Review for Final Exam

1. Review for Final Exam PN 143 Immune/Oncology Nursing Care

2. Multiple Choice (Identify the best answer that completes the statement or question) • HIV is an _________ virus. • A. Opportunistic • B. Obligate • C. Opposite

3. Multiple Response • HIV is transmitted from human to human via: • A. blood • B. Semen • C. Saliva • D. Cervicovaginal secretions • E. All of the above

4. Multiple Response • Conditions that affect the likelihood of infection include: • A. Duration and frequency of exposure • B. Amount of virus inoculated • C. Virulence of the organism • D. The host’s defense capability

5. True or False • Transmission of HIV from mother to unborn child may occur during pregnancy, deliver, or postpartum breastfeeding.

6. True or False • In the normal immune response, B cells reduce virus in the lymph nodes and T cells reduce virus in the blood.

7. Multiple Response • Progressive HIV infection gradually destroys the available pool of T-Helper cells with which of the following consequences: • A. Overall CD4 cell count rises • B. Overall CD4 cell count drops • C. Increased liklihood of opportunistic infections • D. Reduced liklihood of opportunistic infections

8. Multiple Choice • HIV is a member of the family of retroviruses and carries it’s genetic material in RNA rather than DNA. In order to replicate, it must be _______ another living cell and __________________. • A. available to; use that cells cytoplasm • B. inside; convert RNA to DNA • C. alongside; use cellular contents through osmosis • D. inside; use cellular contents to build its wall

9. True or False • Both cellular and humoral immune mechanisms limit HIV replication and slow down the disease progression.

10. True or False • The amount of virus in the blood is directly linked to the rate of virus production which determines the rate of T-suppressor cell destruction.

11. Multiple Choice • AIDS is defined as: • A. an inherited condition that impairs the body’s immune mechanisms • B. an acquired condition that impairs the body’s ability to fight disease • C. an acquired condition that accelerates the body’s ability to produce T-Helper cells • D. An inherited condition in which CD4 cells are destroyed

12. Multiple Choice • The acute retroviral syndrome follow a particular pattern after the initial exposure. Select the appropriate pattern: • A. Virus load peak, virus replication, viral set point • B. Viral set point, virus load peak, viral replication • C. Viral duplication, viral set point, viral load peak • D. Virus replication, viral load peak, viral set point

13. Multiple Response • Early HIV disease presents signs and symptoms such as: • A. persistent unexplained fever • B. night sweats • C. weight loss • D. butterfly rash on face

14. Multiple Choice • When a person tests positive (seropositive) for HIV, the nurse should be able to find, in a chart, evidence that which of the following diagnostic studies results were done: • A. 2 positive ELISA tests and 1 positive Western Blot test • B. 1 positive ELISA test and 1 positive Western Blot test • C. 2 positive ELISA tests • D. A positive Western Blot test

15. True or False • A seronegative test for HIV infection indicates that an individual is free from HIV infection

16. True or False • PneumocystisJiroveci Pneumonia is the most common bacterial infection in an individual with HIV infection

17. Multiple Choice • Histoplasmosis is a fungal infection endemic in central and southern US. To avoid this infection, a nurse would counsel an individual with HIV infection: • A. To avoid chicken coops and caves • B. Do not clean bird cages or clean sinks • C. Wear a mask at all times

18. Multiple Response • Cytomegalovirus (CMV) is a viral opportunistic infection found in the GI system. Complications of CMV may include: • A. Retinitis • B. Encephalitis • C. Colitis • D. Otitis

19. Multiple Choice • Oral/esophageal candidiasis is a _______ infection found in most soils and foods. Symptoms include _____________ and treatment is effective with ____________. • A. bacterial, plaques in the mouth, Fluconazole • B. Bacterial, change in behavior, Dicloxacillin • C. Fungal, whitish yellow patches in the mouth, Fluconazole (Diflucan) • D. Fungal, plaques in the mouth, Dicloxacillin

20. Multiple Choice • Toxoplasmosis is a parasitic opportunistic infection and carried by: • A. Human agents • B. Cats, mammals, and bird host agents • C. Reptiles • D. insects

