BMTCN Exam 2024/2025 with 100% Accurate Solutions, Exams of Nursing

Download BMTCN Exam 2024/2025 with 100% Accurate Solutions and more Exams Nursing in PDF only on Docsity! BMTCN EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS Which of the following is NOT an identified risk factor associated with infection? A. Personal history of infection B. Type of transplantation (autologous or allogeneic) C. Myeloablative Transplant D. None of the Above - Precise Answer ✔✔D. None of the above Clostridium difficile is not a common infection in the post-transplant setting A. True B. False - Precise Answer ✔✔B. False A cord blood transplantation is associated with all of the following except: A. Prolonged neutrophil and immune recovery B. Increase in viral infections C. Decrease in bacterial infections D. Decrease in graft-versus-host disease (GVHD) - Precise Answer ✔✔C. Decrease in bacterial infections Which of the following is true when considering bacterial infections in patients after transplant? A. Patients are at a significant risk for encapsulated bacterial infections B. Multidrug-resistant organisms are not a major concern C. Streptococcus pneumoniae is not a common post-transplant bacterial infection D. Immunizations are not effective in controlling post-transplant bacterial or viral infections - Precise Answer ✔✔A. Patients are at a significant risk for encapsulated bacterial infections The following strategies should be considered in an effort to prevent post-transplant infectious complications: 1. Immunizations should begin immediately following transplant discharge 2. Antiviral and anti-fungal prophylaxis medications should be considered in the post-transplant setting 3. Lifestyle restrictions vary in each transplant center and often are enforced to decrease post-transplant infections. It is important to communicate lifestyle expectations and restrictions to patients and their families 4. Measles, mumps, and rubella immunization should be administered at 12 months A. 1, 2, 3, 4, B. 2 and 3 C. 2 and 4 Graft failure may result from which of the following A. Type of primary disease B. Human leukocyte antigen (HLA) disparity C. Immunosuppression D. GVHD E. All of the above - Precise Answer ✔✔E. All of the above Strategies to prevent graft failure may include all of the following EXCEPT: A. Using a nonmyeloablative conditioning regimen B. Employing antithymocyte globulin in combination with cyclophosphamide for aplastic anemia C. Augmenting cell dose by giving donor buffy coat transfusion D. Administering granulocyte-colony-stimulating factor - mobilized peripheral blood stem cells as an alternative to bone marrow E. Reducing the frequency of pre-transplant blood transfusions - Precise Answer ✔✔A. Using a nonmyeloablative conditioning regimen Early and late transplant-related musculoskeletal complications include all of the following EXCEPT: A. Avascular necrosis (AVN) B. Improved exercise tolerance C. Osteoporosis D. Fracture E. Osteomyelitis - Precise Answer ✔✔B. Improved exercise tolerance Which of the following is a risk factor for AVN? A. Steroid therapy B. Younger age C. Absence of GVHD D. Primary diagnosis of multiple myeloma - Precise Answer ✔✔A. Steroid therapy Which of the following is treatment for diminished bone mineral density? A. Nutritional supplementation with calcium and VitD B. Correction of possible endocrinopathies C. Correction of renal dysfunction D. Use of biophosphonates E. All of the above - Precise Answer ✔✔E. All of the above Which of the following is true of post-HSCT ocular damage? A. It can involve all the parts of the eye B. It may be a consequence of immunosuppression C. It may be influenced by conditioning regimens (chemotherapy, radiation, or both) D. It may be the result of underlying disease E. All of the above - Precise Answer ✔✔E. All of the above Manifestations of ocular GVHD include all of the following EXCEPT: A. Dry, gritty, or painful eyes B. Cicatricial conjunctivitis C. Keratoconjunctivitis D. Absence of early morning mucoid secretions