Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 30: Alterations of Leukocyte and Lymphoid FunctionMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. In infectious mononucleosis (IM), what does the Monospot test detect?a. Immunoglobulin E (IgE)b. Immunoglobulin M (IgM)c. Immunoglobulin G (IgG)d. Immunoglobulin A (IgA)ANS: BThe Monospot test is used to diagnose infectious mononucleosis by detecting heterophile antibodies. These are a heterogeneous group of immunoglobulin M (IgM) antibodies that are agglutinins against nonhuman red blood cells and are present in IM.PTS: 1 DIF: Cognitive Level: Remembering 2. A patient has been diagnosed with acute lymphocytic leukemia (ALL) and asks the healthcare professional to describe it. What description by the professional is most accurate?a. ALL is a progressive neoplasm defined by the presence of greater than 30% lymphoblasts in the bone marrow or blood.b. In ALL, immature blasts cells replace normal myelocytic cells, megakaryocytes, and erythrocytes.c. B cells fail to mature into plasma cells that synthesize immunoglobulins.d. The translocation of genetic material from genes 9 and 22 create an abnormal, fused gene identified as BCR-ABL.ANS: AALL is a progressive neoplasm defined by the presence of greater than 30% lymphoblasts in the bone marrow or blood. Leukemia is a malignant disorder of leukocytes and does not involve immunoglobulins. The BCR-ABL gene has been identified in chronic myelogenous leukemia, not ALL.PTS: 1 DIF: Cognitive Level: Understanding 3. Which description is consistent with chronic myelogenous leukemia (CML)?a. Defects exist in the ras oncogene, TP53 tumor-suppressor gene, and INK4A, the gene encoding a cell-cycle regulatory protein.b. Leukocytosis and a predominance of blast cells characterize the bone marrow and peripheral blood. As the immature blasts increase, they replace normal myelocytic cells, megakaryocytes, and erythrocytes.c. B cells fail to mature into plasma cells that synthesize immunoglobulins.d. The translocation of genetic material from genes 9 and 22 creates an abnormal, fused protein identified as BCR-ABL1.ANS: DThe presence of the BCR-ABLI fusion gene distinguishes CML from other myeloproliferative disorders.PTS: 1 DIF: Cognitive Level: Remembering 4. A patient is admitted to the hospital with multiple myeloma (MM). Which diagnostic test should the healthcare professional assess as the priority?a. Serum potassium levelb. Serum calcium levelc. Bone scan or limb x-raysd. Bone marrow biopsyANS: BMany clinical manifestations of MM are due to hypercalcemia. Since calcium can affect cardiac conduction, the priority diagnostic test is serum calcium levels. Bone destruction does occur in MM, but obtaining images of bones is not a higher priority than the calcium. The patient already has been diagnosed with MM, so a bone marrow biopsy may not be needed at this time. Potassium and other electrolytes will be assessed but not as the priority.PTS: 1 DIF: Cognitive Level: Applying 5. Reed-Sternberg (RS) cells represent malignant transformation and proliferation of which of these?a. Interleukin (IL)-1, IL-2, IL-5, and IL-6b. Tumor necrosis factor-betac. B cellsd. T cellsANS: CReed-Sternberg cells are associated with Hodgkin lymphoma and represent a malignant transformation of B cells. They are not related to interleukins, tumor necrosis factor-beta, or T cells.PTS: 1 DIF: Cognitive Level: RememberingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 6. Local signs and symptoms of Hodgkin disease-related lymphadenopathy are a result of what?a. Pressure and ischemiab. Pressure and obstructionc. Inflammation and ischemiad. Inflammation and pressureANS: BLocal symptoms caused by pressure and obstruction of the lymph nodes are the result of lymphadenopathy. The other options do not contribute to the lymphadenopathy associated with Hodgkin disease.PTS: 1 DIF: Cognitive Level: Remembering 7. Which virus is associated with Burkitt lymphoma in African children?a. Cytomegalovirusb. Adenovirusc. Human papillomavirusd. Epstein-Barr virusANS: DEpstein-Barr virus, found in nasopharyngeal secretions, is associated with Burkitt lymphoma in African children. The other viruses are not associated with this malignancy.PTS: 1 DIF: Cognitive Level: Remembering 8. A hospitalized patient’s lab work is as follows: WBC 2000, bands 14.8%, and segmented neutrophils 5. The healthcare professional calculates the patient’s absolute neutrophil count (ANC). What action does the professional take next?a. Implements protocols to prevent life-threatening infectionsb. Encourages the patient to limit any visitors for the present timec. Does nothing; this is a normal ANC for the white cell countd. Holds the patient’s medications until the ANC returns to normalANS: AThe ANC is calculated by multiplying the white blood cell count by the sum of the bands and segmented neutrophils. This patient’s ANC is 396, placing him or her at extremely high risk of developing a life-threatening infection. Visitors may need to be limited but that will not protect the patient from all sources of infection. The patient’s medications would not all be held because of this finding.PTS: 1 DIF: Cognitive Level: Analyzing 9. A person has been diagnosed with acute lymphocytic leukemia (ALL) that is positive for the Philadelphia chromosome. What statement by the healthcare professional is most appropriate?a. “This is good news and means the ALL is not very aggressive.”b. “This is a very rare finding in adults who have ALL.”c. “We are planning to get your disease in remission, but it will be hard.”d. “You will need colony-stimulating support during your treatment.”ANS: CThe Philadelphia chromosome is seen in about 30% of adults with ALL and is a poor prognostic indicator. The healthcare professional should recognize this and reassure the patient that they will be doing everything they can to get the disease in remission. Colony-stimulating factor is given when the white blood cell count is too low, which can occur in nearly all neoplasms due to treatment.PTS: 1 DIF: Cognitive Level: Understanding 10. A person comes to the healthcare clinic and reports night sweats and fever. The healthcare professional obtains a chest x-ray which shows a mediastinal mass. What other assessment or diagnostic test does the professional provide as a
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