Blood & Marrow Transplant Certified Nurse (BMTCN) Practice Exam

These questions are part of the practice quiz. Start practicing

• The garlic-like taste during stem cell infusion is most likely caused by exposure to which substance?
• An advanced practice hematopoietic stem cell transplant nurse moving from Texas to Indiana seeks licensure requirements. The best resource is which of the following?
• What does the medical management of moderate hyponatremia from SIADH include?
• It is important to teach patients early in the transplant process to avoid contact with fresh plants to prevent infection with which organism?
• Which of the following increases the risk of infertility after an HSCT?
• Cisplatin as part of the conditioning regimen is most likely to cause which electrolyte disturbance?
• Two hours after HSCT infusion, a patient reports red urine. What is the most likely cause?
• Which of the following is a treatment for diminished bone mineral density?
• Which of the following is a fundamental component of advance care planning?
• Donor lymphocyte infusion after allo-HSCT is used to improve what?
• Which statement about HPV vaccination post-transplant is true?
• How are ABO-incompatible stem cell products managed when donor and recipient are not ABO compatible?
• Post-transplant lymphoproliferative disease is associated with Epstein-Barr virus due to which immune dysfunction?
• A patient with AML and 15% blasts should:
• Which statement about post-transplant sexual quality of life should the nurse explain?
• Xerostomia increases the risk of which infection?
• Combining sirolimus with a calcineurin inhibitor increases the risk of which complication?
• Families of pediatric patients who received radiation as part of conditioning should be aware that neurocognitive delays may require what?
• Which of the following strategies is NOT used to prevent graft failure?
• Which is a risk factor for HSCT-related osteopenia?
• After HSCT, a patient exhibits restlessness, pacing, and nail biting. The nurse anticipates an order for which type of medication?
• Four months after an allogeneic transplant, a patient reports dry, red skin with plaques. What is the most likely cause?
• What is an advantage of using umbilical cord blood for HSCT?
• Which combination of findings is most characteristic of acute graft-versus-host disease in allogeneic HSCT recipients?
• Moist desquamation is characterized by which finding?
• ATG is used to prevent and treat acute rejection in organ transplantation. Which is a primary purpose of ATG?
• Which of the following is likely to be effective for treating sleep-wake disturbances?
• Why was TMP-SMX changed to pentamidine in a post-transplant patient?
• Which of the following is NOT listed as a potential donor complication after bone marrow harvest?
• A haploidentical allogeneic transplant patient has ATG ordered. The purpose of ATG in the preparative regimen is to:
• Which statement correctly describes complete chimerism?
• The following strategies are used to manage cardiovascular disease in post-HSCT patients EXCEPT:
• Which factor is the most important prognostic element for pulmonary aspergillosis risk after transplantation?
• Ten days after an autologous transplant for myeloma, fever, rash, weight gain, and rales on exam. This presentation most likely indicates which condition?
• During the preparative phase of HSCT, Total Body Irradiation is most often used to treat which type of malignancies?
• In the late post-transplant phase (>100 days), which of the following organisms is commonly associated with infections due to chronic GVHD?
• High-dose myeloablative chemoradiation can cause hepatic sinusoidal obstruction syndrome, which is also referred to as
• Which clinical finding is associated with polymyositis?
• In SIADH, what is the typical volume status of the patient?
• In conditioning regimens, what is the primary role of antithymocyte globulin (ATG)?
• A patient with grade IV GI GVHD does not want parenteral nutrition, while his wife insists on feeding him. Which ethical principle applies?
• A patient receiving a fresh hematopoietic stem cell infusion is at increased risk for which of the following complications?
• Graft-versus-host disease is a concern after which type of hematopoietic stem cell transplantation?
• Which vaccine is listed as currently investigational for HSCT recipients?
• A day +35 allogeneic HSCT patient develops a pruritic, erythematous, maculopapular rash on the plantar and palmar surfaces. This finding most likely indicates which condition?
• A patient who received a T-cell depleted transplant is at risk for developing which within the first year?
• Which action is essential for nurse protection prior to administering chemotherapeutic agents?
• What is the best initial step to determine the evidence supporting a nursing intervention?
• Polymyositis presents with which primary symptom?
• Cyclosporine trough levels are typically drawn at what times relative to dosing?
• Tumor lysis syndrome results from rapid death of malignant cells, releasing intracellular contents into the bloodstream. Which statement best describes the typical lab findings?
• Which statement best describes the approach to topical steroids for stage 1-2 cutaneous GVHD?
• Which measure is appropriate for managing oral mucositis in HSCT patients?
• Patients with strong religious and spiritual support are more likely to experience which outcome?
• Which is a major cause of electrolyte imbalances in HSCT recipients?
• What is an advantage of bone marrow as a stem cell source?
• Which of the following are types of granulocytic cells?
• A patient on day +35 after allogeneic transplant presents with severe diarrhea and a widespread rash with elevated bilirubin. What GVHD stage best matches these findings?
• Which type of hematopoietic stem cell transplant engrafts the fastest?
• In HSCT, which measure serves as a surrogate marker of transfusion efficacy?
• Graft failure or graft rejection is associated with all of the following EXCEPT:
• Engraftment is enhanced when ATG is used in the conditioning regimen.
• Which of the following is NOT a risk factor predicting poorer psychological outcome in HSCT recipients?
• Long-term use of CNIs affects which organ most prominently?
• Which disease can be treated with autologous transplantation?
• What is the most likely cause of cataracts after HSCT?
• On day 9 following conditioning, a transplant recipient reports inability to swallow with dry mouth. Examination shows debris on teeth and gums. What is the most likely complication?
• What is an important predictive marker of T cell immune recovery following HSCT?
• What is the rationale for administering a preparative regimen to an HSCT recipient?
