the parents that John will not be immunized because of his dx b. tell the parents that John should not go to day care c. immunize John with diphtheria, tetanus, and pertussis; Haemophilus influenzae type b (HIB); hepatitis B (HBV); and poliomyelitis vaccines d. immunize John with measles, mumps, and rubella, HIB; and HBV vaccines only

c. of thrombocytopenia, in which the life expectancy may be only 2 yrs

Julie's brother has chronic lymphatic leukemia. She overheard that he was in state IV and asks what this means. According to the Rai classification system, stage IV is a stage: a. at which the lymphocytes are greater than 10,000 mm3 b. with an absolute lymphocytosis, in which the clt may live 7-10 yrs or more c. of thrombocytopenia, in which the life expectancy may be only 2 yrs d. of anemia

c. iron-deficiency anemia

Laurie, age 29, appears with the following signs: pale conjunctiva and nailbeds, tachycardia, heart murmur, cheilosis, stomatitis, splenomegaly, koilonychia, and glossitis. What do you suspect? a. vitam B12 deficient b. folate deficiency c. iron-deficiency anemia d. chronic fatigue syndrome

a. obtain a lead level

Lisa, age 2, had a complete blood count drawn at her last visit. It indicates that she has a microcytic hypochromic anemia. What should you do now at this visit? a. obtain a lead level b. instruct Lisa's parents to increase the amt of milk in her diet c. start Lisa on ferrous sulfate (feosol) and check the CBC in 6 wks d. recheck the CBC on this visit

c. we will stop at the store and buy plastic eating utensils

Mandy's 16 y/o daughter has hepatitis A. Which of the following statements made by Mandy indicates that she understand the teaching you have just completed? a. I guess she needs to be hospitalized until she is recovered b. we will keep her at home with strict isolation precautions c. we will stop at the store and buy plastic eating utensils d. we will stop at the drugstore and pick up prescription medications immediately

c. abdominal pain, pallor, and tachycardia

Mandy, age 6, recently was dc fromt he hospital after a sickle cell crisis. You are teaching her parents to be alert to the manifestations of splenic sequestration and tell them to be alert to: a. vomiting and diarrhea b. decreased mental acuity c. abdominal pain, pallor, and tachycardia d. abdominal pain and vomiting

c. yes, you have an increased risk for hormone dependent cancers because of your obesity

Maria asks if being overweight predisposes her to cancer. How do you respond? a. no you have the same risk as a normal weight individual b. you have less of a risk of cancer than normal weight individuals because you have protein stores to combat mutant cells c. yes, you have an increased risk for hormone dependent cancers because of your obesity d. yes, you have an increased risk because you have many more cells in all the organs of your body

c. hepatitis D

Maurice is an IV drug abuser with chronic hepatitis B (HBV). The development of which type of hepatitis poses the greatest risk to a clt with HBV? a. hepatitis A b. hepatitis C c. hepatitis D d. hepatitis E

c. adenocarcinomas of the colon, lung, breast, ovary, stomach, and pancrease

Mindy states that a relative is having a carcinoembryonic antigen (CEA) test done to detect some type of cancer. She wants to know what kind. You tell her a CEA is performed to detect: a. adenocarcinoma of the prostate b. medullary cancer of the thyroid c. adenocarcinomas of the colon, lung, breast, ovary, stomach, and pancreas d. multiple myeloma

c. cytomegalovirus infection

Mrs. James c/o unilateral blurry vision and partial blindness in the left eye. On PE, you find decreased peripheral vision on her left side. Funduscopic exam reveals cottom-wool spots. Your most likely dx is: a. cryptococcosis b. toxoplasmosis c. cytomegalovirus infection d. herpes simplex virus infection

d. stop the warfarin today and repeat the INR tomorrow

Mrs. Smith is a 72 y/o pt who takes warfarin for chronic atrial fibrillation. Today his INR is 4.0 His CBC is normal and there is no evidence of bleeding. the NP should: a. stop the warfarin for the next four days and repeat the INR on day 5 b. admit to the hospital immediately c. administer Vitamin K and repeat INR in two hrs d. stop the warfarin today and repeat the INR tomorrow

d. you have to accept this eventually; just glance at it today

Nancy recently had a mastectomy and refuses to look at the site. Her husband does all the dressing changes. When she comes into the office for a postoperative checkup, what would you say to her? a. you will look at it when you are ready b. you must look at it today c. everything is going to be OK, it looks fine d. you have to accept this eventually; just glance at it today

rare autosomal recessive disorder that causes chronic hemolytic anemia, usually with the onset in childhood

Pyruvate kinase deficiency is a

c. cryptosporidiosis

Raina has HIV infection and is having a problem with massive diarrhea. You suspect the cause is: a. cryptococcosis b. toxoplasmosis c. cryptosporidiosis d. cytomegalovirus

a. latex condoms

Sally has HIV infection and ask which method of birth control, other than abstinence, would be best for her. You suggest a. latex condoms b. the spermicide nonoxynol-9 c. an IUD d. an oral contraceptive

b. endoscopic retrograde cholangiopancreatography

Sam is being worked up for pancreatic cancer. He states that the doctor wants to put a "scope" in and inject dye into his ducts. He wants to know more about this. What procedure is he referring to? a. percutaneous transhepatic cholangiography b. endoscopic retrograde cholangiopancreatography c. angiography d. upper GI series

d. bone marrow smear

Sam, age 4, is brought into the office by his mother. His sxs are pallor, fatigue, bleeding, fever, bone pain, adenopathy, arthralgias, and hepatosplenomegaly. You refer him to a specialist. Which of the following tests do you expect the specialist to perform to confirm a dx? a. an enzyme-linked immunosorbent assay b. monospot test c. a prothrombin time, partial thromboplastin time, bleeding time, complete blood count, and peripheral smear d. bone marrow smear

b. brain tumor

Sam, age 5, is receiving radiation tx for his acute lymphocytic leukemia. He is at increased risk of developing which type of cancer as a secondary malignancy when he becomes an adult? a. chronic lymphocytic leukemia b. brain tumor c. liver cancer d. esophageal cancer

c. 1 hr before eating or between meals

Sandra, age 19 is pregnant. She is c/o breathlessness, tiredness, weakness, and is pale. After dxing anemia, you order medication and tell her to take it: a. only with meals because it can be irritation to the stomach b. in the morning if she experiences morning sickness c. 1 hr before eating or between meals d. at bedtime

b. 5,000 to 8,000 mm3

Sandy is being given platelets because of acture leukemia. One pack of platelets should raise her count by how much? a. 2, 000 to 4,000 mm3 b. 5,000 to 8,000 mm3 c. 9,000 to 12,000 mm3 d. about 15, 000 mm3

a. aspirin or aspirin compounds

Sara comes today with numerous petechiae on her arms. You know that she is not taking warfarin (coumadin). What other drugs do you ask her about? a. aspirin or aspirin compounds b. antihypertensive agents c. oral contraceptives d. anticonvulsants

d. alcohol modifies the metabolism of carcinogens in the esophagus and increases their effectiveness

Shelly has esophageal cancer and ask you if alcohol played a part in its development. How do you respond? a. your cancer was caused by your cigarette smoking, nothing else b. alcohol is also a carcinogen c. alcohol directly alters the DNA and causes mutations d. alcohol modifies the metabolism of carcinogens in the esophagus and increases their effectiveness

d. order a serum iron, TIBC, and serum ferritin level

Sherri's blood work returns with a decreased mean cell volume (MCV) and a decreased mean cellular hemoglobin concentration (MCHC). What should you do next? a. order a serum iron and total iron binding cap0acity (TIBC) b. order a serum ferritin c. order a serum folate level d. order a serum iron, TIBC, and serum ferritin level

b. perform a fecal occult blood test

Stuart, age 49, has sltly reduced hemoglobin and hematocrit readings. What is your next action after you ask him about his diet? a. repeat the lab tests b. perform a fecal occult blood test c. start him on an iron preparation d. start him on folic acid

