Transcript Slide 1

Immune System
Review/Questions
Term III
Ana H. Corona, MSN, FNP-C
Nursing Instructor
November 2007
More presentations at www.nurseana.com
Mayo Clinic, Leukemia Society of America,
CDC, NIH, 2007; ExamCram
HIV
 HIV belongs to a class of viruses called
retroviruses.
 Retroviruses: viruses that carry their genetic
material in the form of RNA (ribonucleic acid)
and that have the enzyme reverse transcriptase
 Retroviruses in order to replicate (duplicate),
they must make a DNA (deoxyribonucleic acid)
copy of their RNA. It is the DNA genes that allow
the virus to replicate.
HIV
HIV can replicate only inside cells,
commanding the cell's machinery to
reproduce.
Only HIV and other retroviruses once
inside a cell use an enzyme called
reverse transciptase to convert their RNA
into DNA, which can be incorporated into
the host cell's genes.
HIV
HIV belongs to a subgroup of retroviruses
known as lentiviruses "slow" viruses.
The course of infection with these viruses
is characterized by a long interval between
initial infection and the onset of serious
symptoms.
AIDS
 Acquired Immunodeficiency Syndrome (AIDS) is
the final stage of HIV infection.
 The CDC establish the definition of AIDS, which
occurs in HIV-infected persons with fewer than
200 CD4+T cells and/or persons with HIV who
develop certain opportunistic infections.
 In 1992, the CDC redefined AIDS to include 26
CDC-defined AIDS indicator illnesses and
clinical conditions that affect persons with
advanced HIV.
CD4+T cells
 CD4+T cells are the immune system's key infection
fighters and the entity that allows HIV to enter, attach and
infect the body's immune system.
 The CD4+T cells (also called T4 cells) are disabled and
destroyed by the virus, often with no symptoms, causing a
significant decrease in the blood levels of T4 cells.
 In the advanced stages of HIV, the body may have fewer
than 200 T4 cells, while a healthy adult's count is 1,000 or
more.
 In this way, the body's immune system is continuously
weakened from the moment of infection and the inability
of the immune system to fight infection opens the door to
opportunistic infections.
AIDS
AIDS is a disease developed by a person
living with HIV.
The term AIDS applies to the most
advanced stages of HIV infection.
Although an HIV-positive test result does
not mean that a person has AIDS, most
people will develop AIDS as a result of
their HIV infection.
HIV/AIDS
 There are four main stages in the progression of
an HIV infected person developing AIDS.
 The period following the initial HIV infection is
called the window period.
 It is called this because this period reflects the
window of time between infection with the virus
and when HIV antibodies develop in the
bloodstream.
 An HIV test that looks for antibodies taken
during this time can result in a false negative,
though antibodies usually appear within six
months of the initial infection.
Seroconversion
Refers to the period of time during which
your body is busy producing HIV
antibodies, trying to protect itself against
the virus.
This is the period after the initial infection
when many people experience flu-like
symptoms and swollen lymph nodes – this
is a highly infectious stage.
Seroconversion
 After most people seroconvert, they usually
experience a symptom-free period or
asymptomatic period.
 This stage can last anywhere from 6 months to
over 10 years, varying from person to person.
 Although the person with HIV is experiencing no
symptoms, the virus is still replicating inside the
body and weakening the immune system.
 After this period, severe CD4+T cell loss leads to
the symptomatic period, in which the body
experiences the symptoms associated to HIV
 This is the final stage before developing AIDS.
Opportunistic Infections
According to the CDC, AIDS-defining
opportunistic illnesses are the major cause
of morbidity and mortality among HIV
infected persons.
Opportunistic infections are a result of the
weakened immune system present in
persons with HIV/AIDS.
An infection takes the "opportunity"
provided by the weakened immune system
to cause an illness that is usually
controlled by a healthy immune system.
Opportunistic Infections
These infections are sometimes lifethreatening and require medical
intervention to prevent or treat serious
illnesses.
Persons living with advanced HIV infection
suffer opportunistic infections of the lungs,
brain, eyes and other organs.
HIV symptoms
It is common during the first two to four
weeks of infection that people experience
flu-like symptoms and enlarged lymph
nodes.
This is because the virus migrates to
various organs in the body, particularly the
lymphoid organs. During this stage people
are highly infectious and HIV is present in
large quantities in genital secretions.
According to the Centers for Disease Control and Prevention, the following
are symptoms that may be warning signs of HIV infections:
 Rapid weight loss
 Dry cough
 Recurring fever or
profuse night sweats
 Profound and
unexplained fatigue
 Swollen lymph glands
in the armpits, groin
or neck
 Diarrhea that lasts for
more than a week
 White spots on the
tongue, mouth or in the
throat
 Pneumonia
 Red, brown, pink or
purplish blotches on or
under the skin or inside
the mouth, nose or
eyelids
 Memory loss,
depression and other
neurological disorders
Transmission of HIV
 HIV infection most commonly occurs through
sexual contact.
 However, the virus can also be spread through
blood-to-blood contact -- such as sharing
needles or blood transfusions involving
unscreened blood.
 HIV is not transmitted through casual contact
such as touching or sharing towels, bedding,
utensils, telephones, swimming pools, or toilet
seats.
 No evidence of transmission through kissing,
sweat, tears, urine or feces.
 Sex does not transmit HIV, but certain bodily
fluids: blood, semen (including "pre-cum"),
vaginal secretions and breast milk.
Transmission
 High-risk behaviors that can result in HIV
transmission are sharing needles for drugs,
tattoos, body piercing, vitamins or steroids with
an HIV-infected person and/or engaging in
unprotected anal, vaginal or oral sex with a
person who is HIV infected.
 The virus also can be transmitted from an HIVinfected mother to her child through pregnancy,
birth or breastfeeding.
 Mucous membranes are porous and viruses and
other pathogens are able to pass through.
 When a person already has a sexually
transmitted disease, sex organs may be flooded
with CD4+T cells, making it much easier for HIV
to infect.
Transmission
Mucous membranes are porous and
viruses and other pathogens are able to
pass through.
When a person already has a sexually
transmitted disease, sex organs may be
flooded with CD4+T cells, making it much
easier for HIV to infect.
HIV Medications
Twenty-nine medications have been
approved by the U.S. government to fight
HIV.
View HIV medications by brand name at
the following website:
http://www.thebody.com/content/art40488.html
Hodgkin's Lymphoma
 Is a cancer of the lymphatic system, which is
part of your immune system.
 Cells in the lymphatic system grow abnormally
and may spread beyond the lymphatic system.
 As Hodgkin's disease progresses, it
compromises the body's ability to fight infection.
 Is one of two common types of cancers of the
lymphatic system. Non-Hodgkin's lymphoma, the
other type, is far more common.
 Advances in diagnosis, staging and treatment of
Hodgkin's disease have helped to make this
once uniformly fatal disease highly treatable with
the potential for full recovery.
Hodgkin's Lymphoma Signs & Symptoms
 Flu like symptoms
 Painless swelling of lymph nodes on the neck,
armpits or groin
 Persistent fatigue
 Fever and chills
 Night sweats
 Unexplained weight loss as much as 10 percent
or more of body weight
 Loss of appetite
 Itching
Hodgkin's lymphoma etiology
 The exact cause is unknown.
