NURS 316 FINAL EXAM ACTUAL QUESTIONS AND
SOLUTIONS GRADED A+
✔✔Cell autoimmunity - ✔✔Attack "self" cells
T cell or Ig-mediated autoantibodies
Organ-specific or systemic
Underlying etiology is unknown
Molecular mimicry
✔✔WBC - ✔✔white blood cells (leukocytes) protect against infection
Produced in bone marrow
✔✔Three major categories of WBC - ✔✔Monocytes
Lymphocytes
Granulocytes
✔✔WBC disorders - ✔✔leukemia
Acute lymphoblastic leukemia
Chronic lymphocytic leukemia
Acute myelogenous leukemia
Chronic Myelogenous leukemia
Hodgkin's lymphoma
Non-Hodgkin's lymphoma
Multiple Myeloma
✔✔Acute Lymphocytic Leukemia - ✔✔Aggressive, more common in children
Many chromosomal and genetic alterations
Immature T or B cells
S/S: nonspecific, anemia, increased bleeding, lymph node elargements, splenomegaly,
increased infection risk, bone pain
Tx: Chemotherapy, bone marrow transplant, CAR-T
✔✔Chronic Lymphocytic Leukemia - ✔✔Most common leukemia in US
Individuals 70 or older
Etiology: Any agent that can disrupt DNA
Zeta-chain-associated protein tyrosine kinase 70: + indicates worse prognosis, - better
prognosis
B cell malignancy; express proto-oncogene bcl2 allowing constant proliferation
S/S: leukemia S/S
Diagnosis: Lymphocytosis w/WBC >20,000, Bone marrow biopsy
Tx: Chemotherapy, Radiation
Complications: Richter's transformation
✔✔Acute Myelogenous Leukemia - ✔✔Proliferation of undifferentiated myeloid cells
Myeloid blasts can invade other issues
,Risk increased with previous chemotherapy radiation
Commonly related to activation of oncogenes
Diagnosis: CBC, genetic translocation between chromosome 8 and 12
Chemotherapy and bone marrow transplant are treatments
✔✔Chronic Myelogenous Leukemia - ✔✔Overproduction of mature myeloid cells
Age 65 or older
Clinical course 3 phases: Chronic, Accelerated, Blast crisis phase
Usual symptoms of leukemia: Anemia, increased infection, increased bleeding
Diagnosis: CBC, PCR
Tx: Drugs that inhibit tyrosine kinase, Bone marrow transplant
✔✔non- Hodgkin's lymphoma - ✔✔B, T, or NK cells
Middle aged or older
Chromosomal translocations
Some pathogens: HIV, Hep C
Immunosuppressive treatment may increase NHL risk
Enlarged, painless lymph node is often first
Diagnosis: Lymph ode biopsy
Tx: Chemotherapy, Immunotherapy, Radiation. Surgery
✔✔Hodgkin's disease - ✔✔B cell
Most common lymphoma in young children
Diagnosis: Reed-Sternberg cells, Immunohistochemistry to determine cell surface
S/S: Enlarged lymph node may be present
Tx: Combination chemotherapy, ration, immunotherapy
✔✔Multiple Myeloma - ✔✔Plasma B cells: abnormal Igs
Genetic and chromosomal abnormalities present
Diagnosis: 10% or more plasma cells in bone marrow, Bence Jones proteins, beta-2
macroglobulin levels
Bone pain is a common complaint especially in back
Increased risk of infection as antibodies are abnormal and ineffective
Renal disease common manifestation and presence indicates poor prognosis
Staging based on Revised International Staging System
Tx: Chemotherapy, stem cell transplant
✔✔WBC malignancies - ✔✔Leukemia
Lymphoma
✔✔Leukemia - ✔✔Neoplastic proliferation of blood cells
90% of cases are adults
Third most common caner in children
Nonfunctional, cancerous WBCs proliferate
S/S: Anemia, Leukopenia, Thrombocytopenia, Bone pain, Enlarged lymph node,
Splenomegaly
, Diagnosis: CBC, Bone marrow aspiration, Fluorescence in-situ hybridization,
Polymerase chain reaction, Flow cytometry
Tx: Chemotherapy, Radiation, Stem cell transplant, CAR-T cell cancer immunotherpy
