Download Practice Test on Hematopoietic Stem Cell Transplantation (HSCT) and more Exams Advanced Education in PDF only on Docsity!
bmtcn - practice test
granulocytic cell types include - correct answer basophil, eosinophil & neutrophil strong predictor of relapse following an allo? - correct answer disease stage diagnostic test for ocular gvhd? - correct answer schirmers test s/s of ocular gvhd - correct answer allo recipient, gritty sensation in eyes, photosensitivity Stem cell products with an ABO incompatibility between donor and recipient are managed by which of the following? a - Depletion of red blood cells after collection b - Cryopreservation to prevent a adverse reaction c - Product irradiation prior to infusion d - Removal of white blood cells through filtering - correct answer a - Depletion of red blood cells after collection. rbc can be filtered after collection if there is an ABO incompatibility A patient continues to have symptoms of acute GVHD after a fourteen day course of glucocorticoids. What medication does the nurse anticipate an order for? a - Antithymocyte globulin b - Mineralocorticoids c - Cyclosporine d - Intravenous immunoglobulin - correct answer a - Antithymocyte globulin, ATG is the secondary treatment for GVHD that is not responding.
A young child undergoing a peripheral blood stem cell apheresis procedure reports a tingling sensation in the lips, hands and feet. Which of the following infusion orders does the nurse expect? a - Packed red blood cells b - Potassium c - Calcium gluconate d - Magnesium - correct answer c - Calcium gluconate, Citrate is commonly used as an anticoagulant during the apheresis procedure. Hypocalcemia is a common side effect of citrate, especially in small children 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 - age of the caregivers." b - current disease status." c- support resources available to the patient." d - baseline organ function." - correct answer a - age of the caregivers." Age of the caregivers is not a criteria determining recipient status. The cluster of differentiation system is used to: a - crossmatch for blood product transfusion. b - identify different types of cytokines. c - measure immune function. d - classify cell surface proteins on leukocytes. - correct answer d - classify cell surface proteins on leukocytes. The cluster of differentiation system classifies cell surface proteins. The impact of stress on social function following transplant is greatest between: a - survivor and extended family members.
d - Diffuse alveolar hemorrhage - correct answer c - Bronchiolitis obliterans Bronchiolitis obliterans manifests 3 months to 2 years after transplant and is characterized by diffuse wheezing A nurse reflecting on professional practice may consider: a - side effects of a chemotherapy agent. b - how to maintain professional boundaries. c - sharing details of patient care with a mutual friend. d - the Three Rights of Delegation. - correct answer b - how to maintain professional boundaries. Maintaining professional nurse/patient boundaries is a standard of professional practice. Which of the following factors increases the risk of squamous cell carcinoma following transplant? a - Underlying diagnosis of Fanconi anemia b - Previous diagnosis of aGVHD c - History of non-Hodgkin lymphoma d - History of acute myelogenous leukemia - correct answer a - Underlying diagnosis of Fanconi anemia Patients with FA have a predisposition to squamous cell carcinoma following transplant. A patient with chronic GVHD who is prescribed steroids needs to be re-immunized. The nurse knows that the patient can receive immunizations when the GVHD is resolved and the steroid dose is less than: a - 20 mg/day. b - 15 mg/day. c - 5 mg/day. d - 10 mg/day. - correct answer c - 5 mg/day.
Which of the following factors is associated with primary graft failure? a - CD34 selected cellular product b - HLA match with the donor c - Peripheral blood stem cell graft source d - Viral infection in the recipient - correct answer d - Viral infection in the recipient Prior to the initiation of treatment for engraftment syndrome, what is a priority nursing action? a - Ensure the infectious disease workup is complete b - Place the patient in protective isolation for 14 days c - Discontinue filgrastim administration d - Obtain order for IV fluids - correct answer a - Ensure the infectious disease workup is complete Which of the following is a potential barrier in advanced care planning for patients who have received an HSCT? a - Provider discomfort discussing end-of-life issues b - Length of time required to complete documents c - Accessibility to a lawyer d - Difficulty understanding documents - correct answer a - Provider discomfort discussing end-of-life issues Post transplant lymphoproliferative disease (PTLD) is most often associated with which of the following infections? a - Aspergillus b - Cytomegalovirus c - Epstein Barr virus d - Candida - correct answer c - Epstein Barr virus 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?