 There are five types of Hodgkin's disease all
among a group of cancers called lymphomas —
cancers of the lymphatic system.
 Hodgkin's disease commonly begins in lymph
nodes located in the upper part of your body. Some
lymph nodes are in areas more readily noticed,
such as in the neck, above the collarbone, under
the arms or in the groin area.
 Enlarged lymph nodes in the chest cavity also are
common.
 Eventually, Hodgkin's disease may spread outside
your lymph nodes to virtually any part of your body.
Risk Factors
 Age. Ages between 15 and 40, and those older
than 55, are most at risk of Hodgkin's disease.
 Family history. Having a brother or a sister with
the disease (may be due to environmental
exposures rather than genetic factors).
 Sex. Males more likely to develop Hodgkin's.
 Past Epstein-Barr infection. People who have
had illnesses caused by the Epstein-Barr virus,
such as infectious mononucleosis, are more likely
to develop Hodgkin's disease than people who
haven't had a past Epstein-Barr infection.
 Compromised immune system. Having a
compromised immune system, such as from
HIV/AIDS or from having an organ transplant
requiring medications to suppress immune
response.
Screenings
 Many people with Hodgkin's disease experience
no classic symptoms.
 Sometimes, an abnormality found on a chest Xray done for nonspecific symptoms leads to an
eventual diagnosis of Hodgkin's disease.
 Because the symptoms of Hodgkin's are similar
to those of other disorders, such as influenza,
the disease can be difficult to diagnose. Some
distinctive characteristics help diagnose
Hodgkin's disease, and these include:
 Orderly spread. The pattern of spread is
orderly, progressing from one group of lymph
nodes to the next.
Diagnostic
 Pathology: presence of Reed-Sternberg cells.
 The affected lymph nodes may contain only a few
of these malignant cells.
 X-ray
 CT scan
 Magnetic resonance imaging (MRI)
 Gallium scan,
 Positron emission tomography (PET) scan
 Bone marrow biopsy
 Blood tests
 If the disease is predominantly in the abdomen,
you may need exploratory surgery to help define
the extent of the disease.
Staging Hodgkin's disease
 Staging likely affect treatment options.
 Stage I. The cancer is limited to one lymph node
region or a single organ.
 Stage II. The cancer is in two different lymph
nodes, but is limited to a section of the body either
above or below the diaphragm.
 Stage III. When the cancer moves to lymph nodes
both above and below the diaphragm, but hasn't
spread from the lymph nodes to other organs.
 Stage IV. This is the most advanced stage of
Hodgkin's disease. Stage IV Hodgkin's disease
affects not only the lymph nodes but also other
parts of your body, such as the bone marrow or
your liver.
Treatment
Radiation
Chemotherapy
Chemotherapy drugs
 ABVD, which consists of doxorubicin (Adriamycin),
bleomycin, vinblastine and dacarbazine (new
regimen with less side effects and currently
preferred treatment).
 BEACOPP, consists of bleomycin, etoposide,
Adriamycin, cyclophosphamide, vincristine
(Oncovin), procarbazine and prednisone
 COPP/ABVD, consists of cyclophosphamide,
Oncovin, procarbazine, prednisone, Adriamycin,
bleomycin, vinblastine and dacarbazine
 Stanford V, which consists of Adriamycin,
vinblastine, mechlorethamine, etoposide,
vincristine, bleomycin and prednisone
 MOPP, which consists of mechlorethamine,
Oncovin, procarbazine and prednisone (had been
the basic regimen, but it's very toxic).
Bone Marrow Transplant
 If the disease recurs after an initial
chemotherapy-induced remission, high-dose
chemotherapy and transplantation of your own
(autologous) bone marrow or peripheral stem
cells may lead to prolonged remission.
 Peripheral stem cells are bone marrow cells
mobilized from the bone marrow into the
bloodstream.
 Because high doses of chemotherapy destroy
bone marrow, the marrow or peripheral blood
stem cells are collected before treatment and
frozen.
 Following chemotherapy, the cells, which have
been protected from the effects of the treatment,
are injected back into the body.
Leukemia
Leukemia is the general term used to
describe four different disease-types
called:
Acute Myelogenous Leukemia (AML)
Acute Lymphocytic Leukemia (ALL)
Chronic Myelogenous Leukemia (CML)
Chronic Lymphocytic Leukemia (CLL)
Terms
The terms lymphocytic or lymphoblastic
indicate that the cancerous change takes
place in a type of marrow cell that forms
lymphocytes.
The terms myelogenous or myeloid
indicate that the cell change takes place in
a type of marrow cell that normally goes
on to form red cells, some types of white
cells, and platelets.
Acute/Chronic Leukemias
 Acute lymphocytic leukemia and acute
myelogenous leukemia are each composed of
blast cells, known as lymphoblasts or
myeloblasts.
 Acute leukemias progress rapidly without
treatment.
 Chronic leukemias have few or no blast cells.
 Chronic lymphocytic leukemia and chronic
myelogenous leukemia usually progress slowly
compared to acute leukemias.
Etiology
 The four types of leukemia each begin in a cell in
the bone marrow.
 The cell undergoes a leukemic change and it
multiplies into many cells.
 The leukemia cells grow and survive better than
normal cells, over time, they crowd out normal
cells.
 Normal stem cells in the marrow form three main
cell-types: Red cells, platelets and white cells.
 There are two major types of white cells: germingesting cells (neutrophils and monocytes) and
lymphocytes, which are part of the body's
immune system and help to fight to infection.
 The rate at which leukemia progresses and how
the cells replace the normal blood and marrow
cells are different with each type of leukemia.
Acute Leukemia
 In acute myelogenous leukemia (AML) and
acute lymphocytic leukemia (ALL), the original
acute leukemia cell goes on to form about a
trillion more leukemia cells.
 These cells are described as "nonfunctional"
because they do not work like normal cells.
 They also crowd out the normal cells in the
marrow; in turn, this causes a decrease in the
number of new normal cells made in the marrow.
 This further results in low red cell counts
(anemia).
Chronic Leukemia
 In chronic myelogenous leukemia (CML), the
leukemia cell that starts the disease makes red
cells, white cells and platelets that function almost
like normal cells.
 The number of red cells is usually less than
normal, resulting in anemia.
 Many WBCs and many platelets are still made.
 WBCs are nearly normal their counts are high and
continue to rise.
 This can cause serious problems if the patient
does not get treatment.
 If untreated, the WBC count can rise so high that
blood flow slows down and anemia becomes
severe
Chronic Lymphocytic Leukemia
 The leukemia cell that starts the disease makes too many
lymphocytes that do not function. These cells replace
normal cells in the marrow and lymph nodes.
 They interfere with the work of normal lymphocytes, which
weakens the patient's immune response.
 The high # of leukemia cells in the marrow may crowd out
normal blood-forming cells and lead to anemia
 A very high # of leukemia cells building up in the marrow
also can lead to low neutrophil and platelet counts.
 Patients with CLL may have disease that does not
progress for a long time.
 Patient may remain in good health and do not need
treatment for long periods of time.
 Most patients require treatment at the time of diagnosis or
soon after.
