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MS3 FINAL EXAM REVIEW QUESTIONS & ANSWERS
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MS3 FINAL EXAM REVIEW QUESTIONS & ANSWERS
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MS3 FINAL EXAM REVIEW QUESTIONS & ANSWERSAn older adult patient who is having an annual check-up tells the nurse, "I feel fine, and
I don't want to pay for all these unnecessary cancer screening tests!" Which information
should the nurse plan to teach this patient?
a. Consequences of aging on cell-mediated immunity
b. Decrease in antibody production associated with aging
c. Impact of poor nutrition on immune function in older people
d. Incidence of cancer-associated infections in older individuals - Answers- a.
Consequences of aging on cell-mediated immunity
The primary impact of aging on immune function is on T cells, which are important for
immune surveillance and tumor immunity.
What instructions about plasmapheresis should the nurse include in the teaching plan
for a patient diagnosed with systemic lupus erythematosus (SLE)?
a. Plasmapheresis eliminates eosinophils and basophils from blood.
b. Plasmapheresis decreases the damage to organs from T lymphocytes.
c. Plasmapheresis removes antibody-antigen complexes from circulation.
d. Plasmapheresis prevents foreign antibodies from damaging various body tissues. -
Answers- c. Plasmapheresis removes antibody-antigen complexes from circulation.
Plasmapheresis is used in SLE to remove antibodies, antibody-antigen complexes, and
complement from blood. T lymphocytes, foreign antibodies, eosinophils, and basophils
do not directly contribute to the tissue damage in SLE.
The patient with an autoimmune disease will be treated with plasmapheresis. What
should the nurse teach the patient about this treatment?
It will gather platelets for use later when needed.
It will cause anemia because it removes whole blood and red blood cells are damaged.
It will remove the IgG autoantibodies and antigen complexes from the plasma.
It will remove the peripheral stem cells in order to cure the autoimmune disease. -
Answers- It will remove the IgG autoantibodies and antigen complexes from the plasma.
Plasmapheresis removes plasma that contains autoantibodies (usually IgG class) and
antigen-antibody complexes to remove the pathologic substances in the plasma without
causing anemia.
A patient with systemic lupus erythematosus is receiving plasmapheresis to treat an
acute attack. What symptoms will the nurse monitor to determine if the patient develops
complications related to the procedure?
Hypotension, paresthesias, and dizziness
Polyuria, decreased reflexes, and lethargy
Intense thirst, flushed skin, and weight gain
Abdominal cramping, diarrhea, and leg weakness - Answers- Hypotension,
paresthesias, and dizziness
,Common complications associated with plasmapheresis are hypotension and citrate
toxicity. Citrate is used as an anticoagulant and may cause hypocalcemia, which may
manifest as headache, paresthesias, and dizziness.
Ten days after receiving a bone marrow transplant, a patient develops a skin rash on
the palms and soles, jaundice, and diarrhea. What does the nurse determine these
clinical manifestations are indicating?
The patient is experiencing a type I allergic reaction.
An atopic reaction is causing the patient's symptoms.
The patient is experiencing rejection of the bone marrow.
Cells in the transplanted bone marrow are attacking the host tissue. - Answers- Cells in
the transplanted bone marrow are attacking the host tissue.
Which patient is at risk for developing graft-versus-host disease (GVHD)?
A 65-yr-old man who received an autologous blood transfusion
A 40-yr-old man who received a kidney transplant from a living donor
A 65-yr-old woman who received a pancreas and kidney from a deceased donor
A 40-yr-old woman who received a bone marrow transplant from a close relative -
Answers- A 40-yr-old woman who received a bone marrow transplant from a close
relative
GVHD occurs when an immunoincompetent patient is transfused or transplanted with
immunocompetent cells. Examples include blood transfusions or the transplantation of
bone marrow, fetal thymus, or fetal liver. An autologous blood transfusion is the
collection and reinfusion of the individual's own blood or blood components. There is no
risk for GVHD in this situation.
A patient has a hemoglobin level of 8.2 gm/dL and hematocrit of 28%, and is receiving a
transfusion of packed red blood cells. The patient reports back pain, chills, and has a
fever during the transfusion. What is the priority nursing action?
Call the physician
Stop the transfusion
Administer acetaminophen for the pain and fever
Monitor the patient for the remainder of the transfusion - Answers- Stop the transfusion
Which statement by the patient who has had an organ transplant would indicate that the
patient understands the teaching about the immunosuppressive medications?
"My drug dosages will be lower because the medications enhance each other."
"Taking more than one medication will put me at risk for developing allergies."
"I will be more prone to malignancies because I will be taking more than one drug."
