Anatomy of Hematologic System

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A young child with consanguineous parents has developmental delay and a history of multiple recurrent bacterial infections and short stature. He presents to the emergency department following trauma and requires a blood transfusion. Blood work identifies leukocytosis, neutrophilia, and the Bombay blood group (absent H antigen as well as absent A and B antigens). What is this patient's diagnosis?

  • A. Chediak-Higashi syndrome
  • B. Leukocyte adhesion deficiency (LAD) Type II
  • C. CD18 deficiency
  • D. Griscelli syndrome
Correct Answer: B

Rationale: The correct answer is B: Leukocyte adhesion deficiency (LAD) Type II. This diagnosis is supported by the patient's history of recurrent bacterial infections, leukocytosis, neutrophilia, and the Bombay blood group. LAD Type II is characterized by a defect in the CD18 integrin molecules, leading to impaired leukocyte adhesion and migration to sites of infection. The Bombay blood group is due to the absence of H antigen, which is also seen in LAD Type II.

A: Chediak-Higashi syndrome is characterized by recurrent infections, albinism, and peripheral neuropathy, not leukocyte adhesion deficiency.
C: CD18 deficiency is actually another term for LAD Type I, not LAD Type II.
D: Griscelli syndrome presents with silvery hair and immunodeficiency, but does not involve leukocyte adhesion deficiency.

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Graft versus host disease is a complication of transfusion in patients of bone marrow transplantation. This can be best avoided by

  • A. Transfusion of packed cells
  • B. Irradiating the blood components before transfusion
  • C. Transfusing fresh whole blood
  • D. Replacement by crystalloids
Correct Answer: B

Rationale: The correct answer is B: Irradiating the blood components before transfusion. Graft versus host disease occurs when donor immune cells attack the recipient's tissues. Irradiating blood components helps to eliminate donor T cells, reducing the risk of this complication. Choice A (Transfusion of packed cells) does not address the issue of donor T cells. Choice C (Transfusing fresh whole blood) may actually increase the risk as it contains more viable donor immune cells. Choice D (Replacement by crystalloids) is not a suitable alternative for blood transfusion.

A patient with non-Hodgkin's lymphoma is receiving information from the oncology nurse. The patient asks the nurse why she should stop drinking and smoking and stay out of the sun. What would be the nurse's best response?

  • A. Everyone should do these things because they're health promotion activities that apply to everyone.
  • B. You don't want to develop a second cancer, do you?
  • C. You need to do this just to be on the safe side.
  • D. It's important to reduce other factors that increase the risk of second cancers.
Correct Answer: D

Rationale: The correct answer is D because reducing factors that increase the risk of second cancers is crucial for a patient with non-Hodgkin's lymphoma. Alcohol, smoking, and sun exposure are known risk factors for developing secondary cancers. By avoiding these behaviors, the patient can lower the chances of developing another cancer. Choice A is incorrect as it does not specifically address the patient's situation. Choice B uses fear tactics and may not be the most effective way to educate the patient. Choice C is vague and does not provide a clear rationale. Overall, choice D is the best response as it directly addresses the patient's concern and provides a logical explanation for the importance of changing these behaviors.

The nurse is documenting findings after completing data collection with a patient. What term should the nurse use to document a large area of discoloration from hemorrhage under the skin?

  • A. Pallor
  • B. Rubor
  • C. Petechiae
  • D. Ecchymosis
Correct Answer: D

Rationale: The correct term to document a large area of discoloration from hemorrhage under the skin is ecchymosis. Ecchymosis refers to a bruise caused by the extravasation of blood into the subcutaneous tissues. Pallor (A) is paleness, rubor (B) is redness, and petechiae (C) are tiny, pinpoint-sized red or purple spots on the skin due to bleeding. Ecchymosis is the most appropriate term for describing a large area of discoloration from hemorrhage under the skin as it specifically denotes a bruise resulting from blood leakage into tissues.

An infant is born with a 7 cm × 6 cm lesion over the upper extremity from the elbow to the shoulder. The lesion is indurated and purpuric, with some petechiae around the edges. No other areas of petechiae are noted on the skin. The infant is doing well without other systemic problems. i were 9 and 9. You are called by the pediatric nurse practitioner to the NICU. What is the most appropriate next step?

  • A. Do nothing because the infant is doing well and had good Apgars.
  • B. Obtain an ultrasound for more information about the lesion.
  • C. Obtain an MRI to assess the extent of the lesion.
  • D. Obtain labs, including a CBC with platelet count and fibrinogen.
Correct Answer: D

Rationale: The correct answer is D: Obtain labs, including a CBC with platelet count and fibrinogen. This is the most appropriate next step because the infant's presentation with an indurated and purpuric lesion raises concern for a possible bleeding disorder or coagulopathy. By obtaining labs, including a CBC with platelet count and fibrinogen, we can assess the infant's hemostatic profile and rule out any underlying hematologic abnormalities. This step is crucial in ensuring the infant's well-being and guiding further management if any abnormalities are detected.

Why the other choices are incorrect:
A: Doing nothing is not appropriate as the presentation warrants further investigation.
B: An ultrasound may not provide useful information in this scenario as the lesion is concerning for a systemic issue.
C: An MRI is not the initial diagnostic test of choice for evaluating a possible bleeding disorder or coagulopathy.

The nurse is assessing a client experiencing anemia. Which laboratory findings will the nurse expect for this client? (Select all that apply.)

  • A. Increased hematocrit
  • B. Decreased red blood cell count
  • C. Decreased serum iron
  • D. Decreased hemoglobin
Correct Answer: b

Rationale: Correct Answer: B - Decreased red blood cell count

Rationale:
1. Anemia is defined by a decrease in red blood cells, causing decreased oxygen-carrying capacity.
2. A decreased red blood cell count is a key indicator of anemia.
3. Other choices are incorrect:
A. Increased hematocrit is not expected in anemia, as it indicates a higher concentration of red blood cells.
C. Decreased serum iron may be seen in iron-deficiency anemia but is not a universal finding in all types of anemia.
D. Decreased hemoglobin is a common finding in anemia but is not as specific as a decreased red blood cell count.

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