Etiology
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People can get leukemia at any age.
It is most common in people over age 60.
The most common types in adults are AML and CLL.
ALL is the most common form of leukemia in children.
Some risk factors for AML are:
Certain chemotherapies used for lymphoma or other types
of cancer
Down syndrome and some other genetic diseases
Chronic exposure to benzene (such as in the workplace)
that exceeds federally approved safety limits
Radiation therapy used to treat other types of cancer
Tobacco smoke.
Exposure to high doses of radiation therapy is also a risk
factor for ALL and CML. Other possible risk factors for the
four types of leukemia are continually under study.
Symptoms for Acute Leukemia
 Tiredness or no energy
 Shortness of breath during physical activity
 Pale skin
 Mild fever or night sweats
 Slow healing of cuts and excess bleeding
 Black-and-blue marks (bruises) for no clear
reason
 Pinhead-size red spots under the skin
 Aches in bones or joints (for example, knees,
hips or shoulders)
 Low white cell counts, especially monocytes or
neutrophils.
CLL or CML
 May not have any symptoms.
 CLL may notice enlarged lymph nodes in the
neck, armpit or groin.
 Tired or short of breath or have frequent
infections,
 If CLL is more severe, a blood test may show an
increase in the lymphocyte count.
 CML signs and symptoms tend to develop
slowly.
 People with CML may feel tired and short of
breath while doing everyday activities; they may
also have an enlarged spleen
 "dragging" feeling on the upper left side of the
belly, night sweats and weight loss.
Diagnosis
 A CBC is used to diagnose leukemia.
 This blood test may show high or low levels of
white cells and show leukemic cells in the blood.
 Sometimes, platelet counts and red cell counts
are low.
 Bone marrow tests are often done to confirm the
diagnosis and to look for chromosome
abnormalities.
 These tests identify the leukemia cell-type.
 A complete blood exam and a number of other
tests are used to diagnose the type of leukemia.
 These tests can be repeated after treatment
begins to measure how well the treatment is
working.
Treatment
 Patients with an acute leukemia begin induction
therapy with chemotherapy in the hospital.
 Consolidation therapy or post induction therapy.
 This part of treatment may include chemotherapy
with or without allogeneic stem cell transplantation
(bone marrow transplantation).
 Patients with CML need to begin treatment once
they are diagnosed.
 They usually begin treatment with imatinib
mesylate (Gleevec®).
 This drug is taken by mouth. Gleevec® does not
cure CML. But it keeps CML under control for
many patients for as long as they take it.
 Other drugs, such as dasatinib (Sprycel®), are
used for certain patients instead of Gleevec®.
Treatments
 Allogeneic stem cell transplantation is the only
treatment that can cure CML at this time.
 This treatment is most successful in younger
patients.
 But patients up to 60 years of age who have a
matched donor may be considered for this
treatment.
 Allogeneic transplantation can be a high-risk
procedure.
 Studies are under way to see whether CML
patients have better long term outcomes with
drug therapy or with transplantation.
 Some CLL patients do not need treatment for
long periods of time after diagnosis.
1
 A 43-YEAR-OLD AFRICAN AMERICAN MALE
IS ADMITTED WITH SICKLE CELL ANEMIA.
THE NURSE PLANS TO ASSESS
CIRCULATION IN THE LOWER EXTREMITIES
EVERY 2 HOURS. WHICH OF THE
FOLLOWING OUTCOME CRITERIA WOULD
THE NURSE USE?
A. BODY TEMPERATURE OF 99°F OR LESS
B. TOES MOVED IN ACTIVE RANGE OF
MOTION
C. SENSATION REPORTED WHEN SOLES OF
FEET ARE TOUCHED
D. CAPILLARY REFILL OF < 3 SECONDS
1
Answer D is correct. It is important to
assess the extremities for blood vessel
occlusion in the client with sickle cell
anemia because a change in capillary refill
would indicate a change in circulation.
Body temperature, motion, and sensation
would not give information regarding
peripheral circulation; therefore, answers
A, B, and C are incorrect.
2
 A 30-YEAR-OLD MALE FROM HAITI IS
BROUGHT TO THE EMERGENCY
DEPARTMENT IN SICKLE CELL CRISIS.
WHAT IS THE BEST POSITION FOR THIS
CLIENT?
A. SIDE-LYING WITH KNEES FLEXED
B. KNEE-CHEST
C. HIGH FOWLER'S WITH KNEES FLEXED
D. SEMI-FOWLER'S WITH LEGS EXTENDED
ON THE BED
2
Answer D is correct. Placing the client in
semi-Fowler’s position provides the best
oxygenation for this client. Flexion of the
hips and knees, which includes the kneechest position, impedes circulation and is
not correct positioning for this client.
Therefore, answers A, B, and C are
incorrect.
3
 A 25-YEAR-OLD MALE IS ADMITTED IN
SICKLE CELL CRISIS. WHICH OF THE
FOLLOWING INTERVENTIONS WOULD BE
OF HIGHEST PRIORITY FOR THIS CLIENT?
A. TAKING HOURLY BLOOD PRESSURES WITH
MECHANICAL CUFF
B. ENCOURAGING FLUID INTAKE OF AT LEAST
200ML PER HOUR
C. POSITION IN HIGH FOWLER'S WITH KNEE
GATCH RAISED
D. ADMINISTERING TYLENOL AS ORDERED
3
Answer B is correct. It is important to
keep the client in sickle cell crisis hydrated
to prevent further sickling of the blood.
Answer A is incorrect because a
mechanical cuff places too much pressure
on the arm. Answer C is incorrect because
raising the knee gatch impedes circulation.
Answer D is incorrect because Tylenol is
too mild an analgesic for the client in
crisis.
4
 Which of the following foods would the
nurse encourage the client in sickle cell
crisis to eat?
A. PEACHES
B. COTTAGE CHEESE
C. POPSICLE
D. LIMA BEANS
4
Answer C is correct. Hydration is
important in the client with sickle cell
disease to prevent thrombus formation.
Popsicles, gelatin, juice, and pudding have
high fluid content. The foods in answers A,
B, and D do not aid in hydration and are,
therefore, incorrect.
5
 A newly admitted client has sickle cell crisis.
The nurse is planning care based on
assessment of the client. The client is
complaining of severe pain in his feet and
hands. The pulse oximetry is 92. Which of the
following interventions would be implemented
first? Assume that there are orders for each
intervention.
A. ADJUST THE ROOM TEMPERATURE
B. GIVE A BOLUS OF IV FLUIDS
C. START O2
D. ADMINISTER MEPERIDINE (DEMEROL)
75MG IV PUSH
5
 Answer C is correct. The most prominent
clinical manifestation of sickle cell crisis is pain.
However, the pulse oximetry indicates that
oxygen levels are low; thus, oxygenation takes
precedence over pain relief. Answer A is
incorrect because although a warm environment
reduces pain and minimizes sickling, it would not
be a priority. Answer B is incorrect because
although hydration is important, it would not
require a bolus. Answer D is incorrect because
Demerol is acidifying to the blood and increases
sickling.
6
 THE NURSE IS INSTRUCTING A CLIENT
WITH IRON-DEFICIENCY ANEMIA. WHICH
OF THE FOLLOWING MEAL PLANS WOULD
THE NURSE EXPECT THE CLIENT TO
SELECT?