. microcytic, hypochromic red cells

Thalassemia minor can be recognized by: a. microcytic, normochromic red cells b. normocytic, normochromic red cells c. microcytic, hypochromic red cells d. normocytic, hyperchromic red cells

d. Schilling test

The test in which a small, radioactive tracer dose of cyanocobalamin is given by mouth and then a 24 hr urine sample is collected and assayed for radioactivity is the: a. Coombs' test b. oligonucleotide probe test c. sperocytic test d. Schilling test

b. hodgkin's lymphoma

Your clt, George, age 60 presents with pruritus and c/o of lymphadenopathy in his neck. He also c/o of night sweats and noticed a low-grade fever. He has not lost any wt and otherwise feels well. He is widowed and has been dating a new woman recently On PE, you find enlarged supraclavicular nodes. a. lung cancer b. hodgkin's lymphoma c. a lingering viral infection from a bout of flu he had 6 wks ago c. non-Hodgkin's lymphoma

c. hgb= 9.6mg/dL

a 15 y/o is about 10% below her ideal body weight. She c/o dizziness when she stands. Lab studies were performed. Besides malnutrition, what else could account for her dizziness? a. BUN is mildly elevated b. glucose=80mg/dL c. hgb= 9.6mg/dL d. potassium is 3.5meq/L

a. doxycyline

a 16 y/o has been dxed with Lym disease. Which drug should be used to tx him? a. doxycyline b. amoxicillin-clavulanate c. trimethoprim-sulfamethoxazole d. cephalexin

d. multi-vitamin with iron

a 26 y/o female has thalassemia minor. What should be limited in her diet to avoid hepatotoxicity? a. vitamin C b. vitamin B12 c. folic acid d. multi-vitamin with iron

c. the pt should consider hepatitis B immunization

a 35 y.o pt has the following lab values. How should they be interpreted? HBsAg(-), HBsAB(-), HBcAb(-) a. the pt had hepatitis B b. the pt has hepatitis B c. the pt should consider hepatitis B immunization d. the pt has had hepatitis B immunization

d. the pt has been immunized

a 40 y/o pt has the following lab values. How should they be interpreted? HBsAg(-), HBsAb(+), HBcAb(-) a. the pt has hepatitis b. the pt had hepatitis c. the pt should consider immunization d. the pt has been immunized

b. the pt does not have HCV

a 43 y/o pt who has been dx with hepatitis B has the following lab values. How should they be interpreted based on these values? HCV IgG(-), RIBA (radio immuno blot assay) (-) a. the pt has HBV and HCV b. the pt does not have HCV c. the pt could have HCV d. the results are indeterminate

a. the pt has hepatitis

a 45 y/o pt has the following lab values. How should they be interpreted? HBsAg(+), HBsAb(-), HBcAb(+) a. the pt has hepatitis b. the pt had hepatitis c. the pt should consider immunization d. the results are indeterminate

a. the pt has HCV

a 48 y/o pt has the following lab values. How should they be interpreted? HCV IgG(+), RIBA (radio immuno blot assay) (+) a. the pt has HCV b. the pt does not have HCV c. the pt should consider immunization d. the results are indeterminate

d. osteoarthritis

a 65 y/o male is being txed with oral medications for HTN, hyperlipidemia, diabetes and osteoarthritis. The most likely reason for his iron deficiency anemia is oral tx for: a. hypertension b. hyperlipidemia c. diabetes d. osteoarthritis

a. multiple myeloma

a 66 y/o African American male c/o pain in his trunk, especially his ribs. Cardiovascular disease is ruled out. He has a normocytic, normochromic anemia with hypercalcemia. The differential dx should include: a. multiple myeloma b. lymphoma c. leukemia d. parathyroid disease

c. alcohol abuse

a 70 y/o male has an elevated MCV with an anemia. His triglycerides are 420. What should be suspected? a. pernicious anemia b. folate deficiency c. alcohol abuse d. hypertriglyceridemia

b. lymphoma

a 70 y/o male has lymph nodes in his axillary and inguinal areas that are palpable but non-tender. He states that he feels well today. What should be included in a differential dx for this pt? a. leukemia b. lymphoma c. asymtomatic lymphadenitis d. cat-scratch disease

c. acetaminophen

a 70 y/o presents to the NPs office for a well exam today. What medication probable has no affect on screening for occult blood in the stool? a. aspirin b. clopidogrel c. acetaminophen d. ibuprofen

b. folic acid and pernicious

a 75 y/o pt who has multiple chronic diseases has been in very poor healthy for a decade. What type of anemias is he most likely to exhibit? a. iron deficiency and folic acid b. folic acid and pernicious c. iron deficiency and anemia of chronic disease d. thalassemia and vitamin B12

b. pernicious anemia

a B12 deficiency can produce: a. microcytic anemia b. pernicious anemia c. sideroblastic anemia d. insomnia

b. iron deficiency anemia

a child and father live in an old house. they both are found to be lead toxic. What type anemia is typically observed in pts who are lead toxic? a. pernicious anemia b. iron deficiency anemia c. lead anemia d. anemia of chronic disease

c. start therapy now because the clt's CD4 count is less than 500 and the HIV RNA level is > than 10,000

a clt with HIV infection has a CD4 count of 305 and an HIV RNA level of 13,549. The clt is asymptomatic. What is your course of action? a. negotiate with your clt a time to start therapy b. recheck the lab results in 1 month. If the counts remain like this, start tx. c. start therapy now because the clt's CD4 count is less than 500 and the HIV RNA level is > than 10,000 d. wait to start therapy until the clt becomes asymptomatic

a. drug fever

a clt with HIV infection has a fever of unknown origin (FUO). Which of the following is a possible cause of an FUO in a clt with HIV? a. drug fever b. upper respiratory infection c. nothing specific; this is a systemic disease manifestation d. urinary tract infection

a. avoid aspirin and sulfa drugs

a female pt has been dx with Glucose-6-phosphate dehydrogenase deficiency (G6PD). What should be done to prevent lysis of red cells in this pt? a. avoid aspirin and sulfa drugs b. minimize iron consumption in her diet c. receive immunizations timely d. consume adequate amts of water daily

a. dark green leafy vegetables and dried peas and beans

a female vegetarian presents to your clinic with iron deficiency anemia. What can the nP suggest she eat to help with resolution of iron deficiency anemia? a. dark green leafy vegetables and dried peas and beans b. mushrooms, oatmeal, and whole grain breads c. beets, broccoli, and beef d. baked potatoes, beets, and broccoli

c. the HIV status of the pt further testing

a healthcare provider was stuck with a needle from a pt suspected to be infected with HIV. a rapid HIV test was performed and was found to be positive. this means that the: a. healthcare provider has been infected with HIV b. the pts is infected with HIV c. the HIV status of the pt further testing d. the HIV status of the health provider requires further testing

d. dysplasia

a loss of DNA control over differentiation that occurs in response to adverse conditions is referred to as: a. hyperplasia b. metaplasia c. anaplasia d. dysplasia

a. RDW

a measure of the degree of variation in red cell size in indicated by: a. RDW b. MCHC c. MCV d. MCH

d. Virchow's node

a metastatic tumor from below the diaphragm is suspected when you palpate which of the following nodes in the left supraclavicular space? a. Wringer's node b. Sim's node c. Wiskott-Aldrich node d. Virchow's node

