Immunology Oncology Review Questions 2

1. Immunology & Oncology Review Questions 2 Ana Corona, MSN, FNP-C Nursing Instructor November 2008 Mosby�s NCLEX Review Questions 2007 Davis NCLEX-PN 2007

2. Q-1 After years of unprotected sex, a 20-year-old man is diagnosed as having AIDS. The client states, "I'm not worried because they have a cure for AIDS." The best response by the nurse should be: "Repeated phlebotomies may be able to rid you of the virus." "You may be cured of AIDS after prolonged pharmacologic therapy." "Perhaps you should have worn condoms to prevent contracting the virus." "There is no cure for AIDS but there are drugs that can slow down the virus."

3. A-1 4 This is an honest response that corrects the client's misconception about the effectiveness of the current antiviral medications.

4. Q-2 The nursing staff has a team conference on AIDS and discusses the routes of transmission of the human immunodeficiency virus (HIV). The discussion reveals that an individual has no risk of exposure to HIV when that individual: Has intercourse with just the spouse Makes a donation of a pint of whole blood Limits sexual contact to those without HIV antibodies Uses a condom each time there is sexual intercourse

5. A-2 2 Equipment used is disposable; the donor does not come into contact with anyone else's blood.

6. Q-3 The nurse knows that a positive diagnosis for HIV infection is made based on: Positive ELISA and Western blot tests A history of high-risk sexual behaviors Evidence of extreme weight loss and high fever Identification of an associated opportunistic infection

7. A-3 1 These tests confirm the presence of HIV antibodies that occur in response to the presence of the human immunodeficiency virus.

8. Q-4 Blood screening tests of the immune system of a client with AIDS would indicate: A decrease in CD4 T cells An increase in thymic hormones An increase in immunoglobulin E A decrease in the serum level of glucose-6-phosphate dehydrogenase

9. A-4 1 The HIV selectively infects helper T-cell lymphocytes; therefore, 300 or fewer CD4 T cells per cubic millimeter of blood or CD4 cells accounting for less than 20% of lymphocytes is suggestive of AIDS.

10. Q-5 When taking the blood pressure of a client who has AIDS, the nurse must: Wear clean gloves Use barrier techniques Wear a mask and gown Wash the hands thoroughly

11. A-5 4 Because this procedure does not involve contact with blood or secretions, additional protection is not indicated.

12. Q-6 A client with acquired immunodeficiency syndrome (AIDS) and Cryptococcus pneumonia is incontinent of feces and urine and producing copious sputum. When providing care for this client, the nurse's priority should be to: Wear goggles when suctioning the client's airway Use gown, mask, and gloves when bathing the client Use gloves to administer oral medications to the client Wear a gown when assisting the client with the bedpan

13. A-6 2 These items prevent contact with feces, sputum, or other body fluids during intimate body care.

14. Q-7 In addition to Pneumocystis jiroveci, a client with AIDS also has an ulcer 4 cm in diameter on the leg. Considering the client's total health status, the most critical nursing diagnosis would be: Social Isolation Impaired Skin Integrity Impaired Gas Exchange Imbalanced Nutrition: Less Than Body Requirements

15. A-7 3 Pneumocystis jiroveci is a protozoan that causes pneumonia in immunosuppressed hosts, which can cause death in 60% of the clients; the client's respiratory status is the priority.

16. Q-8 A client receiving chemotherapy and a steroid has a white blood cell count of 12,000/mm3 and a red blood cell count of 4.5 million/mm3. The instruction that should receive priority by the nurse is: Omit the daily dose of prednisone Avoid large crowds and persons with infections Shave with an electric rather than a safety razor Increase the intake of high-protein foods and red meats

17. A-8 2 Moderate leukopenia increases the risk of infection; the client should be taught protective measures

18. Q-9 An older adult develops severe bone marrow depression from chemotherapy for cancer of the prostate. The nurse should: Monitor for signs of alopecia Increase daily intake of fluids Monitor intake and output of fluids Use a soft toothbrush for oral hygiene

19. A-9 4 Thrombocytopenia occurs with most chemotherapy treatment programs; using a soft toothbrush helps prevent bleeding gums.

