The Hematologic System ATI

The Hematologic System ATI Related

Review The Hematologic System ATI related questions and content

A 16-year-old female patient with severe factor XI deficiency presents with acute appendicitis and requires urgent surgery. You are called by the surgeon, who wants to know what, if any, blood products or treatments are required to reduce the risk of perioperative bleeding. The patient weighs 62 kg. What should you tell him to administer?

  • A. Cryoprecipitate (five units), which will likely raise her factor XI level to 20%
  • B. Factor XI concentrate (20 units/kg), which will raise her factor XI level to 20%
  • C. Fresh frozen plasma (20 mL/kg), which will raise her factor XI level to 20%
  • D. Prothrombin complex concentrate (40 units/kg), which will raise her factor XI level to 20%
Correct Answer: C

Rationale: The correct answer is C: Fresh frozen plasma (20 mL/kg), which will raise her factor XI level to 20%. Fresh frozen plasma contains various clotting factors, including factor XI. In patients with severe factor XI deficiency, like this 16-year-old female, fresh frozen plasma can provide factor XI replacement and improve hemostasis. The dose of 20 mL/kg is appropriate to achieve a factor XI level of around 20%, which is sufficient for hemostasis during surgery.

Now, let's analyze the other choices:
A: Cryoprecipitate (five units), which will likely raise her factor XI level to 20% - Cryoprecipitate contains factor VIII and fibrinogen, but the amount of factor XI in cryoprecipitate is minimal and may not significantly raise factor XI levels to the required 20%.

B: Factor XI concentrate (20 units/kg), which will raise her factor XI level to 20% - While factor XI concentrate is

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The International Normalized Ratio (INR) was developed for the purpose of

  • A. Monitoring heparin therapy
  • B. Monitoring oral anticoagulant therapy
  • C. Screening for intrinsic clotting system abnormalities
  • D. Standardizing the monitoring of warfarin therapy
Correct Answer: D

Rationale: The correct answer is D because the International Normalized Ratio (INR) was specifically developed to standardize the monitoring of warfarin therapy. INR allows for consistent interpretation of prothrombin time results across different laboratories, ensuring accurate dosing of warfarin. Choice A is incorrect because heparin therapy is typically monitored using activated partial thromboplastin time (aPTT). Choice B is incorrect as INR, not aPTT, is used for monitoring oral anticoagulant therapy such as warfarin. Choice C is incorrect as INR is not used for screening clotting system abnormalities, but rather for monitoring anticoagulant therapy.

A patient is prescribed a transfusion of washed packed red blood cells. What should the nurse realize as being the rationale for the using this type of blood?

  • A. Reduces the risk of hypothermia
  • B. Cleans the blood cells of impurities
  • C. Reduces the risk of a febrile reaction
  • D. Removes potential harmful particles from the blood
Correct Answer: C

Rationale: The correct answer is C because washing packed red blood cells reduces the risk of a febrile reaction by removing white blood cells, plasma proteins, and other substances that could lead to an immune response. Choice A is incorrect as hypothermia is not a primary concern with washed packed red blood cells. Choice B is incorrect as the process does not cleanse blood cells of impurities. Choice D is incorrect as the main purpose of washing blood cells is to reduce the risk of adverse reactions, not to remove harmful particles.

Platelet aggregation is an important event in hemostasis. Which of the following statement is true for platelet aggregation in vascular injury?

  • A. There will be initial vasodilation
  • B. Clotting factors play no role in its formation
  • C. Platelets change their shape during the process
  • D. Serotonin stimulates platelet aggregation
Correct Answer: C

Rationale: The correct answer is C: Platelets change their shape during the process of platelet aggregation in vascular injury. Platelets undergo shape change from a discoid to a spiky form, leading to the exposure of their glycoprotein receptors, which then bind to fibrinogen and other platelets to form a platelet plug. This process is crucial for hemostasis and preventing excessive bleeding.

Explanation for why other choices are incorrect:
A: There will be initial vasodilation - Vasodilation is not a direct result of platelet aggregation but rather an initial response to vascular injury to increase blood flow to the area.
B: Clotting factors play no role in its formation - Clotting factors are essential for the later stages of hemostasis, but platelet aggregation is primarily driven by platelet activation and shape change.
D: Serotonin stimulates platelet aggregation - While serotonin is released from platelets upon activation, it does not directly stimulate platelet aggregation.

Plat. Transfusion is not indicated in:

  • A. aplastic an.
  • B. uraemia with bleeding
  • C. DIC
  • D. immunogenic thrombocytopenia
Correct Answer: D

Rationale: Plat. transfusion is not indicated in immunogenic thrombocytopenia (ITP) because it is an autoimmune disorder where the body destroys its own platelets. Transfusing platelets won't solve the underlying issue of platelet destruction. In aplastic anemia (A), platelet transfusion can help due to low platelet production. In uremia with bleeding (B) and DIC (C), platelet transfusion is necessary to manage bleeding due to decreased platelet function or consumption.

Dengue is a common vector-borne disease prevalent in tropical countries. Which of the following statement is true for dengue fever?

  • A. It is caused by a DNA virus
  • B. The vector once infected with the virus remains infective for life
  • C. The vector prefers polluted water for propagation
  • D. Joint symptoms are commoner in dengue fever compared to chikungunya
Correct Answer: B

Rationale: The correct answer is B because the Aedes mosquito, the vector for dengue fever, remains infective for life once it is infected with the dengue virus. This is due to the virus establishing a lifelong infection in the mosquito's salivary glands. The other choices are incorrect because: A) Dengue is caused by an RNA virus, not a DNA virus. C) The Aedes mosquito prefers clean, stagnant water for breeding, not polluted water. D) Joint symptoms are commoner in chikungunya, not dengue fever.

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