E. Confluent areas of punctate keratopathy - Precise Answer ✔✔D. Abscence of early morning mucoid secretions Which of the following is true cataract formation? A. It can be attributed to radiation and steroid therapy and is not a direct result of GVHD itself B. It isn't uncommon cause a visual acuity loss C. The risk is decreased with total body irradiation D. It does not lead to increased incidence of cataract surgery - Precise Answer ✔✔A. It can be attributed to radiation and steroid therapy and is not a direct result of GVHD itself Risk factors that can predict a poorer overall psychological outcome include all of the following EXCEPT: A. Prior psychiatric morbidity or history B. Pre-transplant nonadherence C. Lack of stable social support D. History of considerable regimen -related toxicity E. Male Sex - Precise Answer ✔✔E. Male Sex Amphotericin B and corticosteroids can result in which of the following electrolyte imbalance? A. Hypernatremia B. Hypokalemia C. Hypocalcemia D. Hypercalcemia - Precise Answer ✔✔B. Hypokalemia The nurse is caring for a HSCT recipient with acute lymphoblastic leukemia and has drawn and sent laboratory samples for the morning. The recipient's lab report shows a corrected calcium level of 7.6 mg/dl and the patient is symptomatic. The nurse would anticipate an order to administer? A. Calcium gluconate IV B. Zoledronate acid IV C. Sodium Bicarbonate IV D. Insulin/glucose IV - Precise Answer ✔✔A. Calcium gluconate IV The patient is receiving tacrolimus IV following an allogenic HSCT. The patient is at greatest risk for developing which electrolyte imbalance? A. Hyponatremia B. Hyperkalemia C. Hypomagnesemia D. Hypernatremia - Precise Answer ✔✔C. Hypomagnesemia A patient with multiple myeloma is complaining of increased weakness seven days following HCST. Morning lab results reveal the following: K+ 3.8, Mg 2.2, Ph 1.9, and corrected Cl 10.2mg/dl. The nursing priority would be to obtain an order to administer which of the following medications? A. Sodium Bicarb IV B. Potassium phosphate IV C. Magnesium sulfate IV D. Calcium gluconate IV - Precise Answer ✔✔B. Potassium Phosphate IV A patient receiving cisplatin as a part of the conditioning regimen prior to HSCT. Which of the following metabolic alterations will the nurse expect? A. hypomagnesemia B. Hypokalemia C. Hyperkalemia D. Hypocalcemia - Precise Answer ✔✔A. Hypomagnesemia A recipient is being admitted for an allogenic HSCT. One of the most important assessments during admission is to establish which of the following? A. favorite foods B. anxiety level C. baseline weight D. learning preference - Precise Answer ✔✔C. baseline weight A recipient has received an auto HSCT. When does the nurse anticipate neutrophil engraftment? A. 26-28 days post transplant B. 14-21 days post transplant C. 7-9 days post transplant D. 30-42 days post transplant - Precise Answer ✔✔B. 14-21 days post transplant A recipient is 15 days post an allo HSCT with high-dose chemo and is complaining of mouth sores. On assessment, the nurse observes erythema and ulcerations in the oral cavity. History includes seropositivity for HSV, cytomegalovirus (CMV), and Epstein-barr virus (EBV). What is the possible reactivation? A. EBV B. CMV C. HSV D. Varicella-zoster virus - Precise Answer ✔✔C. HSV Which of the following is a common fungal pathogen in the late transplant phase? A. Aspergillus B. HSV C. CMV A recipient is 14 days post auto HSCT and is experiencing pallor, SOB with exertion, fatigue, tachycardia, and dizziness. Which of the following could the symptoms be indicating? A. Anemia B. Thrombocytopenia C. Pulmonary edema D. Acute cutaneous GVHD - Precise Answer ✔✔A. Anemia A patient is on day 14 after undergoing an allo HSCT and has continued to experience poor appetite and severe, watery diarrhea. A several -day history includes neutropenic fever with antibiotics and antiemetics. A priority nursing intervention would include which of the following? A. obtaining stool sample for culture B. applying a barrier cream to rectal area C. planning a diet