Complications: Tumor lysis syndrome, Differentiation syndrome, Cytokine release
syndrome
✔✔Lymphoma - ✔✔Proliferation of B or T lymphocytes in lymphoid tissue
Solid tumors
3% of US population per year
Nonfunctional, cancerous WBCs proliferate
S/S: Anemia, Leukopenia, Thrombocytopenia, Bone pain, Enlarged lymph node,
Splenomegaly
Diagnosis: CBC, Bone marrow aspiration, Fluorescence in-situ hybridization,
Polymerase chain reaction, Flow cytometry
Tx: Chemotherapy, Radiation, Stem cell transplant, CAR-T cell cancer immunotherpy
Complications: Tumor lysis syndrome, Differentiation syndrome, Cytokine release
syndrome
✔✔RBC disorders - ✔✔Acute Blood loss anemia
Chronic blood loss anemia
hemoytic anemia
Red blood cell maturation defects
Polycythemia
✔✔Acute blood loss anemia - ✔✔Trauma, hemorrhage, clotting disorder
Diagnosis: NCNC with reticulocytotic, FOBT determine GI blood loss
Tx: For blood loss, establish hemostasis and fluid volume
S/S: <15% orthostatic hypotension and anxiety, 15-30% SNS activity, increased HR, 30-
40% HR greater than 120bpm hypotension urine output decrease, >40% severe
hypotension, decreased consciousness, HR greater than 140 no urine output.
✔✔Chronic blood loss anemia - ✔✔Causes: GI bleed, Medications
S/S: because blood loss slow, pt may report no noticeable changes
Diagnosis: Iron depletion often occurs, Microcytic and hypochromic anemia, Low iron,
low ferritin, increased TBIC
Tx: Remedy reason for blood loss, Replace iron: oral ferrous sulfate
✔✔Different types of Hemolytic Anemias - ✔✔Hemoglobinopathy
Sickle cell anemia
Thalassemia
Hereditary spherocytosis
BLood transfusion reactions
hemolytic disease of the newborn
Anemia Due to lead poising
✔✔Sickle Cell Anemia - ✔✔Autosomal hemoglobinopathy
SOLUTIONS GRADED A+
✔✔Cell autoimmunity - ✔✔Attack "self" cells
T cell or Ig-mediated autoantibodies
Organ-specific or systemic
Underlying etiology is unknown
Molecular mimicry
✔✔WBC - ✔✔white blood cells (leukocytes) protect against infection
Produced in bone marrow
✔✔Three major categories of WBC - ✔✔Monocytes
Lymphocytes
Granulocytes
✔✔WBC disorders - ✔✔leukemia
Acute lymphoblastic leukemia
Chronic lymphocytic leukemia
Acute myelogenous leukemia
Chronic Myelogenous leukemia
Hodgkin's lymphoma
Non-Hodgkin's lymphoma
Multiple Myeloma
✔✔Acute Lymphocytic Leukemia - ✔✔Aggressive, more common in children
Many chromosomal and genetic alterations
Immature T or B cells
S/S: nonspecific, anemia, increased bleeding, lymph node elargements, splenomegaly,
increased infection risk, bone pain
Tx: Chemotherapy, bone marrow transplant, CAR-T
✔✔Chronic Lymphocytic Leukemia - ✔✔Most common leukemia in US
Individuals 70 or older
Etiology: Any agent that can disrupt DNA
Zeta-chain-associated protein tyrosine kinase 70: + indicates worse prognosis, - better
prognosis
B cell malignancy; express proto-oncogene bcl2 allowing constant proliferation
S/S: leukemia S/S
Diagnosis: Lymphocytosis w/WBC >20,000, Bone marrow biopsy
Tx: Chemotherapy, Radiation
Complications: Richter's transformation
✔✔Acute Myelogenous Leukemia - ✔✔Proliferation of undifferentiated myeloid cells
Myeloid blasts can invade other issues
,Risk increased with previous chemotherapy radiation
Commonly related to activation of oncogenes
Diagnosis: CBC, genetic translocation between chromosome 8 and 12
Chemotherapy and bone marrow transplant are treatments
✔✔Chronic Myelogenous Leukemia - ✔✔Overproduction of mature myeloid cells
Age 65 or older
