The Hematologic System ATI

The Hematologic System ATI Related

Review The Hematologic System ATI related questions and content

A nurse is caring for a patient who is being treated for leukemia in the hospital. The patient was able to maintain her nutritional status for the first few weeks following her diagnosis but is now exhibiting early signs and symptoms of malnutrition. In collaboration with the dietitian, the nurse should implement what intervention?

  • A. Arrange for total parenteral nutrition (TPN).
  • B. Facilitate placement of a percutaneous endoscopic gastrostomy (PEG) tube.
  • C. Provide the patient with several small, soft-textured meals each day.
  • D. Assign responsibility for the patient's nutrition to the patient's friends and family.
Correct Answer: C

Rationale: The correct answer is C: Provide the patient with several small, soft-textured meals each day. This intervention is appropriate for the patient showing early signs of malnutrition as it aims to increase the patient's nutrient intake in a manageable way. Small, soft-textured meals are easier for the patient to consume and digest, promoting better absorption of nutrients. This approach also aligns with the principle of promoting oral intake whenever possible before resorting to more invasive measures like TPN or PEG tube placement.

Incorrect choices:
A: Total parenteral nutrition (TPN) is typically reserved for patients who cannot tolerate oral feeding at all or have significant malabsorption issues.
B: Percutaneous endoscopic gastrostomy (PEG) tube placement is usually considered if the patient cannot meet their nutritional needs orally in the long term.
D: Assigning responsibility for the patient's nutrition to friends and family is not a sustainable or appropriate solution for addressing malnutrition in a hospitalized patient.

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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 a patient with severe factor XI deficiency, administering fresh frozen plasma can increase factor XI levels and help reduce the risk of perioperative bleeding. The dose of 20 mL/kg is appropriate for this patient's weight of 62 kg. Cryoprecipitate (choice A) may contain factor XI but is not the optimal choice for raising factor XI levels specifically. Factor XI concentrate (choice B) would be ideal but is not commonly available, making fresh frozen plasma a more practical option. Prothrombin complex concentrate (choice D) primarily contains factors II, VII, IX, and X, but not factor XI, so it would not effectively raise factor XI levels in this patient.

Diagnostic testing has resulted in a diagnosis of acute myeloid leukemia (AML) in an adult patient who is otherwise healthy. The patient and the care team have collaborated and the patient will soon begin induction therapy. The nurse should prepare the patient for which of the following?

  • A. Daily treatment with targeted treatment medications
  • B. Radiation therapy on a daily basis
  • C. Hematopoietic stem cell transplantation
  • D. An aggressive course of chemotherapy
Correct Answer: D

Rationale: The correct answer is D: An aggressive course of chemotherapy. In the treatment of AML, induction therapy typically involves a combination of chemotherapy drugs to achieve remission. Chemotherapy targets rapidly dividing cancer cells in the bone marrow. This approach aims to eradicate leukemic cells and allow normal blood cell production to resume. Daily treatment with targeted medications (choice A) is not typically the first-line approach for AML. Radiation therapy (choice B) is not commonly used in the induction phase of AML treatment. Hematopoietic stem cell transplantation (choice C) is a treatment option for certain cases of AML but is usually considered after achieving remission with chemotherapy. Therefore, the most appropriate preparation for the patient in this scenario is to expect an aggressive course of chemotherapy to begin induction therapy.

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 once a mosquito vector, usually Aedes aegypti, is infected with the dengue virus, it remains infective for life. This is due to the virus establishing a lifelong infection in the mosquito's salivary glands.

A: Incorrect. Dengue is caused by an RNA virus, specifically the flavivirus.
C: Incorrect. Aedes mosquitoes prefer clean, stagnant water for breeding, not polluted water.
D: Incorrect. Joint symptoms are common in both dengue fever and chikungunya, but usually more severe in chikungunya.

You are seeing a 12-year-old female who presented to the emergency department with the sudden onset of severe abdominal pain. Imaging that was obtained to rule out appendicitis revealed a mass adjacent to the bladder. The mass was surgically resected, and pathology demonstrated a paraganglioma. Which of the studies below would be most useful to determine disease stage for this patient?

  • A. Bone Scan
  • B. Lumbar puncture for cerebrospinal fluid cytology
  • C. Bone marrow aspirate and biopsy
  • D. Ga 68-DOTATATE PET/CT
Correct Answer: D

Rationale: The correct answer is D: Ga 68-DOTATATE PET/CT. Paragangliomas are neuroendocrine tumors that can secrete catecholamines and have a high expression of somatostatin receptors. Ga 68-DOTATATE PET/CT is the most appropriate imaging study to determine disease stage in patients with paragangliomas because it can detect the somatostatin receptor expression in these tumors, aiding in localization, staging, and treatment planning.

A: Bone scan is not the most useful study for determining disease stage in paraganglioma.
B: Lumbar puncture for cerebrospinal fluid cytology is not relevant for staging paraganglioma.
C: Bone marrow aspirate and biopsy are not the most appropriate studies for staging paraganglioma.

Peripheral bl. Picture is most useful in:

  • A. NHL
  • B. multiple myeloma
  • C. myelodysplastic syndrome
  • D. CML
Correct Answer: D

Rationale: The correct answer is D: CML. Peripheral blood picture is most useful in CML because it typically shows increased white blood cell count with left shift, basophilia, and presence of the Philadelphia chromosome. In contrast, A (NHL) primarily involves lymph nodes, B (multiple myeloma) shows monoclonal protein in serum/bone marrow, and C (myelodysplastic syndrome) presents with cytopenias and dysplastic changes in blood cells. Therefore, based on the specific findings seen in CML on peripheral blood, it is the most appropriate choice.

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