ATI Hematologic System Test

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A laboratory study is conducted to determine the optimal usage of platelets for transfusion. The blood bank inventory along with the transfusion records and medical records of subjects who were recipients of platelet transfusion are reviewed. Which of the following conclusions is most likely to be made from this study?

  • A. Frozen storage of platelets helps increase the units available.
  • B. Platelet transfusions are rarely successful in patients with autoimmune thrombocytopenia.
  • C. Platelet units carry no risk for transmission of hepatitis C infection.
  • D. Pooled donor platelets are preferred over single-donor platelets.
Correct Answer: B

Rationale: Step-by-step rationale for why answer B is correct:
1. Autoimmune thrombocytopenia is a condition where the body's immune system attacks and destroys its own platelets.
2. Platelet transfusions in patients with autoimmune thrombocytopenia are less likely to be successful due to the underlying immune response.
3. Reviewing transfusion records of subjects with this condition would likely show a pattern of unsuccessful platelet transfusions.
4. This conclusion is supported by medical knowledge and understanding of autoimmune thrombocytopenia.

Summary:
- Choice A is incorrect because frozen storage of platelets does not necessarily increase units available in the context of the study.
- Choice C is incorrect as platelet units can carry a risk of transmission for hepatitis C infection.
- Choice D is incorrect as the preference for pooled donor platelets over single-donor platelets is not a conclusion that can be drawn from the study.

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A 9-year-old boy is being treated for standard-risk acute lymphoblastic leukemia. His treatment protocol calls for administration of intravenous methotrexate and intramuscular L-asparaginase during interim maintenance chemotherapy. What is the most appropriate sequence of drug administration?

  • A. Administer L-asparaginase during the methotrexate infusion.
  • B. Administer L-asparaginase immediately after the methotrexate infusion.
  • C. Administer both drugs at the same time to maximize synergistic activity.
  • D. Administer methotrexate 24 hours after the asparaginase.
Correct Answer: B

Rationale: The correct answer is B: Administer L-asparaginase immediately after the methotrexate infusion. This sequence is appropriate because methotrexate can interfere with the activity of L-asparaginase if given concurrently, affecting the efficacy of both drugs. Administering L-asparaginase immediately after the methotrexate infusion allows for optimal therapeutic effects of both medications without compromising their individual actions.

Choice A (Administer L-asparaginase during the methotrexate infusion) is incorrect because it may lead to drug interactions and reduced effectiveness of both drugs. Choice C (Administer both drugs at the same time) is incorrect for the same reason as choice A. Choice D (Administer methotrexate 24 hours after the asparaginase) is incorrect as it does not follow the optimal timing for these medications during treatment.

You receive a phone call from a community pediatrician who is caring for a 2-year-old toddler with a cancer predisposition syndrome. The pediatrician describes a child at the 95th percentile for height and weight with a history of corrective oral surgery to reduce a large tongue and a history of an omphalocele in infancy. The pediatrician is currently performing ultrasound of the abdomen and laboratory evaluation for this patient every 3 months. Which tumor is this patient most at risk of developing?

  • A. Pleuropulmonary blastoma
  • B. Hepatocellular carcinoma
  • C. Cystic nephroma
  • D. Nephroblastoma
Correct Answer: D

Rationale: The correct answer is D: Nephroblastoma (Wilms tumor). This patient likely has Beckwith-Wiedemann syndrome given the features of overgrowth, macroglossia, and omphalocele. Beckwith-Wiedemann syndrome is associated with an increased risk of Wilms tumor. Wilms tumor is the most common renal malignancy in childhood. Monitoring for Wilms tumor with ultrasound and laboratory evaluations is appropriate due to the increased risk in this patient population.

Choice A: Pleuropulmonary blastoma is a rare lung tumor more commonly seen in children under 2 years old. It is not typically associated with Beckwith-Wiedemann syndrome.

Choice B: Hepatocellular carcinoma is a primary liver cancer more commonly seen in adults, not children with Beckwith-Wiedemann syndrome.

Choice C: Cystic nephroma is a benign kidney tumor typically seen in young children, but it is not associated with Beckwith-Wiedemann syndrome nor is it malignant

A nurse is caring for a client who is about to begin taking epoetin. An increase in which of the following laboratory values should indicate to the nurse that the therapy is effective?

  • A. PT
  • B. WBC
  • C. Hgb
  • D. Platelets
Correct Answer: C

Rationale: The correct answer is C: Hgb (hemoglobin). Epoetin is a medication used to stimulate red blood cell production, which should increase hemoglobin levels. Higher hemoglobin levels indicate improved oxygen-carrying capacity and overall effectiveness of the therapy. PT (A), WBC (B), and Platelets (D) are not directly affected by epoetin therapy, so an increase in these values would not be indicative of the medication's effectiveness.

An older client asks the nurse why 'people my age' have weaker immune systems than younger people. What responses by the nurse are best? (Select all that apply.)

  • A. Bone marrow produces more blood cells as you age.'
  • B. You may have decreased levels of circulating platelets.'
  • C. You have lower levels of plasma proteins in the blood.'
  • D. Lymphocytes become more reactive to antigens.'
Correct Answer: C

Rationale: Rationale:
- As we age, there is a decrease in the production of plasma proteins, which are essential for immune function.
- Lower levels of plasma proteins can lead to a weaker immune response.
- This decline in plasma proteins can make older individuals more susceptible to infections.
- Choices A, B, and D are incorrect as they do not directly address the impact of aging on immune system function.

A nurse is caring for a client who has hemophilia A and is about to begin taking desmopressin to prevent bleeding. The nurse should monitor the client for which of the following adverse reactions?

  • A. Weight loss
  • B. Edema
  • C. Polyuria
  • D. Bradycardia
Correct Answer: B

Rationale: The correct answer is B: Edema. Desmopressin is a synthetic form of vasopressin that can cause fluid retention, leading to edema. This is a common adverse reaction associated with desmopressin use. Weight loss (choice A) is not a typical adverse reaction of desmopressin. Polyuria (choice C) is actually a desired effect of desmopressin, as it helps to concentrate urine. Bradycardia (choice D) is not directly associated with desmopressin use. Monitoring for edema is important to ensure the client's safety and adjust treatment as needed.

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