20. Q-10 The laboratory results of a client following chemotherapy for cancer indicate bone marrow depression. The nurse should encourage the client to: Use an electric razor when shaving Drink citrus juices frequently for nourishment Increase activity levels and ambulate frequently Sleep with the head of the bed slightly elevated

21. A-10 1 Suppression of bone marrow increases bleeding susceptibility associated with decreased platelets.

22. Q-11 A client who has had bone pain of insidious onset for 4 months is suspected of having multiple myeloma. The nurse understands that one of the diagnostic findings specific for multiple myeloma would be: Occult blood in the stool Low serum calcium levels Bence Jones protein in the urine Positive bacterial culture of sputum

23. A-11 3 This protein (globulin) results from tumor cell metabolites; it is present in clients with multiple myeloma.

24. Q-12 The nurse understands that the most definitive test to confirm a diagnosis of multiple myeloma is: Bone marrow biopsy Serum test for hypercalcemia Urine test for Bence Jones protein X-ray films of the ribs, spine, and skull

25. A-12 1 A definite confirmation of multiple myeloma can only be made through a bone marrow biopsy; this is a plasma cell malignancy with widespread bone destruction.

26. Q-13 A client, diagnosed with multiple myeloma, asks the physician about what treatment will be administered. The nurse would expect the physician to reply: "Alpha-interferon therapy." "Radiation therapy on an outpatient basis." "Surgery to remove the lesion and lymph nodes." "Chemotherapy employing a combination of drugs."

27. A-13 4 A variety of drugs affect rapidly dividing cells at different stages of cell division.

28. Q-14 A client with multiple myeloma, who is receiving chemotherapy, has a temperature that has risen 3 degrees during a 6-hour period and is now 102.2� F. The nurse should: Administer the prescribed antipyretic and notify the physician Obtain the other vital signs and recheck the temperature in 1 hour Assess the amount and color of urine and obtain a specimen for a urinalysis Note the consistency of respiratory secretions and obtain a specimen for culture

29. A-14 1 Because an elevated temperature increases metabolic demands, the pyrexia must be treated immediately; the physician should be notified because this client is immunodeficient, from both the disease and the chemotherapy; a search for the cause of the pyrexia can then be initiated.

30. Q-15 A client with multiple myeloma asks how the disease may progress. When teaching this client, the nurse should discuss the possibility that: Blood transfusions may be necessary Frequent urinary tract infections may result IV fluid therapy may be administered in the home The disease is exacerbated by exposure to ultraviolet rays

31. A-15 1 Blood products (packed RBCs or platelets) are administered when warranted

32. Q-16 The nurse is aware that a client is receiving azathioprine (Imuran), cyclosporine, and prednisone before kidney transplant surgery to: Stimulate leukocytosis Provide passive immunity Prevent iatrogenic infection Reduce antibody production

33. A-16 4 These drugs suppress the immune system, decreasing the body's production of antibodies in response to the new organ, which acts as an antigen; these drugs decrease the risk of rejection.

34. Q-17 A male client with the diagnosis of multiple myeloma is told that he has a poor prognosis. He and his wife have decided to travel, attend the theater, and go to sporting events. When preparing further teaching for this client, the nurse should take into consideration that: Travel will cause depletion of his already exhausted energy stores A positive mental attitude will decrease the effects of stress and improve his prognosis He is prone to develop infections when exposed to large crowds, which may shorten his life As long as he does not have an accident that causes a hemorrhage, his traveling will not affect his prognosis

35. A-17 3 The bone marrow is impaired; the effectiveness of white blood cells and immunoglobulins is reduced, which increases susceptibility to bacterial infections.