b. hypersplenism

a platelet count less than 150,000/mm3 may indicate: a. possible hemorrhage b. hypersplenism c. polycythemia vera d. malignancy

a. no tx is needed

a pt calls your office. He states that he just came in from the woods and discovered a tick on his upper arm. He states that he has removed the ticka nd the area is slightly red. What should he be advised? a. no tx is needed b. he should be prescribed doxycycline c. he needs a topical scrub to prevent Lyme disease d. he should come to the office for a ceftriaxone injection

c. he has an infection of unknown origin

a pt demonstrates leukocytosis. This means: a. he has a bacterial infection b. he has a viral infection c. he has an infection of unknown origin d. he does not have an infection

b. order a CBC

a pt exhibits petechiae on both lower legs but has no other complaints. How should the NP proceeds? a. refer to hematology b. order a CBC c. order blood cultures d. stop aspirin and re-assess in one week

b. more susceptible to bacterial infection

a pt had a splenectomy after an automobile accident 3 months ago. Pts who are asplenic are: a. at an increased risk of hepatomegaly b. more susceptible to bacterial infection c. at risk for bleeding disorders d. more likely to exhibit anemia

b. iron deficiency anemia

a pt has CBC results that indicate a microcytic, hypochromic anemia. The NP should suspect: a. pernicious anemia b. iron deficiency anemia c. vitamin B12 deficiency d. sickle cell anemia

b. lymphocytes

a pt has HBV. he probably has a predominance of: a. leukocytes b. lymphocytes c. neutrophils d. eosinophils

c. cephalosporins

a pt has a penicillin allergy. He describes an anaphylactic reaction. Which medication class should be specifically avoided in him? a. quinolones b. macrolides c. cephalosporins d. tetracyclines

c. he is immune to hepatitis B

a pt has a positive hepatitis B surface antibody. His core antibody is negative. This indicates: a. he has acute hepatitis B and needs immunization b. he has chronic hepatitis B c. he is immune to hepatitis B d. he needs immunization to hepatitis B

d. cervical lymphadenopathy may be prominent

a pt has been dxed with mononucleosis. Which statement is correct? a. he is likely an adolescent male b. splenomegaly is more likely than not c. he cannot be co-infected with Strept d. cervical lymphadenopathy may be prominent

d. influenza

a pt has had an anaphylactic rx to eggs. She should avoid immunization with: a. varicella b. hepatitis B c. IPV d. influenza

a. increased TIBC

a pt has heavy menses. which lab value below reflects an iron deficiency anemia? a. increased TIBC b. decreased TIBC c. normal serum iron d. decreased RDS

c. he has no immunity to hepatitis A

a pt has the following lab values. What does this mean? Hepatitis A: (-) IgM (-)IgG a. he has Hepatitis A b. he has immunity to hepatitis A c. he has no immunity to hepatitis A d. more data is needed

b. on an empty stomach

a pt is being txed for iron deficiency anemia. Iron is better absorbed: a. with food b. on an empty stomach c. with a food rich in vitamin C d. in the evening

b. hypochronic

a pt is found to have an anemia. The pt's MCH is decreased. The pt's anemia can be described as: a. macrocytic b. hypochronic c. macrochromic d. normochromic

a. hyperchromic

a pt is found to have an anemia. The pt's MCH is increased. The pt's anemia can be described as: a. hyperchromic b. hypochronic c. macrochromic d. normochromic

d. normochromic

a pt is found to have an anemia. The pt's MCH is normal. The pt's anemia can be described as: a. macrocytic b. normocytic c. macrochromic d. normochromic

c. microcytic

a pt is found to have an anemia. The pt's MCV is decreased. The pt's anemia can be described as: a. macrocytic b. normocytic c. microcytic d. normochromic

a. macrocytic

a pt is found to have an anemia. The pt's MCV is increased. The pt's anemia can be described as: a. macrocytic b. normocytic c. macrochromic d. normochromic

b. normocytic

a pt is found to have an anemia. The pt's MCV is normal. The pt's anemia can be described as: a. macrocytic b. normocytic c. macrochromic d. normochromic

c. eosinophils

a pt is having an allergic rx to seafood. Which white cell will probably be increased? a. neutrophil b. lymphocytes c. eosinophils d. basophils

a. receive doxycycline for Lyme disease

a pt with a positive hx of a tick bite about two weeks ago and erythema migrans has a positive ELISA for borrelia. The Western blot is positive. How should he be managed? a. receive doxycycline for Lyme disease b. receive penicillin for rocky Mountain spotted fever c. he does not have Lyme disease or rocky Mountain spotted fever d. he needs additional testing to confirm Lyme disease

a. an antacid

a pt with iron deficiency anemia takes an iron supplementation daily. What should he be advised to avoid within a couple of hrs of taking iron? a. an antacid b. heavy exercise c. potassium supplements d. grapefruit juice

c. he could have a negative monospot

a pt with mononucleosis has pharyngitis, fever, and lymphadenopathy. His sxs started 3 days ago a. he will have a positive monospot b. he will have a normal CBC c. he could have a negative monospot d. he could have a positive monospot and normal CBC

a. lymphocytosis

a pt with mononucleosis wuld most likely have: a. lymphocytosis b. eosinophilia c. leukocytosis d. monocytosis

c. glossitis

a pt with pernicious anemia may be observed to have: a darkening of the skin b. joint aches c. glossitis d. thrombocytopenia

b. demonstrates the amt of iron in storage

a serum ferritin level: a. could indicate thalassemia in a pt b. demonstrates the amt of iron in storage c. indicates when a pt has iron deficiency anemia d. confirms a low hgb and hct

b. memory issue and glossitis

a vitamin b-12 deficiency might be suspected in an older pt with what complaints? a. fatigue and restless legs b. memory issue and glossitis c. painful legs with exercise d. insomnia and anorexia

A female patient has been diagnosed with Glucose-6-phosphate dehydrogenase deficiency (G6PD). What should be done to prevent lysis of red cells in this patient? a. Avoid aspirin and sulfa drugs b. Minimize iron consumption in her diet c. Receive immunizations timely d. Consume adequate amounts of water daily

a. Avoid aspirin and sulfa drugs Rationale: G6PD deficiency is an X-linked disorder. This mean it is carried on the X chromosome. Both male and female infants may exhibit this. G6PD is the most common enxymatic disorder of red blood cells in humans. These patients should avoid certain substances like aspirin, sulfa drugs, and fava beans because consumption can precipitate lysis of red blood cells. Timely immunizations and adequate daily water consumption are beneficial to all patients but not specifically those with G6PD.

Which anemia is described as a macrocytic anemia? a. Folic acid deficiency anemia b. Thalassemia c. Iron deficiency anemia d. Sickle cell anemia

a. Folic acid deficiency anemia Rationale: Folic acid and Vitamin B12 deficiency anemias are characterized by macrocytic red cells. Thalassemia and iron deficiency anemias are microcytic anemias. Sickle-cell anemia is characterized by sickle-shaped red cells; hence the name, sickle cell anemia.

An older adult has suspected vitamin B12 deficiency. Which of the following lab indices is most indicative of a vitamin B12 deficiency? a. Increased MCV b. Increased MCH c. Decreased hematocrit d. Thrombocytosis

a. Increased MCV Rationale: A Vitamin B12 deficiency can produce an anemia called pernicious anemia. This is most commonly found in older adults and is characterized by macrocytosis, and increased MCV. In other words, the red cells are larger than expected. An increased MCH may be seen in a Vitamin B12 deficiency, but this is unusual. A decreased hematocrit will be seen in most anemias, but this is not specific to a B12 deficiency. Thrombocytosis refers to an increased number of platelets in the blood stream.

