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Question 1.1. A couple who are expecting their first child have been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple have approached their nurse practitioner with this request and are seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting them. How can the nurse practitioner best respond to the couple’s inquiry? (Points : 0.4)        “Stem cells can help correct autoimmune diseases and some congenital defects.”
        “Stem cells can be used to regenerate damaged organs should the need ever arise.”
        “Stem cells can be used as a source of reserve cells for the entire blood production system.”
        “Stem cells can help treat some cancers and anemias, but they must come from your child himself or herself.”

 Question 2.2. A 2-year-old girl has had repeated ear and upper respiratory tract infections since she was born. A pediatrician has determined a diagnosis of transient hypogammaglobulinemia of infancy. What is the physiological origin of the child’s recurrent infections? (Points : 0.4)      Antibody production by plasma cells is compromised because of impaired communication between B and T cells.
        The child had a congenital absence of immunoglobulin G (IgG) antibodies and her body is only slowly beginning to produce them independently.
        The child was born with immunoglobulin A (IgA) and immunoglobulin (IgM) antibodies, suggesting intrauterine infection.
        The child lacks the antigen presenting cells integral to normal B-cell antibody production.

 Question 3.3. A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy? (Points : 0.4)        Repeated exposure to offending allergens binds the basophils and mast cells that mediate the allergic response.
        Exposure to allergens in large, regular quantities overwhelms the IgE antibodies that mediate the allergic response.
        Repeated exposure stimulates adrenal production of epinephrine, mitigating the allergic response.
        Injections of allergens simulate production of IgG, which blocks antigens from combining with IgE.

 Question 4.4. A 14-year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms? (Points : 0.4)        The Epstein-Barr virus (EBV) is lysing many of the boy’s neutrophils.
        Viruses are killing some of his B cells and becoming incorporated into the genomes of others.
        The EBV inhibits the maturation of white cells within his peripheral lymph nodes.
        The virus responsible for mononucleosis inhibits the maturation of myeloblasts into promyelocytes.

 Question 5.5. A 16-year-old female has been brought to her primary care nurse practitioner by her mother due to the girl’s persistent sore throat and malaise. Which of the following facts revealed in the girl’s history and examination would lead the nurse practitioner to rule out infectious mononucleosis? (Points : 0.4)        The girl has a temperature of 38.1°C (100.6°F) and has enlarged lymph nodes.
        Her liver and spleen are both enlarged.
        Blood work reveals an increased white blood cell count.
        Chest auscultation reveals crackles in her lower lung fields bilaterally.

 Question 6.6. A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has: (Points : 0.4)        A mild parasitic infection
        A severe bacterial infection
        A mild viral infection
        A severe fungal infection

 Question 7.7. Which of the following patients is most likely to benefit from transplantation of thymic tissue or major histocompatibility complex (MHC)-compatible bone marrow? (Points : 0.4)        A 12-year-old girl with a history of epilepsy and low IgG levels secondary to phenytoin use
        A 7-year-old boy whose blood work indicates decreased IgA and IgG with increased IgM
        A 6-year-old boy whose pre-B cells are incapable of translation to normal B cells
        A 9-year-old girl who has a diagnosis of IgA deficiency

 Question 8.8. Which of the following statements most accurately conveys an aspect of lymphatic system activity? (Points : 0.4)        B and T lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures.
        B cells and macrophages are released from the bone marrow in their completed state.
        Stem cells in the lymph nodes initiate and regulate the process of white cell synthesis.
        Leukocytes bypass vascular circulation and are distributed instead by the lymphatic system.

 Question 9.9. A child has been diagnosed with thalassemia. Which of the following other health problems is the child at risk for? (Points : 0.4)        Hypocoagulation
        Iron and ferritin deficiencies
        Splenomegaly and hepatomegaly

 Question 10.10. The blood work of a 44-year-old male patient with a diagnosis of liver disease secondary to alcohol abuse indicates low levels of albumin. Which of the following phenomena would a clinician be most justified in anticipating? (Points : 0.4)        Impaired immune function
        Acid-base imbalances
        Impaired thermoregulation
        Fluid imbalances

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