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BMTCN Practice Questions with correct answers
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BMTCN Practice QuestionsThe administration of Epstein-Barr virus (EBV) cytotoxic T-lymphocytes has been found
to be a feasible therapeutic option in which EBV mediated-disease process?
a) Lymphoproliferative disease
b) Neuroblastoma
c) Nasopharyngeal rhabdomyosarcoma
d) Acute lymphocytic leukemia
A) Lymphoproliferative disease
Post-Transplant Lymphoproliferative Disorder PTLD is an aggressive, rare, and
potentially fatal proliferation of lymphoid cells of donor origin, usually occurring within
the first four months after allogeneic HSCT. PTLD is caused by the opportunistic
expansion of Epstein-Barr virus (EBV)-transformed donor B cells in a host with
suppressed T-cell function
Donor leukocyte infusion is an appropriate treatment option for a patient who has
relapsed post allogeneic transplant with:
a) acute lymphocytic leukemia.
b) severe aplastic anemia.
c) chronic myelogenous leukemia.
d) acute lymphoblastic lymphoma.
C) chronic myelogenous leukemia
DLI has shown promising results for patients with CML in the chronic phase, with
remission rates of 70%- 80%. Unfortunately, this approach is less effective in patients
with CML in blast crisis or patients with MM, myelodysplasias, lymphomas, and acute
leukemias
The success of DLI for the treatment of post-transplant relapse of chronic myeloid
leukemia has led researchers to explore the role of combining T-cell depletion with a
preplanned course of DLI post-transplant
,It has been demonstrated clinically that graft-versus-tumor responses occur with DLI in
60%-80% of patients with chronic myeloid leukemia and to a lesser extent with acute
myeloid leukemia, chronic lymphocytic leukemia, multiple myeloma, non-Hodgkin
lymphoma, and renal cell carcinomas
Which of the following is most important prognostic element for a patient being treated
for pulmonary aspergillosis post-transplant?
a) Granulocyte recovery
b) Therapeutic serum fluconazole levels.
c) Serum IgG levels maintained greater than 400
d) Total number of CD34 positive cells in the donor's stem cells
A) Granulocyte recovery
The most conventional way to monitor immediate hematopoietic recovery is through
granulocyte recovery. Granulocyte recovery is more rapid with blood versus bone
marrow autografts, regardless of whether mobilization is achieved with chemotherapy or
with hematopoietic growth factors
Patients who are most at risk for fungal infections are those who are neutropenic, are on
prolonged immunosuppression, or have chronic GVHD
Risk factors for an HSCT patient to develop aspergillosis include prolonged
granulocytopenia, the presence of GVHD, prolonged immunosuppression, human
leukocyte antigen (HLA) mismatch, construction near the hospital or a windy external
environment, certain foods and plants, and high-dose corticosteroid therapy
The Foundation for the Accreditation of Cellular Therapy requires notification of positive
microbial culture results on cellular therapy products to the:
a) recipient
b) donor
c) Food and Drug Administration.
d) American Association of Blood Banks
A) Recipient
The goal of this evaluation is to protect the safety of the donor and the recipient. The
potential transmission of communicable diseases from the donor to recipient is a
,serious concern. Therefore, laboratory testing includes complete blood count,
electrolytes, and renal, hepatic, and endocrine testing. Infectious disease testing
includes hepatitis B, hepatitis C, HIV, cytomegalovirus, herpes simplex virus, syphilis,
and human T-lymphotropic virus, as well as other infectious disease testing the
transplant center deems appropriate. The donor also will have blood and Rh typing,
HLA testing, and pregnancy testing if applicable. A thorough physical examination and
medical history, including travel, immunization, and transfusion histories, will be
obtained
The potential transmission of communicable diseases from the donor to recipient is a
serious concern. Therefore, laboratory testing includes complete blood count,
electrolytes, and renal, hepatic, and endocrine testing. Infectious disease testing
includes hepatitis B, hepatitis C, HIV, cytomegalovirus, herpes simplex virus, syphilis,
and human T-lymphotropic virus, as well as other infectious disease testing the
transplant center deems appropriate. The donor also will have blood and Rh typing,
HLA testing, and pregnancy testing if applicable. A thorough physical examination and
medical history, including travel, immunization, and transfusion histories, will be
obtained
A patient is undergoing peripheral blood stem cell mobilization for an autologous
transplant and starts to experience fever, fatigue and bone pain. This is most likely due
to:
a) a bacterial infection.