• Chronic GVHD of eyes significantly affects quality of life after allogenic HSCT. What usually is the first treatment modality?
• Which condition would most likely require a reduced-intensity preparative regimen?
• In professional practice, which topic is most appropriate for maintaining professional boundaries?
• Based on the research process, which of the following is an example of delivering effective, high-quality care?
• Fifteen days after allogeneic HSCT, a patient with oral mucositis and prior HSV, CMV, EBV seropositivity demonstrates mouth sores. Which virus reactivation is most likely?
• Which immunization should an asplenic child who has undergone a transplant receive?
• Which statement about bone marrow stromal cells is true?
• What is a disadvantage of a syngeneic hematopoietic stem cell transplant?
• Which statement about cyclosporine interactions is true?
• Regarding measles, mumps, and rubella vaccination for HSCT survivors, when is it typically considered safe to administer?
• To avoid deconditioning after HSCT, patients should
• Which of the following decreases the risk of developing acute GVHD after an allogeneic transplant for a male patient?
• Which factor is NOT a risk for developing secondary solid tumors after transplant?
• Sickle cell disease is triggered by a mutation in the beta-globin gene, substituting which amino acid at the sixth position?
• Which medication is a chemokine antagonist that is used for stem cell mobilization?
• The photosensitizing agent used with extracorporeal photopheresis exerts its anti-proliferative effect by
• Which medication is used in conjunction with extracorporeal photopheresis?
• A post-transplant patient presents with pallor and fatigue. Which laboratory value would most likely be decreased?
• Which infectious disease tests are included in donor screening for HSCT?
• Cataract development post transplant is linked to which treatment regimen?
• Compared with bone marrow, peripheral blood stem cell grafts have which of the following advantages?
• What is the most likely cause of hematuria and garlic-like taste reported by the patient during a stem cell infusion?
• The risk of transplant-associated microangiopathy increases when sirolimus is used in combination with CNIs. Which statement is true?
• A patient is 14 days after allogeneic HSCT with poor appetite and severe, watery diarrhea. A priority nursing intervention would include which of the following?
• Infections occurring after autologous transplant are most commonly related to which factor?
• Neutrophils are produced from which of the following progenitor cells?
• Graft-versus-tumor effect is promoted by which of the following?
• A nurse on an inpatient transplant unit reports altered sleep patterns, inability to concentrate, and feelings of helplessness and indifference after the death of a patient. Which condition is most likely?
• For mild hyponatremia due to SIADH, which management is often effective?
• When should measles, mumps, and rubella immunization be administered according to post-transplant guidelines?
• A patient who recently had HSCT experiences agitation, severe anxiety, insomnia, depression, and hypervigilance. What is the most likely diagnosis?
• For management of oral mucositis, which practice is recommended?
• Which of the following can present an ethical conflict with regard to using umbilical cord blood for transplant?
• Which HSCT donor source has the lowest risk of GVHD?
• Which of the following may be helpful in reducing vaginal tissue atrophy and vaginal synechiae?
• Which statement about cataract formation after HSCT is true?
• Which of the following is NOT a disadvantage of umbilical cord blood as a stem cell source?
• A patient with chronic GVHD is experiencing jaundice and abdominal pain and has elevated liver function tests. The nurse should anticipate an order for which of the following?
• Which class of drugs do cyclosporine and tacrolimus belong to in GVHD prophylaxis?
• Which of the following medications would a 55-year old male with multiple myeloma most likely receive prior to an autologous stem cell transplant?
• What percentage of the population has a matched sibling donor?
• What is the typical target range for tacrolimus whole blood concentrations in most centers?
• Tacrolimus ointments in cutaneous GVHD are used how?
• Which of the following should be provided to a twenty-one year old female receiving cyclophosphamide and TBI?
• Which factor most increases the risk of developing treatment-related myelodysplastic syndrome after hematopoietic stem cell transplantation?
• Which of the following is NOT typically included in self-care approaches for patients with terminal illness?
• Which HLA class presents antigens to helper T cells?
• Patients with chronic GVHD are at increased risk for which complication?
• What is a primary purpose of total body irradiation in conditioning?
• Why is the additive DMSO used during stem cell processing?
• Most cases of chronic GVHD are diagnosed within the first year, with a median onset of four to six months. Which statement best describes this onset?
• Which chemotherapy agent is most associated with therapy-related AML after prior cancer treatment including neuroblastoma?
• Following umbilical cord blood transplantation, which viral infections have been linked to increased morbidity and death?
• Late post-transplant infections are generally related to impairment of which immune component?
• Which test is used to document ocular dryness in HSCT recipients?
• Which medication is used as pre-emptive treatment for a patient who had an HSCT and is now presenting with elevated EBV titers?
• In HSCT patients, pleural effusion in the first weeks after transplantation is most associated with which risk factor?
• Which factor represents a barrier to treating sexual dysfunction in HSCT survivors?
• Which portion of the immunoglobulin activates the complement pathway?
• A patient with multiple myeloma is receiving high-dose melphalan and is instructed to chew ice during infusion to reduce mucositis. This is an example of which concept?
• Which dietary item should be avoided to prevent increasing cyclosporine A levels?
• After hematopoietic stem cell transplantation, a patient reports erectile dysfunction. Which statement is most appropriate?
• A recipient is 14 days post-autologous HSCT and is experiencing pallor, shortness of breath with exertion, fatigue, tachycardia, and dizziness. Which of the following could these symptoms indicate?
• Which blood product is most commonly associated with febrile nonhemolytic transfusion reactions in HSCT recipients?
• Which statement about radiation-induced second malignancies is true?
• If a patient has moderate cutaneous chronic GVHD, which quality-of-life dimensions may be affected?