36. Q-18 When discussing immunity with a client who has returned from living in a foreign country for 10 years, the nurse recalls that active immunity occurs when: Protein antigens are formed in the blood to fight invading antibodies Protein substances are formed within the body to neutralize antigens Blood antigens are aided by phagocytes in defending the body against pathogens Sensitized lymphocytes from an immune donor act as antibodies against invading pathogens

37. A-18 2 Active immunity occurs when the individual's cells produce antibodies in response to an agent or its products; these antibodies will destroy the agent (antigen) should it enter the body again.

38. Q-19 The nurse should plan to teach a client with pancytopenia caused by chemotherapy to: Begin a program of aggressive, strict mouth care Avoid traumatic injuries and exposure to infection Increase oral fluid intake to a minimum of 3000 mL daily Report any unusual muscle cramps or tingling sensations in the extremities

39. A-19 2 Reduced platelets increase the likelihood of uncontrolled bleeding; reduced lymphocytes increase susceptibility to infection

40. Q-20 A client has received three courses of chemotherapy and is admitted for tests before continuing with the fourth in the series. The physician decides to omit the treatment because the client demonstrates myelosuppression. When discussing this with the client, the nurse should explain that: Calcium and vitamin D must be increased in the diet because of the effects of myelosuppression Eating a balanced diet, resting, and trying to avoid bleeding and infections are appropriate at this time The development of myelosuppression explains why the client has nausea, vomiting, anorexia, and alopecia Frequent testing for restlessness, muscle control, and pupillary response will be necessary because the meninges may be irritable

41. A-20 2 Myelosuppression involves decreased red blood cells (anemia) resulting in less oxygen-carrying capacity of the blood and fatigue; decreased white blood cells (leukopenia) resulting in potential for infection; and decreased platelets (thrombocytopenia) resulting in potential for bleeding.

42. Q-21 A client comes to the clinic for a physical and asks to be tested for AIDS. The nurse explains that the initial screening for AIDS will be done via the: CD4 T cell count Western blot test Polymerase chain reaction test Enzyme-linked immunosorbent assay

43. A-21 4 This is the first screening test done to detect serum antibodies that bind to HIV antigens on test plates

44. Q-22 A client with cancer of the lung asks the nurse about biologic therapy (e.g., monoclonal antibodies, interferon) for cancer. In addition to referring the client to the physician for a specific answer, the nurse should base a response on the fact that this therapy is: Directed at altering the structure of the malignant cells Now a primary mode of therapy for a variety of cancers Used as an adjuvant therapy with other therapies to reduce and eradicate the tumor Effective regardless of the type of tumor cells involved and that this is its major advantage

45. A-22 3 Currently biologic therapy is used as an adjuvant therapy with surgery, radiation, and chemotherapy

46. Q-23 A client is diagnosed with tuberculosis associated with HIV infection. The test results that are crucial for the nurse to review before starting antitubercular pharmacotherapy are: Liver function studies Pulmonary function studies Electrocardiogram and echocardiogram White blood cell counts and sedimentation rate

47. A-23 1 Antitubercular drugs such as isoniazid (INH), rifampin (Rifadin), and para-aminosalicylic acid (PAS) are hepatotoxic.

48. Q-24 A client with HIV-associated Pneumocystis jiroveci pneumonia is to receive pentamidine isethionate (Pentam 300) IV once daily. To ensure client safety the nurse should: Mix the drug with sterile saline without a preservative Administer the drug over a period of 20 to 30 minutes Monitor the blood pressure for hypertension during and after therapy Assess blood glucose levels daily during therapy and several times after therapy

49. A-24 4 Pentamidine can cause either hypoglycemia or hyperglycemia even after therapy is discontinued, and therefore blood glucose levels should be monitored.

50. Q-25 A hospice client who has intractable pain and is receiving analgesics asks for another dose of pain medication. Oxycodone (Oxycontin) one to two tablets every 4 to 6 hours has been prescribed. The nurse's primary consideration when responding to the client's request is to: Prevent addiction Determine why the drug is needed Provide alternate comfort measures Help reduce the client's pain immediately

51. A-25 4 Hospice clients with intractable pain need increasing levels of analgesics and should be maintained at a pain-free level, even if addiction occurs.