Which disease listed below can be associated with lymphocytosis? a. Mononucleosis b. Strep throat c. Iron deficiency anemia d. Hemolytic anemia

a. Mononucleosis Rationale:

Which white cell should be present in the greatest number in a patient who is healthy today? a. Neutrophils b. Basophils c. Eosinophils d. Lymphocytes

a. Neutrophils Rationale: Neutrophils usually comprise 60-70% of white cells in a patient who has no infection. Other names for neutrophils are "polys", also known as polymorphonuclear leukocytes; or "segs", also known as segmented neutrophils. Any of these terms can be used because they all refer to the same white cells.

A measure of the degree of variation of red cell size is indicated by a. RDW b. MCHC c. MCV d. MCH

a. RDW Rationale:

The laboratory identifies metamyelocytes in a 50-year-old patient who had a CBC performed. What might be an expected finding in this patient? a. Splenomegaly b. Elevated liver function studies c. Decreased uric acid level d. Decreased platelet count

a. Splenomegaly Rationale:

A 66-year-old African American male complains of pain in his trunk, especially his ribs. Cardiovascular disease is ruled out. He has a normocytic, normochromic anemia with hypercalcemia. The differential diagnosis should include a. multiple myeloma b. lymphoma c. leukemia d. parathyroid disease

a. multiple myeloma Rationale: Multiple myeloma is a neoplastic proliferation in the bone marrow that results in skeletal destruction. It is more common in older patients; the average age of diagnosis is 66 years. Common clinical findings are pain in the long bones, especially those of the trunk and back. Accompanying findings are anemia, usually normocytic/normochromic, hypercalcemia, and renal insufficiency. Parathyroid disease can produce increased calcium levels, but it is not associated with pain in the trunk.

a. increased RDW

an 18 y/o female pt has iron deficiency anemia. If this anemia has occurred in the past 3-4 months, what might be expected? a. increased RDW b. decreased RDW c. elevated serum ferritin d. decreased total iron binding capacity

d. about 65 yrs old

an African American male c/o of pain in his back and trunk. He is dx with muliple myeoloma. He is probably: a. about 21 y/o b. about mid 30s c. younger than 50 yrs d. about 65 yrs old

d. may have a GI bleed

an elderly male dx with a microcytic, hypochromic anemia: a. should be worked up for a malignancy b. might be consuming excessive amts of alcohol c. will have a decreased RBC count d. may have a GI bleed

b. pernicious anemia

an example of a macrocytic anemia is: a. iron deficiency anemia b. pernicious anemia c. anemia of chronic disease d. sideroblastic anemia

d. IgE

an increase of which immunoglobulin (Ig) signifies atopic disorders such as allergic rhinitis, allergic asthma, atopic dermatitis, and parasitic infestation? a. IgG b. IgM c. IgA d. IgE

b. associated with chronic disease

an obese 78 y/o male with poorly controlled HTN and diabetes has a normocytic, normochromic anemia. This anemia is likely: a. iron deficiency b. associated with chronic disease c. pernicious anemia d. folic acid deficiency anemia

a. increased MCV

an older adult has suspected B12 deficiency. Which of the following lab indices is most indicative of a B12 deficiency? a. increased MCV b. increased MCH c. decreased hematocrit d. thrombocytosis

b. macrocytosis

an older pt has suspected B12 deficiency. Which of the following lab indices is more indicative of a B12 deficiency? a. microcytosis b. macrocytosis c. leukocytosis d. thrombocytosis

d. women who are several weeks postpartum after a normal labor and delivery

antibodies (inhibitors) directed against factor VIII can arise spontaneously in a number of situations. These include a. clts who have mitral regurgitation b. as sequelae to a strep throat c. clts on antibiotics d. women who are several weeks postpartum after a normal labor and delivery

A 75-year-old patient who has multiple chronic diseases has been in very poor health for a decade. What type of anemia is he most likely to exhibit? a. Iron deficiency and folic acid b. Folic acid and pernicious c. Iron deficiency and anemia of chronic disease d. Thalassemia and Vitamin B12

b. Folic acid and pernicious Rationale: Having multiple chronic illnesses does increase the likelihood of having folic acid deficiency. Pernicious anemia, secondary to Vitamin B12 deficiency, is commonly seen in older patients with chronic illnesses too. Many patients have both concurrently. Patients with folic acid deficiency and/or Vitamin B12 deficiency are more likely to be elderly, in poor health, and have poor diets. It may also be seen in patients who consume excessive amounts of alcohol. Nothing in history indicates this as the etiology.

Which adult female patient has an anemia? a. Hgb = 14.4 b. Hct = 35.2 c. Hgb = 13.5 d. Hct = 40.1

b. Hct = 35.2 Rationale:

A 70-year-old male had lymph nose in his axillary and inguinal areas that are palpable but not tender. He states that he feels well today. What should be included in a differential diagnosis for this patient? a. Leukemia b. Lymphoma c. Asymptomatic lymphadenitis d. Cat-scratch fever

b. Lymphoma Rationale: Lymphoma is malignancy of the lymphatic system. Hodgkin and Non-Hodgkin lymphomas are examples. In older patients, Non-Hodgkin's lymphoma is considerably more common. It is characterized by enlarged lymph nodes and may be accompanied by fever, cough, night sweats, and fatigue. Asymmetric adenopathy is most common in Hodgkin lymphoma; in Non-Hodgkin lymphoma, adenopathy is disseminated.

What hallmark finding is associated with both B12 and folate deficiencies? a. Glossitis b. Macrocytosis c. Memory loss d. An MCV < 80 fL

b. Macrocytosis Rationale:

An obese 78-year-old male with poorly controlled hypertension and diabetes has a normocytic, normochromic anemia. This anemia is likely a. iron deficiency b. associated with chronic disease c. pernicious anemia d. folic acid deficiency anemia

b. associated with chronic disease Rationale: This is a classic anemia of chronic disease. This is especially evident when chronic diseases are poorly controlled. It is most frequently characterized by a normocytic, normochromic anemia. Iron deficiency anemia is microcytic, hypochromic anemia. Iron deficiency anemia is microcytic, hypochromic. Pernicious anemia is associated with B12 deficiency, and folic acid deficiency anemia are both macrocytic anemias.

A patient has CBC results that indicate a microcytic, hypochromic anemia. The nurse practitioner should suspect a. pernicious anemia b. iron deficiency anemia c. vitamin B12 deficiency d. sickle cell anemia

b. iron deficiency anemia Rationale: Iron deficiency anemia is characterized by a microcytic, hypochromic anemia. Pernicious anemia, caused usually by a Vitamin B12 deficiency, is a macrocytic anemia. Sickle-cell anemia is characterized by sickle-shaped cells.

A patient had a splenectomy after an automobile accident 3 months ago. Patients who are asplenic are a. at an increased risk of hepatomegaly b. more susceptible to bacterial infection c. at risk for bleeding disorders d. more likely to exhibit anemia

b. more susceptible to bacterial infection Rationale:

A patient is found to have an anemia. The patient's MCV is normal. The patient's anemia can be described as a. macrocytic b. normocytic c. macrochromic d. normochromic

b. normocytic Rationale: The MCV, mean corpuscular volume, indicates the size of the red cells. If this is normal, it is described as a normocytic anemia. If the MCV is decreased, the anemia is described as a microcytic anemia. When the MCV is increased, the anemia is described as microcytic. Macrochromic does not describe red blood cells. Normochromic describes the degree of hemoglobin incorporated into red cells and is indicated by the MCH.