• Two years after HSCT, a patient reports a dry cough, dyspnea, and wheezing. What does the nurse suspect?
• Which statement about organ involvement in chronic GVHD is correct?
• A patient who relapses following an HSCT will most likely relapse within:
• A Schirmer test value of what measurement is used to document new ocular sicca in HSCT recipients (5 minutes test)?
• How many days should lapse between dental extraction and the start of conditioning?
• Following an allogeneic transplant, a patient reports weakness and fatigue that has worsened over the past week. Which nursing intervention is most appropriate?
• Which relapse strategy involves withdrawal of immunosuppression to elicit a graft-versus-tumor effect?
• Identify an example of a myeloid cell from the following?
• In HSCT matching, which HLA antigens are among the most important to match?
• Type 4 PTLD corresponds to which histology?
• What percentage of transplant patients experience acute GVHD that requires treatment?
• Which factors contribute to thymic damage leading to slow T-cell recovery after HSCT?
• Which statement about late effects clinics is true?
• Eight months after allogeneic HSCT, a patient reports gritty eyes and photophobia. Which test is most likely ordered to evaluate this ocular symptom?
• Chronic GVHD that develops without clinical evidence of previous acute GVHD is referred to as:
• When teaching a patient about cyclophosphamide as part of the preparative regimen, which instruction is important?
• Stage 3 GVHD skin involvement corresponds to which description?
• In HSCT recipients, what is the leading cause of death?
• Which factor contributes to radiation-induced second malignancies after allogeneic HSCT?
• The pretransplant conditioning regimen is meant to:
• Which phenomenon occurs approximately 7-14 days after HSCT and features fever, erythroderma, and noncardiogenic pulmonary edema?
• A patient with sickle cell disease is receiving a stem cell product from a haploidentical donor. To reduce the incidence of GVHD, the product may require which processing step?
• In drug-induced thrombotic microangiopathy (DITMA), what is the first step in management?
• Which areas require low-potency steroid cream, such as hydrocortisone 1%, in cutaneous GVHD?
• In allogeneic HSCT, Total Body Irradiation serves to
• Which of the following is a risk factor for AVN?
• Which consequence can result from xerostomia?
• Is it unlikely that someone will develop chronic GVHD without a history of acute GVHD?
• Which cell type is primarily associated with numeric recovery of the bone marrow after HSCT?
• Which region of the immunoglobulin binds to antigens?
• GVHD can occur during taper or withdrawal of immunosuppression. This type is referred to as:
• Premature ovarian failure after HSCT is most closely related to which factor?
• When starting voriconazole in a patient on cyclosporine, what should the nurse understand?
• How should the healthcare team address the psychosocial needs of transplant patients and caregivers?
• Sirolimus can cause which of the following toxicities?
• Chronic GVHD carries a reduced risk of recurrent disease due to graft-versus-leukemia effect.
• What is the first organ usually involved in acute GVHD?
• Compared to adults, pediatric HSCT donors are at greater risk for which complication of apheresis?
• Relapsed disease treatment strategy includes which option?
• Grapefruit should be avoided when taking which medication?
• According to CTCAE, a HSCT recipient with diarrhea consisting of 5 episodes in 24 hours and an increase of 4-6 stools per day from baseline is what grade?
• A patient who received HSCT develops heart failure and arrhythmias. The most likely culprit is which agent?
• What is the recommended infection prevention measure for HSCT patients?
• Microangiopathic hemolytic anemia can be a complication of which immunosuppressive therapy?
• Upon admission for HSCT, which assessment is considered one of the most important to establish baseline?
• What strategy can help prevent hypocalcemia during leukapheresis?
• What is the prognosis for Type 4 PTLD when treated with aggressive chemotherapy?
• Which HSCT type uses donor cells from another person?
• A long-term risk after HSCT includes which of the following?
• In HSCT conditioning regimens, which agent is used to prevent graft failure?
• To address an increase in central line-associated bloodstream infections, an interdisciplinary team analyses data and guidelines. What is the next step?
• A disadvantage for an identical twin syngeneic transplant is:
• Which drug is used to both prevent graft rejection and GVHD?
• What is one of the major tasks in diagnosing acute or chronic GVHD?
• Premature ovarian failure after HSCT can be treated with which therapy to relieve symptoms?
• In managing GVHD-related diarrhea after ruling out infection, which of the following is recommended?
• Which statement describes a barrier to palliative care?
• Stage 1 and 2 skin GVHD often can be treated with which therapy?
• Granulocytes generate neutrophils, basophils, and eosinophils. Which cell is a granulocyte?
• Chemotherapy-induced mucositis typically begins how many days after infusion and peaks around which day range?
• Amphotericin B and corticosteroids can cause which electrolyte imbalance?
• The risk of ovarian failure, regardless of pubertal status, is associated with the use of which chemotherapy?
• Graft failure has an incidence within which range?
• A phase II clinical trial participant asks for help understanding their concerns about continuing. What is the best nurse response?
• Which strategy is commonly used to reduce the risk of GVHD after HSCT?
• What is an advantage of syngeneic hematopoietic stem cell transplantation?
• Which aspect of immune reconstitution takes the longest to achieve full function after HSCT?
• The nurse knows that the administration of high dose cyclophosphamide early in the transplant process is to:
• Which of the following statements is true about radiation-induced second malignancies (RISM)?
• They are acute side effects that occur during treatment
• A patient who received high-dose cyclophosphamide two days ago is now experiencing dyspnea, chest pain, orthopnea, cough, fever, and tachycardia. Which of the following is most likely?
• Which organ is NOT typically listed among the common targets of chronic GVHD?
• Autologous HSCT neutrophil engraftment occurs typically how many days after transplantation?