52. Q-26 A 32-year-old woman with stage III-B Hodgkin's disease is started on chemotherapy. The nurse should teach the client to report immediately the occurrence of: A sore mouth A fever of 100� F Moderate diarrhea after treatment Nausea for 6 hours after treatment

53. A-26 1 This may indicate infection, which must be treated immediately because chemotherapy may lead to pancytopenia and immunosuppression; stomatitis is common with chemotherapy and should be brought to the physician's attention because a swish-and-swallow anesthetic solution can be ordered to make the client more comfortable.

54. Q-27 A client with cancer, who is receiving a chemotherapeutic regimen that includes vincristine (Oncovin), complains of numbness and loss of feeling in the legs below the knees. The client wants to know if the problem means the cancer is growing or if it is related to the medication. The nurse's answer should be based on the fact that: Enlarged lymph nodes in the groin, related to the cancer, may cause these symptoms Most chemotherapeutic regimens do not affect the nervous or peripheral vascular system Vascular occlusion may cause this problem and immediate medical evaluation is indicated Peripheral neuropathies can result from chemotherapy and usually are reversible if addressed early

55. A-27 4 Muscle weakness, tingling, and numbness are related to drugs like Oncovin; neuropathies are usually transient if the drug is stopped or reduced

56. Q-28 A client with small cell lung cancer is receiving chemotherapy. A complete blood count is ordered before each round of chemotherapy. The value in a complete blood count that the nurse should be most concerned about would be: RBCs WBCs Platelets Hematocrit

57. A-28 2 Antineoplastic drugs depress bone marrow, which causes leukopenia; the client must be protected from infection, which could be life threatening.

58. Q-29 A client with cancer develops pancytopenia during the course of chemotherapy. The client asks the nurse why this has occurred. The nurse should explain that: Normal cells are also susceptible to the effects of chemotherapeutic drugs Steroid hormones have a depressant effect on the spleen and bone marrow Lymph node activity is depressed by radiation therapy used prior to chemotherapy Dehydration caused by nausea, vomiting, and diarrhea results in hemoconcentration

59. A-29 1 Chemotherapy destroys normal erythrocytes, white blood cells, and platelets indiscriminately along with the neoplastic cells because these are all rapidly dividing cells that are most vulnerable to the effects of chemotherapy.

60. Q-30 A client with multiple myeloma is receiving melphalan (Alkeran), an alkylating agent. During follow-up visits to the oncology clinic, for which side effect should the client be monitored? Hirsutism Leukopenia Constipation Photosensitivity

61. A-30 2 Melphalan (Alkeran) depresses the bone marrow, causing a reduction in white blood cells (leukopenia), red blood cells (anemia), and thrombocytes (thrombocytopenia); leukopenia increases the risk of infection.

62. Q-31 The physician prescribes finasteride (Proscar) for a 52-year-old client with benign prostatic hyperplasia. The nurse informs the client that: Male pattern baldness can occur Results can be expected in 6 to 12 weeks Compliance will prevent the development of prostatic cancer Protection should be worn during intercourse with a pregnant female

63. A-31 4 Contact with semen of a client taking Proscar can adversely affect a developing male fetus

64. Q-32 A client with cancer is receiving a multiple chemotherapy protocol. Included in the protocol is leucovorin calcium (Wellcovorin). The nurse recognizes that this drug is administered to: Potentiate the effect of alkylating agents Diminish the toxicity of folic acid antagonists Limit the occurrence of vomiting associated with chemotherapy Interfere with cell division at a different stage of cell division than the other drugs

65. A-32 2 Leucovorin calcium limits toxicity of folic acid antagonists, such as methotrexate sodium, by competing for transport into cells.

