ATI Hematologic System Quizlet

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A 10-year-old patient with aplastic anemia, who is blood type B negative, is receiving a red blood cell transfusion. About 10 minutes after the transfusion starts, the patient develops anxiety and lower back pain. The transfusion continues for another 5 minutes until it is stopped when he develops a temperature of 40 °C with chills and rigors. A transfusion reaction work-up is most likely to reveal what findings?

  • A. Spherocytes on peripheral blood smear
  • B. Gram-negative Bacillus on gram stain of remaining RBC unit
  • C. Chest x-ray with bilateral pulmonary infiltrates that are new compared to an x-ray done last week
  • D. DAT positive for C3
Correct Answer: D

Rationale: The correct answer is D: DAT positive for C3. This finding suggests complement-mediated hemolysis, which is consistent with a transfusion reaction known as transfusion-related acute lung injury (TRALI). TRALI presents with respiratory distress, fever, and chills due to immune complexes activating the complement system. A: Spherocytes indicate hemolysis, which is not specific to TRALI. B: Gram-negative Bacillus suggests bacterial contamination, leading to sepsis, not TRALI. C: Bilateral pulmonary infiltrates are seen in transfusion-associated circulatory overload (TACO), not TRALI.

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A 17-year-old female presents with cervical adenopathy and a history of daily fevers and drenching night sweats. A biopsy is performed and reveals classic Hodgkin lymphoma. Which of the following is least appropriate as part of the staging workup?

  • A. Chest x-ray
  • B. CT scan of chest, abdomen, and pelvis
  • C. Functional imaging (PET scan)
  • D. Lumbar puncture and cerebrospinal fluid (CSF) analysis
Correct Answer: D

Rationale: The correct answer is D: Lumbar puncture and cerebrospinal fluid (CSF) analysis. In Hodgkin lymphoma staging, CNS involvement is rare at initial presentation. Therefore, routine CSF analysis is not recommended unless there are specific neurological symptoms suggestive of CNS disease. A lumbar puncture carries risks of complications and should not be performed routinely. Choices A, B, and C are appropriate for staging in Hodgkin lymphoma to evaluate for distant metastases and characterize disease extent.

A patient who is undergoing consolidation therapy for the treatment of leukemia has been experiencing debilitating fatigue. How can the nurse best meet this patient's needs for physical activity?

  • A. Teach the patient about the risks of immobility and the benefits of exercise.
  • B. Assist the patient to a chair during awake times, as tolerated.
  • C. Collaborate with the physical therapist to arrange for stair exercises.
  • D. Teach the patient to perform deep breathing and coughing exercises.
Correct Answer: B

Rationale: The correct answer is B because assisting the patient to a chair during awake times, as tolerated, is the most appropriate intervention for a patient experiencing debilitating fatigue during consolidation therapy for leukemia. This option promotes mobility and prevents further deconditioning without overwhelming the patient.

A: Teaching about risks and benefits may not directly address the immediate need for physical activity.
C: Stair exercises may be too strenuous for a fatigued patient and could potentially exacerbate their condition.
D: Deep breathing and coughing exercises are important but do not directly address the need for physical activity to combat fatigue.

A 17-year-old female presents with cervical adenopathy and a history of daily fevers and drenching night sweats. A biopsy is performed and reveals classic Hodgkin lymphoma. Which of the following is least appropriate as part of the staging workup?

  • A. Chest x-ray
  • B. CT scan of chest, abdomen, and pelvis
  • C. Functional imaging (PET scan)
  • D. Lumbar puncture and cerebrospinal fluid (CSF) analysis
Correct Answer: D

Rationale: The correct answer is D, Lumbar puncture and cerebrospinal fluid (CSF) analysis. In Hodgkin lymphoma, central nervous system involvement is rare at presentation, making routine CSF analysis unnecessary. Staging workup typically includes imaging studies (A, B, C) to assess disease extent and involvement of distant organs. CSF analysis is reserved for cases with neurological symptoms or signs suggestive of CNS involvement. Therefore, in this case, the least appropriate option for staging workup is D.

Splenectomy is contraindicated in:

  • A. pyruvate kinase def.
  • B. ITP
  • C. BM failure
  • D. angiogenic myeloid metaplasia
Correct Answer: C

Rationale: The correct answer is C: BM failure. Splenectomy is contraindicated in patients with bone marrow failure due to conditions such as aplastic anemia or myelodysplastic syndromes. The spleen plays a role in removing abnormal blood cells, and removing it can worsen cytopenias in these patients. Choices A, B, and D are not contraindications for splenectomy as they do not directly involve the bone marrow function. Pyruvate kinase deficiency (A) does not affect bone marrow function, ITP (B) is a platelet disorder, and angiogenic myeloid metaplasia (D) is a condition related to abnormal blood cell production, not bone marrow failure.

The nurse notes that a patient's gaping wound is developing a blood clot. Which body substance is responsible for this clot formation?

  • A. Plasma
  • B. Platelets
  • C. Red blood cells
  • D. White blood cells
Correct Answer: B

Rationale: Platelets are responsible for clot formation in the body. When a wound occurs, platelets are activated and adhere to the site, forming a plug to stop bleeding. They release chemicals to further enhance clot formation. Plasma is the liquid component of blood, red blood cells carry oxygen, and white blood cells are part of the immune system, none of which are directly involved in clot formation.

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