Deck 30: Alterations in White Blood Cell Function and Oncologic Emergencies

Question 1

A patient tells the nurse that he had a tuberculin test several months ago,and the site of injection became very red and inflamed.How should the nurse interpret this information?

A)This Arthus reaction is common with tuberculin tests.
B)This type IV hypersensitivity response indicates the tuberculin test was positive.
C)Since this type II hypersensitivity response occurred,the patient should never have another tuberculin test.
D)The patient will require chest x-ray confirmation of this type I hypersensitivity response.

Answer 1

This type IV hypersensitivity response indicates the tuberculin test was positive.

Question 2

The nurse is instructing a patient with a compromised immune status on the signs and symptoms of infections.What should be included in these instructions?

A)Increased sputum production
B)Cloudy urine
C)Irritated oral mucosa
D)Purulent wound drainage

Answer 2

Irritated oral mucosa

Question 3

A patient with leukemia begins to have seizures.The nurse realizes that the onset of seizure activity is most likely associated with which occurrence?

A)The patient's hemodynamic instability has decreased cerebral perfusion.
B)Malignant cells have infiltrated into the central nervous system.
C)Pancytopenia is occurring.
D)Expansion of malignant cells has started.

Answer 3

Malignant cells have infiltrated into the central nervous system.

Question 4

A patient,recovering from skin grafts to the arm because of burn injuries,is demonstrating an increase of drainage,bleeding,and edema.The nurse prepares to treat which complication?

A)Arthus reaction
B)Serum sickness
C)Type I hypersensitivity reaction
D)Type IV hypersensitivity reaction

Question 5

The nurse is assessing a patient for altered immunocompetence.Which findings would indicate that the patient is at risk for developing an immunocompetence-associated illness? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Slow wound healing and easy bruising
B)Bursitis and muscle cramps
C)Heart palpitations
D)Heartburn and increased flatus
E)Mouth sores and oral patches

Question 6

A patient infected with HIV is being monitored for the development of AIDS.Which characteristics would the nurse monitor? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)White blood count
B)CD4+ T-cell count
C)Presence of recurrent E.coli urinary tract infection
D)Presence of Pneumocystis jiroveci (PJP)infection
E)Presence of cytomegalovirus (CMV)

Question 7

An older adult patient admitted with malnutrition begins to demonstrate signs of pneumonia.The nurse would explain which possible etiology of this pneumonia?

A)There is a lack of nutrients to support immune function.
B)Insufficient fluid intake has allowed bacteria to grow.
C)The patient's malnutrition resulted from poor living conditions making infection more likely.
D)Poor nutrition has resulted in a deficiency of vitamin C.

Question 8

A patient with an autoimmune disorder says,"I don't know why this happened to me.I try to exercise and eat well." How should the nurse respond?

A)"These disorders are usually associated with a vitamin deficiency."
B)"These problems happen when your body misinterprets normal cells as being foreign and attempts to destroy them."
C)"It happened because you were exposed to something repeatedly,and then the body decided it needed to destroy it."
D)"Chronic illnesses are the cause of autoimmune disorders."

Question 9

A patient tells the nurse that it seems like the only time she gets a cold is when she is under higher than normal stress.What information should the nurse provide?

A)"You probably don't eat as well when you are under stress."
B)"You probably don't rest and sleep as well when your stress is high."
C)"Stress causes your body to have an autoimmune response."
D)"Stress increases cortisol,which suppresses your immune system."

Question 10

A patient with acute myelogenous leukemia is scheduled for a hematopoietic stem-cell transplant (HSCT).How would the nurse categorize this patient's treatment goal?

A)Remission from the disease for at least 5 years
B)Prolongation of the chronic phase of the disease for at least 10 years
C)To effect cure
D)To shorten the acute phase of the disease

Question 11

A patient hospitalized for treatment of a mediastinal malignancy is at risk for developing superior vena cava (SVC)syndrome.The nurse would monitor for the development of which signs of this disorder? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Headache
B)Distended neck veins
C)Flushed face
D)Decreased pedal pulses
E)Pain in the lower back

Question 12

A patient is prescribed filgrastim (Neupogen).Which nursing intervention is indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Prepare the medication for intramuscular injection.
B)Allow the medication to warm to room temperature for no longer than 6 hours.
C)Withdraw prescribed amount and return remaining medication to refrigerator for later use.
D)Discard vial if left at room temperature for longer than 4 hours.
E)Give the medication at least 24 hours following cytotoxic chemotherapy.

Question 13

The blood sample from a patient's bone marrow biopsy included Auer rods.The nurse would prepare to provide care for which disorder?

A)Acute myelogenous leukemia
B)Chronic myelogenous leukemia
C)Acute lymphocytic leukemia
D)Chronic lymphocytic leukemia

Question 14

A female patient is concerned after learning that a person with whom she had a casual sexual encounter has been diagnosed as being HIV positive.Which other patient statement would the nurse evaluate as significant?

A)"I have not felt bad since the possible exposure."
B)"We were only together for about a week and had sex 3 or 4 times."
C)"I did have a cold and sore throat last week,but it has cleared up without problems."
D)"I had a normal period just a few days after we broke up."

Question 15

A patient being treated with isoniazid for tuberculosis develops symptoms of systemic lupus erythematosus (SLE).The patient says,"I can't believe that I am so sick.First I get TB and now this.What is going to happen to me?" What nursing response is indicated?

A)"You will have to learn to manage both the TB and the SLE."
B)"Once your TB is cured,we can help you fight the SLE."
C)"Often the SLE symptoms go away after the TB medication is changed."
D)"Your immune system must be under a great deal of stress for both of these diseases to develop."

Question 16

A 55-year-old patient tells the nurse that he seems to be getting "more colds" as he gets older.Which possible explanation would the nurse have for this observation?

A)Aging causes the immune system to have difficulty determining self from non-self cells.
B)With aging,the body has increased difficulty recognizing mutated cells.
C)The thymus gland shrinks with aging,reducing the maturation and differentiation of T cells needed to fight infections.
D)The thyroid gland begins to malfunction after the 4th decade of life.

Question 17

A patient with neutropenia develops a fever.Which nursing action is most important?

A)Discuss the finding with the primary care provider.
B)Encourage oral fluids.
C)Review the medical record for trending.
D)Document this expected finding.

Question 18

A patient receiving a blood transfusion reports nausea and back pain 10 minutes into the transfusion.The nurse realizes the patient is experiencing which type of hypersensitivity response?

A)Type I
B)Type III
C)Type IV
D)Type II

Question 19

A patient in the acute care unit has developed neutropenia.A nurse would identify which history as a possible etiology of this condition?

A)The patient had symptoms of an untreated bacterial infection for a week prior to admission.
B)The patient's blood sugar was 120 mg/dL on admission.
C)The patient's lab work reveals a vitamin C deficiency.
D)The patient has been receiving chemotherapy treatment for lung cancer.

Question 20

A patient receiving treatment for lymphoma suddenly becomes critically ill and is diagnosed with tumor lysis syndrome.The nurse would review laboratory results for which expected levels? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)High serum phosphate
B)Low serum potassium
C)Low serum calcium
D)High uric acid
E)Hyponatremia