21. Multiple Response • To avoid contact with the organism that carries toxoplasmosis, the nurse would educate a patient with HIV infection and his/her significant support system about: • A. Washing hands well and when • B. Avoid eating undercooked and raw meat • C. Client not to change little boxes • D. Client not to feel the dog

22. Multiple Choice • Kaposi’s Sarcoma is an opportunistic malignancy associated with infecion with a herpes virus spread via sexual transmission. Characteristic lesions appear as: • A. macular light pink spots • B. macular pink, red, purple areas on the skin • C. papular brown lesions • D. macular, papular brown pruritic lesions

23. Multiple Choice • Symptoms of Kaposi’s Sarcoma develop when: • A. the malignancy spreads to the GI tract and lungs • B. one of the lesions become infected • C. pain is noticed in a lesion • D. the malignancy spreads to the brain

24. Multiple Choice • Non-Hodgkins lymphoma is the second most comman malignancy in patients with AIDS. Diagnosis is based on: • A. Swollen or enlarged lymph nodes • B. Blood sampling for lymphocyte count • C. Report of symptoms: fever, night sweats, weight loss • D. Biopsy of lymphoid tissue

25. Multiple Choice • Palliative care is a termed used for patients whose disease is not responsive to curative treatment. The goal of palliative care is to address: • A. Offer new experimental treatments that offer hope for a cure • B. Improve quality of life • C. Return the patient back to his/her normal baseline pre-disease process • D. Offer a new perspective on the future

26. Multiple Choice • Mr. J. was diagnosed with HIV infection last week. He lives with his mother and both are asking the nurse many questions about living with this disease. Priority nursing interventions for them would include: • A. Encourage patient and family to live a day at a time • B. Encourage patient to participate in his own care • C. Educate about HIV • D. Encourage patient and family to live life to the fullest

27. Multiple Choice • Mr. J. told his mother how depressed he was that he had the diagnosis of HIV infection. His mother shared the same feelings. At the next clinic visit they brought this up with the nurse. The nurse recognized their situation as a part of grieving. To assist with grieving, the nurse would: • A. Let them know they are not alone and that there are many others in a similar situation and that they too can be brave to face the future • B. Explore feelings, fear, and treatment options with patient and his mother • C. Tell them about support groups and let them know that you will sign them up • D. Refer their concerns to the physician

28. True or False • Every health care worker involved with an HIV infected patient needs to know the diagnosis.

29. Multiple Response • Prior to drawing blood for HIV testing, what measures are standard practice related to HIV testing? • A. Pre and post counseling • B. confidential or anonymous testing is an option • C. Mandatory informing of HIV status to significant others • D. Informed consent must be signed prior to blood draw

30. Multiple Response • Decreasing the risks of occupational exposure to HIV is an essential part of health care practice. Steps to accomplish this include: • A. Handwashing • B. Universal Precautions • C. Reverse isolation • D. after an exposure, HIV testing: baseline, 6 months, and 12 months

31. True or False • Cancer is a group of diseases characterized by the uncontrolled growth and spread of abnormal cells

32. Multiple Choice • Carcinogenesis is: • A. The way cancer cells spread throughout the whole body • B. The process by which normal cells are transformed into cancer cells • C. Is started by exposure to ultraviolet rays • D. Caused by fumes from rubber or dust

33. Multiple Response • Cancer prevention and early detection can discover cancer in its earliest stages. Some tests that will detect early cancer cells include: • A. PAP smear • B. Colorectal tests • C. Blood in the stool • D. PSA antigens

34. Multiple Choice • When cells are destroyed, cells of the same type reproduce until the correct number have been replenished. Cancer cells, instead of limiting their growth to meet specific needs, reproduce in a disorderly and unrestricted manner. This uncontrolled or abnormal growth of cells is referred to as: • A. Metastasis • B. Benign mass • C. Neoplasm • D. Carcinoma

35. Multiple Choice • Diagnosis of Cancer may be achieved by means of: • A. biopsy, endoscopy, and diagnostic imaging • B. Xray, abdominal exam, patient report • C. patient report, CBC, Ultrasound • D. biopsy, CMP, chest xray

