Anatomy of Hematologic System

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A study is designed to investigate the rates of central line–associated blood stream infections (CLABSI) among pediatric hematology/oncology patients. Investigators wish to compare the length of stay (LOS) between subjects receiving three common central line types (totally implanted catheter [port], peripherally inserted central catheter [PICC], and tunneled externalized catheter [TEC]). It is discovered that LOS is not normally distributed. What is the appropriate test for comparing the LOS between patients receiving the three central line types?

  • A. Student's t test
  • B. ANOVA
  • C. Wilcoxon-Mann-Whitney test
  • D. Kruskal-Wallis test
Correct Answer: D

Rationale: The correct answer is D: Kruskal-Wallis test. Since the LOS data is not normally distributed, parametric tests like Student's t test and ANOVA are not appropriate. The Kruskal-Wallis test is a non-parametric test used to compare three or more independent groups when the data is not normally distributed. It ranks the LOS values across the three central line types and tests whether there are differences in medians. The Wilcoxon-Mann-Whitney test (choice C) is used for comparing two independent groups, not three. Therefore, it is not the appropriate test in this scenario.

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Hepato-splenomegaly with lymphadenopathy occur in all except:

  • A. ALL
  • B. lymphoma
  • C. CML
  • D. dissiminated TB
Correct Answer: C

Rationale: Step 1: Hepato-splenomegaly with lymphadenopathy is commonly seen in hematologic malignancies.
Step 2: Chronic Myeloid Leukemia (CML) primarily presents with splenomegaly, but not lymphadenopathy.
Step 3: Acute Lymphoblastic Leukemia (ALL), lymphoma, and disseminated TB can all present with these findings.
Step 4: Therefore, the correct answer is C - CML, as it does not typically present with lymphadenopathy. Other choices are incorrect as they can present with these symptoms.

A 60-year-old patient with chronic myeloid leukemia will be treated in the home setting and the nurse is preparing appropriate health education. What topic should the nurse emphasize?

  • A. The importance of adhering to the prescribed drug regimen
  • B. The need to ensure that vaccinations are up to date
  • C. The importance of daily physical activity
  • D. The need to avoid shellfish and raw foods
Correct Answer: A

Rationale: The correct answer is A: The importance of adhering to the prescribed drug regimen. This is crucial for managing chronic myeloid leukemia effectively. Non-adherence can lead to disease progression and treatment failure. Option B is important but not as critical as medication adherence. Option C is generally good for overall health but not specific to managing the disease. Option D is irrelevant to the management of chronic myeloid leukemia.

What is the nurse's priority when caring for a client who just completed a bone marrow aspiration and biopsy?

  • A. Teach the client to avoid activity for 24 to 48 hours to prevent infection.
  • B. Administer a nonsteroidal anti-inflammatory drug (NSAID) to promote comfort.
  • C. Check the pressure dressing frequently for signs of excessive or active bleeding.
  • D. Report the laboratory results to the primary health care provider.
Correct Answer: C

Rationale: The correct answer is C: Check the pressure dressing frequently for signs of excessive or active bleeding. This is the priority because post bone marrow aspiration and biopsy, there is a risk of bleeding due to the procedure. By checking the dressing, the nurse can assess for any signs of excessive bleeding or hematoma formation, which are crucial to prevent complications.

A: Teaching the client to avoid activity is important but not the priority immediately post-procedure.
B: Administering NSAIDs may not be appropriate as they can increase the risk of bleeding.
D: Reporting the lab results is important but not the priority over ensuring immediate post-procedure safety.

A patient shows prolonged prothrombin time and activated partial thromboplastin time. Blood test otherwise is normal. Which of the following is the most probably diagnosis for this patient's condition?

  • A. Hemophilia A
  • B. Thrombocytopenia
  • C. Von Willebrand factor disease
  • D. Vitamin K deficiency
Correct Answer: D

Rationale: The correct answer is D: Vitamin K deficiency. Prolonged prothrombin time and activated partial thromboplastin time indicate impaired blood clotting, which is a characteristic of Vitamin K deficiency. Vitamin K is essential for the synthesis of clotting factors II, VII, IX, and X. Hemophilia A (Choice A) is a genetic disorder resulting in a deficiency of clotting factor VIII, leading to prolonged activated partial thromboplastin time only. Thrombocytopenia (Choice B) is a condition characterized by low platelet count, which can lead to bleeding but does not affect clotting factors. Von Willebrand disease (Choice C) is a genetic disorder affecting von Willebrand factor and platelet function, not clotting factors.

A peripheral blood smear showing increase in numbers of neutrophils, band cells, basophils, eosinophils, and platelets is most suggestive

  • A. Acute myeloid leukemia
  • B. Acute lymphoid leukemia
  • C. Chronic myelocytic leukemia
  • D. Chronic lymphocytic leukemia
Correct Answer: C

Rationale: Rationale: A peripheral blood smear showing an increase in neutrophils, basophils, eosinophils, and platelets is indicative of Chronic Myelocytic Leukemia (CML). Neutrophils, basophils, and eosinophils are myeloid lineage cells typically elevated in CML. The presence of increased platelets is also common in CML due to the overproduction of cells in the bone marrow.

Summary of other choices:
A: Acute myeloid leukemia - Typically presents with a predominance of immature myeloid cells like blasts, rather than an increase in mature myeloid cells.
B: Acute lymphoid leukemia - Primarily involves lymphoid lineage cells, not myeloid cells as seen in the blood smear.
D: Chronic lymphocytic leukemia - Characterized by an increase in mature lymphocytes, not myeloid cells like neutrophils, basophils, and eosinophils.

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