ATI Immune

Question 1

Chemo priority assessment finding?

Answer 1

erythema at IV insertion site- greatest risk to pt is extravasation and infection.

Not priority- loss of hair, anorexia, mucositis of oral cavity

Question 2

pt on chemo with bone marrow suppression teaching?

Answer 2

dont eat fresh fruits and vegetables- can contain bacteria.
Dont take aspirin or other plt inhibitors- risk of bleeding with bone marrow supression.
Rinsing toothbrush with warm water wont kill bacteria.

Question 3

Highest risk for pneumonia?

Answer 3

old pt in LTC facility with dysphagia. 3 risk factors.

Question 4

Risk factor for skin cancer?

Answer 4

occupational chemical exposure to carcinogens.

Question 5

Risk factor for colon cancer?

Answer 5

low fiber diet

Question 6

Risk factor for liver cancer?

Answer 6

high alcohol intake

Question 7

Risk factor for cervical cancer?

Answer 7

HPV

Question 8

Complications of Systemic Lupus Erythematosus?

Answer 8

decreased urine output due to kidney damage.
Dyspnea- pleural effusion is common respiratory complication.
Joint inflammation.
Lupus Nephritis.

Question 9

Pap smear tests for?

Answer 9

cervical cancer

Question 10

Pt with hodgkin’s lymphoma undergoing external radiation, care plan?

Answer 10

Avoid direct sun exposure to the skin- can be damaging.
Dont use antibacterial soap- too harsh.
Dont use lotion, can damage skin.
Skin should be patted dry not rubbed to avoid damaging skin.

Question 11

Neutropenic patient?

Answer 11

Dont let grandchild visit that attends school- puts immunocompromised pt at risk.
Eat low bacteria diet.
Can have artificial flowers.
Place paper cups, and plastic utensils in pts room- only used by the pt.

Question 12

Diagnostic for Hodgkin’s Lymphoma?

Answer 12

Reed Sternberg Cells- cancer cells specific to hodgkins lymphoma, found in lymph nodes.

Question 13

Diagnostic for multiple myeloma?

Answer 13

overgrowth of B-lymphocyte plasma cells

Question 14

Epstein Barr virus?

Answer 14

Associated with the development of Burkitt’s lymphoma. Also assoc with development of hodgkins lymphoma but not diagnostic for the disease.

Question 15

Diagnostic for leukemia?

Answer 15

overproduction of blast phase cells?

Question 16

Pt has elevated prostate specific antigen level, what test will they get?

Answer 16

digital rectal exam- determines size and consistence of the prostate. assists with differentiating between benign prostatic hypertrophy and prostate cancer.

Question 17

Diagnostic of testicular cancer?

Answer 17

human chorionic gonadotropin level

Question 18

RA priority?

Answer 18

take meds on regular schedule- most effective way of managing chronic RA.

Not highest priority but may help with comfort- wear comfortable clothing, use progressive relaxation techniques, ask fam to help with household chores.

Question 19

Educating male adolescents about testicular cancer?

Answer 19

examine your testicles immediately after showering for easier palpation on a monthly basis.

Question 20

Going on hike, Lyme disease teaching?

Answer 20

if you develop pain and stiffness in joints, see doctor. stage 1 lyme disease- flu like symptoms, bulls eye rash, muscle & joint pain and stiffness.
Dont need to get tested right after tick bite- 4-6 weeks.
Remove tick with tweezers or fingers.
Wear light colored clothing so ticks can be seen.

Question 21

Peanut allergy teaching priority?

Answer 21

Carry an emergency anaphylaxis kit.

Not highest priority- medical alert bracelet, read food labels, inform other hcp.

Question 22

clindamycin (Cleocin) for acute pelvic inflammatory disease, adverse reaction highest priority?

Answer 22

Watery diarrhea- greatest risk is pseudomembranous colitis.

Other AE but not priority- vaginitis, urinary frequency, nausea/vomiting

Question 23

Hep B risk?