with bland foods D. Providing small, frequent meals - Precise Answer ✔✔A. obtaining stool sample for culture On day nine following the conditioning regimen, a transplant recipient reports inability to swallow with dry mouth. On exam of the oral mucosa, the nurse observes debris on the teeth and gums. What is the most likely complication? A. Candida B. Dysphagia C. Mucositis D. Xerostomia - Precise Answer ✔✔D. Xerostomia A recipient reports a decrease in taste sensation with decreased intake of breakfast and lunch. What is the symptom called? A. Stomatitis B. Xerostomia C. Hypogeusia D. Infection - Precise Answer ✔✔C. Hypogeusia An HSCT recipient is complaining of diarrhea for the past three days consisting of five episodes in the last 24 hours. According to the National Cancer Common Terminology Criteria for Adverse Events, this indicates which grade of diarrhea? A. grade 2 B. grade 3 C. grade 4 D. grade 5 - Precise Answer ✔✔A. grade 2 A transplant recipient has received a myeloablative conditioning regimen over the past two days, which is now complete. In the beginning of day 4, the recipient develops nausea and vomiting. The recipient is experiencing which type of chemo induced nausea and vomiting? A. Acute B. Delayed C. Chronic D. Anticipatory - Precise Answer ✔✔B. delayed A recipient has developed oral mucositis following the start of an intense conditioning regimen. When does oral mucositis peak? A. 8-10 days B. 3-5 days C. 1-2 days D. 12-14 days - Precise Answer ✔✔D.12-14 days What is the mainstay for treatment of severe oral mucositis? A. Pain management B. Magic mouthwash C. viscous lidocaine D. bland rinses - Precise Answer ✔✔A. pain management Which of the following is a chemotherapy agent with a high emetic risk? A. Paclitaxel B. cyclophosphamide C. bleomycin D. vinorelbine - Precise Answer ✔✔B. cyclophosphamide A recipient is experiencing signs and symptoms of xerostomia. The rexcipient is at highest risk to develop what infection? Which of the following is a barrier to palliative care? A. Unpredictability of the illness trajectory with acute exacerbation requiring highly technical therapies B. The patient and family asking for information regarding palliative care services C. Social work D. Discussing options with the patient and family at a time when the patient can make an informed, autonomous decision - Precise Answer ✔✔A. Unpredictability of the illness trajectory with acute exacerbation requiring highly technical therapies Self care approaches for patients with terminal illness should include all of the following EXCEPT? A. Symptoms and pain management that affects quality of life B. Psychological and emotional adaptation to their illness C. Stress relief with symptoms that cannot easily be altered D. Self-titration of pain medication by patients - Precise Answer ✔✔D. self-titration of pain medication by patients Which of the following is an example of a myeloid cell? A. Thymus-derived cells (T cells) B. Bone marrow-derived cells (B cells) C. Monocytes D. Natural killer cells - Precise Answer ✔✔C. monocytes Several factors affect immune reconstitution following hematopoietic stem cell transplant. These include all of the following EXCEPT: A. Recipients response to conditioning treatment B. Viral infections C. Chronic graft-versus host disease D. Longevity of mature lymphocytes present at the time of transplant - Precise Answer ✔✔B. viral infections Hematopoiesis occurs primarily in which area? A. bone marrow B. Spleen C. Thymus gland D. lymph nodes - Precise Answer ✔✔A. bone marrow Which of the following statements is true about innate immunity? A. It occurs in response to T-cell activation B. It occurs in response to B-cell activation C. It is a natural process that uses phagocytes that release inflammatory mediators in response to infections or illness D. It is a natural process that occurs primarily in the spleen - Precise Answer ✔✔C. It is a natural process that uses phagocytes that release inflammatory mediators in response to infections or illness Which is NOT a