ATI Hematologic System Quizlet

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A nurse is preparing to administer a prescribed dose of desmopressin to a client who has hemophilia A. The client's laboratory results indicate that the client has a sodium level of 130 mEq/L. Which of the following actions should the nurse take?

  • A. Clarify the prescription with the provider.
  • B. Administer the drug with an analgesic.
  • C. Administer the required dose orally.
  • D. Assess factor IX levels.
Correct Answer: A

Rationale: The correct answer is A: Clarify the prescription with the provider. Desmopressin is contraindicated in clients with low sodium levels due to the risk of hyponatremia. By having a sodium level of 130 mEq/L, the client is at risk for further lowering of sodium levels if desmopressin is administered. Therefore, the nurse should clarify the prescription with the provider to ensure the safety of the client.

B: Administer the drug with an analgesic - Irrelevant and not related to the administration of desmopressin in a client with hemophilia A and low sodium levels.

C: Administer the required dose orally - The route of administration does not address the concern of potential hyponatremia with desmopressin.

D: Assess factor IX levels - While important in managing hemophilia A, assessing factor IX levels does not address the immediate concern of potential harm from desmopressin administration in a

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Your patient with relapsed high-risk neuroblastoma returns to your care after travelling to an outside institution for [131]I-MIBG therapy. In the weeks following [131]I-MIBG therapy, what adverse events directly attributable to this therapy will the patient most likely encounter?

  • A. Myelosuppression requiring growth factor and blood product support
  • B. Severe mucositis
  • C. Hemorrhagic cystitis
  • D. Symptomatic hypothyroidism
Correct Answer: A

Rationale: The correct answer is A: Myelosuppression requiring growth factor and blood product support.

Rationale:
1. [131]I-MIBG therapy targets neuroblastoma cells but can also affect bone marrow, leading to myelosuppression.
2. Myelosuppression can result in low blood cell counts, necessitating growth factors and blood product support.
3. Severe mucositis (B) is not a common adverse event of [131]I-MIBG therapy.
4. Hemorrhagic cystitis (C) is more commonly associated with certain chemotherapies, not [131]I-MIBG.
5. Symptomatic hypothyroidism (D) is a potential long-term side effect, not an immediate consequence following [131]I-MIBG therapy.

The nurse is reviewing laboratory results and notes an aPTT level of 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication?

  • A. Aspirin
  • B. Heparin
  • C. Warfarin
  • D. Erythropoietin
Correct Answer: B

Rationale: The correct answer is B: Heparin. An aPTT level of 28 seconds is below the therapeutic range for heparin, indicating a subtherapeutic dose. The nurse should notify the healthcare provider to adjust the heparin dosage to achieve the desired anticoagulant effect. Aspirin (choice A) does not affect aPTT levels. Warfarin (choice C) affects PT/INR, not aPTT. Erythropoietin (choice D) is not related to aPTT levels.

A 6-year-old boy is noted to have worsening visual acuity on serial eye exams. Recent MRI of his brain and orbits reveals an optic chiasm mass, most consistent with an optic pathway glioma. Upon further examination, the physician notes axillary freckling and numerous “spots” on the patient's skin. This patient most likely has a which of the following genetic disorders?

  • A. Neurofibromatosis type-1 (NF1)
  • B. Li Fraumeni syndrome
  • C. Tuberous sclerosis
  • D. Cystic Fibrosis
Correct Answer: A

Rationale: The correct answer is A: Neurofibromatosis type-1 (NF1). This is because the patient presents with optic pathway glioma, axillary freckling, and numerous skin spots, which are classic features of NF1. NF1 is associated with multiple neurocutaneous manifestations, including café-au-lait spots, neurofibromas, and optic pathway gliomas. Li Fraumeni syndrome (B) is a cancer predisposition syndrome characterized by a high risk of developing various cancers, not typically associated with optic pathway gliomas or skin manifestations. Tuberous sclerosis (C) presents with features like facial angiofibromas, cortical tubers, and cardiac rhabdomyomas, not axillary freckling or optic pathway gliomas. Cystic Fibrosis (D) is a genetic disorder affecting the lungs and digestive system, not associated with the symptoms described in the patient.

A 3-year-old boy is referred to you for evaluation of right leukocoria. Funduscopic examination under anesthesia reveals a large amelanotic mass occupying more than two-thirds of the vitreous space in his right eye, with massive retinal detachment, consistent with group E retinoblastoma. The left eye is normal. An MRI confirms the funduscopic findings and shows no extraocular disease. What is the most appropriate next step in the management of this child's disease?

  • A. Enucleation
  • B. Systemic chemotherapy
  • C. Brachytherapy
  • D. Needle biopsy
Correct Answer: A

Rationale: The correct answer is A: Enucleation. In this case, the child has a group E retinoblastoma in the right eye, with massive retinal detachment. Enucleation, or surgical removal of the eye, is the most appropriate next step as the tumor is extensive and poses a risk of metastasis. Enucleation helps prevent spread of the cancer to other parts of the body and provides the best chance for cure. Systemic chemotherapy (B) and brachytherapy (C) are not ideal for such advanced cases due to the high risk of metastasis. Needle biopsy (D) is not recommended as the diagnosis is already confirmed by funduscopic examination and MRI.

Splenectomy is contraindicated in:

  • A. pyruvate kinase def.
  • B. ITP
  • C. BM failure
  • D. angiogenic myeloid metaplasia
Correct Answer: C

Rationale: Splenectomy is contraindicated in bone marrow (BM) failure because the spleen plays a crucial role in hematopoiesis and immune function. Removing the spleen can worsen BM failure by disrupting hematopoiesis and exacerbating the existing condition. In pyruvate kinase deficiency, splenectomy can improve symptoms by reducing hemolysis. In immune thrombocytopenic purpura (ITP), splenectomy may be considered as a treatment option to increase platelet count. Angiogenic myeloid metaplasia does not have a direct contraindication for splenectomy, as the primary concern is the underlying disease pathology, not the surgical intervention.

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