b) growth factors.
c) cytokine storm.
d) bone marrow hypoplasia.
B) growth factors
The most common side effects associated with growth factors used for mobilization
include bone pain, fever, and malaise
Daily nursing assessments should include a discussion of symptoms and an evaluation
of the patient's temperature, pulse, respirations, blood pressure, and weight. Patients
may be instructed to take acetaminophen for bone pain or headache. Occasionally,
patients will request a stronger pain reliever, such as acetaminophen with codeine.
Other side effects should be assessed and treated symptomatically. More serious side
effects (e.g., pleural or pericardial effusions) may necessitate stopping the growth
factors
,What is the best initial step in determining the evidence available to support a current
nursing intervention?
a) Conduct a research study comparing two different processes to see which is better
b) Ask fellow nurses on the unit what their current practice is
c) Review current literature regarding the intervention, identify gaps or inconsistencies
in nursing practice
d) Evidence is not necessary to guide nursing practice
C) Review current literature regarding the intervention, identify gaps or inconsistencies
in nursing practice.
Managers should support introduction of new nursing interventions based on valid
research findings and encourage staff endeavors to implement new research findings
when possible. Clinical staff should be encouraged to review current journals for new,
relevant research findings. Staff should also be encouraged to question current nursing
practices and look for gaps where there is a lack of research-based practice
(Haberman, 2007). Identifying gaps in the literature and inconsistencies in HSCT
practices is an important first step in designing evidence-based projects that can be
used to standardize practice and link best practices to improved patient outcomes
(Bevans et al., 2009).
Microangiopathic hemolytic anemia can be a complication from which
immunosuppressive therapy?
a) Tocilizumab
b) Antithymocyte globulin (ATG)
c) Cyclosporine
d) Alemtuzumab
C) Cyclosporine
Commonly encountered side effects of cyclosporine A include glucose intolerance,
hirsutism, hyperkalemia, hypertension, magnesium wasting, renal insufficiency, and
tremor (Malat & Culkin, 2016). Other side effects include confusion, cortical blindness,
gingival hyperplasia, headache, hemolytic uremic syndrome, hyperchloremic metabolic
acidosis, hyperlipidemia, hyperuricemia, microangiopathic hemolytic anemia,
palmar-plantar dysesthesia, and seizures (Malat & Culkin, 2016
,An 8-year old patient who received an HSCT develops a grade 2 acute GVHD skin
rash. The nurse anticipates which of the following orders for initial treatment?
a) Initiation of photophresis
b) Infliximab
c) Topical steroid cream
d) Increased dose of oral immunosuppressive therapy
C) Topical Steroid Cream
Consider use of antipruritic or steroid topical agents to manage symptoms
Rule of Nines is used to estimate the extent of skin involvement. Clinically significant
acute GVHD usually is defined as overall grades 2-4. Grade 2 = Rash on 25%- 50% of
skin
Tacrolimus ointment and topical steroids of varying potencies are effective in treating
cutaneous erythema and pruritus and vulvovaginal manifestations of chronic GVHD and
may be a useful therapeutic bridge to other therapies that have a slower onset, such as
PUVA or ECP
Two hundred days after an allogenic HSCT, a patient reports dry mouth, taste
alterations, and oral pain. The nurse anticipates receiving an order for which of the
following?
a) Topical steroid rinses
b) Magic mouthwash
c) Oxycodone
d) Nystatin suspension
A) Topical steroid rinses
Topical steroids (a) Stage 1 and 2 skin GVHD often can be successfully treated with
topical steroid creams and should be tried to avoid further systemic immunosuppressant
therapy.