A patient is being treated for iron deficiency anemia. Iron is better absorbed a. with food b. on an empty stomach c. with a food rich in Vitamin C d. in the evening

b. on an empty stomach Rationale: Iron is better absorbed on an empty stomach. This is the most efficient way to absorb iron. However, it is poorly tolerated on an empty stomach and many times patients have to eat something in order to tolerate oral forms of iron. If this is the case, it should be taken with a food rich in Vitamin C since this enhances iron absorption. Time of day does not affect iron absorption.

An example of macrocytic anemia is a. iron deficiency anemia b. pernicious anemia c. anemia of chronic disease d. sideroblastic anemia

b. pernicious anemia Rationale: A macrocytic anemia indicates that size of red blood cells is larger than expected, hence, the prefix, macro. Iron deficiency anemia produces microcytic anemia. Anemia of chronic disease can produce a microcytic or normocytic anemia, but usually a normocytic anemia is evident. Sideroblastic anemia produces a microcytic anemia.

d. you may have difficulty salvaging iron from old red blood cells for reuse

barbie, age 27, had her spleen removed after an automobile accident. You are seeing her in the office for the first time since her dc from the hospital. She ask you how her surgery will affect her in the future. How do you respond? a. your red blood cell production will be slowed b. your lymphatic system may have difficulty transporting lymph fluid to the blood vessels c. you will have difficulty storing the nutritional agents needed to make red blood cells d. you may have difficulty salvaging iron from old red blood cells for reuse

c. confirm the dx with biopsy

before initiating cancer tx, the first crucial step is to: a. stage the cancer b. define the goals of tx c. confirm the dx with biopsy d. choose a tx plan from the many tx options

d. none of the above; there is no early detection

bladder cancer can be detected early by: a. an annual urine culture b. a bladder tumor marker blood test c. an annual cystocopy d. none of the above; there is no early detection

A patient is having an allergic reaction to seafood. Which white cell will probably be increased? a. Neutrophils b. Lymphocytes c. Eosinophils d. Basophils

c. Eosinophils Rationale: In a CBC, the white cell that increases during an allergic reaction is the eosinophil. Generally, the percentage of eosinophils in a normal CBC is 2-4%. Increases in eosinophils are observed in patients with allergic reactions as well as patients with parasitic infections.

Which anemias are described as microcytic, hypochromic anemia? a. Vitamin B12 and iron deficiency anemia b. Folic acid and iron deficiency anemia c. Iron deficiency anemia and thalassemia d. Sickle cell anemia and anemia if chronic disease

c. Iron deficiency anemia and thalassemia Rationale: Iron deficiency anemia is characterized by small (microcytic), pale (hypochromic) red cells. Thalassemia is a microcytic, hypochromic anemia also. There is a strong familial component. Folic acid and Vitamin B12 deficiency anemias are characterized by macrocytic red cells. Sickle-cell anemia is characterized by sickle-shaped red cells. Hence, the name sickle cell anemia.

A patient with pernicious anemia may be observed to have a. darkening of the skin b. joint aches c. glossitis d. thrombocytopenia

c. glossitis Rationale: Glossitis is an inflammation of the tongue with a change in its usual color. It may be tender also. This is commonly observed in patients who have a Vitamin B12 deficiency anemia (precarious anemia). The tongue can appear pale, bright red, or swollen. Glossitis is not seen in all patients with pernicious anemia, but this finding should prompt the healthcare provider to assess Vitamin B12 and folate levels. Pernicious anemia is not associated with any of the other choices in this question.

Thrombocytopenia may present as a. fatigue b. fever c. purpura d. a butterfly rash

c. purpura Rationale:

Lead toxicity can be associated with a. folic acid deficiency anemia b. anemia of chronic disease c. sideroblastic anemia d. vitamin B12 deficiency

c. sideroblastic anemia Rationale: Sideroblastic anemia occurs when iron is unable to be incorporated into the hemoglobin molecule despite there being adequate amounts of iron available. An iron deficiency anemia results. This can be due to an inherited enzyme deficiency, it can be acquired as in the case of lead toxicity, or it can be of idiopathic origin. Lead can produce a sideroblastic anemia because it prevents iron from being incorporated into the heme portion of the hemoglobin molecule. Sideroblasts may be visible on blood smear. They represent and accumulation of iron in the cell's mitochondria.

a. cognitive, motor, and behavioral changes

clts with AIDS typically experience the neurological symptomatic triad consisting of: a. cognitive, motor, and behavioral changes b. seizures, paresthesias, and dysesthesias c. Kaposi's sarcoma, cryptococcal meningitis, and depression d. seizures, depression, and paresthesias

Which choice below can be attributed to the two most common causes of iron deficiency anemia in adults? a. Bleeding in the gastrointestinal tract and through loss of bone mass b. Aging and menses c. Poor diet and lack of adequate iron intake d. Gynecologic losses and bleeding in the gastrointestinal tract

d. Gynecologic losses and bleeding in the gastrointestinal tract Rationale: The most common body systems associated with blood loss are the gynecologic tract (GYN) and the gastrointestinal (GI) tract in patients of all ages. In women of menstruating age, the GYN tract is a common source of blood loss, especially when menses is heavy. The GI tract is more likely to be the source of blood loss when adults are iron deficient, especially if they possess risk factors for iron deficiency anemia, such as chronic aspirin or NSAID use.

A 26-year-old female has thalassemia minor. What should be limited in her diet to avoid hepatotoxicity? a. Vitamin C b. Vitamin B12 c. Folic Acid d. Multi-vitamin with Iron

d. Multi-vitamin with Iron Rationale: A patient with thalassemia minor has a disease characterized by overproduction of one chain of the hemoglobin molecule. Beta thalassemia patients usually require no specific therapy. These patients are asymptomatic, but may be chronically, mildly anemic. They should avoid an iron overload by supplementation, but, generally, are able to safely take iron when iron deficiency anemia and the thalassemia co-exist.

Leukemia may have a varied clinical presentation. Which characteristic would be unusual to find in a patient with leukemia? a. Thrombocytopenia b. Hepatosplenomegaly c. Severe anemia d. Sickle-shaped cells

d. Sickle-shaped cells Rationale: Leukemia is characterized by failure of the bone marrow. The bone marrow produces red cells, white cells, and platelets. Clinical presentation reflects deficiency in one or more of these cell types and may be identified on CBC. Therefore, patient symptoms vary at presentation. Hepatosplenomegaly may be observed in a patient with leukemia. Sickle shaped cells are seen in patients with sickle cell anemia (SCA) and would not be observed in a patient with leukemia unless he also had sickle cell anemia.

A patient is found to have an anemia. The patient's MCH is normal. The patient's anemia can be described as a. macrocytic b. normocytic c. macrochromic d. normochromic

d. normochromic Rationale: The MCH, mean corpuscular hemoglobin, indicates the degree of hemoglobin incorporation into red blood cells. If this is normal, it is described as a normochromic anemia. If the MCH is decreased, the anemia is described as a hypochromic anemia. When the MCH is increased, the anemia is described as hyperchromic. Macrochromic does not describe red blood cells. Microcytic and normocytic describe size of red blood cells and is indicated by the MCV.