• The impact of stress on social function following transplant is greatest between:
• What is the one organ more commonly involved in chronic GVHD than in acute GVHD?
• Which of the following may adversely affect successful engraftment?
• Melphalan is the primary conditioning agent for which conditions?
• Which agent is an anti-TNF used for GVHD?
• An HSCT recipient diagnosed with HSV receiving foscarnet IV would likely require which of the following orders?
• A survivor of an HSCT is at high risk for developing:
• Which strategy is used to augment the donor cell dose to help prevent graft failure?
• What does RISM stand for in oncology after radiation therapy?
• Which statement about PTLD is true?
• Which chemokine receptor regulates stem cell release into the peripheral circulation?
• TR is a 28-year-old woman with AML in her second complete remission admitted for a matched unrelated donor allogeneic stem cell transplantation. Her conditioning regimen is myeloablative busulfan/cyclophosphamide with tacrolimus and MTX on days +1, +3, +6, and +11. Day +50 rash stage 2 GVHD. What is the initial management?
• Which is NOT a common indication for allogeneic transplant?
• According to NIH guidelines, consider systemic treatment for chronic GVHD if:
• Oral mucositis peaks at what time after start of conditioning?
• For a patient with grade 4 GVHD who cannot tolerate steroids and reports wanting to die, what is the most appropriate nursing intervention?
• Which statement best describes innate immunity?
• Before administering preparative regimens for transplant, nurses should do which of the following?
• Graft-versus-Tumor responses after DLI are observed most commonly in which disease?
• Quality improvement in healthcare is defined as systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups. Which option best reflects this definition?
• When a patient senses a leaking IV site during a chemotherapy infusion, what does the nurse do first?
• Transplant-associated microangiopathy occurs with which immunosuppressants?
• Which immunosuppressive medication can result in serum sickness?
• DMSO serves as what in stem cell processing?
• A patient who has not responded to four random donor platelet transfusions is likely to receive which type of platelet product?
• A patient who will be receiving a second transplant has a history of nausea while receiving chemotherapy. Which type of nausea is the patient now most likely to experience?
• Which agent is NOT listed among chemotherapy agents potentially toxic to the heart in the referenced material?
• Which adjunctive therapy may be helpful if topical treatment for cutaneous GVHD is inadequate?
• Which of the following is a non-HLA barrier to transplant research?
• Which HLA class presents antigens to cytotoxic T cells?
• Compared with the general population, lifetime life expectancy after HSCT is decreased by approximately what percent?
• Graft failure may result from which of the following?
• The cluster of differentiation system is used to:
• Which of the following could prevent mobilization and collection of stem cells for a patient with myeloma?
• Which two-drug combination is recommended to prevent GVHD?
• Which of the following is a rationale for using high-dose total body irradiation (TBI) during conditioning for hematopoietic stem cell transplant?
• Which is most important for the nurse to remember when teaching the caregiver of a patient who will receive an HSCT?
• Which infection is considered a late post-transplant infection?
• Which statement best describes mucosal treatment options for vaginal symptoms in HSCT patients?
• Which vaccine may be given during the post-transplant setting to help prevent common infections?
• A 17-year-old patient with refractory leukemia after a second HSCT requests therapy discontinuation. As the patient's advocate, what is the most appropriate response for the nurse?
• The apheresis machine may be primed with irradiated red blood cells for patients weighing less than:
• Which of the following is a serious side effect of cyclosporine?
• Patients should be monitored for signs of cardiac disease post-HSCT by which statement is most accurate?
• Which of the following is a typical symptom management strategy during leukapheresis to prevent hypocalcemia?
• Pulmonary fibrosis is a potential complication of which common transplant preparative agent?
• A female patient begins to have dense, coarse, and excessive hair growth on the face, neck, and chest after taking vincristine. Which term best describes this condition?
• What is the primary goal of phase 2 clinical trials in HSCT-related therapy?
• Which is a possible complication of thiotepa administration?
• Which important teaching point should the nurse include for a patient taking tacrolimus?
• Which of the following is a common expected side effect of cyclosporine?
• During autologous stem cell mobilization, fever, fatigue, and bone pain are most likely due to:
• Systemic therapy is generally required for which grades of acute GVHD?
• In a preparative regimen including busulfan, fludarabine, and antithymocyte globulin, which medication is planned to be administered prior to the ATG infusion?
• Prior to reimmunizing patients after transplantation, which marker is used to show immune recovery?
• A transplant center using audits to identify improvement opportunities demonstrates which quality function?
• A patient taking cyclosporine should be taught to:
• Which of the following is a potential barrier to advance care planning for HSCT recipients?
• Transplant-related toxicity is a barrier that contributes to underutilization for which disease?
• Chronic GVHD can be manifested in the hematopoietic system and cytopenias including:
• What is the leading cause of death after a cord blood transplant?
• Underutilization for certain diseases occurs due to transplant-related toxicity. For which of the following diseases is this a barrier?
• Which of the following is a long-term side effect of total body irradiation (TBI)?
• A patient 28 days post-allogeneic HSCT has WBC 2100, hematocrit 25.9, neutrophils 22%, and bands 4%. What is the absolute neutrophil count?
• Initial treatment for thrombotic microangiopathy includes:
• Which intervention is used to reduce GVHD risk after haploidentical HSCT?
• Which of the following medications should a patient taking cyclosporine avoid following an allogenic HSCT?
• Immunophenotyping by flow cytometry is commonly used to detect:
• A caregiver reports a patient with unusual and aggressive behavior, sleep problems, and sadness. Which condition is most consistent with these symptoms?
• During hematopoiesis, myeloid progenitor cells primarily mature into which of the following cell types?
• After HSCT, re-immunization is generally started around which time from transplant?
• In autologous HSCT, which graft source is associated with faster granulocyte recovery?