36. Multiple Response • Cancer can be treated a number of ways. Some therapies include: • A. surgery • B. radiation • C. chemotherapy • D. antibiotic therapy

37. Multiple Response • With a nursing diagnosis of: Acute Pain related to tumor enlargement (med. Dx.) AEB increasing abdominal girth with large hard mass; appropriate nursing interventions would include: • A. Oral pain medication: long acting with fast-acting med for breakthrough pain • B. Monitor appetite and food intake. Offer foods that he/she enjoys • C. Preop preparation for curative surgery • D. Active, supportive listening

38. Multiple Choice • Chemotherapy is often given in combination to treat cancer. The rationale for this is: • A. It doubles the chances to kill the cancer growth when 2 medications are use • B. Many side effects are avoided with 2 different drugs • C. It is designed to attack cancer cells at different stages of their development • D. It reduces the risk for fluid overload since both drugs can usually be mixed in a single infusion

39. True or False • Normal cells are often destroyed by the chemotherapy intended for the cancer cells.

40. Multiple Choice • Bone Marrow transplantation is the process of replacing diseased or damaged bone marrow with normally functioning bone marrow. The safest means of transfusing bone marrow with the best option of success is: • A. An allogenictranplantation • B. A matched unrelated donor transplantation • C. An autologous infusion of packed red blood cells • D. An autolgoustranplantation

41. Multiple Response • One of the issues faced by patients undergoing chemotherapy includes difficulty coping with the treatment and impact on their lives. Nursing can help these patients in the following ways: • A. Teaching and providing support • B. Guiding them to set priorities • C. Encouraging relaxation techniques • D. Listening

42. Multiple Choice • One side effect of chemotherapy is excess fluid volume called ascites when accumulated in the abdominal cavity. Treatment for this condition is called: • A. Peritoneal dialysis • B. Mediport implantation • C. Paracentesis • D. gastric lavage

43. Multiple Choice • A patient with neutropenia has a low white blood cell count. The significance of this situation is: • A. The body’s inability to resist the growth of cancer cells • B. The body’s reduced ability to fight infection • C. Increased risk for anemia • D. Increased risk for bleeding

44. Other • One of the most common side effects of chemotherapy is anorexia. Patients are not able to maintain enough nutrition to meet the body’s requirements to sustain life. List 4 general guidelines that will help with nutrition intake: • 1. • 2. • 3. • 4.

45. Other • Bowel habits can be significantly altered while an individual is on chemotherapy. Constipation may be a significant problem due to: • A. High fat, high caloric diet • B. lack of fiber and fluid in the diet • C. low sodium diet • D. mechanical soft diet

46. Multiple Choice • Medical Emergencies can happen to patients on chemotherapy due to distrubances in electrolytes, tumor growth, and other metabolic imbalances. One such emergency happens when bone begins to resorb. This is known as: • A. DIC • B. Tumor Lysis Syndrome • C. Hypercalcemia • D. Superior Vena Cava Syndrome

47. Multiple Choice • Another oncologic emergency occurs when malignant cells are cut or broken and potassium, phosphate, and uric acid spill into the bloodstream. The condition is referred to as: • A. tumor lysis syndrome • B. hypercalcemia • C. DIC • D. tumor necrosis

48. Other • One nursing diagnosis related to patients with advanced cancer is stated as: “self-care deficit related to _________ AEB _______________. • A. Dementia; poor personal hygiene • B. Fatigue with advancing cancer; poor personal hygiene • C. Advancing cancer; lack of caregiver • D. Weakness; low ANC

49. Other • Fill in: • The absence or scarcity of neutrophils in the blood makes a person vulnerable to ______. After chemotherapy, the ANC is usually _____ and then slowly _____ reflecting the fact that the ____ ______ is recovering and new ______ ______ are beginning to grow and mature.

50. Multiple Response • When the ANC is low, there are some nursing interventions to be followed to protect the patient. These would include: • A. reverse isolation • B. stool and urine precautions • C. caregivers wearing a mask when caring for the client • D. the client wearing a mask when out of their room