ATI Hematologic System

ATI Hematologic System Related

Review ATI Hematologic System related questions and content

A 15-year-old female presents with 1 month of fatigue and 3 days of chest pain and shortness of breath. Her physical exam is unremarkable. A chest x-ray shows a large mediastinal mass that is greater than 33% of the diameter of her chest cavity. A biopsy shows nodular sclerosing, classic Hodgkin lymphoma (cHL). Metastatic workup at diagnosis, including CT scan of neck, chest, abdomen, and pelvis and PET scan, shows no other site of disease. According to the Ann Arbor staging system, the patient has which stage of cHL?

  • A. Stage I
  • B. Stage II
  • C. Stage III
  • D. Stage IV
Correct Answer: A

Rationale: The correct answer is A: Stage I. In the Ann Arbor staging system for Hodgkin lymphoma, Stage I indicates involvement of a single lymph node region (I) or a single extralymphatic site (IE) without systemic symptoms. In this case, the patient has a large mediastinal mass but no other sites of disease on metastatic workup. This corresponds to Stage I disease.

Choice B: Stage II would indicate involvement of two or more lymph node regions on the same side of the diaphragm.
Choice C: Stage III would indicate involvement of lymph node regions on both sides of the diaphragm.
Choice D: Stage IV would indicate disseminated involvement of one or more extralymphatic organs or tissues.

Therefore, based on the information provided, the correct stage for this patient is Stage I as per the Ann Arbor staging system.

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A patient with leukemia has developed stomatitis and is experiencing a nutritional deficit. An oral anesthetic has consequently been prescribed. What health education should the nurse provide to the patient?

  • A. Chew with care to avoid inadvertently biting the tongue.
  • B. Use the oral anesthetic 1 hour prior to meal time.
  • C. Brush teeth before and after eating.
  • D. Swallow slowly and deliberately.
Correct Answer: A

Rationale: The correct answer is A: Chew with care to avoid inadvertently biting the tongue. Stomatitis causes inflammation in the mouth, making it painful to eat. By chewing carefully, the patient can prevent accidentally biting the tongue or cheek, which can worsen the pain. Using the oral anesthetic before meals (choice B) may provide some relief, but the key is to prevent further injury. Brushing teeth before and after eating (choice C) and swallowing slowly (choice D) do not directly address the issue of preventing accidental bites and are not as essential for managing stomatitis.

The following pathological features is true regarding non-Hodgkin lymphoma (NHL)

  • A. Classical Reed-Sternberg (RS) cells are neoplastic cells
  • B. B cell phenotype is more common
  • C. Contiguous group of lymph nodes are affected
  • D. It is not associated with leukemic phase of disease
Correct Answer: B

Rationale: Step 1: Non-Hodgkin lymphoma (NHL) can arise from either B cells or T cells. B cell NHL is more common than T cell NHL.
Step 2: The B cell phenotype is predominant in NHL, making choice B correct.
Step 3: Classical Reed-Sternberg cells are characteristic of Hodgkin lymphoma, not NHL, making choice A incorrect.
Step 4: NHL can involve non-contiguous lymph nodes, ruling out choice C.
Step 5: NHL can present with leukemic involvement, refuting choice D.
Overall, the B cell phenotype being more common in NHL makes choice B the correct answer.

An older adult patient is undergoing diagnostic testing for chronic lymphocytic leukemia (CLL). What assessment finding is certain to be present if the patient has CLL?

  • A. Increased numbers of blast cells
  • B. Increased lymphocyte levels
  • C. Intractable bone pain
  • D. Thrombocytopenia with no evidence of bleeding
Correct Answer: B

Rationale: Step-by-step rationale:
1. CLL is characterized by the proliferation of abnormal lymphocytes.
2. Increased lymphocyte levels are a hallmark of CLL due to the accumulation of these abnormal cells.
3. Lymphocytosis is a key diagnostic feature in CLL.
4. Other choices are incorrect because blast cells are characteristic of acute leukemia, bone pain is more common in multiple myeloma, and thrombocytopenia with no bleeding is not a specific finding in CLL.

Summary: Increased lymphocyte levels are certain to be present in a patient with CLL due to the abnormal proliferation of lymphocytes. Other choices are incorrect as they do not align with the characteristic features of CLL.

A 13-year-old Hispanic girl is found to have a WBC count of 6,500/mm3 with 40% Auer rod–containing granular blasts that, by flow cytometry, express very bright CD33 but are negative for human leukocyte antigen–DR isotype (HLA-DR). She is oozing blood around her peripheral IV site. Coagulation studies reveal an international normalized ratio (INR) of 3.4, a fibrinogen of 170, and a markedly elevated D-dimer. Marrow aspirate shows nearly 90% blasts with a similar morphology. You send the marrow to the fluorescence in situ hybridization (FISH) lab and request STAT testing for the most likely recurrent genetic abnormality based on the clinical presentation. How do you plan to initiate therapy?

  • A. Perform a lumbar puncture to determine leukemic involvement, then proceed with induction chemotherapy.
  • B. Begin therapy with all-trans retinoic acid (ATRA) immediately while aggressively managing coagulopathy with blood product support.
  • C. Start dexamethasone and hydroxyurea immediately while aggressively managing coagulopathy with blood product support.
  • D. Start induction chemotherapy, obtain HLA typing, and start a donor search because of the poor prognosis associated with this leukemic phenotype.
Correct Answer: B

Rationale: The correct answer is B because the clinical presentation suggests acute promyelocytic leukemia (APL). APL is characterized by Auer rod-containing granular blasts, which are positive for CD33 and negative for HLA-DR. The presence of coagulopathy with elevated D-dimer and oozing blood indicates a high risk of disseminated intravascular coagulation (DIC), a common complication of APL. Immediate treatment with all-trans retinoic acid (ATRA) is crucial in APL to induce differentiation of the leukemic cells and prevent further coagulopathy. Aggressively managing the coagulopathy with blood product support is also important to stabilize the patient.

Choice A is incorrect because a lumbar puncture is not necessary for APL diagnosis, and immediate induction chemotherapy with ATRA is the standard of care. Choice C is incorrect because dexamethasone and hydroxyurea are not the first-line therapies for APL.

A nurse is caring for four clients. After reviewing today's laboratory results, which client would the nurse assess first?

  • A. Client with an international normalized ratio of 2.8
  • B. Client with a platelet count of 128,000/mm3 (128 x 109/L).
  • C. Client with a prothrombin time (PT) of 28 seconds
  • D. Client with a red blood cell count of 5.1 million/mcl. (5.1 x 1012/L)
Correct Answer: C

Rationale: The correct answer is C: Client with a prothrombin time (PT) of 28 seconds. A PT measures the time it takes for blood to clot, indicating the client's clotting ability. A PT of 28 seconds is prolonged, suggesting a potential bleeding risk. This client should be assessed first to prevent any complications related to inadequate clotting.

A: Client with an international normalized ratio of 2.8 - Although an elevated INR indicates a risk of bleeding, it is not as time-sensitive as a prolonged PT.
B: Client with a platelet count of 128,000/mm3 - While low platelets can lead to bleeding, a prolonged PT is more critical for immediate assessment.
D: Client with a red blood cell count of 5.1 million/mcl - This value is within normal range and does not indicate an urgent issue related to clotting.

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