A. ROAST BEEF, GELATIN SALAD, GREEN
BEANS, AND PEACH PIE
B. CHICKEN SALAD SANDWICH, COLESLAW,
FRENCH FRIES, ICE CREAM
C. EGG SALAD ON WHEAT BREAD, CARROT
STICKS, LETTUCE SALAD, RAISIN PIE
D. PORK CHOP, CREAMED POTATOES, CORN,
AND COCONUT CAKE
6
Answer C is correct. Egg yolks, wheat
bread, carrots, raisins, and green, leafy
vegetables are all high in iron, which is an
important mineral for this client. Roast
beef, cabbage, and pork chops are also
high in iron, but the side dishes
accompanying these choices are not;
therefore, answers A, B, and D are
incorrect.
7
 CLIENTS WITH SICKLE CELL ANEMIA ARE
TAUGHT TO AVOID ACTIVITIES THAT CAUSE
HYPOXIA AND HYPOXEMIA. WHICH OF THE
FOLLOWING ACTIVITIES WOULD THE
NURSE RECOMMEND?
A. A FAMILY VACATION IN THE ROCKY
MOUNTAINS
B. CHAPERONING THE LOCAL BOYS CLUB ON
A SNOW-SKIING TRIP
C. TRAVELING BY AIRPLANE FOR BUSINESS
TRIPS
D. A BUS TRIP TO THE MUSEUM OF NATURAL
HISTORY
7
Answer D is correct. Taking a trip to the
museum is the only answer that does not
pose a threat. A family vacation in the
Rocky Mountains at high altitudes, cold
temperatures, and airplane travel can
cause sickling episodes and should be
avoided; therefore, answers A, B, and C
are incorrect.
8
 THE NURSE IS CONDUCTING AN
ADMISSION ASSESSMENT OF A CLIENT
WITH VITAMIN B12 DEFICIENCY. WHICH OF
THE FOLLOWING WOULD THE NURSE
INCLUDE IN THE PHYSICAL ASSESSMENT?
A. PALPATE THE SPLEEN
B. TAKE THE BLOOD PRESSURE
C. EXAMINE THE FEET FOR PETECHIAE
D. EXAMINE THE TONGUE
8
Answer D is correct. The tongue is
smooth and beefy red in the client with
vitamin B12 deficiency, so examining the
tongue should be included in the physical
assessment. Bleeding, splenomegaly, and
blood pressure changes do not occur,
making answers A, B, and C incorrect.
9
 AN AFRICAN AMERICAN FEMALE COMES
TO THE OUTPATIENT CLINIC. THE
PHYSICIAN SUSPECTS VITAMIN B12
DEFICIENCY ANEMIA. BECAUSE JAUNDICE
IS OFTEN A CLINICAL MANIFESTATION OF
THIS TYPE OF ANEMIA, WHAT BODY PART
WOULD BE THE BEST INDICATOR?
A. CONJUNCTIVA OF THE EYE
B. SOLES OF THE FEET
C. ROOF OF THE MOUTH
D. SHINS
9
Answer C is correct. The oral mucosa
and hard palate (roof of the mouth) are the
best indicators of jaundice in dark-skinned
persons. The conjunctiva can have normal
deposits of fat, which give a yellowish hue;
thus, answer A is incorrect. The soles of
the feet can be yellow if they are
calloused, making answer B incorrect; the
shins would be an area of darker pigment,
so answer D is incorrect.
10
 THE NURSE IS CONDUCTING A PHYSICAL
ASSESSMENT ON A CLIENT WITH ANEMIA.
WHICH OF THE FOLLOWING CLINICAL
MANIFESTATIONS WOULD BE MOST
INDICATIVE OF THE ANEMIA?
A. BP 146/88
B. RESPIRATIONS 28 SHALLOW
C. WEIGHT GAIN OF 10 POUNDS IN 6 MONTHS
D. PINK COMPLEXION
10
Answer B is correct. When there are
fewer red blood cells, there is less
hemoglobin and less oxygen. Therefore,
the client is often short of breath, as
indicated in answer B. The client with
anemia is often pale in color, has weight
loss, and may be hypotensive. Answers A,
C, and D are within normal and, therefore,
are incorrect.
11
 THE NURSE IS TEACHING THE CLIENT WITH
POLYCYTHEMIA VERA ABOUT PREVENTION
OF COMPLICATIONS OF THE DISEASE.
WHICH OF THE FOLLOWING STATEMENTS
BY THE CLIENT INDICATES A NEED FOR
FURTHER TEACHING?
A. "I WILL DRINK 500ML OF FLUID OR LESS
EACH DAY."
B. "I WILL WEAR SUPPORT HOSE WHEN I AM
UP."
C. "I WILL USE AN ELECTRIC RAZOR FOR
SHAVING."
D. "I WILL EAT FOODS LOW IN IRON."
11
 Answer A is correct. The client with
polycythemia vera is at risk for thrombus
formation. Hydrating the client with at least 3L of
fluid per day is important in preventing clot
formation, so the statement to drink less than
500mL is incorrect. Answers B, C, and D are
incorrect because they all contribute to the
prevention of complications. Support hose
promotes venous return, the electric razor
prevents bleeding due to injury, and a diet low in
iron is essential to preventing further red cell
formation.
12
 A 33-YEAR-OLD MALE IS BEING EVALUATED
FOR POSSIBLE ACUTE LEUKEMIA. WHICH
OF THE FOLLOWING WOULD THE NURSE
INQUIRE ABOUT AS A PART OF THE
ASSESSMENT?
A. THE CLIENT COLLECTS STAMPS AS A
HOBBY.
B. THE CLIENT RECENTLY LOST HIS JOB AS A
POSTAL WORKER.
C. THE CLIENT HAD RADIATION FOR
TREATMENT OF HODGKIN'S DISEASE AS A
TEENAGER.
D. THE CLIENT'S BROTHER HAD LEUKEMIA AS
A CHILD.
12
Answer C is correct. Radiation treatment
for other types of cancer can result in
leukemia. Some hobbies and occupations
involving chemicals are linked to leukemia,
but not the ones in these answers;
therefore, answers A and B are incorrect.
Answer D is incorrect because the
incidence of leukemia is higher in twins
than in siblings.
13
 AN AFRICAN AMERICAN CLIENT IS
ADMITTED WITH ACUTE LEUKEMIA. THE
NURSE IS ASSESSING FOR SIGNS AND
SYMPTOMS OF BLEEDING. WHERE IS THE
BEST SITE FOR EXAMINING FOR THE
PRESENCE OF PETECHIAE?
A. THE ABDOMEN
B. THE THORAX
C. THE EARLOBES
D. THE SOLES OF THE FEET
13
Answer D is correct. Petechiae are not
usually visualized on dark skin. The soles
of the feet and palms of the hand provide
a lighter surface for assessing the client
for petichiae. Answers A, B, and C are
incorrect because the skin might be too
dark to make an assessment.
14
 A CLIENT WITH ACUTE LEUKEMIA IS
ADMITTED TO THE ONCOLOGY UNIT.