• From the common myeloid progenitor, which lineage produces neutrophils, basophils, and eosinophils?
• Which statement about ocular involvement in chronic GVHD is true?
• Which of the following is NOT a role of the caregiver?
• Which statement denies a patient’s eligibility for hospice services?
• Which endocrine intervention may support growth in HSCT survivors with growth concerns?
• Which of the following has been shown to reduce the severity of oral chronic GVHD?
• Which statement by a nurse would indicate further teaching about transplant recipients evaluation is required?
• 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:
• What type of chimerism describes complete replacement of the recipient's hematopoietic system by donor cells?
• In a patient taking cyclosporine who starts voriconazole, what monitoring action should be taken?
• Post transplant lymphoproliferative disease is most often associated with which infection?
• Which statement best describes the expected sexual health outcome for many adults after HSCT?
• The mainstay for treatment of severe oral mucositis is which?
• For facial involvement in chronic GVHD, which option best reflects the recommended topical agents?
• A patient with multiple myeloma seven days after HSCT has a low phosphate level requiring replacement. Which IV medication would you order?
• A 45-year-old woman with acute myeloid leukemia has a twin sister who offers to donate, but the physician opts to use a donor from the National Marrow Donor Program. Which statement best explains this choice?
• Lifelong life expectancy after HSCT is generally reduced by about 30% when compared to the general population, and this reduction is not dependent on current age. Which statement is correct?
• When calculating calcineurin inhibitor dosing in HSCT patients on voriconazole, what is recommended?
• Which of the following is a treatment option for patients with high ferritin levels?
• In the context of fertility after HSCT with high-dose cyclophosphamide, which statement is most accurate?
• Which immunosuppressant is associated with serum sickness as a potential adverse effect?
• Which of the following is NOT identified as an infection risk factor?
• What best describes PTSD in transplant survivors?
• Total body irradiation (TBI) has the effect of suppressing the recipient's immune system to facilitate engraftment of donor cells. Which option best describes this effect?
• During peripheral blood stem cell apheresis, which infusion is commonly given to prevent hypocalcemia caused by citrate binding?
• What is a documented drawback for bone marrow donation from a donor?
• Xerostomia can lead to which oral complication?
• An allogeneic transplant recipient on cyclosporine and mycophenolic acid presents with an itchy rash. What is the initial management?
• Which interpersonal relationship with the survivor of an HSCT has the strongest influence on social function and well-being?
• In post-transplant nutrition, enteral feeding is used to accomplish which purpose?
• A typical strategy for preventing hypocalcemia in patients undergoing leukapheresis is to:
• Which exposure places a patient at risk for cataracts after HSCT?
• Compared with myeloablative regimens, nonmyeloablative regimens cause what level of marrow suppression?
• For a 26-year-old Caucasian male with AML, which donor would be optimal?
• Which combination of outcomes is most commonly associated with ovarian failure in prepubertal females after hematopoietic stem cell transplantation (HSCT)?
• In hematopoietic stem cell transplantation, what is the most important risk factor for graft failure?
• Prior to initiating treatment for engraftment syndrome, what is a priority nursing action?
• Calcineurin inhibitors are used to prevent which of the following?
• Which of the following is a contributing factor to the development of sinusoidal obstructive syndrome in the early post-transplant period?
• Which of the following is recommended to prevent infection for a patient who had an HSCT?
• A recipient reports a decrease in taste sensation with decreased intake of breakfast and lunch. What is this symptom called?
• Which of the following is a violation of professional boundaries?
• Which of the following is a disadvantage of using bone marrow as a stem cell source?
• Which factor does NOT contribute to immune reconstitution after HSCT?
• Which agent is not listed among chemotherapy agents potentially toxic to the heart?
• Which combinations represent risk factors associated with post-HSCT cardiovascular disease?
• Seven days after autologous HSCT, patient with fever, rash, dyspnea, and oxygen saturation 89% on room air. The nurse should suspect which of the following?
• Which approach is most appropriate for addressing sexual health with HSCT survivors?
• A pediatric patient with diffuse high-grade lymphoma is scheduled to begin the preparative regimen prior to transplant. What information should the nurse share with the patient's caregiver?
• Which cell type is part of innate immunity?
• In myeloablative allogeneic hematopoietic stem cell transplantation, what provides disease surveillance after transplant?
• A recipient more than 100 days after autologous HSCT is relocating to another state. What is the most important nursing intervention?
• Which statement about stromal cells is correct?
• Engraftment syndrome may be difficult to distinguish from GVHD and presents with fever plus which features?
• A patient undergoing preparative regimen with busulfan and cyclophosphamide should have which long-term side effect discussed?
• Allogeneic bone marrow HSCT engraftment typically occurs in which days?
• What is the standard regimen of immunosuppression for myeloablative transplant?
• Which statement about post-HSCT cardiovascular disease reporting is correct?
• After bone marrow harvest, which recommendation is correct?
• Which pediatric condition can be treated with an autologous transplant?
• Two years after HSCT, what is the most likely cause of death?
• Acute GVHD commonly involves which organs?
• Which statements about rituximab in chronic GVHD therapy are true?
• What effect might higher levels of depression have on transplant patients?
• A 25-year-old recipient with an unrelated donor graft (9/10 HLA matched) and CMV-positive status in both donor and recipient has been transfused prior to transplant. What is the biggest risk factor for developing GVHD?
• Allogeneic reduced-intensity conditioning engraftment occurs within which day range?
• According to sun exposure guidance for post-transplant patients, when should sunscreen be applied?
• Scoring of chronic GVHD involves which of the following?
• Tissue damage within target organs due to activated T-cells occurs in which phase of GVHD?
• Which statement best describes the scope of a generalist oncology nurse?