A 65-year-old man is being treated with oral medications for hypertension, hyperlipidemia, diabetes, and osteoarthritis. The most likely reason for his iron deficiency anemia is oral treatment for a. hypertension b. hyperlipidemia c. diabetes d. osteoarthritis

d. osteoarthritis Rationale: Osteoarthritis is often treated with analgesics and non-steroid anti-inflammatory drugs (NSAIDs). NSAIDs can be associated with GI bleeding, especially when they are taken chronically. This patient should be screened for blood in his stool. The other diseases listed, as well as the treatments for them, or not associated with iron deficiency anemia.

a. pneumocystis jiroveci pneumonia (PCP)

despite successful primary prophylaxis, which infection remains a common AIDS-defining dx? a. pneumocystis jiroveci pneumonia (PCP) b. cryptococcosis c. cryptosporidiosis d. candidiasis

c. cancers in the sigmoid colon

fecal occult blood testing (FOBT) is most effective in identifying: a. cancers in the right colon b. polyps c. cancers in the sigmoid colon d. cancers in the transverse colon

d. give folic acid 1mg PO daily

health maintenance in adults with sickle cell anemia includes which of the following: a. early sterilization should be performed to prevent transmission of the disease b. administer hepatitis A vaccine c. avoid use of oral contraceptives because of increased risk of clotting d. give folic acid 1mg PO daily

b. pernicious anemia

hemolytic anemia may be an inherited condition. Which of the following is not an inherited condition related to hemolytic anemia? a. hereditary spherocytosis b. pernicious anemia c. glucose-6-phosphate dehydrogenase deficiency d. sickle cell anemia

a. lymphocytosis and atypical lymphocytes b. elevated monocytes

in a pt with mononucleosis, which lab abnormality is most common? a. lymphocytosis and atypical lymphocytes b. elevated monocytes c. a decreased total white count d. elevated liver enzymes

a sore that does not heal

in teaching your clt about the American Cancer Society's CAUTION model, which identifies signs of many cancers, you teach her that the A stands for:

change in bowel or bladder habits

in teaching your clt about the American Cancer Society's CAUTION model, which identifies signs of many cancers, you teach her that the C stands for:

indigestion or difficulty in swallowing

in teaching your clt about the American Cancer Society's CAUTION model, which identifies signs of many cancers, you teach her that the I stands for:

b. nagging cough or hoarseness

in teaching your clt about the American Cancer Society's CAUTION model, which identifies signs of many cancers, you teach her that the N stands for: a. night sweats b. nagging cough or hoarseness c. nausea and vomiting d. noxious odor

obvious change in wart or mole

in teaching your clt about the American Cancer Society's CAUTION model, which identifies signs of many cancers, you teach her that the O stands for:

thickening or lump in the breast or elsewhere

in teaching your clt about the American Cancer Society's CAUTION model, which identifies signs of many cancers, you teach her that the T stands for:

unusual bleeding or discharge

in teaching your clt about the American Cancer Society's CAUTION model, which identifies signs of many cancers, you teach her that the U stands for:

c. sideroblastic anemia

lead toxicity can be associated with: a. folic acid deficiency anemia b. anemia of chronic disease c. sideroblastic anemia d. vitamin B12 deficiency

d. sickle shaped cells

leukemia may have varied clinical presentations. Which characteristic would be unusual to find in a pt with leukemia? a. thrombocytopenia b. hepatosplenomegaly c. severe anemia d. sickle shaped cells

d. a deficiency of folic acid

macrocytic normochromic anemias are caused by: a. acute blood loss b. an infection or tumor c. a nutritional deficiency of iron d. a deficiency of folic acid

c. lower back pain & hypercalcemia (additional s/s include: long bone pain (especially of the trunk & back); anemia (normocytic/normochromic) & renal insufficiency

multiple myeloma is a plasma cell malignancy in which the bone marrow is replaced, & there is bone destruction & paraprotein formation. Myeloma is a disease of older adults overall (median age at presentation, 66 yrs). Common presenting sxs include: a. nausea & vomiting & chronic cough b. fatigue & splenomegaly c. lower back pain & hypercalcemia d. nausea & vomiting & fatigue

d. host modification

one major approach to cancer prevention is: a. colonoscopy b. new drug trials c. Pap smears for women of all ages d. host modification

b. not enough intrinsic factor

pernicious anemia is a result of: a. not enough folic acid b. not enough intrinsic factor c. not enough vitamin D d. not enough iron

a. an increase in immunoglobulin A and G antibodies

physiological changes in the immune system of older adults include: a. an increase in immunoglobulin A and G antibodies b. a high rate of T-lymphocyte proliferation c. an increase in the number of cytotoxic T cells d. an increase in CD8, which affects regulation of the immune system

c. immobilization and malignancy

pregnant women may be prone to thrombophilias, which may be inherited or acquired. Which of the following is an example of a factor that predisposes pregnant women to acquired thrombophilic states in pregnancy? a. factor V Leiden b. homocystine c. immobilization and malignancy d. protein S and protein C

d. trimethoprim-sulfamethoxazole (TMP-SMZ) DS 1 tab daily for 10 days

prophylaxis for the first episode of Pneumocystis jiroveci pneumonia in an adult or adolescent clt infected with HIV is: a. isoniazid (nydrazid) 300mg PO and pyridoxine (vitamin B6 50mg PO daily for 12 days b. clarithromycin 500mg PO bid for 2 wks c. rifampin 600mg PO daily for 12 months d. trimethoprim-sulfamethoxazole (TMP-SMZ) DS 1 tab daily for 10 days

c. human cytomegalovirus

prostate cancer is associated with which of the following viruses? a. herpes simplex virus types 1 and 2 b. human herpesvirus 6 c. human cytomegalovirus d. human T-lymphotropic viruses

c. 9 months

screening infants for anemia should occur at what age? a. 6 months b. no screening is recommended c. 9 months d. 12 months

b. a rise in the ESR is a normal part of aging

select a statement that is true about the erythrocyte sedimentation rate (ESR) a. it is a very specific indicator of inflammation b. a rise in the ESR is a normal part of aging c. it is useful in detecting pancreatic cancer d. it is diagnostic for rheumatoid arthritis

c. 42 yrs

sickle cell anemia affects African Americans. Approximately 1 in 400 African Americans in the US has sickle cells disease (SCD). Advances in tx have been made, but life expectancy is still limited. The mean survival time for men with the disease is approximately: a. 24 yrs b. 34 yrs c. 42 yrs d. 52 yrs

autosomal recessive disorder in which an abnormal hemoglobin leads to chronic hemolytic anemia with a variety of severe clinical consequences

sickle cell anemia is an

b. approximately 8% of american blacks

sickle cell anemia is an autosomal recessive disorder caused by the hemoglobin S gene. An abnormal hemoglobin leads to chronic hemolytic anemia with numerous clinical manifestations and becomes a chronic multisystem disease, with death from organ failure, usually between ages 40 and 50. the hemoglobin S gene is carried by: a. approximately 4% of the US population b. approximately 8% of american blacks c. approximately 4% of latinos d. approximately 12% of native americans

b. anticonvulsants, tricyclic antidepressants, and corticosteroids

some pharmacological adjuncts to analgesics in clts with uncontrolled cancer pain include: a. anticonvulsants and tricyclic antidepressants b. anticonvulsants, tricyclic antidepressants, and corticosteroids c. selective serotonin receptor inhibitors d. benzodiazepines

a. positive antinuclear antibody (ANA), malar rash, and photosensitivity

systemic lupus erythematosus is dx on the basis of: a. positive antinuclear antibody (ANA), malar rash, and photosensitivity b. positive ANA, weight loss, and night sweats c. negative ANA, photosensitivity and renal disease d. leukopenia, negative ANA, and photosensitivity

c. increased destruction of RBC

thalassemia is caused by: a. blood loss b. impaired production of all blood-forming elements c. increased destruction of RBC d. autoimmune antibodies