66. Q-33 A client who is receiving chemotherapy for cancer has nausea and vomiting because of the therapy. The client wants to know if it is true that smoking marijuana would help. Counseling by the nurse should include the fact that: Smoking marijuana is legal as long as it is prescribed by a physician Marijuana is more effective for nausea and vomiting if it is injected, but it can cause drowsiness Smoking marijuana is not effective in the control of nausea and vomiting caused by chemotherapy Tetrahydrocannabinol (THC), the ingredient in marijuana, can be taken in pill form and acts as an antiemetic

67. A-33 4 THC acts as an antiemetic in some persons and can be absorbed through the gastrointestinal tract or inhaled

68. Q-34 A client with metastatic melanoma is being treated with interferon. The nurse is aware that the teaching about this drug is understood when the client states: "I will increase my fluid intake to 2 to 3 L daily." "I need to discard any reconstituted solution at the end of the week." "I can continue driving my car as before, as long as I have the stamina." "I should be able to continue my usual activity while taking this medication."

69. A-34 1 This helps flush the kidneys and prevent nephrotoxicity, especially during the early phase of treatment.

70. Q-35 A client with a parotid tumor that involves the lymph glands in the neck is being treated aggressively with radiotherapy, surgery, and chemotherapy. The physician prescribes vincristine (Oncovin), cyclophosphamide (Cytoxan), and prednisone. Before each chemotherapeutic dose, the client should be assessed for: Peripheral paresthesia Anginal-type chest pain Ophthalmic papilledema Bilateral crackles in the lung

71. A-35 1 Peripheral paresthesia is an indication of toxicity from a plant alkaloid such as vincristine (Oncovin)

72. Q-36 After a course of doxorubicin hydrochloride (Adriamycin), the physician decides to prescribe cisplatin (Platinol) for a client with metastatic cancer. To prevent toxic effects, the nurse should: Administer the ordered leucovorin Encourage regular vigorous oral care Increase hydration to promote diuresis Provide a high-protein, low-residue diet

73. A-36 3 Cisplatin is nephrotoxic and can cause kidney damage unless the client is adequately hydrated to flush the kidneys.

74. Q-37 A client is to receive chemotherapy for colon cancer. The practitioner orders an intravenous dose of metoclopramide (Reglan) 30 minutes before the chemotherapy infusion. The nurse understands that this medication will: Stimulate production of gastrointestinal secretions Enhance relaxation of the upper gastrointestinal tract Prolong excretion of the chemotherapeutic medication Increase absorption of the chemotherapeutic medication

75. A-37 2 The relaxation effect increases the passage of food through the gastrointestinal tract limiting reverse peristalsis, gastroesophageal reflux, and vomiting, all of which are precipitated by chemotherapeutic agents

76. Q-38 A client who is immunosuppressed is receiving filgrastim (Neupogen). When assessing the client's response to this medication, the finding that would be considered significant is an increase in: Platelets Erythrocytes Thrombocytes White blood cells

77. A-38 4 Neupogen, a granulocyte colony-stimulating factor, increases the production of neutrophils with little effect on the production of hematopoietic cells.

78. Q-39 The physician orders epoetin (Procrit) for a client who has AIDS. When administering this medication, the nurse should: Use the Z-track technique Use a 1-inch, 25-gauge needle Obtain the client's pulse rate first Shake the vial before withdrawing the solution

79. A-39 2 Epoetin (Procrit) is administered via the subcutaneous or intravenous route; a 1-inch, 25-gauge needle is appropriate for either method of administration.

80. Q-40 After thoracic surgery for removal of a cancerous lesion in the lung, the client is very drowsy, complains of pain when awakening, and then falls asleep. The client has an order for morphine sulfate via IV every 3 hours prn. Assessment reveals that the client's blood pressure ranges between 90/60 and 100/70. The nurse's best initial action would be to: Obtain an order for a vasoconstrictor Administer the morphine as ordered Give half the prescribed amount of morphine Withhold the morphine until the blood pressure stabilizes

81. A-40 4 Morphine may decrease the blood pressure further; clients who are drowsy may sleep without medication immediately after surgery.

82. Q-41 A client with AIDS is receiving zidovudine (AZT). It is most important for the nurse to monitor the client's: Cardiac enzymes Serum electrolytes HIV antibody levels Complete blood count

83. A-41 4 AZT can cause anemia, leukopenia, and granulocytopenia; these blood dyscrasias can be life threatening, so the CBC is monitored.

