Review for Final Exam

PN 143 Immune/Oncology Nursing Care

Multiple Choice (Identify the best answer that completes the statement or

question)

• HIV is an _________ virus.• A. Opportunistic• B. Obligate• C. Opposite

Multiple Response

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

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

True or False

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

True or False

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

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

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

True or False

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

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.

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

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

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

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

True or False

• A seronegative test for HIV infection indicates that an individual is free from HIV infection

True or False

• Pneumocystis Jiroveci Pneumonia is the most common bacterial infection in an individual with HIV infection

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

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

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

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

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

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

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

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

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

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

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

True or False

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

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

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

True or False

• Cancer is a group of diseases characterized by the uncontrolled growth and spread of abnormal cells

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

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

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

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

Multiple Response

• Cancer can be treated a number of ways. Some therapies include:

• A. surgery• B. radiation• C. chemotherapy• D. antibiotic therapy

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

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

True or False

• Normal cells are often destroyed by the chemotherapy intended for the cancer cells.

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 allogenic tranplantation• B. A matched unrelated donor transplantation• C. An autologous infusion of packed red blood cells• D. An autolgous tranplantation

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

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

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

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.

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

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

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

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

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.

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

True or False

• An understanding of the patient’s specific disease process and method of transmission of infectious microorganism helps determing the use of protective barriers.

• One type of chemotherapy category is known as hormonal agents. These agents alter the hormonal environment by:

• A. interfering with DNA replication of malignant cells• B. competing with estrogen for binding sites in the

breast and other tissues• C. damaging the tumor cells in the “s” phase of the

cell cycle• D. Stopping cell division

Multiple Response

• Symptom control of cancer treatment also includes pharmacological interventions. Antiemetics reduce or eliminate the sense of nausea and/or vomiting. Which of the medications below would be classified as an antiemetic?

• A. Ondansetron• B. Metoclopramide• C. Prochorperazine• D. Asparaginase

Multiple Choice

• Which of the following medications would be classified as an antidiarrheal?

• A. Naproxyn• B. Ativan• C. Lomotil• D. Hycantin

Other

In one sentence, answer the following question:

What is pain?

Multiple Response

• Barriers to effective pain management reflect problems on several levels for all involved with a person’s pain. Which of the following are included in those problems?

• A. Problems related to the health care system• B. Problems related to the patient• C. Problems related to health care professionals• D. Problems of availability of treatment

Multiple Choice

• Tolerance, physical dependence, and addiction are all distinct terms that contribute to confusion and misconceptions about pain management. Tolerance is defined as:

• A. Reduced effect from the use of a substance due to it’s repeated use

• B. The body’s developed or acquired dependence on a medication, particularly prolonged use of an opioid.

• C. loss of control over the use of a chemical subtance• D. strong compulsion to obtain and use the drug

True or False

• Drug exposure is the only contributing factor responsible for tolerance, physical dependence, and addiction.

True or False

• Fear of causing addiction to opioids is a major barrier to appropriate pain management.

Multiple Choice

• Taking a patient’s pain history, including: type and pain pattern, intensity, onset, exacerbating factors is part of the nursing assessment referred to as:

• A. Pain Assessment• B. Psychosocial assessment• C. Neuro assessment• D. Quality –of- Life assessment

Other

• When interviewing a client about their pain situation, open-ended questions will help to obtain complete information. Give 2 examples of open-ended questions.

Multiple Choice

• Neuropathic pain is a complex and chronic pain state. This usually happens when:

• A. a nerve has been severed• B. nerve fibers themselves are damaged,

injured, or dysfunctional• C. only when a person is on chemotherapy tx.• D. during childbirth

• Neuropathic pain studies suggest the use of NSAIDs or a stronger pain medication in the narcotic family of drugs. There are also medications that support or help the primary analgesic to be effective. For neuropathic pain, these would include:

• A. Benzodiazepines• B. Antipyretics• C. Anticonvulsants and antidepressants• D. Hormonal agents

Multiple Choice

• One common theory regarding the transmission of pain is known as the “gate theory”. In essence, this theory states that:

• A. If other stimuli besides pain are transmitted, the “gate” through which the pain impulses must travel is temporarily blocked by the other stimuli

• B. When gates are open, pain impulses become blocked; when closed, pain impulses flow freely.

• C. Pain that travels through the A fibers opens the gates and is therefore sharp and well localized

• D. Pain that travels through the C fibers closes the gates and is therefore dull and nonlocalized.

Multiple Response

• Nursing interventions can provide significant pain relief and comfort to patients. Which of the following nursing actions can be used to provide pain relief?

• A. Position change• B. Back rub; massage• C. Performing accupressure or accupuncture• D. Foot reflexology

Multiple Choice

• When providing pharmacological measures to provide pain relief, the underlying principle is to use a longterm/long-acting pain med as the primary medication and have a fast-acting medication on hand for breakthrough pain. Which of the following combinations meets the criteria of this principle?

• A. Oxycodone, MS Concentrate• B. Oxycontin, oxycodone q 4 hrs prn• C. MS Contin, MS concentrate• D. Fentanyl patch, acetaminophen q 6 hrs prn

Other

• Controlled Substances are “scheduled” according to their _______________.

Multiple Choice

• Opioid analgesics are classified according to their actions. ______ are drugs that produce a predictable response at the intended site of action and _______ are drugs that block the action of another drug and counteract the effects of the previous drug given.

• A. Schedule II; Schedule III• B. adjuvant, CNS depressant• C. Schedule III; Schedule V• D. agonist, antagonist

True or False

• Narcotics must be kept under a double lock.

Multiple Response

• Constipation is a significant concern as a complication of opioid therapy. This condition can be treated by which of the following:

• A. Sufficient fluid and fiber daily• B. Stool softener• C. Laxative• D. Instruct the client to rest more