Answer 23

engaging in unprotected sex.

Question 24

Suspicion of breast cancer?

Answer 24

breast tissue with orange peel appearance- indicated advanced breast cancer due to blockage of lymph channels.
Mass that is non movable.

Montgomery tubercles on areola are normal.

Question 25

Skin cancer suspicion?

Answer 25

asymetrical papule that is pigmented- supports suspicion of malignant menanoma

Question 26

Psoriasis?

Answer 26

patch of silvery white scales with red epidermal base

Question 27

Seborrheic keratosis?

Answer 27

collection of irregular dry papules black in color

Question 28

Keloid?

Answer 28

elevated red lesion that arrises from a scar.

Question 29

Bacterial pharyngitis s/s/ diagnostics?

Answer 29

enlarged lymph nodes, fever

throat culture confirms the dx- need to ID specific microorganisms present in the pharynx.

Question 30

Mononeucleosis dx test?

Answer 30

monospot test

Question 31

Indirect laryngscopy used for?

Answer 31

to visually assess pharyngeal structures

Question 32

CXR used for?

Answer 32

pneumonia, pleural effusion

Question 33

Kidney transplant, hyperacute rejection-

Answer 33

organ will be removed if hyperacute rejection occurs. this is the only tx.
Immunosupressive therapy is to prevent chronic rejection not hyperacute.
If chronic rejection occurs the organ might develop scar tissue.
Acute rejection may occur in the first few weeks. hyperacute is different.

Question 34

amoxicillin (Amoxil) teaching?

Answer 34

Birth control pills are less effective.
Take with food.
Capsules can be opened and mixed with liquid and tablets can be crushed.
Take the med until you finish the bottle, even if you are better.

Question 35

HPV vaccine?

Answer 35

give in 3 doses beginning at age 11 or 12. second dose given 1-2 months after the first, 3rd dose given 6 months after the first.
Can be given to males up to 26.

Question 36

Pt with leukemia has platelet count 48,000. what to do?

Answer 36

check urine and stool for occult blood- pt who is thrombocytopenic is at risk for occult bleeding.

Question 37

Sign HIV has progressed to AIDS?

Answer 37

Small purple skin lesions- indicates Kaposi’s sarcoma, signifies AIDS, category C disease.

(Fever + diarrhea lasting >1 month= category B disease)
(Persistent generalized lymphadenopathy= category A disease)

Question 38

CD4 cells in AIDS

Answer 38

Dx of AIDS= cd4 count below 200 cells/mm3

Question 39

Systemic lupus erythematosus?

Answer 39

Wear gloves when it is cold outside- raynauds commonly accompanies SLE.
Use sunscreen with at least SPF 30.
Cannot be cured with immunosupressive therapy- chronic autoimmune disease.
Can affect all body systems- including pleural effusions, pneumonia.

Question 40

HIV pt, meds are effective in controlling disease progression when?

Answer 40

there is a decreased viral load- the viral protein amount is decreasing in the blood- positive response to treatment.

(low or decreasing ratio of cd4/cd8 indicates disease is progressing.)

Question 41

Pt hx copd admitted w/ viral pneumonia, contact PCP when?

Answer 41

Left shift seen in WBC differential- indicates that the pneumonia is bacterial not viral.

Question 42

Pt with RA taking methotrexate (Trexall). teaching?

Answer 42

Expect symptoms to subside in 4-6 weeks.
Administered once/week.
Increase intake of folic acid to help decr. SE.

Question 43

DC teaching to HIV positive pt?

Answer 43

Discard beverages that have been unrefrigerated for an hour- can support growth of bacteria.
Clean bathroom with 10% bleach solution.
Laundry soiled with body fluid should be washed in hot water.
Dont spend extended periods of time outside in places where contact with microorganisms is likely- gardening is bad.

Question 44

Acute Leukemia?

Answer 44

Elevated WBC, decreased HGB & HCT, decreased platelets.