Anatomy of Hematologic System

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A 13-year-old girl presents with acute myeloid leukemia (AML) and a WBC count of 120,000/mm3. Cytogenetics reveals a normal karyotype, and fluorescence in situ hybridization (FISH) tests for inv(16), t(8;21), t(15;17); 11q23 abnormalities; monosomy 7; and 5q deletion are negative. Molecular testing is negative for mutations in FLT3, NPM1, and CEBPA. She is treated with 10 days of daunorubicin, AraC, and gemtuzumab for induction therapy. On day 30, she recovers counts, and a bone marrow aspiration shows 2.2% leukemic blasts by flow cytometry. She receives a second course of treatment with daunorubicin and AraC, and her marrow is now in morphologic remission and is MRD-negative by flow cytometry. She has no HLA-matched siblings, but an unrelated donor search reveals a large number of potential matches. Which course of treatment is most likely to result in the best outcome?

  • A. Give two more courses of intensification chemotherapy.
  • B. Perform an autologous hematopoietic stem cell transplant (HSCT).
  • C. Give one more course of intensification chemotherapy and then perform a matched unrelated donor HSCT.
  • D. Give one more course of intensification chemotherapy and then 1 year of maintenance chemotherapy.
Correct Answer: C

Rationale: The correct answer is C because the patient is in morphologic remission and MRD-negative after the second course of treatment. Given her high-risk AML and lack of HLA-matched siblings, a matched unrelated donor HSCT offers the best chance for long-term remission. Autologous HSCT (choice B) would risk reintroducing leukemic cells. Giving more courses of intensification chemotherapy alone (choice A) may not eradicate the disease. Maintenance chemotherapy alone (choice D) is not sufficient for high-risk AML. Therefore, choice C is the best option for maximizing the chances of a favorable outcome in this case.

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A nurse is caring for a client who is experiencing an acute ischemic cerebrovascular event due to a thrombus in a cerebral vessel. Which of the following drugs should the nurse expect to administer?

  • A. Alteplase
  • B. Aspirin
  • C. Clopidogrel
  • D. Heparin
Correct Answer: A

Rationale: The correct answer is A: Alteplase. Alteplase is a thrombolytic agent used to dissolve blood clots and restore blood flow in acute ischemic stroke. It is crucial to administer within a specific time frame for the best outcome. Aspirin (B) and Clopidogrel (C) are antiplatelet agents that prevent further clot formation but are not used for immediate clot dissolution in acute ischemic stroke. Heparin (D) is an anticoagulant that prevents clot formation and is not typically used as the initial treatment for acute ischemic stroke.

The nurse examines the lymph nodes of a patient during a physical assessment. Which assessment finding would be of most concern to the nurse?

  • A. A 2-cm nontender supraclavicular node
  • B. A 1-cm mobile and nontender axillary node
  • C. An inability to palpate any superficial lymph nodes
  • D. Firm inguinal nodes in a patient with an infected foot
Correct Answer: A

Rationale: The correct answer is A: A 2-cm nontender supraclavicular node. This finding is concerning because supraclavicular nodes are not normally palpable. Enlarged supraclavicular nodes can indicate metastatic cancer. B is incorrect because mobile and nontender axillary nodes are usually benign. C is incorrect as the inability to palpate superficial nodes may be normal. D is incorrect as firm inguinal nodes could indicate a localized infection or inflammation.

A 20-month-old otherwise healthy male presents late for his 18-month well child check. During his first year of life, he took iron-fortified formula and had a point-of-care hemoglobin (Hgb) of 12 g/dL at his 1-year well child check. His mother reports that he is a picky eater but loves milk and has recently become obsessive about chewing the corners of his cardboard books. Physical examination is normal except for a flow murmur. Which combination of laboratory test results listed below would most likely characterize this patient?

  • A. Hgb 8.7 g/dL, mean corpuscular volume (MCV) 60 fL, serum ferritin 2 ng/mL
  • B. Hgb 12.0 g/dL, MCV 80 fL, serum ferritin 30 ng/mL
  • C. Hgb 9.2 g/dL, MCV 60 fL, serum ferritin 30 ng/mL
  • D. Hgb 11.2 g/dL, MCV 90 fL, serum ferritin 7 ng/mL
Correct Answer: A

Rationale: The correct answer is A because it indicates iron deficiency anemia. The low Hgb of 8.7 g/dL is below normal range for his age. The MCV of 60 fL is low, indicating microcytic anemia which is characteristic of iron deficiency. The serum ferritin level of 2 ng/mL is very low, supporting the diagnosis.

Choice B is incorrect as the Hgb and MCV are within normal range, and the ferritin level is not indicative of iron deficiency. Choice C has a low Hgb but normal MCV and ferritin level. Choice D has a normal Hgb and low ferritin, but the MCV is high, inconsistent with iron deficiency anemia.

A 60-year-old patient with chronic myeloid leukemia will be treated in the home setting and the nurse is preparing appropriate health education. What topic should the nurse emphasize?

  • A. The importance of adhering to the prescribed drug regimen
  • B. The need to ensure that vaccinations are up to date
  • C. The importance of daily physical activity
  • D. The need to avoid shellfish and raw foods
Correct Answer: A

Rationale: The correct answer is A: The importance of adhering to the prescribed drug regimen. This is crucial for managing chronic myeloid leukemia effectively. Non-adherence can lead to disease progression and treatment failure. Option B is important but not as critical as medication adherence. Option C is generally good for overall health but not specific to managing the disease. Option D is irrelevant to the management of chronic myeloid leukemia.

What is the nurse's priority when caring for a client who just completed a bone marrow aspiration and biopsy?

  • A. Teach the client to avoid activity for 24 to 48 hours to prevent infection.
  • B. Administer a nonsteroidal anti-inflammatory drug (NSAID) to promote comfort.
  • C. Check the pressure dressing frequently for signs of excessive or active bleeding.
  • D. Report the laboratory results to the primary health care provider.
Correct Answer: C

Rationale: The correct answer is C: Check the pressure dressing frequently for signs of excessive or active bleeding. This is the priority because post bone marrow aspiration and biopsy, there is a risk of bleeding due to the procedure. By checking the dressing, the nurse can assess for any signs of excessive bleeding or hematoma formation, which are crucial to prevent complications.

A: Teaching the client to avoid activity is important but not the priority immediately post-procedure.
B: Administering NSAIDs may not be appropriate as they can increase the risk of bleeding.
D: Reporting the lab results is important but not the priority over ensuring immediate post-procedure safety.

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