WHICH OF THE FOLLOWING WOULD BE
MOST IMPORTANT FOR THE NURSE TO
INQUIRE?
A. "HAVE YOU NOTICED A CHANGE IN
SLEEPING HABITS RECENTLY?"
B. "HAVE YOU HAD A RESPIRATORY
INFECTION IN THE LAST 6 MONTHS?"
C. "HAVE YOU LOST WEIGHT RECENTLY?"
D. "HAVE YOU NOTICED CHANGES IN YOUR
ALERTNESS?"
14
Answer B is correct. The client with
leukemia is at risk for infection and has
often had recurrent respiratory infections
during the previous 6 months.
Insomnolence, weight loss, and a
decrease in alertness also occur in
leukemia, but bleeding tendencies and
infections are the primary clinical
manifestations; therefore, answers A, C,
and D are incorrect.
15
 WHICH OF THE FOLLOWING WOULD BE
THE PRIORITY NURSING DIAGNOSIS FOR
THE ADULT CLIENT WITH ACUTE
LEUKEMIA?
A. ORAL MUCOUS MEMBRANE, ALTERED
RELATED TO CHEMOTHERAPY
B. RISK FOR INJURY RELATED TO
THROMBOCYTOPENIA
C. FATIGUE RELATED TO THE DISEASE
PROCESS
D. INTERRUPTED FAMILY PROCESSES
RELATED TO LIFE-THREATENING ILLNESS
OF A FAMILY MEMBER
15
Answer B is correct. The client with
acute leukemia has bleeding tendencies
due to decreased platelet counts, and any
injury would exacerbate the problem. The
client would require close monitoring for
hemorrhage, which is of higher priority
than the diagnoses in answers A, C, and
D, which are incorrect.
16
 A 21-YEAR-OLD MALE WITH HODGKIN'S
LYMPHOMA IS A SENIOR AT THE LOCAL
UNIVERSITY. HE IS ENGAGED TO BE
MARRIED AND IS TO BEGIN A NEW JOB
UPON GRADUATION. WHICH OF THE
FOLLOWING DIAGNOSES WOULD BE A
PRIORITY FOR THIS CLIENT?
A. SEXUAL DYSFUNCTION RELATED TO
RADIATION THERAPY
B. ANTICIPATORY GRIEVING RELATED TO
TERMINAL ILLNESS
C. TISSUE INTEGRITY RELATED TO
PROLONGED BED REST
D. FATIGUE RELATED TO CHEMOTHERAPY
16
Answer A is correct. Radiation therapy
often causes sterility in male clients and
would be of primary importance to this
client. The psychosocial needs of the
client are important to address in light of
the age and life choices. Hodgkin’s
disease, however, has a good prognosis
when diagnosed early. Answers B, C, and
D are incorrect because they are of lesser
priority.
17
 A CLIENT HAS AUTOIMMUNE
THROMBOCYTOPENIC PURPURA. TO
DETERMINE THE CLIENT'S
RESPONSE TO TREATMENT, THE
NURSE WOULD MONITOR:
A. PLATELET COUNT
B. WHITE BLOOD CELL COUNT
C. POTASSIUM LEVELS
D. PARTIAL PROTHROMBIN TIME (PTT)
17
Answer A is correct. Clients with
autoimmune thrombocytopenic purpura
(ATP) have low platelet counts, making
answer A the correct answer. White cell
counts, potassium levels, and PTT are not
affected in ATP; thus, answers B, C, and D
are incorrect.
18
 THE HOME HEALTH NURSE IS VISITING A
CLIENT WITH AUTOIMMUNE
THROMBOCYTOPENIC PURPURA (ATP).
THE CLIENT'S PLATELET COUNT
CURRENTLY IS 80, IT WILL BE MOST
IMPORTANT TO TEACH THE CLIENT AND
FAMILY ABOUT:
A. BLEEDING PRECAUTIONS
B. PREVENTION OF FALLS
C. OXYGEN THERAPY
D. CONSERVATION OF ENERGY
18
Answer A is correct. The normal platelet
count is 120,000–400, Bleeding occurs in
clients with low platelets. The priority is to
prevent and minimize bleeding.
Oxygenation in answer C is important, but
platelets do not carry oxygen. Answers B
and D are of lesser priority and are
incorrect in this instance.
19
 A CLIENT WITH HEMOPHILIA HAS A
NOSEBLEED. WHICH NURSING ACTION IS
MOST APPROPRIATE TO CONTROL THE
BLEEDING?
A. PLACE THE CLIENT IN A SITTING POSITION
WITH THE HEAD HYPEREXTENDED
B. PACK THE NARES TIGHTLY WITH GAUZE TO
APPLY PRESSURE TO THE SOURCE OF
BLEEDING
C. PINCH THE SOFT LOWER PART OF THE
NOSE FOR A MINIMUM OF 5 MINUTES
D. APPLY ICE PACKS TO THE FOREHEAD AND
BACK OF THE NECK
19
Answer C is correct. The client should be
positioned upright and leaning forward, to
prevent aspiration of blood. Answers A, B,
and D are incorrect because direct
pressure to the nose stops the bleeding,
and ice packs should be applied directly to
the nose as well. If a pack is necessary,
the nares are loosely packed.
20
 A CLIENT WITH VAGINAL CANCER IS BEING
TREATED WITH A RADIOACTIVE VAGINAL
IMPLANT. THE CLIENT'S HUSBAND ASKS
THE NURSE IF HE CAN SPEND THE NIGHT
WITH HIS WIFE. THE NURSE SHOULD
EXPLAIN THAT:
A. OVERNIGHT STAYS BY FAMILY MEMBERS IS
AGAINST HOSPITAL POLICY.
B. THERE IS NO NEED FOR HIM TO STAY
BECAUSE STAFFING IS ADEQUATE.
C. HIS WIFE WILL REST MUCH BETTER
KNOWING THAT HE IS AT HOME.
D. VISITATION IS LIMITED TO 30 MINUTES
WHEN THE IMPLANT IS IN PLACE.
20
 Answer D is correct. Clients with radium
implants should have close contact limited to 30
minutes per visit. The general rule is limiting time
spent exposed to radium, putting distance
between people and the radium source, and
using lead to shield against the radium. Teaching
the family member these principles is extremely
important. Answers A, B, and C are not
empathetic and do not address the question;
therefore, they are incorrect.
21
 A CLIENT WITH LEUKEMIA IS RECEIVING
TRIMETREXATE. AFTER REVIEWING THE
CLIENT'S CHART, THE PHYSICIAN ORDERS
WELLCOVORIN (LEUCOVORIN CALCIUM).
THE RATIONALE FOR ADMINISTERING
LEUCOVORIN CALCIUM TO A CLIENT
RECEIVING TRIMETREXATE IS TO:
A. TREAT IRON-DEFICIENCY ANEMIA CAUSED
BY CHEMOTHERAPEUTIC AGENTS
B. CREATE A SYNERGISTIC EFFECT THAT
SHORTENS TREATMENT TIME
C. INCREASE THE NUMBER OF CIRCULATING
NEUTROPHILS
D. REVERSE DRUG TOXICITY AND PREVENT
TISSUE DAMAGE
21
Answer D is correct. Leucovorin is the
antidote for Methotrexate and Trimetrexate
which are folic acid antagonists.