• What is the strongest risk factor for chronic GVHD?
• During stem cell infusion, a patient experiences facial swelling. What drug should be ordered after stopping the infusion?
• A patient developed Type 4 PTLD three years after an allogeneic HSCT. Which treatment would the nurse expect an order for?
• Neurocognitive changes in survivors can affect all except which area?
• Which of the following is a morning eye symptom associated with ocular GVHD?
• In the late transplant phase, which fungal pathogen is most commonly encountered?
• Why are annual gynecologic examinations and consideration of human papillomavirus vaccination important after allogeneic transplant?
• Type 4 PTLDs develop at least how many years post-transplant?
• Which factor affects the success of stem cell mobilization?
• Which of the following is a class II HLA antigen?
• Which statement about premature ovarian failure after HSCT is true?
• Chronic GVHD with significant side effects from oral immunosuppressive therapy can be alleviated by which therapy?
• An HSCT recipient is more likely to have a febrile nonhemolytic transfusion reaction from which of the following transfusions?
• An HSCT recipient on tacrolimus for GVHD prophylaxis reports loose stools. Which laboratory abnormality would you expect?
• A patient receiving tacrolimus IV after allogeneic HSCT is at greatest risk for which electrolyte abnormality?
• Phase 1 of GVHD pathophysiology occurs when which event takes place?
• Which of the following is a calcineurin inhibitor commonly used for GVHD prophylaxis?
• EBV cytotoxic T-lymphocytes have been found to be a feasible therapeutic option for treatment of which EBV-mediated disease process?
• What is the treatment for a patient after an allogenic transplant who is diagnosed with thrombotic microangiopathy?
• In haploidentical transplantation using post-transplant cyclophosphamide, the use of peripheral blood stem cells has which of the following effects on GVHD?
• Which intervention is most important for the nurse to perform for a patient near the end of life?
• What remains the leading cause of post-transplant mortality and morbidity?
• An HSCT recipient is experiencing weakness and numbness around the mouth. This symptom may be related to which electrolyte abnormality?
• In pediatric patients who receive radiation as part of transplant conditioning, what is the most common secondary malignancy?
• What ethical principle is defined as preventing or avoiding harm?
• Which of the following is a risk factor for the development of PTLD after allogeneic HSCT?
• Which organ is most at risk of cardiotoxicity from anthracycline exposure in HSCT patients?
• Hematopoiesis primarily occurs in which anatomical site?
• Following a transplant with equine ATG and high-dose cyclophosphamide, what is the most appropriate fertility counseling for a young male approaching marriage?
• Tacrolimus used for GVHD prophylaxis exerts its effect by:
• Which of the following drugs will most likely lead to heart failure as part of the conditioning treatment?
• Classic chronic GVHD has manifestations of autoimmune diseases and no features characteristic of acute GVHD. It is a syndrome that involves multiple organs including skin, eyes, oral mucosa, lung, gastrointestinal tract, and liver. Which statement best describes classic chronic GVHD?
• During which period is the risk of relapse highest after HSCT?
• PTLDs are strongly associated with which donor-derived EBV infection?
• What are the most commonly involved organs in chronic GVHD?
• In SIADH, what is the recommended approach to IV fluids?
• A medical treatment that removes blood via machine and isolates white blood cells has shown to reduce the severity of oral chronic GVHD. Identify the treatment from below.
• What is the rationale for delivering total body irradiation in fractionated doses?
• What is an advantage of using bone marrow as a source of stem cells?
• In acute GVHD with overall grade +3, which bilirubin range is expected?
• Overlap GVHD is defined as which of the following?
• Before starting antidiarrheal therapy in GVHD-related diarrhea, what must be ruled out?
• What is the first step in selecting a donor for an allogenic HSCT?
• Which condition is a major contributor to long-term morbidity and mortality after HSCT?
• To whom must positive microbial culture results on cellular therapy products be reported per FAC T?
• An important poor prognostic feature of chronic GVHD is which of the following?
• The time it takes for engraftment to occur following HSCT is dependent on:
• The thymus is damaged by aging, conditioning regimens, and GVHD. As a result, adult patients show little T-cell recovery for months to years after transplantation. Which statement best describes this effect on T-cell recovery?
• Perineal-rectal dry desquamation is best described by which finding?
• Relapsed disease strategies may involve cellular adoptive immunotherapies. Which of the following is listed as an example?
• What treatment is recommended for female patients who develop osteoporosis and chemically-induced menopause?
• Which factor leads to an increased incidence of chronic GVHD?
• Which of the following is a finding associated with ocular GVHD?
• Type 4 PTLD develops at least how long after transplant?
• Where is red bone marrow found, according to the description provided?
• In an autologous transplant, the stem cells are sourced from whom?
• Progression of the rash to the face, chest, back, and arms with diarrhea of 1-2 L/day and elevated bilirubin of 2 mg/dL, along with weakness and poor appetite, indicates which overall GVHD grade?
• A patient with GVHD reports indigestion and diarrhea after eating cottage cheese and ice cream. Which of the following foods should the nurse encourage the patient to eat?
• Which medication is routinely used for mobilization of hematopoietic stem cells?
• What is one characteristic feature of chronic GVHD of the mouth?
• Engraftment of white blood cells after HSCT typically occurs within how many weeks?
• Post-Transplant Lymphoproliferative Disorder (PTLD) after allogeneic HSCT is caused by which mechanism?
• Which statement accurately describes a syngeneic transplant?
• Which description best defines mixed chimerism?
• What is a good reason to use high-dose total body irradiation during conditioning?
• Which of the following places a patient who received an HSCT at risk for cardiovascular disease?
• A daughter privately asks the physician to avoid talking about potential complications of transplantation because she fears her mother will forgo transplant if she hears the word “death.” What ethical principle would this violate?