common indication for allo transplantation? A. Acute myeloid leukemia B. Myelodysplastic Syndrome C. Chronic Myeloid leukemia D. Breast cancer - Precise Answer ✔✔D. Breast cancer Graft-versus-tumor effect is promoted by which of the following? A. withdrawal of immunosuppressive therapy B. Administration of donor lymphocyte infusion C. A and B D. Increased dose of immunosuppressive therapy - Precise Answer ✔✔C. A and B Which of the following is NOT a role of the caregiver? A. Provide physical and emotional support B. Assist with the recovery following HSCT C. Assist with medication administration D. Recommend over the counter medications for management of post HSCT symptoms - Precise Answer ✔✔D. Recommend over the counter medications for management of post HSCT symptoms MJ is to undergo and auto transplant. From whom will he receive his stem cells? A. Matched related donor B. matched unrelated donor D. organ toxicities would increase with lower-intensity conditioning regimens - Precise Answer ✔✔A. transplant-related mortality would decrease with the lower-intensity conditioning regimens What is NOT a rationale for using a myeloablative transplant conditioning regimen? A. increased tumor kill B. decreased risk of graft rejection C. increased graft vs tumor effect D. increased immunosuppression - Precise Answer ✔✔C. increased graft vs tumor effect PJ is a 58 year old woman who is receiving a reduced intensity allo stem cell transplant for acute myeloid leukemia. During allo stem cell infusion, P.J. begins to feel short of breath and appears pale and diaphoretic. The nurse notes bronchospasm and wheezing upon auscultation of the. lungs. PJ is most likely experiencing what type of reaction? A. acute hemolytic reaction B. anaphylactic reaction C. urticarial reaction D. dimethyl sulfoxide toxicity - Precise Answer ✔✔B. anaphylactic reaction Acute tumor lysis syndrome is characterized by all of the following electrolyte abnormalities EXCEPT: A. hyperkalemia B. hyperuricemia C. hypophosphatemia D. hypocalcemia - Precise Answer ✔✔C. hypophosphatemia CT blood type and his donor blood type have a minor ABO incompatibility. Which statement about minor ABO incompatibility is incorrect? A. it is noted when the recipient is type O and the donor is type A, B, or AB B. the recipient Is at risk for acute and delayed hemolytic reactions after the blood product is transfused C. the type O donor has natural antibodies to A or B blood types, giving the recipient a risk of acute hemolysis D. Delayed hemolysis can occur once the graft produces anti-A and anti- B to the recipient's current blood type of A, B, or AB. The recipient usually will have a mixed blood type for a time - Precise Answer ✔✔A. it is noted when the recipient is type O and the donor is type A, B, or AB What is the correct method for preventing the side effect of syndrome of inappropriate antidiuretic hormone secretion (SIADH) A. SIADH is not a preventable condition B. give high-rate IV fluids throughout the conditioning chemotherapy regimen C. keep patients on fluid restriction throughout the conditioning chemo regimen D. give furosemide throughout the chemo regimen - Precise Answer ✔✔A. SIADH is not a preventable condition What is the first line medication used to prevent Pneumocystis jiroveci pneumonia? A. ciprofloxacin B. acyclovir C. voriconazole D. trimethoprim - sulfamethoxazole - Precise Answer ✔✔D. trimethoprim-sulfamethoxazole Which is NOT a symptom of engraftment syndrome? A. fever B. mouth sores C. rash D. hypoxia - Precise Answer ✔✔B. mouth sores The major cause or mortality in cord blood transplant is which of the following? A. bleeding B. malnutrition C. infection D. renal failure - Precise Answer ✔✔C. infection C. give drugs at least 4 hours apart to avoid interaction, dose-reduce CNI by 1/3 to 1/4, and follow levels closely D. none of the above - Precise Answer ✔✔C give drugs at least 4 hours apart to avoid interaction, dose reduce CNI by 1/3 to 1/4, and follow levels closely Which graft source has a higher risk of developing acute