Use steroid mouth rinses, topical clobetasol ointment, effervescent budesonide,
tacrolimus or cyclosporine A ointments/topical preparations, oral PUVA, pilocarpine and
anethole trithione for xerostomia, and fluoride gels/ rinses to decrease caries.
,Oral GVHD manifestations can be managed with a variety of topical therapies applied to
the oral mucosa or lips via rinses or ointments including budesonide, clobetasol,
dexamethasone, or tacrolimus (Elsaadany, Ahmed, & Aghbary, 2017), or oral UV
phototherapy (Strong Rodrigues et al., 2018). In patients with oral and ocular dryness,
pilocarpine 5 mg orally every six hours can reduce dryness and may be beneficial in
treating these symptoms
Which of the following factors is associated with primary graft failure?
a) Peripheral blood stem cell graft source
b) Viral infection in the recipient
c) HLA match with the donor
d) CD34 selected cellular product
B) Viral infection in the recipient
In allogeneic transplants-graft failure is more commonly seen with HLA-mismatched
donor bone marrow, umbilical cord blood transplant, or T-cell–depleted bone marrow but
also may be related to primary disease, inadequate dose of stem cells,
immunosuppression, immune-mediated processes, septicemia, ABO incompatibility,
viral infections, and drug toxicity (Martin, 2016; Norton et al., 2016
The caregiver of a patient at a clinic reports witnessing unusual and aggressive
behavior, sleep problems, and sadness. The nurse believes the patient may be
exhibiting signs of:
a) Posterior reversible encephalopathy syndrome (PRES)
b) Bipolar disorder
c) PTSD
d) Tacrolimus toxicity
C) PTSD
Signs and symptoms of PTSD in older children, adolescents, or adults a) Flashbacks
and nightmares b) Unusual behavior c) Losing interest in activities d) Feeling sad e)
Aggressive behavior f ) Sleep problems
,Cataract development post transplant is linked to which of the following treatment
regimens?
a) TBI
b) Fludarabine
c) Carboplatin
d) Etoposide
A) TBI
Long-term side effects of TBI include but are not limited
to bone necrosis, bronchiolitis obliterans, cardiotoxicity,
cataracts, endocrine disorders caused by hypopituitarism
When providing information to a patient diagnosed with cutaneous chronic graft versus
host disease, the nurse emphasizes:
a) There is not an increased risk of infection during treatment
b) The importance of tapering steroid medications
c) That steroid creams are ineffective
d) The importance of using sunscreen with adequate SPF barrier
D) The importance of using sunscreen with adequate SPF barrier
Routinely and liberally use a sunscreen with a sun protection factor (SPF) of 15 or
higher. Apply the lotion one half-hour before going out in the sun. Apply a generous
amount and cover all exposed skin. Reapply at least every 2 hours and after swimming
or perspiring.
Which of the following is the first step in the pathophysiological process for acute
GVHD?
a) Damage of host tissue
b) Engraftment syndrome
c) Cytokine release syndrome
d) Inflammatory effectors
A) Damage of host tissue
,GVHD occurs when T lymphocytes contained in an allogeneic hematopoietic stem cell
graft proliferate and differentiate in vivo in response to antigens present on host tissue
recognized by the graft as foreign. Directly, and through the secretion of inflammatory
cytokines (Cooke et al., 2017), these donor T lymphocytes attack host tissues and
produce the signs and symptoms of acute GVHD.
Pathophysiology: Three phases of GVHD 1. Phase 1: Occurs prior to the transplant
when the preparative, or conditioning, regimen of chemotherapy (with or without
radiation) may damage host tissues, including intestinal mucosa, skin, and liver, and the
mucosa becomes permeable
Stem cell products with an ABO incompatibility between donor and recipient are
managed by which of the following?
a) Product irradiation prior to infusion
b) Removal of white blood cells through filtering
c) Cryopreservation to prevent an adverse reaction
d) Depletion of red blood cells after collection
D) Depletion of red blood cells after collection
If the donor and recipient are not ABO compatible, the red blood cells can be removed
through red cell depletion from the collected marrow, thus avoiding the problem of red
cell lysis after infusion of the marrow.