Leucovorin is a folic acid derivative.
Answers A, B, and C are incorrect
because Leucovorin does not treat iron
deficiency, increase neutrophils, or have a
synergistic effect.
22
 A client with a diagnosis of HPV is at risk
for which of the following?
A. HODGKIN'S LYMPHOMA
B. CERVICAL CANCER
C. MULTIPLE MYELOMA
D. OVARIAN CANCER
22
Answer B is correct. The client with HPV
is at higher risk for cervical and vaginal
cancer related to this STI. She is not at
higher risk for the other cancers
mentioned in answers A, C, and D, so
those are incorrect.
23
 A CLIENT HAS CANCER OF THE
PANCREAS. THE NURSE SHOULD BE
MOST CONCERNED ABOUT WHICH
NURSING DIAGNOSIS?
A. ALTERATION IN NUTRITION
B. ALTERATION IN BOWEL ELIMINATION
C. ALTERATION IN SKIN INTEGRITY
D. INEFFECTIVE INDIVIDUAL COPING
23
Answer A is correct. Cancer of the
pancreas frequently leads to severe
nausea and vomiting and altered nutrition.
The other problems are of lesser concern;
thus, answers B, C, and D are incorrect.
24
 THE HOME HEALTH NURSE IS VISITING AN
18-YEAR-OLD WITH OSTEOGENESIS
IMPERFECTA. WHICH INFORMATION
OBTAINED ON THE VISIT WOULD CAUSE
THE MOST CONCERN? THE CLIENT:
A. LIKES TO PLAY FOOTBALL
B. DRINKS SEVERAL CARBONATED DRINKS
PER DAY
C. HAS TWO SISTERS WITH SICKLE CELL
TRACT
D. IS TAKING ACETAMINOPHEN TO CONTROL
PAIN
24
 Answer A is correct. The client with
osteogenesis imperfecta is at risk for
pathological fractures and is likely to experience
these fractures if he participates in contact
sports. The client might experience symptoms of
hypoxia if he becomes dehydrated or
deoxygenated; extreme exercise, especially in
warm weather, can exacerbate the condition.
Answers B, C, and D are not factors for concern.
25
 The nurse working the organ transplant unit is
caring for a client with a white blood cell count
of During evening visitation, a visitor brings a
basket of fruit. What action should the nurse
take?
A. ALLOW THE CLIENT TO KEEP THE FRUIT
B. PLACE THE FRUIT NEXT TO THE BED FOR
EASY ACCESS BY THE CLIENT
C. OFFER TO WASH THE FRUIT FOR THE
CLIENT
D. TELL THE FAMILY MEMBERS TO TAKE THE
FRUIT HOME
25
 Answer D is correct. The client with
neutropenia should not have fresh fruit because
it should be peeled and/or cooked before eating.
He should also not eat foods grown on or in the
ground or eat from the salad bar. The nurse
should remove potted or cut flowers from the
room as well. Any source of bacteria should be
eliminated, if possible. Answers A, B, and C will
not help prevent bacterial invasions.
26
 A 6-YEAR-OLD CLIENT IS ADMITTED TO THE UNIT
WITH A HEMOGLOBIN OF 6G/DL. THE PHYSICIAN
HAS WRITTEN AN ORDER TO TRANSFUSE 2 UNITS
OF WHOLE BLOOD. WHEN DISCUSSING THE
TREATMENT, THE CHILD'S MOTHER TELLS THE
NURSE THAT SHE DOES NOT BELIEVE IN HAVING
BLOOD TRANSFUSIONS AND THAT SHE WILL NOT
ALLOW HER CHILD TO HAVE THE TREATMENT.
WHAT NURSING ACTION IS MOST APPROPRIATE?
A. ASK THE MOTHER TO LEAVE WHILE THE BLOOD
TRANSFUSION IS IN PROGRESS
B. ENCOURAGE THE MOTHER TO RECONSIDER
C. EXPLAIN THE CONSEQUENCES WITHOUT
TREATMENT
D. NOTIFY THE PHYSICIAN OF THE MOTHER'S
REFUSAL
26
Answer D is correct. If the client’s mother
refuses the blood transfusion, the doctor
should be notified. Because the client is a
minor, the court might order treatment.
Answer A is incorrect. Because it is not the
primary responsibility for the nurse to
encourage the mother to consent or
explain the consequences, so answers B
and C are incorrect.
27
 THE NURSE IS CARING FOR THE CLIENT
RECEIVING AMPHOTERICIN B. WHICH OF
THE FOLLOWING INDICATES THAT THE
CLIENT HAS EXPERIENCED TOXICITY TO
THIS DRUG?
A. CHANGES IN VISION
B. NAUSEA
C. URINARY FREQUENCY
D. CHANGES IN SKIN COLOR
27
 Answer D is correct. Clients taking
Amphotericin B should be monitored for liver,
renal, and bone marrow function because this
drug is toxic to the kidneys and liver, and causes
bone marrow suppression. Jaundice is a sign of
liver toxicity and is not specific to the use of
Amphotericin B. Changes in vision are not
related, and nausea is a side effect, not a sign of
toxicity; nor is urinary frequency. Thus, answers
A, B, and C are incorrect.
28
 A CLIENT WITH PNEUMACYSTIS CARINI
PNEUMONIA IS RECEIVING
TRIMETREXATE. THE RATIONALE FOR
ADMINISTERING LEUCOVORIN CALCIUM
TO A CLIENT RECEIVING METHOTREXATE
IS TO:
A. TREAT ANEMIA.
B. CREATE A SYNERGISTIC EFFECT.
C. INCREASE THE NUMBER OF WHITE BLOOD
CELLS.
D. REVERSE DRUG TOXICITY.
28
Answer D is correct. Methotrexate is a
folic acid antagonist. Leucovorin is the
drug given for toxicity to this drug. It is not
used to treat iron-deficiency anemia,
create a synergistic effects, or increase
the number of circulating neutrophils.
Therefore, answers A, B, and C are
incorrect
29
 A CLIENT WITH BLADDER CANCER IS
BEING TREATED WITH IRIDIUM SEED
IMPLANTS. THE NURSE'S
DISCHARGE TEACHING SHOULD
INCLUDE TELLING THE CLIENT TO:
A. STRAIN HIS URINE
B. INCREASE HIS FLUID INTAKE
C. REPORT URINARY FREQUENCY
D. AVOID PROLONGED SITTING
29
Answer A is correct. Iridium seeds can
be expelled during urination, so the client
should be taught to strain his urine and
report to the doctor if any of the seeds are
expelled. Increasing fluids, reporting
urinary frequency, and avoiding prolonged
sitting are not necessary; therefore,
answers B, C, and D are incorrect.
30
 A CLIENT HOSPITALIZED WITH MRSA
(METHICILLIN-RESISTANT STAPH AUREUS) IS
PLACED ON CONTACT PRECAUTIONS. WHICH
STATEMENT IS TRUE REGARDING PRECAUTIONS
FOR INFECTIONS SPREAD BY CONTACT?
A. THE CLIENT SHOULD BE PLACED IN A ROOM WITH
NEGATIVE PRESSURE.