• During the neutropenic period following HSCT, which pathogen is most likely to cause infection?
• Late post-transplant infections are often linked to reactivation of which virus when immunotherapies are tapered?
• Two major approaches to prophylaxis of acute GVHD following hematopoietic stem cell transplantation are:
• A patient 12 years after allogeneic HSCT diagnosed with non squamous cell carcinoma. Which factor increases risk of this secondary malignancy?
• In managing hyponatremia caused by SIADH, what is the initial step?
• Which of the following contributes to altered sexual health in male patients following an HSCT?
• Which donor statement indicates a need for further teaching?
• A transplant recipient has completed myeloablative conditioning two days ago; on day 4 develops nausea and vomiting. This is which type of chemotherapy-induced nausea and vomiting?
• A patient reports facial swelling during the stem cell infusion. The nurse should immediately stop the infusion and anticipate an order for which medication?
• Which organization makes transplant outcome data and reporting an element of quality management standards?
• Which statement is true about post-HSCT ocular damage?
• Long-term mortality after HSCT remains higher than the general population for many years. Which statement is true?
• Numeric recovery of blood marrow cellular elements following an HSCT involves which of the following?
• Immunosuppressants used in HSCT destroy thymus-dependent T cells and other immune cells responsible for cellular-mediated immunity. Immunosuppressants suppress which arm of the immune system?
• Which of the following can cause PCP pneumonia in the post transplant population?
• Which of the following is NOT listed as an osteopenia risk factor in HSCT patients?
• Which measure is used to minimize renal compromise from DMSO during stem cell infusion?
• Which of the following is NOT predictive of benefit from reduced-intensity allogeneic HSCT?
• One week later, diarrhea volume increases to 3000 ml/day. How should the patient be treated?
• Which statement best describes the mechanism by which extracorporeal photopheresis (ECP) reduces GVHD?
• In the Statement on the Scope and Standards of Oncology Nursing Practice, Standard XII emphasizes leadership. Which measurement criterion supports this standard?
• Regarding ABO compatibility with a donor in HSCT, which statement is true?
• Sickle cell disease is triggered by a single nucleotide mutation in the beta-globin protein, which replaces glutamate with valine at the sixth position. This leads to increased polymerization when deoxygenated. Which substitution occurs in this mutation?
• Essential education for a patient receiving thiotepa includes which of the following?
• Which statement best reflects sexual function after HSCT?
• A patient with DLBCL reports red tinged urine day +1 of an autologous stem cell transplant. What is the nurse's best response?
• A patient had an allogenic HSCT three years ago and now has type 4 posttransplant lymphoproliferative disease. How should the patient be treated?
• PF has undergone an allogeneic transplant using umbilical cord blood as the stem cell source. This makes her at higher risk for which post-transplant complication?
• When should a quality-of-life assessment in a patient with chronic GVHD occur?
• Bone loss is most rapid during which period of glucocorticoid therapy?
• Post-transplant lymphoproliferative disorders are strongly associated with which virus?
• Which of the following is a nursing intervention for long-term survivors?
• What is the maximum amount of dimethyl sulfoxide (DMSO) in a cellular product that can be safely administered to a patient in a 24 hour period?
• Which of the following is NOT listed as a common impairment in the physical domain after transplant?
• A haploidentical donor refers to a donor who is:
• An adult female patient is experiencing vaginal sicca, inflammation, and dyspareunia. Essential patient education for this condition includes which of the following? Symptoms will:
• Which description best matches a deep sclerotic feature of chronic GVHD skin involvement?
• The caregiver of a patient who had an HSCT is responsible for which of the following actions?
• GVHD diagnostic criteria include fever of greater than 38.3°C on two occasions for more than three days prior to engraftment. This statement is:
• Chemotherapy's most common traumatic side effect is which of the following?
• What is the primary purpose described by the US FDA for a phase 1 trial?
• Which formula correctly corrects serum calcium for albumin?
• Which category accounts for the majority of neutropenic infections after HSCT?
• Which immunosuppressant is commonly associated with hirsutism?
• Which agents may be used as part of multiagent immunosuppression for GVHD prophylaxis?
• A recipient of HSCT for ALL has corrected calcium 7.6 mg/dL and is symptomatic. Which order would you anticipate?
• Which of the following is a strong predictor of relapse following allogeneic HSCT?
• Chronic GVHD occurs most frequently when?
• Iron overload in HSCT recipients may be managed with which therapies?
• Daisy has leukemia and will require HSCT. Which of the following is the most important consideration for teaching the caregiver?
• Which of the following is NOT a manifestation of ocular GVHD?
• What is the most appropriate intervention for a patient taking tacrolimus twice daily with a level of 25 ng/mL?
• Which is a disadvantage of umbilical cord blood transplantation?
• Which factor can increase the breakdown of cryopreserved hematopoietic stem cells for infusion?
• A nurse caring for a patient with severe thrombocytopenia; the patient fell and developed intracranial hemorrhaging; over the next weeks, the nurse had difficulty sleeping, missed work, and avoided walking in the hallway with patients. The nurse's actions are an example of what?
• A cord blood transplant is associated with all of the following EXCEPT:
• Which vaccine is typically deferred until the patient has recovered immune function, has no clinical GVHD, and is off immunosuppression?
• A patient 30 days post-transplant is refusing to ambulate due to “feeling tired and weak.” An appropriate nursing intervention would be to:
• What is the first step in the pathophysiological process for acute GVHD?
• Melphalan is primarily used to treat which conditions in the transplant setting?
• If more than what percentage of the child's total blood volume is needed for priming the apheresis machine, the machine and associated tubing may need to be preprimed with irradiated red blood cells or albumin?
