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. This non-parametric test is used to compare the medians of three or more independent groups when the data is not normally distributed, as in this case with LOS. It is an extension of the Wilcoxon-Mann-Whitney test, which compares two groups. The Kruskal-Wallis test assesses whether the medians of the groups are equal or different by ranking all observations, calculating the sum of ranks for each group, and then comparing these sums. It is appropriate here because it allows for comparison of central line types without assuming normality. The other choices (A: Student's t test and B: ANOVA) require the data to be normally distributed, which is not the case in this scenario. Choice C: Wilcoxon-Mann-Whitney test is for comparing two groups, not three or more.

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Koilonychias is a specific feature of

  • A. Hemolytic anemia
  • B. Sickle cell disease
  • C. Thalassemia major
  • D. Iron deficiency anemia
Correct Answer: D

Rationale: Step-by-step rationale for why D is correct:
1. Koilonychias is characterized by spoon-shaped nails, a common symptom of iron deficiency anemia due to decreased hemoglobin levels.
2. Iron is essential for normal nail growth, and its deficiency can lead to changes in nail shape.
3. Hemolytic anemia (A) is characterized by the premature destruction of red blood cells, not typically associated with koilonychias.
4. Sickle cell disease (B) causes abnormal hemoglobin, leading to sickle-shaped red blood cells, not related to koilonychias.
5. Thalassemia major (C) is a genetic disorder affecting hemoglobin production, but it does not directly cause koilonychias.

The nurse is reviewing the parts of the complete blood count and differential with a patient. Where should the nurse state that neutrophils, eosinophils, and basophils are produced?

  • A. Spleen
  • B. Thymus
  • C. Lymph nodes
  • D. Red bone marrow
Correct Answer: D

Rationale: The correct answer is D: Red bone marrow. Neutrophils, eosinophils, and basophils are all types of white blood cells that are produced in the red bone marrow through a process called hematopoiesis. The red bone marrow is a primary site for the production of blood cells, including these specific types of white blood cells. Neutrophils are important for fighting bacterial infections, eosinophils are involved in allergic reactions and parasitic infections, and basophils play a role in allergic responses. Therefore, it is crucial for the nurse to inform the patient that these cells are produced in the red bone marrow. The other choices (A: Spleen, B: Thymus, C: Lymph nodes) are incorrect as these organs do not play a primary role in the production of these specific types of white blood cells.

A 4-year-old girl with a history of recurrent epistaxis and easy bruising is referred to you for evaluation. She is found to have a prolonged PTT and a factor VIII level that is less than 1%. Both parents have a history of excessive bleeding. She is admitted with a severe episode of epistaxis, and your colleague orders 40 IU/kg of recombinant factor VIII. Her epistaxis resolves initially but within an hour starts again at the same severity as before. What is the best next step?

  • A. Infuse a von Willebrand factor concentrate.
  • B. Give another dose of recombinant factor VIII concentrate.
  • C. Call otorhinolaryngology to pack her nose.
  • D. Check for a factor VIII inhibitor.
Correct Answer: A

Rationale: The correct answer is A: Infuse a von Willebrand factor concentrate. In this case, the 4-year-old girl with a factor VIII deficiency did not respond to recombinant factor VIII, suggesting a possible von Willebrand disease (vWD) as well. Infusing von Willebrand factor concentrate can help address the underlying vWD component, which is necessary for adequate hemostasis. Option B is incorrect because giving another dose of recombinant factor VIII won't address the potential vWD deficiency. Option C is not the best next step as packing the nose does not address the underlying bleeding disorder. Option D is not the immediate next step as checking for a factor VIII inhibitor is important but can be done after addressing the acute bleeding episode with appropriate therapy.

A nurse is reviewing the medication record of a client who is receiving alteplase following an acute myocardial infarction (MI). Which of the following medications should the nurse expect the client to be taking in addition to the alteplase?

  • A. Protamine
  • B. Desmopressin
  • C. Ferrous sulfate
  • D. Heparin
Correct Answer: D

Rationale: The correct answer is D: Heparin. Following an acute MI, a client receiving alteplase may also be prescribed heparin to prevent re-thrombosis and further clot formation. Alteplase is a thrombolytic agent that works by breaking down clots, while heparin is an anticoagulant that helps prevent new clots from forming. Protamine (choice A) is used to reverse the effects of heparin, not typically administered alongside alteplase. Desmopressin (choice B) is used for conditions like diabetes insipidus, unrelated to MI treatment. Ferrous sulfate (choice C) is an iron supplement, not indicated in this scenario.

The nurse is assisting with the preparation of a blood transfusion for a patient. Which type of fluid should the nurse select to transfuse with the blood?

  • A. 0.9% normal saline
  • B. Dextrose 5% and water
  • C. Dextrose 5% and 0.9% normal saline
  • D. Dextrose 5% and 0.45% normal saline
Correct Answer: A

Rationale: The correct answer is A: 0.9% normal saline. When preparing a blood transfusion, it is essential to select a compatible fluid that will not cause hemolysis of the red blood cells. Normal saline is isotonic and compatible with blood, making it the ideal choice. Dextrose solutions can cause hemolysis and should not be used for blood transfusions. Choice B and C contain dextrose, which is not suitable for blood transfusions. Choice D contains a lower concentration of normal saline, which may not be as effective in maintaining the osmotic balance of the blood cells. Therefore, selecting 0.9% normal saline ensures the safety and integrity of the transfused blood.

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