GVHD? A. peripheral blood stem cells B. bone marrow C. umbilical cord blood D. none of the above - Precise Answer ✔✔A. peripheral blood stem cells What is the first organ usually involved with acute GVHD? A. lungs B. eyes C. GI tract D. skin - Precise Answer ✔✔D. skin What is the phenomenon that occurs approximately 7-14 days post HSCT and has the following symptoms: fever, erythroderma, and noncardiogenic pulmonary edema? A. acute GVHD B. engraftment syndrome C. hyperacute GVHD D. overlap syndrome - Precise Answer ✔✔C. hyperacute GVHD What immunosuppressant can cause serum sickness? A. mycophenolate B. cyclosporine C. steroids D. ATG - Precise Answer ✔✔D. ATG Long-term use of CNIs affects what part of the body? A. bones B. heart C. kidneys D. liver - Precise Answer ✔✔A. bones Sirolimus can cause which of the following? A. pulmonary toxicity B. cardiomyopathy C. renal insufficiency D. liver toxicity - Precise Answer ✔✔A. pulmonary toxicity With which of the following does transplant-associated microangiopathy occur? A. sirolimus alone B. sirolimus and steroids C. sirolimus and mycophenolate mofetil D. CNIs (tacrolimus and cyclosporine) - Precise Answer ✔✔D. CNIs (tacrolimus and cyclosporine) Which immunosuppressant can cause hirsutism? A. tacrolimus B. steroids C. sirolimus D. cyclosporine - Precise Answer ✔✔D. cyclosporine Which drug is used to prevent graft rejection and GVHD? A. ATG B. cyclosporine C. tacrolimus D. sirolimus - Precise Answer ✔✔A. ATG Overlap syndrome is a classification of GVHD that consists of which of the following? A. classic acute and persistent recurring late GVHD B. hyperacute GVHD C. features of both acute and chronic GVHD D. chronic GVHD - Precise Answer ✔✔C. features of both acute and chronic GVHD A. open ulcers B. white lines and lacy appearing lesions on the buccal mucosa and tongue palate C. dry mucous membranes D. B and C - Precise Answer ✔✔D. B and C Chronic GVHD of eyes significantly affects quality of life after allo HSCT. What usually is the first treatment modality? A. preservative-free artificial tears B. ophthalmic antibiotic ointment C. lubrication D. cyclosporine eye drop - Precise Answer ✔✔A. preservative-free artificial tears Chronic GVHD can be manifested in the hematopoietic system and cytopenias including: A. lymphocyte count <500 and eosinophilia B. anemia C. thrombocytopenia D. all of the above - Precise Answer ✔✔D. all of the above It is unlikely that someone will develop chronic GVHD without a history of acute GVHD. A. true B. false - Precise Answer ✔✔B. false Scoring of chronic GVHD involves which of the following? A. specific organs and the number of organs involved B. severity within each effected organ C. functional impairment D. all of the above - Precise Answer ✔✔D. all of the above What is the primary 1st line therapy for moderate to severe chronic GVHD? A. Adding a CNI if patient is not on one B. Adding extracorporeal photopheresis C. Adding sirolimus D. Adding systemic steroids - Precise Answer ✔✔D. adding systemic steroids NIH guidelines recommend consideration of systemic treatment for chronic GVHD if: A. three or more organs are involved B. 1 organ has a severity score greater than 2 C. major organ such as the eyes, lungs, or liver is involved D. A and B - Precise Answer ✔✔D. A and B What is one of the major tasks in diagnosing either acute or chronic GVHD? A. rule out other etiologies such as infection of drug reaction B. obtain a biopsy C. assess timing of symptoms D. all of the above - Precise Answer ✔✔D. all of the above For the chronic GVHD of the skin, the use of topical agents may improve symptoms and clinical features. To treat GVHD that involves the face, topical agents include: A. high potency steroids BID for no more than 7 days B. emollients C. antipuritic creams D. CNI creams such as tacrolimus E. low potency steroids such as hydrocortisone F. B, C, D, E - Precise Answer ✔✔F. B,C,D,E What is the organ that is involved more in chronic GVHD than acute GVHD? A. Gi tract B. skin C. liver D. eyes - Precise Answer ✔✔D. eyes