• Cyclosporine is associated with nephrotoxicity. Which option best reflects this toxicity?
• A post-transplant patient has a platelet count of 32,000/mm3. What grade of thrombocytopenia is this?
• Clostridium difficile is not a common infection in the post-transplant setting.
• What is the first action the nurse should take when a patient reports that the IV site is leaking during a chemotherapy infusion?
• Which graft source has a higher risk of developing acute GVHD?
• Which of the following is an example of providing safe, quality care based on the research process?
• Which law requires federally funded school districts to provide accommodations for children who are perceived to have a learning disability, including pediatric cancer survivors?
• What is the reported remission rate range for DLI in chronic phase chronic myeloid leukemia?
• Which conditioning regimen component would most likely cause heart failure?
• Engraftment is defined by achieving an absolute neutrophil count of 500/mm3 for how many consecutive days?
• Allogeneic HSCT for sickle cell disease is curative but traditionally reserved for which age group?
• Which of the following is an example of a myeloid cell?
• Which type of preparative regimen is associated with an increased risk of infertility?
• Which statement is true regarding bacterial infections after transplant?
• What is the most common manifestation of acute liver GVHD?
• What is a disadvantage for the host of matched sibling/related donor stem cell transplants?
• Which approach has been explored to improve DLI outcomes post-transplant in chronic myeloid leukemia?
• In HSCT recipients, conditioning regimens may influence which aspect related to eye health?
• When counseling a patient with cutaneous chronic GVHD, which precaution is most important to include?
• Which chemotherapy has a high emetic risk?
• Which are hypothesized pathophysiology contributions to chronic GVHD?
• What is a potential downside of T-cell depletion in HSCT?
• When explaining the goals of stem cell transplant to a patient with acute myeloid leukemia, which effect is emphasized?
• GVHD occurs due to reaction of which cells against host tissues after allogeneic HSCT?
• During pre-HSCT evaluation, which item is not considered?
• DMSO toxicity during HSCT is associated with which complication related to red cell breakdown?
• Engraftment syndrome is initially treated with which therapy?
• Cyclosporine can cause which of the following side effects?
• Anti-T-cell globulins are derived from which sources?
• Which scenarios provide indirect evidence of the graft-versus-tumor effect?
• Strategies to prevent graft failure may include all of the following EXCEPT:
• During a leukapheresis procedure, a patient reports numbness and tingling around the mouth. Which nursing intervention is the most appropriate?
• Which underlying diagnosis is associated with an increased risk of squamous cell carcinoma after transplant?
• Which of the following clinical findings is associated with calcineurin inhibitors?
• Which cell type is produced by the myeloid lineage and is essential for arterial oxygen transport?
• Regarding umbilical cord blood banking, if cells have not been used by the time the child reaches maturity, which ethical question is raised?
• If GVHD symptoms persist after fourteen days of glucocorticoids, which medication is typically ordered?
• Which chemotherapy agent is associated with patients with cardiac disease in the post-HSCT setting?
• Which graft source is more likely to develop acute graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation?
• Which statement accurately describes engraftment timing for autologous peripheral blood HSCT?
• What platelet threshold defines thrombocytopenia associated with poor prognosis in chronic GVHD at diagnosis?
• A patient reports weakness, fatigue, and a decreased desire to socialize after transplant. What should the nurse do?
• In suspected thrombotic microangiopathy after HSCT, what is the first step in treatment regarding immunosuppressants?
• Three-year overall survival after HSCT differs by age, with outcomes typically being greater than 90% in children and about 62% in adults. Which option best reflects this?
• An 8-year-old HSCT patient with a grade 2 acute GVHD skin rash. The nurse anticipates which order for initial treatment?
• PTLD typically develops within the first how many months after allogeneic HSCT?
• What is the primary first-line therapy for moderate-to-severe chronic GVHD?
• Secondary graft failure after HSCT is most often associated with which of the following?
• During myeloablative conditioning with cyclophosphamide for AML, which electrolyte disturbance is most likely to occur?
• In the Widows et al (2005) study, patients with higher PTSD symptoms differed in several ways. Which of the following was NOT observed?
• Which agents are listed as high-emetic-risk components in conditioning regimens?
• Which factor increases the likelihood of infertility following HSCT?
• Bronchiolitis obliterans is diagnosed primarily by which type of testing?
• In late effects care, what is recommended regarding the primary care physician?
• Which strategies should be considered to prevent post-transplant infectious complications? (choose the option that lists the correct combination)
• A conditioning regimen including cyclophosphamide may cause which side effect during the initial two weeks post-transplant?
• Which of the following is an advantage of a non-myeloablative transplant?
• Which statement is true regarding hormone replacement therapy and bone mineral density?
• Busulfan in conditioning regimens should not be combined with carmustine (BCNU) because of increased risk of what toxicity?
• Donor leukocyte infusion (DLI) is an appropriate treatment option for relapse after allogeneic transplant in which disease?
• Which infection-prevention measure is not recommended for HSCT patients?
• AML without features of MDS is most often associated with which exposure?
• CW presents to clinic on day +30 after allogenic transplant with a rash on her arms and chest. Using the Rule of Nines, what stage is the GVHD?
• Which of the following is NOT listed as a risk factor for aspergillosis after HSCT?
• Immunoglobulins are secreted by which type of cell?
• Which long-term risk is associated with busulfan exposure in conditioning regimens?
• Which approach best supports ongoing sexual and reproductive health in HSCT survivors?
• Compared with bone marrow, peripheral blood stem cell grafts are associated with an increased risk of chronic GVHD. True or False?
• Autologous transplantation has expanded to autoimmune disorders; which disease is mentioned as being treated with autologous transplantation?
• Patients who have received an HSCT should receive which of the following annual immunizations?