Clinical course 3 phases: Chronic, Accelerated, Blast crisis phase
Usual symptoms of leukemia: Anemia, increased infection, increased bleeding
Diagnosis: CBC, PCR
Tx: Drugs that inhibit tyrosine kinase, Bone marrow transplant
✔✔non- Hodgkin's lymphoma - ✔✔B, T, or NK cells
Middle aged or older
Chromosomal translocations
Some pathogens: HIV, Hep C
Immunosuppressive treatment may increase NHL risk
Enlarged, painless lymph node is often first
Diagnosis: Lymph ode biopsy
Tx: Chemotherapy, Immunotherapy, Radiation. Surgery
✔✔Hodgkin's disease - ✔✔B cell
Most common lymphoma in young children
Diagnosis: Reed-Sternberg cells, Immunohistochemistry to determine cell surface
S/S: Enlarged lymph node may be present
Tx: Combination chemotherapy, ration, immunotherapy
✔✔Multiple Myeloma - ✔✔Plasma B cells: abnormal Igs
Genetic and chromosomal abnormalities present
Diagnosis: 10% or more plasma cells in bone marrow, Bence Jones proteins, beta-2
macroglobulin levels
Bone pain is a common complaint especially in back
Increased risk of infection as antibodies are abnormal and ineffective
Renal disease common manifestation and presence indicates poor prognosis
Staging based on Revised International Staging System
Tx: Chemotherapy, stem cell transplant
✔✔WBC malignancies - ✔✔Leukemia
Lymphoma
✔✔Leukemia - ✔✔Neoplastic proliferation of blood cells
90% of cases are adults
Third most common caner in children
Nonfunctional, cancerous WBCs proliferate
S/S: Anemia, Leukopenia, Thrombocytopenia, Bone pain, Enlarged lymph node,
Splenomegaly
, Diagnosis: CBC, Bone marrow aspiration, Fluorescence in-situ hybridization,
Polymerase chain reaction, Flow cytometry
Tx: Chemotherapy, Radiation, Stem cell transplant, CAR-T cell cancer immunotherpy
Complications: Tumor lysis syndrome, Differentiation syndrome, Cytokine release
syndrome
✔✔Lymphoma - ✔✔Proliferation of B or T lymphocytes in lymphoid tissue
Solid tumors
3% of US population per year
Nonfunctional, cancerous WBCs proliferate
S/S: Anemia, Leukopenia, Thrombocytopenia, Bone pain, Enlarged lymph node,
Splenomegaly
Diagnosis: CBC, Bone marrow aspiration, Fluorescence in-situ hybridization,
Polymerase chain reaction, Flow cytometry
Tx: Chemotherapy, Radiation, Stem cell transplant, CAR-T cell cancer immunotherpy
Complications: Tumor lysis syndrome, Differentiation syndrome, Cytokine release
syndrome
✔✔RBC disorders - ✔✔Acute Blood loss anemia
Chronic blood loss anemia
hemoytic anemia
Red blood cell maturation defects
Polycythemia
✔✔Acute blood loss anemia - ✔✔Trauma, hemorrhage, clotting disorder
Diagnosis: NCNC with reticulocytotic, FOBT determine GI blood loss
Tx: For blood loss, establish hemostasis and fluid volume
S/S: <15% orthostatic hypotension and anxiety, 15-30% SNS activity, increased HR, 30-
40% HR greater than 120bpm hypotension urine output decrease, >40% severe
hypotension, decreased consciousness, HR greater than 140 no urine output.
✔✔Chronic blood loss anemia - ✔✔Causes: GI bleed, Medications
S/S: because blood loss slow, pt may report no noticeable changes
Diagnosis: Iron depletion often occurs, Microcytic and hypochromic anemia, Low iron,
low ferritin, increased TBIC
Tx: Remedy reason for blood loss, Replace iron: oral ferrous sulfate
✔✔Different types of Hemolytic Anemias - ✔✔Hemoglobinopathy
Sickle cell anemia
Thalassemia
Hereditary spherocytosis
BLood transfusion reactions
hemolytic disease of the newborn
Anemia Due to lead poising
✔✔Sickle Cell Anemia - ✔✔Autosomal hemoglobinopathy
