ATI Hematologic System

ATI Hematologic System Related

Review ATI Hematologic System related questions and content

A 4-year-old girl with a history of relapsed pre-B-cell acute lymphoblastic leukemia is being admitted for unrelated donor bone marrow transplantation with cyclophosphamide and total body irradiation conditioning. Pretransplant workup shows the following: Recipient: CMV IgG: negative, CMV IgM: negative, HSV I/II antibody: negative, Varicella IgG: positive (vaccinated), Hepatitis B surface antigen: negative, Hepatitis B surface antibody: positive (vaccinated), Hepatitis B core antibody: negative, Hepatitis C antibody: negative. Donor: CMV IgG: negative, CMV IgM: negative, HSV I/II antibody: positive, Varicella IgG: positive, Hepatitis B surface antigen: negative, Hepatitis B core antibody: negative, Hepatitis C antibody: negative. How should the patient be managed during the admission with respect to infection prophylaxis?

  • A. Acyclovir IV for herpes simplex virus (HSV) suppression
  • B. Weekly screening by polymerase chain reaction (PCR) for cytomegalovirus (CMV) in blood
  • C. Antifungal prophylaxis
  • D. Valganciclovir PO for CMV suppression
Correct Answer: C

Rationale: The correct answer is C: Antifungal prophylaxis. In this case, the patient is at high risk for fungal infections post-transplant due to immunosuppression from the conditioning regimen. The patient is negative for CMV IgG and IgM, so CMV prophylaxis is not necessary (eliminating choices B and D). The patient is also negative for HSV antibodies, so acyclovir for HSV suppression is not indicated (eliminating choice A). Therefore, antifungal prophylaxis is the most appropriate choice to prevent fungal infections in this immunocompromised patient. It is essential to protect the patient from opportunistic infections, and antifungal prophylaxis is a crucial component of post-transplant care.

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The nurse is assessing a patient with chronic lung disease. Which finding indicates long-term hypoxia?

  • A. Pallor
  • B. Dyspnea
  • C. Clubbed fingertips
  • D. Pulmonary crackles
Correct Answer: C

Rationale: The correct answer is C: Clubbed fingertips. Clubbing is a sign of prolonged hypoxia due to chronic lung disease. It is characterized by enlargement and rounding of the fingertips. This occurs as a result of chronic hypoxia causing tissue changes in the fingers. Pallor (A) is a pale skin color often indicating decreased blood flow. Dyspnea (B) is difficulty breathing and can be an acute symptom of hypoxia. Pulmonary crackles (D) are abnormal lung sounds indicating fluid accumulation and are not specific to long-term hypoxia.

You receive a phone call that a 3-year-old patient on long-term warfarin therapy for congenital heart disease has an international normalized ratio (INR) of 5.8. On further history, you learn the patient and several family members have had recent gastrointestinal illnesses, but the patient is recovering. His mother reports he is not experiencing bleeding symptoms. Which of the following interventions would be most reasonable in this clinical scenario?

  • A. Hold 1 to 2 doses of warfarin and recheck INR
  • B. Administer oral vitamin K therapy
  • C. Administer fresh frozen plasma (FFP)
  • D. Administer recombinant factor VIIa
Correct Answer: A

Rationale: The correct answer is A: Hold 1 to 2 doses of warfarin and recheck INR. In this scenario, the patient's elevated INR of 5.8 indicates an increased risk of bleeding due to excessive anticoagulation. Since the patient is not experiencing bleeding symptoms and is recovering from gastrointestinal illness, temporarily holding 1 to 2 doses of warfarin is the most reasonable intervention to prevent bleeding complications while allowing the INR to normalize. Rechecking the INR after holding the doses will help assess the patient's response to the intervention. Choices B, C, and D are incorrect because administering oral vitamin K therapy, FFP, or recombinant factor VIIa are more aggressive interventions that are not warranted in this case where the patient is asymptomatic and recovering from a transient illness.

A pediatric fellow is planning a project intended to decrease the incidence of acute chest syndrome among patients with sickle cell disease who are already admitted to the hospital for other reasons. The fellow discussed with her mentor whether the project proposal should be submitted for review by the Institutional Review Board (IRB). The mentor explains that, at their intuition, quality improvement activities do not require IRB review but research projects must be submitted to the IRB. Which of the following is NOT a relevant consideration in determining whether the project is research or quality improvement?

  • A. The aim to create new knowledge for the individual institution versus discovering new and generalizable knowledge
  • B. The chosen methodology which will include repeated Plan-Do-Study-Act cycles
  • C. The intent to publish the results in a peer reviewed hematology journal
  • D. The efforts to hold biases/confounders stable over time, rather than control for them with, for example, randomization
Correct Answer: C

Rationale: The correct answer is C because the intent to publish results in a peer-reviewed journal is not a determining factor in distinguishing between quality improvement and research activities. Here's a step-by-step rationale:
1. Quality improvement focuses on improving processes within an institution to enhance patient care, while research aims to generate new knowledge that is generalizable beyond the institution.
2. The chosen methodology (B) such as using Plan-Do-Study-Act cycles is often associated with quality improvement projects to test and implement changes iteratively.
3. Efforts to hold biases stable over time (D) are more aligned with research, as quality improvement projects may not necessarily require controlling for biases like randomization.
4. The intent to publish in a peer-reviewed journal (C) can apply to both quality improvement and research projects, but the key factor in determining the need for IRB review is whether the project aims to generate generalizable knowledge (research) or improve local processes (quality improvement).

A nurse should identify that clopidogrel is contraindicated for clients who have which of the following conditions?

  • A. Myocardial infarction
  • B. Peptic ulcer disease
  • C. Pancreatitis
  • D. Myasthenia gravis
Correct Answer: B

Rationale: Clopidogrel is an antiplatelet medication that can increase the risk of bleeding. Patients with peptic ulcer disease are at a higher risk of gastrointestinal bleeding, so clopidogrel is contraindicated. Myocardial infarction, pancreatitis, and myasthenia gravis are not contraindications for clopidogrel use.

A 4-year-old male child presents to the emergency department with his fourth invasive Staph infection. CBC consistently identifies moderate neutropenia. Sophisticated lab testing identifies lack of Toll-like receptor responses. The patient undergoes whole exome sequencing and is found to have pathogenic variants in IRAK4. What does 'IRAK4' stand for?

  • A. Interferon gamma receptor-associated kinase 4
  • B. Inducible RAS activating kinase 4
  • C. Interleukin-1 receptor-associated kinase 4
  • D. Immune response activating kinase 4
Correct Answer: C

Rationale: The correct answer is C: Interleukin-1 receptor-associated kinase 4 (IRAK4).
1. IRAK4 is involved in the immune response pathway triggered by interleukin-1 receptor signaling.
2. Lack of Toll-like receptor responses in the patient aligns with the role of IRAK4 in the interleukin-1 receptor pathway.
3. Pathogenic variants in IRAK4 can lead to immunodeficiency, explaining recurrent Staph infections.
4. Choices A, B, and D do not accurately reflect the known function of IRAK4 and its association with interleukin-1 receptor signaling.

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