"The lower doses of my medications can prevent rejection and minimize the side
effects." - Answers- "The lower doses of my medications can prevent rejection and
minimize the side effects."
,Because immunosuppressants work at different phases of the immune response, lower
doses of each drug can be used to produce effective immunosuppression while
minimizing side effects.
The nurse teaches a patient about drug therapy after a kidney transplant. Which
statement by the patient would indicate a need for further instructions?
a. "I need to be monitored closely for development of malignant tumors."
b. "After a couple of years I will be able to stop taking the cyclosporine."
c. "If I develop acute rejection episode, I will need additional types of drugs."
d. "The drugs are combined to inhibit different ways the kidney can be rejected." -
Answers- b. "After a couple of years I will be able to stop taking the cyclosporine."
Cyclosporine, a calcineurin inhibitor, will need to be continued for life.
A pregnant woman with asymptomatic chronic human immunodeficiency virus (HIV)
infection is seen at the clinic. The patient states, "I am very nervous about making my
baby sick." Which information will the nurse include when teaching the patient?
a. The antiretroviral medications used to treat HIV infection are teratogenic.
b. Most infants born to HIV-positive mothers are not infected with the virus.
c. Because it is an early stage of HIV infection, the infant will not contract HIV.
d. Her newborn will be born with HIV unless she uses antiretroviral therapy (ART) -
Answers- ANS: B
Only 25% of infants born to HIV-positive mothers develop HIV infection, even when the
mother does not use ART during pregnancy. The percentage drops to 2% when ART is
used. Perinatal transmission can occur at any stage of HIV infection (although it is less
likely to occur when the viral load is lower). ART can safely be used in pregnancy,
although some ART drugs should be avoided.
The nurse should assess the patient undergoing plasmapheresis for which clinical
manifestation?
a. Shortness of breath
b. High blood pressure
c. Transfusion reaction
d. Extremity numbness - Answers- d. Extremity numbness
Numbness and tingling may occur as the result of the hypocalcemia caused by the
citrate used to prevent coagulation.
Ten days after receiving a bone marrow transplant, a patient develops a skin rash. What
would the nurse suspect is the cause of the rash?
a. The donor T cells are attacking the patient's skin cells.
b. The patient needs treatment to prevent hyperacute rejection.
c. The patient's antibodies are rejecting the donor bone marrow.
d. The patient is experiencing a delayed hypersensitivity reaction. - Answers- a. The
donor T cells are attacking the patient's skin cells.
, The patient's history and symptoms indicate that the patient is experiencing graft-
versus-host disease, in which the donated T cells attack the patient's tissues.
A patient who is receiving an IV antibiotic develops wheezes and dyspnea. In which
order should the nurse implement these prescribed actions? (Put a comma and a space
between each answer choice [A, B, C, D, E]).
a. Discontinue the antibiotic.
b. Give diphenhydramine IV.
c. Inject epinephrine IM or IV.
d. Prepare an infusion of dopamine.
e. Provide 100% oxygen using a nonrebreather mask. - Answers- A, E, C, B, D
a. Discontinue the antibiotic.
e. Provide 100% oxygen using a nonrebreather mask.
c. Inject epinephrine IM or IV.
b. Give diphenhydramine IV
d. Prepare an infusion of dopamine.
A young adult female patient who is human immunodeficiency virus (HIV) positive has a
new prescription for efavirenz (Sustiva). Which information is most important to include
in the medication teaching plan?
a. Take this medication on an empty stomach.
b. Take this medication with a full glass of water.
c. You may have vivid and bizarre dreams as a side effect.
d. Continue to use contraception while taking this medication. - Answers- ANS: D
To prevent harm, it is most critical to inform patients that efavirenz can cause fetal
anomalies and should not be used in patients who may be or may become pregnant.
The other information is also accurate, but it does not directly prevent harm. The
medication should be taken on an empty stomach with water and patients should be
informed that many people who use the drug have reported vivid and sometimes bizarre
dreams.
Eight years after seroconversion, a human immunodeficiency virus (HIV)-infected
patient has a CD4+ cell count of 800/μL and an undetectable viral load. What is the
priority nursing intervention at this time?
a. Encourage adequate nutrition, exercise, and sleep.
b. Teach about the side effects of antiretroviral agents.
c. Explain opportunistic infections and antibiotic prophylaxis.
d. Monitor symptoms of acquired immunodeficiency syndrome (AIDS). - Answers- ANS:
A
The CD4+ level for this patient is in the normal range, indicating that the patient is the
stage of asymptomatic chronic infection when the body is able to produce enough CD4+
cells to maintain a normal CD4+ count. Maintaining healthy lifestyle behaviors is an
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