c - Posaconazole d - Methylprednisolone - correct answer b - Tacrolimus Taking tacrolimus with grapefruit juice can increase tacrolimus levels. Microangiopathic hemolytic anemia can be a complication from which immunosuppressive therapy? a - Tocilizumab b - Alemtuzumab c - Antithymocyte globulin d - Cyclosporine - correct answer d - Cyclosporine Which of the following is a disadvantage in the use of umbilical cord blood? a - Higher risk of GVHD b - Increased risk of graft failure c - Difficult collection process d - Cost - correct answer b - Increased risk of graft failure Cataract development post transplant is linked to which of the following treatment regimens? a - fludarabine b - TBI c - Carboplatin d - Etoposide - correct answer b - TBI Annual gynecologic examinations and vaccinations against human papillomavirus are important aspects of routine health maintenance for patients following allogeneic transplant because patients: a - are at increased risk for gynecomastia following transplant. b - post allogeneic transplant are at increased risk of cervical dysplasia. c - are at an increased risk of contracting sexually transmitted diseases.
d - post allogeneic transplant are at increased risk of aGVHD. - correct answer b - post allogeneic transplant are at increased risk of cervical dysplasia. While explaining the goals of stem cell transplant to a patient with acute myeloid leukemia, the nurse emphasizes that transplantation will: a - improve immune system function. b - reduce tumor burden. c - produce a graft versus leukemia effect. d - provide a chimeric graft post-transplant. - correct answer c - produce a graft versus leukemia effect. 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 - Sinusoidal occlusive syndrome d - Infection - correct answer b - Engraftment syndrome Engraftment syndrome is an inflammatory syndrome that can occur during engraftment after an autologous HSCT. Symptoms include fever, weight gain and pulmonary edema. A pediatric patient with which of the following conditions can be treated with an autologous transplant? a - Neuroblastoma b - Acute myeloid leukemia c - Severe combined immunodeficiency syndrome d - Cerebral adrenal leukodystrophy - correct answer a - Neuroblastoma What is the maximum amount of dimethyl sulfoxide in a cellular product that can be safely administered to a patient in a 24 hour period? a - 3mL/kg
Which of the following is a contributing factor to the development of sinusoidal obstructive syndrome in the early post-transplant period? a - GVHD b - CMV c - Hepatitis d - Drug metabolites - correct answer d - Drug metabolites The caregiver of a patient at a clinic visit reports witnessing unusual and aggressive behavior, sleep problems, and sadness. The nurse believes the patient may be exhibiting signs of: a - tacrolimus toxicity. b - bipolar disorder. c - post traumatic stress disorder. d - posterior reversible encephalopathy syndrome. - correct answer c - post traumatic stress disorder. During the preparative phase of HSCT, TBI is most often used to treat which of the following types of malignancies? a - Myeloblast b - Endodermal c - Myeloid d - Lymphoid - correct answer d - Lymphoid Which of the following is the first step in the pathophysiological process for acute GVHD? a - Damage of host tissue from conditioning b - Cytokine release syndrome c - inflammatory effectors d - Engraftment syndrome - correct answer a - Damage of host tissue A 45-year-old female with acute myeloid leukemia arrives for her pre-transplant evaluation. The patient's twin sister offers to donate, but the physician opts to use a donor from the National Marrow Donor Program because:
a - the cost of immunosuppression medication is high. b - the patient's sister is also identified as her caregiver. c - syngeneic transplants increase the risk of tumor relapse. d - the physician prefers to use the National Marrow Donor Program. - correct answer c - syngeneic transplants increase the risk of tumor relapse. Syngeneic transplants do not elicit a graft versus tumor effect. Secondary graft failure can be a complication of which of the following? a - Viral infection b - Increased cell dose of graft source c - Pulmonary fibrosis d - Venocclusive disease of the liver - correct answer a - Viral infection Which medication is used in conjunction with extracorporeal photopheresis (ECP)? a - Mercaptopurine b - Fluorouracil c - Methoxsalen d - Thioguanine - correct answer c - Methoxsalen Two hundred days after an allogeneic HSCT, a patient reports dry mouth, taste alterations, and oral pain. The nurse anticipates receiving an order for which of the following? a - Nystatin suspension b - Magic mouthwash c - Oxycodone d - topical steroid rinses - correct answer d - topical steroid rinses Topical steroids are first line treatment for oral GVHD. Which of the following is a characteristic of stromal cells? Stromal cells:
The patient's preparative regimen includes busulfan, fludarabine and antithymocyte globulin. The nurse plans to administer which medication prior to the antithymocyte globulin infusion? a - Ondansetron b - Diphenhydramine c - Mannitol d - Aspirin - correct answer b - Diphenhydramine Following an allogeneic transplant, a patient arrives at clinic reporting weakness and fatigue that has worsened over the past week. Which nursing intervention would be most appropriate? a - Suggest the patient take long naps during the day. b - Obtain an order to transfuse one unit of packed red blood cells. c - Request a referral to skilled nursing facility. d - Encourage the patient to incorporate regular aerobic and resistance exercise. - correct answer d - Encourage the patient to incorporate regular aerobic and resistance exercise. Studies have shown that regular aerobic exercise can reduce fatigue. Which of the following decreases the risk of developing acute GVHD after an allogeneic transplant for a male patient? a - Infusion of increased number of stem cells b - Depletion of T lymphocytes from allograft c - Human leukocyte antigen disparity d - Unrelated female donor - correct answer b - Depletion of T lymphocytes from allograft Patients who have received an HSCT should get what annual immunization? - correct answer inactive influenza yearly advantage of using UCB for HSCT? - correct answer you do not need a true HLA match because the cells are not yet mature
most important thing for nurse to remember when teaching caregiver of HSCT pt - correct answer teach information specifically applicable to the individual patient and only relevant to their specific phase of treatment compared to adults, ped HSCT donors are at a greater risk for what complication with apheresis - correct answer hypovolemia = volume of blood collected myeloid stem cells can turn into... - correct answer - erythrocytes (RBCs)
- megakaryocyte -> thrombocytes (plt)
- basophils (-> mast cell), eosinophils, or neutrophil
- monocyte (-> macrophage)
- myeloid dendritic cell lymphatic stem cells can turn into... - correct answer - pre-B cell -> B lymphocyte -> plasma
- prothymocyte -> T lymphocyte -> Th helper cell or Tc cytotoxic cell
- NK cell
- follicular dendritic cell Which of the following is an example of a myeloid cell? a - thymus-derived cell (t cell) b - bone marrow - derived (b cell) c - monocyte d - natural killer cell - correct answer c - monocyte several factors affect immune reconstitution following hsct. these include all of the following EXCEPT: a - recipients response to conditioning regimen b - viral infections c - cGVHD
produce the stromal stem cells which are found in the long bone and produce fat, cartilage, and bone - correct answer yellow bone marrow and fat cells produce the HSC found in the long and flat bones and create rbc, wbc, and platelets
- correct answer red bone marrow HSC are found where during childhood - correct answer long bone HSC are found where during adulthood - correct answer axial skeleton main objective of hematopoiesis - correct answer to maintain the peripheral blood with the proper level of blood components primary organs of immune system include - correct answer bone marrow, thymus, lymph node and spleen The loss of a cell's power to divide and grow is called - correct answer senescence HSC senescence is affected by: - correct answer - natural aging process
- cancer treatment
- transplantation
- reduction in size and function of thymus and immune cells _____ cells are first responders to injury and are NOT pathogen specific. a - myeloid b - lymphoid - correct answer a - myeloid _______ cells respond later and ARE pathogen specific. a - myeloid b - lymphoid - correct answer b - lymphoid
form of typing that provides the degree of genetic match between a MURD and a recipient in prep for an ALLO transplant. - correct answer human leukocyte antigen (HLA) high-res a better HLA match is preferred because: - correct answer 1 - has better overall survival stats 2 - reduced incidence of gvhd 3 - better engraftment rates goal of NONmalignant diseases (ie = chronic granulomatous disease, sickle cell, aplastic anemia, SCID, congenital neutropenia,) is... - correct answer cell line replacement goal of MALIGNANT disease is - correct answer tumor ablation HSCT can treat/be used for what diseases: - correct answer 1 - common malignant and nonmalignant diseases 2 - autoimmune diseases treated under a clinical trial (scleroderma, MS, crohns, systemic lupus, RA) Common malignant diseases requiring AUTO HSCT - correct answer - hodgkins
- non hodgkins (can ALSO require allo)
- MM
- neuroblastoma
- sarcoma
- germ cell tumor
- brain tumors
- breast cancer
- ovarian cancer
- melanoma
- lung cancer
This hsct uses stem cells from an identical twin, has no GVT effect, and does not require immunosuppression due to identical HLA typing - correct answer syngeneic a post transplant infusion of lymphocytes from the original stem cell donor given in the setting of relapsed disease after an ALLO hsct. purpose is to induce GVT effect by prompting immune system to fight the tumor - correct answer donor lymphocyte infusion (DLI) used to increase production of stem cells & mobilize them from marrow into periphery for apheresis collection - correct answer granuloycte-colony-stimulating factor (G-CSF) and plerixafor which 2 stem cell sources have a decreased incidence of gvhd - correct answer UCB and BM < peripheral what kind of regimen increased the opportunities for transplants in individuals age 65 or older? - correct answer nonmyeloablative tissue typing to evaluate the HLA match between donor and recipient antigens - correct answer histocompatibility testing glycoproteins that reside on surface of cells located on chromosome 6 and play a major role in the immune systems ability to recognize self vs nonself - correct answer HLA unique to each person and their major action is to produce immune cells that destroy antigens - correct answer HLAs