Product intended for allogeneic transplant may be red-cell depleted if an ABO mismatch
is present between the donor and recipient.
Depleting the product of RBCs or plasma can reduce the incidence of major and minor
ABO incompatibilities.
The risks of major ABO incompatibility can be overcome by red-cell depletion of the
cellular product in the laboratory prior to transfusion into the recipient, along with
significant IV fluid support to promote cellular debris excretion.
Which statement by a nurse would indicate further teaching about transplant recipients
is required? "Important criteria used to evaluate a patient for HSCT include:
,a) support resources available to the patient"
b) age of the caregivers"
c) baseline organ function"
d) current disease status"
B) age of the caregivers
Recipient evaluation and management: FACT has developed specific requirements for
recipient evaluation prior to transplant. These requirements assess for adequate organ
function, baseline disease status, and general health status. A comprehensive physical,
psychosocial, and financial evaluation is required before patients can undergo
transplantation
Premature ovarian failure after HSCT is related to which of the following?
a) Disease relapse
b) Prescribed immunosuppressive medications
c) Graft vs host disease
d) Treatment with alkylating agents
D) Treatment with alkylating agents
Women and girls undergoing HSCT are at a significant risk of hypogonadism and
infertility, especially those treated with TBI and alkylating agents. Nearly all women older
than 25 years of age treated with myeloablative HSCT experience premature ovarian
failure with associated infertility and early menopause.
Alkylating agents and radiation are associated with a dose-dependent depletion of both
resting and dividing follicles, resulting in infertility and premature ovarian failure (POF).
Prior to the initiation of treatment for engraftment syndrome, what is a priority nursing
action?
a) Obtain order for IV fluids
b) Ensure the infectious disease workup is complete
c) Place the patient in protective isolation for 14 days
d) Discontinue filgrastim administration
B) Ensure the infectious disease workup is complete
, Nursing management a) It is important that an infectious workup is completed before
the initiation of high-dose methylprednisolone. b) Also important is for patients to be at
baseline weight during engraftment. Retained fluids, especially pulmonary, can escalate
engraftment syndrome.
Ten days after an autologous transplant for myeloma, a patient experiences fever, rash,
weight gain, and rales upon auscultation. The nurse knows this is most likely indicative
of which of the following?
a) Thrombotic microangiopathies
b) Engraftment syndrome
c) Infection
d) Sinusoidal occlusive syndrome
B) Engraftment Syndrome
Typical Onset of Pulmonary Complications Following Hematopoietic Stem Cell
Transplantation Day 0 to Day 30 • Acute respiratory distress syndrome • Aspergillosis •
Bacteremias of gastrointestinal origin • Candidemia (Candida sepsis) and candidiasis
(general Candida infections) • Chemotherapy-associated pulmonary toxicity • Diffuse
alveolar hemorrhage • Engraftment syndrome • Idiopathic pneumonia syndrome •
Infections of central venous catheter origin • Infections related to conditioning regimen
and neutropenia • Pleural effusion • Pulmonary edema • Respiratory viruses (respiratory
syncytial virus, parainfluenza, influenza) • Transfusion-related acute lung injury.
Engraftment syndrome typically presents with fever and hypoxia that coincide with white
blood cell recovery. This can progress to diffuse alveolar hemorrhage. High-dose
steroids are used for initial therapy
The diagnosis is made by requiring three major criteria or two minor and one major
criteria, according to Spitzer’s criteria. b) Major criteria: Noninfectious fever, rash,
pulmonary edema, or hypoxia c) Minor criteria: Weight gain, hepatic or renal
dysfunction, or encephalopathy
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