The Hematologic System ATI

The Hematologic System ATI Related

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An 18-year old male patient presents with bruising, fatigue, and diffuse extremity pain. He is noted to be tachypneic and hypoxic and has a diffuse interstitial infiltrate on chest x-ray. CBC reveals a WBC count of 285,000/mm3 (85% myeloblasts, with monocytic morphology), hemoglobin of 7.9 g/dL, and platelet count of 36,000/mm3. What is the most likely cause of the infiltrate and respiratory symptoms and the most appropriate initial treatment?

  • A. Hyperleukocytosis; initiation of induction chemotherapy
  • B. Hyperleukocytosis; leukapheresis or manual exchange transfusion and initiation of induction chemotherapy
  • C. COVID-19 infection; convalescent plasma and prednisone
  • D. Pneumococcal pneumonia; vancomycin
Correct Answer: B

Rationale: The correct answer is B. The patient's presentation with tachypnea, hypoxia, and diffuse interstitial infiltrate on chest x-ray suggests leukostasis syndrome due to hyperleukocytosis. The extremely high WBC count of 285,000/mm3 with myeloblasts indicates acute myeloid leukemia. Leukapheresis or manual exchange transfusion is needed to rapidly reduce the number of leukemic blasts in circulation to prevent complications like tissue hypoxia. Initiation of induction chemotherapy is essential for long-term management of AML.

Choice A is incorrect because induction chemotherapy alone may not rapidly reduce the WBC count in cases of leukostasis. Choice C is incorrect as the patient's clinical scenario is not consistent with COVID-19 infection, and convalescent plasma is not indicated for leukostasis. Choice D is incorrect as the patient's symptoms are not typical for pneumococcal pneumonia, and vancomycin is not the initial

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A patient who is suspected of having acute viral hemorrhagic fever reveals history of tick bite. Which of the following is the most possible causative agent?

  • A. Hantavirus
  • B. Rift Valley virus
  • C. Crimean Congo virus
  • D. Marburg virus
Correct Answer: C

Rationale: The correct answer is C: Crimean Congo virus. This is because Crimean Congo virus is a tick-borne virus known to cause acute viral hemorrhagic fever. Tick bite history increases suspicion for this virus. A: Hantavirus is transmitted through rodent feces and urine. B: Rift Valley virus is transmitted through mosquito bites. D: Marburg virus is transmitted through contact with infected animals.

A nurse is administering epoetin intravenously to a client who has renal failure. Which of the following actions should the nurse take?

  • A. Shake the vial before using.
  • B. Administer via IV bolus over 1 to 3 min.
  • C. Dilute the drug first with D5W.
  • D. Save the used vial for the next dose.
Correct Answer: B

Rationale: The correct answer is B: Administer via IV bolus over 1 to 3 min. This route and method of administration is appropriate for epoetin to ensure proper absorption and effect. Shaking the vial (A) can denature the drug. Diluting with D5W (C) is not recommended as it may alter the drug's effectiveness. Saving the used vial for the next dose (D) is unsafe and violates infection control practices.

A nurse is caring for a client who is about to begin therapy with recombinant factor IX to treat hemophilia B. The client asks the nurse about the risk of disease transmission with recombinant factor IX as compared with plasma derived factor IX. The nurse should explain that the recombinant factor IX practically eliminates the risk for which of the following?

  • A. HIV
  • B. Cytomegalovirus
  • C. Creutzfeldt-Jakob disease
  • D. Anaphylaxis
Correct Answer: C

Rationale: Rationale: The correct answer is C: Creutzfeldt-Jakob disease (CJD). Recombinant factor IX is produced synthetically in a laboratory, eliminating the risk of transmitting prion diseases like CJD. Plasma-derived products, on the other hand, carry a theoretical risk of transmitting CJD due to potential contamination. HIV and cytomegalovirus can be transmitted through blood products, but both plasma-derived and recombinant factor IX are rigorously tested for these viruses. Anaphylaxis is a potential risk with any factor IX product, regardless of the source. Therefore, the nurse should explain to the client that recombinant factor IX practically eliminates the risk of CJD transmission compared to plasma-derived factor IX.

The International Normalized Ratio (INR) was developed for the purpose of

  • A. Monitoring heparin therapy
  • B. Monitoring oral anticoagulant therapy
  • C. Screening for intrinsic clotting system abnormalities
  • D. Standardizing the monitoring of warfarin therapy
Correct Answer: D

Rationale: The correct answer is D because the International Normalized Ratio (INR) was specifically developed to standardize the monitoring of warfarin therapy. INR allows for consistent interpretation of prothrombin time results across different laboratories, ensuring accurate dosing of warfarin. Choice A is incorrect because heparin therapy is typically monitored using activated partial thromboplastin time (aPTT). Choice B is incorrect as INR, not aPTT, is used for monitoring oral anticoagulant therapy such as warfarin. Choice C is incorrect as INR is not used for screening clotting system abnormalities, but rather for monitoring anticoagulant therapy.

Plat. Transfusion is not indicated in:

  • A. aplastic an.
  • B. uraemia with bleeding
  • C. DIC
  • D. immunogenic thrombocytopenia
Correct Answer: D

Rationale: Plat. transfusion is not indicated in immunogenic thrombocytopenia (ITP) because it is an autoimmune disorder where the body destroys its own platelets. Transfusing platelets won't solve the underlying issue of platelet destruction. In aplastic anemia (A), platelet transfusion can help due to low platelet production. In uremia with bleeding (B) and DIC (C), platelet transfusion is necessary to manage bleeding due to decreased platelet function or consumption.

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