B. INFECTION REQUIRES CLOSE CONTACT;
THEREFORE, THE DOOR MAY REMAIN OPEN.
C. TRANSMISSION IS HIGHLY LIKELY, SO THE CLIENT
SHOULD WEAR A MASK AT ALL TIMES.
D. INFECTION REQUIRES SKIN-TO-SKIN CONTACT
AND IS PREVENTED BY HAND WASHING, GLOVES,
AND A GOWN.
30
 Answer D is correct. The client with MRSA
should be placed in isolation. Gloves, a gown,
and a mask should be used when caring for the
client and hand washing is very important. The
door should remain closed, but a negativepressure room is not necessary, so answers A
and B are incorrect. MRSA is spread by contact
with blood or body fluid or by touching the skin of
the client. It is cultured from the nasal passages
of the client, so the client should be instructed to
cover his nose and mouth when he sneezes or
coughs. It is not necessary for the client to wear
the mask at all times; the nurse should wear the
mask, so answer C is incorrect.
31
 THE PHYSICIAN HAS ORDERED A
MINIMAL-BACTERIA DIET FOR A
CLIENT WITH NEUTROPENIA. THE
CLIENT SHOULD BE TAUGHT TO
AVOID EATING:
A. FRUITS
B. SALT
C. PEPPER
D. KETCHUP
31
Answer C is correct. Pepper is not
processed and contains bacteria. Answers
A, B, and D are incorrect because fruits
should be cooked or washed and peeled,
and salt and ketchup are allowed
32
 THE NURSE IS PROVIDING
DISCHARGE TEACHING FOR THE
CLIENT WITH LEUKEMIA. THE CLIENT
SHOULD BE TOLD TO AVOID:
A. USING OIL- OR CREAM-BASED
SOAPS
B. FLOSSING BETWEEN THE TEETH
C. THE INTAKE OF SALT
D. USING AN ELECTRIC RAZOR
32
Answer B is correct. The client who is
immune-suppressed and has bone
marrow suppression should be taught not
to floss his teeth because platelets are
decreased. Using oils and cream-based
soaps is allowed, as is eating salt and
using an electric razor; therefore, answers
A, C, and D are incorrect.
33
A nurse is administering blood to a patient
who has a low hemoglobin count. The
patient asks how long to RBC’s last in my
body? The correct response is.
A: The life span of RBC is 45 days.
B: The life span of RBC is 60 days.
C: The life span of RBC is 90 days.
D: The life span of RBC is 120 days.
33
(D) RBC’s last for 120 days in the body.
34
Which of the following conditions would a
nurse not administer erythromycin?
A: Campylobacterial infection
B: Legionnaire’s disease
C: Pneumonia
D: Multiple Sclerosis
34
(D) Erythromycin is used to treat
conditions A-C.
35
A patient’s chart indicates a history of
meningitis. Which of the following would
you not expect to see with this patient if
this condition were acute?
A: Increased appetite
B: Vomiting
C: Fever
D: Poor tolerance of light
35
(A) Loss of appetite would be expected
36
A nurse if reviewing a patient’s chart and
notices that the patient suffers from
conjunctivitis. Which of the following
microorganisms is related to this
condition?
A: Yersinia pestis
B: Helicobacter pyroli
C: Vibrio cholera
D: Hemophilus aegyptius
36
(D) Choice A is linked to Plague, Choice B
is linked to peptic ulcers, Choice C is
linked to Cholera
37
A nurse if reviewing a patient’s chart and
notices that the patient suffers from Lyme
disease. Which of the following
microorganisms is related to this
condition?
A: Borrelia burgdorferi
B: Streptococcus pyrogens
C: Bacilus anthracis
D: Enterococcus faecalis
37
A) Choice B is linked to Rheumatic fever,
Choice C is linked to Anthrax, Choice D is
linked to Endocarditis.
38
 35. A 20 year-old female attending college is
found unconscious in her dorm room. She has a
fever and a noticeable rash. She has just been
admitted to the hospital. Which of the following
tests is most likely to be performed first?
A: Blood sugar check
B: CT scan
C: Blood cultures
D: Arterial blood gases
38
(C) Blood cultures would be performed to
investigate the fever and rash symptoms.
39
What is the most common cancer among
men?
A: lung
B: prostate
C: brain
D: pancreatic
39
A. Prostate cancer is also very common in
males.
40
What is the most common transfusion
reaction?
A: coma
B: nausea
C: anxiety
D: fever
40
D. The most common adverse reaction
after a transfusion is fever
41
What is another name for the neoplastic
disorder of the bone marrow in which there
is an overproduction of white blood
cells?
A: bone density deficiency
B: leukemia
C: cystic fibrosis
D: arthritis
41
B. Leukemia is a potentially fatal disease.
42
Which is the most common cancer among
females?
A: brain
B: pancreatic
C: lung
D: breast
42
D.Breast cancer is by far the most
common cancer among females.
43
Which of the following foods is NOT high
in iron?
A: meat
B: black beans
C: seafood
D: green vegetables
43
B. It is important to get plenty of iron in the
diet.
44
 Which of the following are not treated
with Methotrexate?
A. Sarcomas
B. Leukemias
C. Ectopic pregnancy
D. Rheumatic fever
44
The answer is D
The right answer was Rheumatic fever.
45
 Which of the following are not treated
with Prednisone?
A. Cushing’s disease
B. Testicular cancer
C. Lympthomas
D. Chronic leukemias
45
The answer is B
Testicular cancer
46
 A client with AIDS is admitted for treatment of
wasting syndrome. Which of the following
dietary modifications can be used to
compensate for the limited absorptive capability
of the intestinal tract?
A. Thoroughly cooking all foods
B. Offering yogurt and buttermilk between meals
C. Forcing fluids
D. Providing small, frequent meals
46
 Answer D is correct. Providing small, frequent
meals will improve the client’s appetite and help
reduce nausea. Answer A is incorrect because it
does not compensate for limited absorption.
Foods and beverages containing live cultures
are discouraged for the immune-compromised
client; therefore, answer B is incorrect. Answer C
is incorrect because forcing fluids will not
compensate for limited absorption of the
intestine.
47
 The treatment protocol for a client with acute
lymphatic leukemia includes prednisone,
methotrexate, and cimetadine. The purpose of
the cimetadine is to:
 Decrease the secretion of pancreatic enzymes
 Enhance the effectiveness of methotrexate
 Promote peristalsis
 Prevent a common side effect of prednisone
47
Answer D is correct. A common side
effect of prednisone is gastric ulcers.
Cimetadine is given to help prevent the
development of ulcers. Answers A, B, and
C do not relate to the use of cimetadine;
therefore, they are incorrect.
48
 Which diet is associated with an
increased risk of colorectal cancer?
A. Low protein, complex carbohydrates
B. High protein, simple carbohydrates
C. High fat, refined carbohydrates
D. Low carbohydrates, complex proteins
48
 Answer C is correct. A diet that is high in fat
and refined carbohydrates increases the risk of
colorectal cancer. High fat content results in an
increase in fecal bile acids, which facilitate
carcinogenic changes. Refined carbohydrates
increase the transit time of food through the
gastrointestinal tract and increase the exposure
time of the intestinal mucosa to cancer-causing
substances. Answers A, B, and D do not relate
to the question; therefore, they are incorrect.
