Section 12. Hematological and Immunological Problems
MULTIPLE CHOICE
1. Sandra is 70 years old and has just been diagnosed with leukemia. She is complaining of bone
and joint pain. Which type of leukemia is most likely the culprit?
A.
Acute lymphoblastic leukemia (ALL)
B.
Acute myelogenous leukemia (AML)
C.
Chronic myelogenous leukemia (CML)
D.
Chronic lymphocytic leukemia (CLL)
2. Which type of bone marrow transplant is obtained from an identical twin?
A.
Xenograft
B.
Autologous
C.
Allogeneic
D.
Syngeneic
3. During treatment for anaphylaxis, which site is used for the initial injection of epinephrine?
A.
Antecubital vein
B.
Abdomen
C.
Upper lateral thigh
D.
Deltoid
4. After the initial treatment for anaphylaxis, which medication should be added to prevent
late-phase anaphylactic reactions?
A.
Albuterol
B.
Diphenhydramine
C.
H2 blocker
D.
Corticosteroid
5. When analyzing synovial fluid, if it has 10,000 white blood cells/mcL with 80%
polymorphonuclear neutrophils (PMNs), it may be indicative of which of the following
conditions?
A.
None, this is a normal result
B.
Scleroderma
C.
Rheumatoid arthritis
D.
Sickle cell disease
6. Which of the following disease-modifying antirheumatic drugs is a folic acid antagonist?
A.
Methotrexate (Rheumatrex)
B.
Etanercept (Enbrel)
C.
Rituximab (Rituxan)
D.
Anakinra (Kineret)
7. Which statement about HIV postexposure prophylaxis (PEP) for health-care workers is the
most accurate?
A.
PEP treatment regimens contain two antiretroviral medications.
B.
PEP should be started within 72 hours of exposure.
C.
PEP follow-up requires renal function tests at 6 weeks after beginning PEP.
D.
PEP will prevent potential hepatitis C infection, if present.
8. For which patient would the clinician recommend annual HIV testing?
A.
One who is in a mutually monogamous relationship that engages in anal sex
B.
One who is a migrant worker
C.
One who is diagnosed with viral hepatitis
D.
One who is pregnant with second child from another male
9. Reuben, age 24, has HIV and just had a routine viral load test done. The results show a falling
viral load. What does this indicate?
A.
A favorable prognostic trend
B.
Disease progression
C.
The need to be more aggressive with Reuben’s medications
D.
Drug resistance mutations
10. A patient with atrial fibrillation is taking warfarin (Coumadin) and has an international
normalized ratio (INR) of 4.0 with no active bleeding. How should the clinician manage this
patient?
A.
Stop the medication for 1 week, and then repeat the INR.
B.
Withhold 1 or more days of anticoagulant therapy.
C.
Restart therapy at a lower dose immediately.
D.
Slowly increase the dose over 3 days.
11. The patient with severe iron deficiency anemia is eating ice chips. Which term should the
clinician use to document this finding?
A.
Cheilosis
B.
Anorexia
C.
Hypochromasia
D.
Pica
12. As a rule of thumb, the estimated level of hematocrit is how many times the value of the
hemoglobin?
A.
Two
B.
Three
C.
Four
D.
Five
13. What is the most common cause of microcytic anemia?
A.
Anemia of chronic disease
B.
Sideroblastic anemia
C.
Iron-deficiency anemia
D.
Pernicious anemia
14. Which symptom is the cardinal subjective symptom of sickle cell crisis?
A.
Pain
B.
Nausea
C.
Light-headedness
D.
Palpitations
15. Which phrase describes rheumatoid arthritis (RA)?
A.
Localized synovial joint destruction
B.
Chronic exocrine dysfunction
C.
Systemic inflammatory disease
D.
Antibody-mediated cellular cytotoxicity response
16. Which blood test is a nonspecific method and most helpful for evaluating the severity and
course of an inflammatory process?
A.
Erythrocyte sedimentation rate
B.
White blood cell count
C.
Polymorphonuclear cells
D.
C-reactive protein (CRP)
17. Infectious mononucleosis results from an acute infection with which of the following?
A.
Epstein-Barr virus
B.
Acute HIV infection
C.
Guillain-Barré
D.
Hepatitis
18. Which condition is the most common cause of generalized musculoskeletal pain in women
ages 20 to 55?
A.
Chronic fatigue syndrome
B.
Anemia
C.
Fibromyalgia syndrome
D.
Sports-related injuries
19. After returning from visiting his grandchildren in Connecticut, George, age 59, complains of a
flulike illness, including fever, chills, and myalgia. He reports having discovered a rash or red
spot that grew in size on his right leg. Which disease should the clinician be considering?
A.
Rubella
B.
Lyme disease
C.
Fibromyalgia syndrome
D.
Shingles
20. Dryness of the eyes and mouth is typical of which condition?
A.
Sjögren’s syndrome
B.
Allergic reaction
C.
Hypothyroidism
D.
Sideroblastic anemia
21. Exposure to ultraviolet (UV)-B and UV-A rays is a triggering factor for acute exacerbations
of which condition?
A.
Rheumatoid arthritis
B.
Gout
C.
Systemic lupus erythematosus
D.
Sjögren’s syndrome
22. What is the current goal of treatment for a patient with HIV infection?
A.
Viral suppression to undetectable levels
B.
Compete eradication of the virus
C.
Limit contact with uninfected individuals
D.
Total abstinence
23. Which test should the clinician use to initially screen for HIV?
A.
Western blot
B.
Enzyme-linked immunosorbent assay
C.