84. Q-42 client is to receive doxorubicin (Adriamycin) as part of a chemotherapy protocol. The major life-threatening side effect of Adriamycin for which the nurse should assess the client is: Pancytopenia Cardiotoxicity Pulmonary fibrosis Ulcerative stomatitis

85. A-42 2 Heart failure and dysrhythmias are the only life-threatening toxic effects unique to Adriamycin.

86. Q-43 A client receiving combination chemotherapy for treatment of metastatic carcinoma asks the nurse in the clinic why more than one type of drug is necessary. The nurse should explain the chemotherapy in relation to: The cell cycle Drug resistance Tumor doubling time Retained radioactive particles

87. A-43 1 Different drugs destroy cells at different stages of their replication; rapidly dividing cells not destroyed by one drug may be destroyed by another drug during a different stage of cell replication.

88. Q-44 A client is receiving combination chemotherapy for treatment of metastatic carcinoma. The nurse should monitor the client for the systemic side effect of: Ascites Nystagmus Leukopenia Polycythemia

89. A-44 3 Leukopenia, a reduction in WBCs, is a systemic effect of chemotherapy as a result of myelosuppression.

90. Q-45 A client is receiving high doses of methotrexate for cancer and is experiencing side effects. The physician orders leucovorin calcium (Wellcovorin) to be administered immediately after the infusion of methotrexate. The best indicator that Wellcovorin has been effective is that the: Client is less nauseated Client's WBC level decreases Client reports an increase in energy Client's methotrexate level is less than 0.05 micromole

91. A-45 4 The laboratory measurement of the client's methotrexate level is the most objective measure of leucovorin's effectiveness. Leucovorin is considered a "rescue" drug because it minimizes the effects of methotrexate on healthy cells by competing with methotrexate at the cellular level, thus neutralizing it and causing it to be excreted.

92. Q-46 The physician plans to administer chemotherapy 2 weeks after a client has had surgery for colon cancer. The delay in instituting the plan for drug therapy is because the drugs: Interfere with cell growth and delay wound healing Cause vomiting, which endangers the integrity of the incisional area Decrease red blood cell production and the resultant anemia would add to postoperative fatigue Increase edema in areas distal to the incision by blocking lymph channels with destroyed lymphocytes

93. A-46 1 Chemotherapeutic agents can attack healthy as well as malignant cells; they generally interfere with protein synthesis and cell division in all rapidly dividing cells, including those regenerating traumatized tissue (as in wound healing), bone marrow, and cutaneous and alimentary tract epithelial tissue.

94. Q-47 The nurse is assigned to a client who has had surgery. Nalbuphine (Nubain) has been ordered for pain. After administering this medication, which side effects/adverse reactions may the nurse expect to occur? (Pick all that may apply) Oliguria Depression Palpitations Tachycardia Constipation Hypertension Urinary retention

95. A-47 3, 5, 7 3 Palpitations are a side effect of Nubain 5 Constipation is a common side effect of Nubain 7 Urinary retention is a severe reaction to Nubain

96. Q-48 A client is receiving morphine for severe metastatic bone pain. To prevent complications from a side effect of morphine, the nurse should: Monitor for diarrhea Observe for an opiate addiction Wake the client every two hours Assess for altered breathing patterns

97. A-48 4 Morphine is a central nervous system depressant that decreases the respiratory rate, which can lead to respiratory arrest.

98. Q-49 The pharmacy technician arrives on the nursing unit to deliver the requested opioids. A nurse is entering a client's room and not available to receive the medications. The most appropriate statement by the nurse to the pharmacy technician would be: "I'm sorry. Could you wait 5 minutes or come back?" "Leave the meds and sign-out sheets by the secretary, please." "Bring them to me and I'll put them away in a couple of minutes." "I'll be out in a few minutes. Could you give them to the unit assistant?"

99. A-49 1 The transfer of controlled substances from one authorized person to another must occur according to protocol; otherwise the controlled substance must be returned to the pharmacy and delivered at a later time.