49
 The nurse is providing dietary
instructions for a client with irondeficiency anemia. Which food is a poor
source of iron?
A. Tomatoes
B. Legumes
C. Dried fruits
D. Nuts
49
Answer A is correct. Tomatoes are a
poor source of iron, although they are an
excellent source of vitamin C, which
increases iron absorption. Answers B, C,
and D are good sources of iron; therefore,
they are incorrect.
50
 A client has been hospitalized with a
diagnosis of laryngeal cancer. Which
factor is most significant in the
development of laryngeal cancer?
A. A family history of laryngeal cancer
B. Chronic inhalation of noxious fumes
C. Frequent straining of the vocal cords
D. A history of alcohol and tobacco use
50
Answer D is correct. A history of frequent
alcohol and tobacco use is the most
significant factor in the development of
cancer of the larynx. Answers A, B, and C
are also factors in the development of
laryngeal cancer, but they are not the most
significant; therefore, they are incorrect.
51
 The nurse is completing an assessment
history of a client with pernicious anemia.
Which complaint differentiates pernicious
anemia from other types of anemia?
A. Difficulty in breathing after exertion
B. Numbness and tingling in the extremities
C. A faster-than-usual heart rate
D. Feelings of lightheadedness
51
Answer B is correct. Numbness and
tingling in the extremities is common in the
client with pernicious anemia, but not
those with other types of anemia. Answers
A, C, and D are incorrect because they are
symptoms of all types of anemia.
52
 A client is being treated for cancer with linear
acceleration radiation. The physician has
marked the radiation site with a blue marking
pen. The nurse should:
A. Remove the unsightly markings with acetone or
alcohol
B. Cover the radiation site with loose gauze
dressing
C. Sprinkle baby powder over the radiated area
D. Refrain from using soap or lotion on the
marked area
52
Answer D is correct. The nurse should
not use water, soap, or lotion on the area
marked for radiation therapy. Answer A is
incorrect because it would remove the
marking. Answers B and C are not
necessary for the client receiving radiation;
therefore, they are incorrect
53
 A client with human immunodeficiency
syndrome has gastrointestinal
symptoms, including diarrhea. The nurse
should teach the client to avoid:
A. Calcium-rich foods
B. Canned or frozen vegetables
C. Processed meat
D. Raw fruits and vegetables
53
Answer D is correct. The client with HIV
should adhere to a low-bacteria diet by
avoiding raw fruits and vegetables.
Answers A, B, and C are incorrect
because they are permitted in the client’s
diet.
54
 A 4-year-old is admitted with acute
leukemia. It will be most important to
monitor the child for:
A. Abdominal pain and anorexia
B. Fatigue and bruising
C. Bleeding and pallor
D. Petechiae and mucosal ulcers
54
Answer C is correct. The child with
leukemia has low platelet counts, which
contribute to spontaneous bleeding.
Answers A, B, and D, common in the child
with leukemia, are not life-threatening.
55
 The physician has scheduled a Whipple
procedure for a client with pancreatic
cancer. The nurse recognizes that the
client's cancer is located in:
A. The tail of the pancreas
B. The head of the pancreas
C. The body of the pancreas
D. The entire pancreas
55
Answer B is correct. The Whipple
procedure is performed for cancer located
in the head of the pancreas. Answers A, C,
and D are not correct because of the
location of the cancer.
56
 The primary cause of anemia in a client
with chronic renal failure is:
A. Poor iron absorption
B. Destruction of red blood cells
C. Lack of intrinsic factor
D. Insufficient erythropoietin
56
Answer D is correct. Insufficient
erythropoietin production is the primary
cause of anemia in the client with chronic
renal failure. Answers A, B, and C do not
relate to the anemia seen in the client with
chronic renal failure; therefore, they are
incorrect.
57
 While caring for a client with cervical cancer,
the nurse notes that the radioactive implant is
lying in the bed. The nurse should:
A. Place the implant in a biohazard bag and return
it to the lab
B. Give the client a pair of gloves and ask her to
reinsert the implant
C. Use tongs to pick up the implant and return it to
a lead-lined container
D. Discard the implant in the commode and
double-flush
57
 Answer C is correct. The radioactive implant
should be picked up with tongs and returned to
the lead-lined container. Answer A is incorrect
because radioactive materials are placed in
lead-lined containers, not plastic ones, and are
returned to the radiation department, not the lab.
Answer B is incorrect because the client should
not touch the implant or try to reinsert it. Answer
D is incorrect because the implant should not be
placed in the commode for disposal.
58
 A high school student returns to school
following a 3-week absence due to
mononucleosis. The school nurse knows it will
be important for the client:
A. To drink additional fluids throughout the day
B. To avoid contact sports for 1–2 months
C. To have a snack twice a day to prevent
hypoglycemia
D. To continue antibiotic therapy for 6 months
58
 Answer B is correct. The client recovering from
mononucleosis should avoid contact sports and
other activities that could result in injury or
rupture of the spleen. Answer A is incorrect
because the client does not need additional
fluids. Hypoglycemia is not associated with
mononucleosis; therefore, answer C is incorrect.
Answer D is incorrect because antibiotics are not
usually indicated in the treatment of
mononucleosis.
59
 A client with breast cancer is returned to the
room following a right total mastectomy. The
nurse should:
A. Elevate the client's right arm on pillows
B. Place the client's right arm in a dependent sling
C. Keep the client's right arm on the bed beside
her
D. Place the client's right arm across her body
59
Answer A is correct. A total mastectomy
involves removal of the entire breast and
some or all of the axillary lymph nodes.
Following surgery, the client’s right arm
should be elevated on pillows, to facilitate
lymph drainage. Answers B, C, and D are
incorrect because they would not help
facilitate lymph drainage and would create
increased edema in the affected extremity
60
 The nurse has taken the blood pressure of a
client hospitalized with methicillin-resistant
staphylococcus aureus. Which action by the
nurse indicates an understanding regarding the
care of clients with MRSA?
A. The nurse leaves the stethoscope in the client's
room for future use.
B. The nurse cleans the stethoscope with alcohol
and returns it to the exam room.
C. The nurse uses the stethoscope to assess the
blood pressure of other assigned clients.
D. The nurse cleans the stethoscope with water,
dries it, and returns it to the nurse's station.
60
Answer A is correct. The stethoscope
should be left in the client’s room for future
use. The stethoscope should not be
returned to the exam room or the nurse’s
station; therefore, answers B and D are
incorrect. The stethoscope should not be
used to assess other clients; therefore,
answer C is incorrect
61
 A client with AIDS complains of a weight
loss of 20 pounds in the past month.
Which diet is suggested for the client
with AIDS?
A. High calorie, high protein, high fat
B. High calorie, high carbohydrate, low
protein
C. High calorie, low carbohydrate, high fat
D. High calorie, high protein, low fat
61
Answer D is correct. The suggested diet
for the client with AIDS is one that is high
calorie, high protein, and low fat. Clients
with AIDS have a reduced tolerance to fat
because of the disease as well as side
effects from some antiviral medications;
therefore, answers A and C are incorrect.
Answer B is incorrect because the client
needs a high-protein diet.