HIV-1/2 antigen/antibody combination immunoassay
D.
Nucleic acid amplification testing
24. Which lab test would the clinician order to monitor for a significant side effect from tenofovir
disoproxil fumarate?
A.
Urine protein
B.
Allele genetic testing
C.
Sodium level
D.
Hemoglobin
25. Which drug category of antiretroviral (ARV) therapy is generally effective in crossing the
blood–brain barrier and may be useful in managing HIV-associated dementia?
A.
Nucleoside reverse transcriptase inhibitors
B.
Protease inhibitors
C.
Integrase inhibitors
D.
Nonnucleoside reverse transcriptase inhibitors
26. Spontaneous bruising may be seen with platelet counts below what level?
A.
100,000 cells/mL
B.
75,000 cells/mL
C.
50,000 cells/mL
D.
30,000 cells/mL
27. Which type of fatigue may improve with exercise after awakening?
A.
Functional
B.
Acute
C.
Persistent
D.
Anemia associated
28. Which assessment finding presents with early rheumatoid disease?
A.
Pain and swelling in both small and large peripheral joints
B.
Rigid joints with diminished range of motion
C.
Joint swelling and immobility on rising
D.
A cardiac rub with pulmonary friction rub
29. Which test is diagnostic of RA?
A.
Rheumatoid factor
B.
Erythrocyte sedimentation rate
C.
C-reactive protein
D.
Anti-citrulline-containing peptide titers
30. What is the mainstay of management for infectious mononucleosis?
A.
Antivirals
B.
Symptom control
C.
Corticosteroids
D.
Isolation
31. Chronic fatigue syndrome (CFS) tends to occur in which individuals?
A.
Active, highly functional adults
B.
Depressed middle-aged adults
C.
Individuals with a depressed immune system
D.
Individuals who are hypochondriacs
32. What is the bulls-eye rash of Lyme disease called?
A.
Erythema infectiosum
B.
Viral exanthem
C.
Erythema migrans
D.
Morbilliform exanthem
33. Which condition if left untreated will progress to complaints that include multiple joint
arthritis?
A.
Sjögren’s syndrome
B.
HIV/AIDS
C.
Guillain-Barré
D.
Lyme disease
34. Keratoconjunctivitis sicca is a classic sign of which condition?
A.
Systemic lupus erythematosus
B.
Sjögren’s syndrome
C.
Fibromyalgia syndrome
D.
Lyme disease
35. Which person is four times more likely to develop systemic lupus erythematosus (SLE) than a
Caucasian?
A.
One of African descent
B.
An Asian
C.
A Hispanic
D.
One from the Middle East
36. The older adult patient has an infection. The clinician should assess for which clinical
manifestation?
A.
Fever
B.
Dementia
C.
Confusion
D.
Ecchymosis
37. Which aspect should the clinician consider when trying to determine the cause of
lymphadenopathy?
A.
Prothrombin time
B.
Marital status
C.
Patient’s age
D.
Blunt trauma
38. The patient has a fever of 104.2°F (40.1°C). Which condition should the clinician be
considering as the etiology of the fever?
A.
Urinary tract infection
B.
Infectious hepatitis
C.
Tuberculosis
D.
Pancreatitis
39. Which type of hypersensitivity reaction should the clinician suspect in a patient who has an
elevated IgE level?
A.
1
B.
2
C.
3
D.
4
40. In which area would the clinician evaluate a tender point in a patient with suspected
fibromyalgia syndrome (FMS)?
A.
Fifth rib
B.
Trapezius
C.
Maxillary
D.
Midforearm
41. A patient has CFS. Which strategy should the clinician consider to manage this patient?
A.
Bedrest
B.
High-impact exercise
C.
Thermal biofeedback
D.
Cognitive-behavioral therapy
42. Which classic rash should the clinician assess for in a patient with SLE?
A.
Butterfly
B.
Bulls-eye
C.
Ringworm
D.
“Slapped” cheeks
43. Which blood cell is excessively elevated in a person who has polycythemia?
A.
Platelets
B.
Neutrophils
C.
Red blood cells
D.
All types of blood cells
44. Which treatment would the clinician recommend for a patient who has relative polycythemia?
A.
Rehydration
B.
Antihistamines
C.
Weekly phlebotomies
D.
Referral to hematologist
45. Which behavior would the clinician advise the patient with sickle cell anemia to avoid?
A.
Becoming overhydrated
B.
Taking folic acid supplements
C.
Becoming physically overtaxed
D.
Taking rest periods during the day
46. The clinician must differentiate chronic vitamin B12 deficiency anemia from folate deficiency
anemia. Which action should the clinician take?
A.
Obtain a complete blood count
B.
Assess for peripheral neuropathy
C.
Inspect for smooth surface on tongue
D.
Determine the size of the red blood cell
47. Which finding from the bone marrow aspiration is typical in a patient with CML?
A.
Schistocytes
B.
Howell-Jolly bodies
C.
Hemoglobin S gene
D.
Philadelphia chromosome
48. How long would the clinician inform the patient to rest after onset of infectious
mononucleosis?
A.
4 days
B.
10 days
C.
2 weeks
D.
4 weeks
49. A patient presents with symptoms of infectious mononucleosis. Which lab chemistry test
should the clinician order?
A.
Viral load
B.
Hemoglobin A1c
C.
Western blot assay
D.
Heterophile antibody test
50. The advance practice registered nurse (APRN) is providing a community health program for
the prevention of Lyme disease. Which information should be included?
A.
Safe sex practices
B.
Hiking precautions
C.
Smoking cessation
D.
Vaccination schedules