b. fever, fatigue, and pharyngitis

the 3 most common signs and sxs of primary HIV infection are: a. wt loss, pharyngitis, and fatigue b. fever, fatigue, and pharyngitis c. night sweats, rash, and headache d. myalgias, fatigue, and fever

c. Kaposi's sarcoma in clt's younger than age 60

the CDC definition of AIDS includes the presence of which of the following disorders, with or without lab evidence of HIV? a. pneumonia in clts younger than age 60 b. dementia in clts younger than age 60 c. Kaposi's sarcoma in clt's younger than age 60 d. primary brain lymphoma in clts older than age 60

c. hemoglobin electrophoresis

the GOLD standard for definitive dx of sickle cell anemia is: a. reticulocyte count b. sickle cell test c. hemoglobin electrophoresis d. peripheral blood smear

b. primary tumor

the T in the TNM staging system refers to: a. tolerance b. primary tumor c. tumor marker d. turgor

c. clotrimazole troches (10mg) 5x daily or nystatin (mycostatin) suspension 500,000-1,000,000 unites 3-5x daily

the first choice of tx for a clt who is positive for HIV and has oral candidiasis is: a. fluconazole (diflucan) 100mg PO daily b. ketoconazole (nizoral) 200mg PO daily c. clotrimazole troches (10mg) 5x daily or nystatin (mycostatin) suspension 500,000-1,000,000 unites 3-5x daily d. griseofulvin (grisactin) 500mg bid

c. high viral load periods

the greatest risk of transmitting HIV is during: a. the acute phase b. the time that detectable antibody is present c. high viral load periods d. late infection phase

a. splenomegaly

the lab identifies metamyelocytes in a 50 y/o pt who had a CBC performed. What might be an expected finding in this pt? a. splenomegaly b. elevated liver function studies c. decreased urine acid level d. decreased platelet count

b. leukocytosis

the major lab abnormality noted inpts with pneumonia is: a. eosinophils b. leukocytosis c. Gram stain positive d. leukopenia

c. brachytherapy

the placement of a high dose of radioactive material directly into a malignant tumor and giving a lower dose to the normal tissues is referred to as: a. radiotherapy b. teletherapy c. brachytherapy d. ionization therapy

c. allow for the prevention of septicemia with prophylactic medication

the primary reason for newborn screening for sickle cell disease is to: a. present the parents with the option for genetic screening in the future b. test siblings if it is proved that the newborn has sickle cell disease c. allow for the prevention of septicemia with prophylactic medication d. prevent a sickle cell crisis

b. anti-histamines

the primary therapeutic intervention for pts who present with hives is: a. steroids b. anti-histamines c. calcium channel blockers d. topical steroid cream

a. when other STDs are present

the risk of HIV transmission is increased: a. when other STDs are present b. in females c. when pts are aware of the HIV status d. in pts with diabetes

b. hepatitis B surface antigen and IgM

the two tests which can indicate with certainty that a pt has hepatitis B at present are: a. hepatitis B surface antigen and antibody b. hepatitis B surface antigen and IgM c. hepatitis B surface antibody and core antibody d. positive IgG and positive core antibody

c. purpura

thrombocytopenia may present as: a. fatigue b. fever c. purpura d. a butterfly rash

b. bladder cancer

tobacco has been linked to which of the following types of cancer? a. colon cancer b. bladder cancer c. prostate cancer d. cervical cancer

d. acute blood loss

under which of the following circumstances is the reticulocyte count elevated? a. aplastic anemia b. iron-deficiency anemias c. poisonings d. acute blood loss

a. fatigue and lymphadenopathy

what are the most common s/s associated with mononucleosis? a. fatigue and lymphadenopathy b. cough and pharyngitis c. splenomegaly and fevel d. rash and pharyngitis

d. gynecologic losses and bleeding in the GI tract

what choice below can be attributed to the two most common causes of iron deficiency anemia in adults? a. bleeding n the GI tract and through loss of bone mass b. aging and menses c. poor diet and lack of adequate iron intake d. gynecologic losses and bleeding in the GI tract

c. rise in neutrophils

what does shift to the left or left shift mean? a. rise in basophils b. rise in monocytes c. rise in neutrophils d. rise in lymphocytes

b. macrocytosis

what hallmark finding is associated with both B12 and folate deficiencies? a. glossitis b. macrocytosis c. memory loss d. an MCV<80fL

b. mucosal erythroplasia

what is the earliest visual sign of oral and pharyngeal squamous cell carcinomas? a. leukoplakia b. mucosal erythroplasia c. loss of sensation in the tongue d. difficulty chewing or swallowing

d. they alter the host environment for cell growth

what is the mechanism of action of steroid hormones in cancer chemotherapy? a. they interfere with DNA or RNA synthesis b. they interfere with DNA replication by attacking DNA synthesis throughout the cell cycle c. they inhibit protein synthesis d. they alter the host environment for cell growth

c. alcohol decreases the ability of persons to adhere to a prescribed medical regime

what is the most significant reason alcohol use is discouraged in persons with HIV infection or AIDS? a. alcohol interferes with the pharmacokinetics of most AIDS b. filling up on the empty calories of alcohol replaces the desire for food c. alcohol decreases the ability of persons to adhere to a prescribed medical regime d. if clts become addicted to alcohol, when AIDS advances, they will become addicted to painkillers

d. case control

what would be the study of choice to determine the cause of a cluster of adult leukemia cases found in an isolated area of a rural state? a. randomized clinical trial b. cohort study c. case series d. case control

c. her father had the disease and her mother was a carrier

when Jane tells you that she has hemophilia, you know that: a. both of her parents also have the disease b. her maternal grandfather probably had the disease and it skipped a generation c. her father had the disease and her mother was a carrier d. her mother had the disease

c. natural passive

when a neonate is initially protected against measles, mumps, and rubella because the mother is immune, this is an example of which type of immunity? a. natural active b. artificial active c. natural passive d. artificial passive

c. in the case of infection

when should you order a CBC for your clt? a. routinely b. before dental work c. in the case of infection d. if she is pregnant

a. isograft

when the donor and recipient of a transplant are identical twins, this is referred to as a(n): a. isograft b. autograft c. allograft d. xenograft

b. hct=35.2

which adult female pt has an anemia? a. hgb=14.4 b. hct=35.2 c. hgb=13.5 d. hct=40.1

a. folic acid deficiency anemia

which anemia is described as a macrocytic anemia? a. folic acid deficiency anemia b. Thalassemia c. iron deficiency anemia d. sickle cell anemia

c. iron deficiency anemia and thalassemia

which anemias are described as microcytic, hypochromic anemias? a. vitamin B12 and iron deficiency anemia b. folic acid and iron deficiency anemia c. iron deficiency anemia and thalassemia d. sickle cell anemia and anemia of chronic disease

b. chondrosarcoma

which bone tumor arises from cartilage and is usually located in the pelvis, femur, proximal humerus, or ribs? a. osteosarcoma b. chondrosarcoma c. Ewing's sarcoma d. fibrosarcoma

d. testicular cancer

which cancer can be cured with chemotherapy alone? a. breast cancer b. malignant melanoma c. bladder cancer d. testicular cancer

a. mononucleosis

which disease listed below can be associated with lymphocytosis? a. mononucleosis b. strept throat c. iron deficiency anemia d. hemolytic anemia

d. african americans

which ethnic grp has the highest overall cancer incidence rate? a. native americans b. asian and pacificislanders c. hispanics d. african americans

c. immune complex-mediated reaction

which hypersensitivity reactions results in a skin test that is erythematous with edema within 3-8 hrs? a. anaphylactic reaction b. cytotoxic reaction c. immune complex-mediated reaction d. delayed hypersensitivity reaction

