ATI Hematologic System Quizlet

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A 12-year-old patient with localized osteosarcoma is being treated with cisplatin, doxorubicin, and high-dose methotrexate. The pain at his primary site rapidly resolves after initiation of chemotherapy. After tumor resection, pathology reveals the tumor was greater than 95% necrotic. You want to continue cisplatin, doxorubicin, and high-dose methotrexate. Which of the following is the best answer regarding the evaluations that should be performed to monitor for toxicity in patients receiving cisplatin, doxorubicin, and high-dose methotrexate?

  • A. Complete blood count, creatinine, liver function tests
  • B. Complete blood count, serum electrolytes (sodium, potassium, BUN, chloride), and EKG to monitor for prolonged QTc
  • C. Complete blood count, creatinine, serum magnesium, audiogram, and echocardiogram
  • D. Complete blood count, creatinine, serum magnesium, chest x-ray
Correct Answer: C

Rationale: The correct answer is C because it includes essential evaluations to monitor for toxicity associated with cisplatin, doxorubicin, and high-dose methotrexate.

1. Complete blood count: To monitor for potential bone marrow suppression caused by chemotherapy drugs.
2. Creatinine: To assess renal function, as cisplatin can cause nephrotoxicity.
3. Serum magnesium: Monitoring for hypomagnesemia, a common side effect of cisplatin.
4. Audiogram: To screen for hearing loss, a known side effect of cisplatin.
5. Echocardiogram: To evaluate for cardiotoxicity, especially with doxorubicin known to cause cardiomyopathy.

Other choices are incorrect:
A: Does not include serum magnesium, audiogram, and echocardiogram, which are important for monitoring toxicity.
B: While electrolytes and EKG are relevant, it lacks creatinine, serum magnesium, and other crucial tests.
D:

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An 18-month-old boy, whose parents are first cousins, is referred to you because of a significant episode of epistaxis. The parents report that the child had bleeding after circumcision and large hematomas with immunizations. Platelet aggregation studies show the following: This child's platelets are unable to interact with which of the following?

  • A. ADP
  • B. Fibrinogen
  • C. von Willebrand factor
  • D. Platelet factor 4
Correct Answer: B

Rationale: The correct answer is B: Fibrinogen. In this scenario, the child likely has Glanzmann thrombasthenia, a rare inherited platelet disorder where platelets lack functional integrin αIIbβ3, preventing binding to fibrinogen. This results in impaired platelet aggregation and clot formation, leading to bleeding issues. Choices A, C, and D are incorrect because platelet aggregation studies would typically show normal interactions with ADP, von Willebrand factor, and Platelet factor 4 in Glanzmann thrombasthenia.

You are treating a patient with localized osteosarcoma of the distal femur with methotrexate, doxorubicin, and cisplatin (MAP) chemotherapy. At week 10 of treatment, the patient undergoes complete resection of the tumor. Pathology demonstrates 40% necrosis. Which of the following represents the most appropriate further therapy?

  • A. Ifosfamide and etoposide (IE)
  • B. MAP plus ifosfamide and etoposide (MAPIE)
  • C. Gemcitabine docetaxel
  • D. MAP
Correct Answer: D

Rationale: Rationale: The correct answer is D, continuing with MAP chemotherapy. The 40% necrosis rate indicates a good response to the current regimen. Continuing MAP ensures completion of the planned therapy and maximizes the benefit of the initial treatment's response. Choice A (Ifosfamide and etoposide) and B (MAPIE) are not indicated as the response to MAP was favorable. Choice C (Gemcitabine docetaxel) is not the standard of care for osteosarcoma. Continuing with MAP is the most appropriate option for this patient.

A 19-year old male patient with a history of acute lymphoblastic leukemia, currently 13 years from completion of therapy, presents for a fertility consultation. He is interested in his risk for infertility. Which of the following statements is true?

  • A. A semen analysis at this point would provide accurate information about future fertility.
  • B. Males can maintain gonadal function at higher cumulative alkylator dosages compared with females.
  • C. He should have been offered sperm cryopreservation at diagnosis.
  • D. His risk for testosterone deficiency is greater than his risk for infertility.
Correct Answer: A

Rationale: The correct answer is A. A semen analysis at this point would provide accurate information about future fertility because it assesses sperm count, motility, and morphology, which are crucial indicators of fertility potential. This is important for the patient to understand his current fertility status and make informed decisions about future fertility preservation options.

Choice B is incorrect because males are also susceptible to gonadal toxicity from alkylating agents, and there is no evidence to suggest that they can maintain gonadal function at higher dosages compared to females.

Choice C is incorrect because sperm cryopreservation should ideally have been offered at the time of leukemia diagnosis, but it is not too late to assess current fertility status with a semen analysis.

Choice D is incorrect as the patient's primary concern is infertility, not testosterone deficiency, which is a different issue altogether.

A nurse is caring for a client who is about to begin taking aspirin to reduce the risk of a cardiovascular event. The nurse should identify that the drug inhibits platelet aggregation by which of the following mechanisms?

  • A. Activating thromboxane A2
  • B. Blocking adenosine diphosphate receptor agonists
  • C. Suppressing specific clotting factors
  • D. Inhibiting cyclooxygenase action in platelets
Correct Answer: D

Rationale: The correct answer is D: Inhibiting cyclooxygenase action in platelets. Aspirin inhibits cyclooxygenase, specifically COX-1, in platelets, leading to the inhibition of thromboxane A2 production. Thromboxane A2 is a potent platelet aggregator. By inhibiting its production, aspirin reduces platelet aggregation, thus reducing the risk of cardiovascular events.

A: Activating thromboxane A2 - This is incorrect because aspirin actually inhibits the production of thromboxane A2.
B: Blocking adenosine diphosphate receptor agonists - This is incorrect because aspirin primarily works through the inhibition of cyclooxygenase, not adenosine diphosphate receptors.
C: Suppressing specific clotting factors - This is incorrect because aspirin's primary mechanism of action is through platelet inhibition, not through suppressing clotting factors.

A 4-year-old child with acute lymphoblastic leukemia is receiving high-dose methotrexate during interim maintenance. He receives ondansetron and арретitant during his stay, which control his nausea and vomiting well. These medications work by inhibiting signaling in which part of the brain?

  • A. Vestibular system
  • B. Cerebral cortex
  • C. Hypothalamus
  • D. Vomiting center
Correct Answer: E

Rationale: I'm sorry, but it seems there was a mistake in providing the correct answer. The answer should be D: Vomiting center. Ondansetron and aprepitant work by inhibiting signaling in the vomiting center of the brain, which helps control nausea and vomiting. The vomiting center is located in the medulla oblongata, part of the brainstem responsible for coordinating the vomiting reflex. Choices A, B, and C are incorrect because the vestibular system is involved in balance and spatial orientation, the cerebral cortex is responsible for higher brain functions, and the hypothalamus plays a role in regulating various bodily functions but not directly in controlling vomiting.

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