c. ferritin

which is the best serum test to perform to spot an iron-deficiency anemia early before it progresses to flull-blown anemia? a. hemoglobin b. hematocrit c. ferritin d. reticulocytes

a. IgG

which is the most abundant immunoglobulin (Ig) found in the blood, lymph, and intestines? a. IgG b. IgA c. IgM d. IgD

b. sulfamethoxazole

which medication should be avoided in a pt with a sulfa allergy? a. sulfonylurea b. sulfamethoxazole c. naproxen d. cefazolin

a. vitamin B12

which of the following CANNOT be a microcytic anemia? a. vitamin B12 b. anemia of chronic disease c. iron deficiency anemia d. thalassemia

a. Burkitt's lymphoma

which of the following cancers is associated with Epstein-Barr virus? a. Burkitt's lymphoma b. Kaposi's sarcoma c. lymphoma d. adult T-cell leukemia

b. cigarette smoking, diabetes, and a high fat diet

which of the following increases the risk of pancreatic cancer? a. high carbohydrate diet b. cigarette smoking, diabetes, and a high fat diet c. diabetes and lack of activity d. yo-yo dieting

c. removable white plaques

which of the following indicates that John, a 32 y/o clt with AIDS, has oropharyngeal candidiasis? a. small vesicles b. fissured, white, thickened patches c. removable white plaques d. flat topped papules with thin, bluish-white spiderweb lines

a. leiomyoma

which of the following is a benign neoplasm? a. leiomyoma b. osteosarcoma c. glioma d. seminoma

b. chemotherapy drugs

which of the following is a genotoxic carcinogen? a. vinyl chloride polymers b. chemotherapy drugs c. asbestos d. wood and leather dust

b. glucose-6-phosphate dehydrogenase deficiency

which of the following is an X-linked recessive disorder commonly seen in African American men? a. sickle cell anemia b. glucose-6-phosphate dehydrogenase deficiency c. pyruvate kinase deficiency d. Bernard-Soulier syndrome

a. decreasing the amt of liquids

which of the following is not an effective strategy to prevent the nausea and vomiting associated with the effects of radiation and chemotherapy a. decreasing the amt of liquids b. eating a soft, bland diet low in fat and sugar c. relaxation d. distraction

c. antibody testing

which of the following lab studies is used to determine if a clt has had hepatitis? a. serum protein b. protein electrophoresis c. antibody testing d. globulin levels

c. taking the infant to an outdoor event

which of the following situations might precipitate a sickle cell crisis in an infant? a. taking the infant to visit a relative b. hepatitis B immunization c. taking the infant to an outdoor event d. having the infant sleep on its back

a. there are few conditions that cause depletion of CD4 cells other than HIV

which of the following statements regarding HIV is correct? a. there are few conditions that cause depletion of CD4 cells other than HIV b. CD4 cell counts vary very little in individuals infected with HIV c. a normal CD4 counts is <200/mm3 d. CD4 counts are the first abnormality seen in pts with HIV

a. neutrophils

which of the following white blood cell types is elevated in acute infections, the stress response, myelocytic leukemia and inflammatory or metabolic disorders? a. neutrophils b. eosinophils c. basophils d. monocytes

d. monocytes

which of the following white blood cell types is elevated in in chronic inflammatory disorder, TB, viral infections, leukemia, Hodgkin's disease and multiple myeloma? a. neutrophils b. eosinophils c. basophils d. monocytes

c. basophils

which of the following white blood cell types is elevated in in hypersensitivity responses, chronic myelogenous leukemia, chickenpox or smallpox, after a splenectomy, and in hypothyroidism? a. neutrophils b. eosinophils c. basophils d. monocytes

b. eosinophils

which of the following white blood cell types is elevated in parasitic infections, hypersensitivity reactions and autoimmune disorders? a. neutrophils b. eosinophils c. basophils d. monocytes

d. inadequate amts can produce cognitive changes

which statement is true about vitamin B12? a. it is easily absorbed throught the GI tract b. deficiencies are seen in elderly pts only c. low levels can result in elevated lipid levels d. inadequate amts can produce cognitive changes

a. alpha fetoprotein

which tumor marker may detect a tumor of the ovary or testis? a. alpha fetoprotein b. carcinoembronic antigen c. human chorionic gonadotropin d. cancer antigen 125

c. chronic lymphocytic leukemia

which type of leukemia produces sxs with an insidious onset including weakness, fatigue, massive lymphadenopathy, pruritic vesicular skin lesions, anemia, and thrombocytopenia? a. acute lymphocytic leukemia b. acute myelogenous leukemia c. chronic lymphocytic leukemia d. chronic myelogenous leukemia

a. neutrophils

which white cell should be present in the greatest number in a pt who is healthy today? a. neutrophils b. basophils c. eosinophils d. lymphocytes

c. lymphoma of the mediastinum

you are examinging Joe, age 9 months, and note a palpable right supraclavicular node. You know that this finding is suspicious for: a. candidiasis b. cryptococcosis c. lymphoma of the mediastinum d. abdominal malignancy

a. disseminated malignancy, particularly of the

you have a new clt, Rob, age 67, who presents with a generalized lymphadenopathy. You know that this is indicative of: a. disseminated malignancy, particularly of the hematological system b. cancer of the liver c. Sjogren's syndrome d. pancreatic cancer

d. unsafe sexual behaviors

you suspect that your new clt Ralph has hepatitis C,although he is currently asymptomatic. Your suspicion is based on his medical hx, which includes which of the following factors that has been identified as a red flag for this disease? a. lactose intolerance b. frequent sore throats and upper respiratory infection c. a hx of mononucleosis at age 17 d. unsafe sexual behaviors

a. thrombocytopenia and elevated transaminase

your 18 y/o clt, Mandy, has infectious mononucleosis. What might you expect her blood work to reflect? a. thrombocytopenia and elevated transaminase b. elevated WBCs c. decreased WBCs d. decreased serum globulins

c. immunodeficiency

your clt, Jack, has decreased lymphocytes. You suspect: a. bacterial infection b. viral infection c. immunodeficiency d. parasitic infections

c. mononucleosis

your clt, Jeannie, age 64, comes to you complaining of tinnitus and lightheadedness without LOC. On PE, you note splenomegaly. to sort out your differential dx, you order an alkaline phosphatase and vitamin B12 level because you are ruling out a dx of: a. liver cancer b. pancreatic cancer c. mononucleosis d. polycythemia vera

c. she must be sent for a mammogram as soon as possible

your clt, Mrs. Old, age 64, is here to see you because she has pain in her left breast. She reports no pain in her right breast and no noted lesions or masses on breast self-exam, which she performs month. You know that: a. at her age, you do not need to worry about breast cancer b. initial presentation of breast pain is usually not suspicious for a malignancy c. she must be sent for a mammogram as soon as possible d. she has no personal or family hx of breast cancer; therefore, you are not concerned

d. splenectomy

your clt, Ms. Jones, has an elevated platelet count. You suspect: a. systemic lupus erythematosus b. infectious mononucleosis c. disseminated intravascular coagulation (DIC) d. splenectomy

d. liver disease

your clt, Shelly, has an elevated mean cell volume (MCV). What should you be considering in terms of dx? a. iron-deficiency anemia b. hemolytic anemias c. lead poisoning d. liver disease

a. artificial tears and chewing sugarless gum

your clt. Mr. Jones, has Sjogren's syndrome. Which tx do you suggest? a. artificial tears and chewing sugarless gum b. frequent rinsing out of the mouth with mouthwash c. drinking at least one glass of milk per day d. removing wax from the ears at regular intervals

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