The Hematologic System ATI

The Hematologic System ATI Related

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An 18-year old male patient with acute lymphoblastic leukemia recently started maintenance therapy and is complaining of increased hip pain. The pain increases during weight-bearing activity; however, it occasionally hurts at night as well. His CBCd is normal. Which of the following risk factors is most commonly associated with this process?

  • A. Younger age at diagnosis
  • B. Non-White race
  • C. Low body-mass index
  • D. Dexamethasone exposure
Correct Answer: D

Rationale: The correct answer is D: Dexamethasone exposure. Dexamethasone is a corticosteroid commonly used in the treatment of acute lymphoblastic leukemia. It can cause avascular necrosis of the hip due to its effect on bone metabolism, leading to increased hip pain during weight-bearing activities. This is a known side effect seen more commonly in patients exposed to dexamethasone.

Incorrect Choices:
A: Younger age at diagnosis - Age is not a known risk factor for avascular necrosis in this context.
B: Non-White race - Race is not a known risk factor for avascular necrosis in this context.
C: Low body-mass index - Body mass index is not a known risk factor for avascular necrosis in this context.

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The nurse is assisting with the collection of data from a patient with a hematologic disorder. On which body system should the nurse expect to focus when collecting this data?

  • A. Respiratory
  • B. Genitourinary
  • C. Cardiovascular
  • D. All body systems
Correct Answer: D

Rationale: The correct answer is D because hematologic disorders affect all body systems due to their impact on blood production, clotting, and oxygen transport. The nurse needs to assess respiratory system for oxygenation, genitourinary system for kidney function, cardiovascular system for circulation, and other systems for secondary effects. Choices A, B, and C are incorrect as they focus on specific systems, while hematologic disorders can impact multiple systems. It is important to consider the interconnectedness of the body and assess all systems comprehensively.

The nurse is concerned that a patient is demonstrating signs of red blood cell production. What laboratory value did the nurse most likely use to make this decision?

  • A. Iron
  • B. Bilirubin
  • C. Thrombin
  • D. Intrinsic factor
Correct Answer: B

Rationale: The correct answer is B: Bilirubin. Elevated levels of bilirubin can indicate increased red blood cell breakdown or hemolysis, prompting the body to produce more red blood cells to compensate for the loss. Iron (A) is involved in red blood cell production but is not a direct indicator. Thrombin (C) is a clotting factor, not related to red blood cell production. Intrinsic factor (D) is necessary for vitamin B12 absorption, not directly linked to red blood cell production. Therefore, Bilirubin is the most likely laboratory value used to indicate increased red blood cell production.

You are seeing a 12-year-old female who presented to the emergency department with the sudden onset of severe abdominal pain. Imaging that was obtained to rule out appendicitis revealed a mass adjacent to the bladder. The mass was surgically resected, and pathology demonstrated a paraganglioma. Which of the studies below would be most useful to determine disease stage for this patient?

  • A. Bone Scan
  • B. Lumbar puncture for cerebrospinal fluid cytology
  • C. Bone marrow aspirate and biopsy
  • D. Ga 68-DOTATATE PET/CT
Correct Answer: D

Rationale: The correct answer is D: Ga 68-DOTATATE PET/CT. Paragangliomas are neuroendocrine tumors that can secrete catecholamines and have a high expression of somatostatin receptors. Ga 68-DOTATATE PET/CT is the most appropriate imaging study to determine disease stage in patients with paragangliomas because it can detect the somatostatin receptor expression in these tumors, aiding in localization, staging, and treatment planning.

A: Bone scan is not the most useful study for determining disease stage in paraganglioma.
B: Lumbar puncture for cerebrospinal fluid cytology is not relevant for staging paraganglioma.
C: Bone marrow aspirate and biopsy are not the most appropriate studies for staging paraganglioma.

Incorrect about pernicious an:

  • A. hyperchlorhydria
  • B. premature graying of hair
  • C. anti intrinsic factor antibody in 60% of pts.
  • D. gastric polyp may occur
Correct Answer: A

Rationale: The correct answer is A: hyperchlorhydria. Pernicious anemia is characterized by vitamin B12 deficiency due to impaired absorption, not excess stomach acid. Premature graying of hair is unrelated. Presence of anti-intrinsic factor antibody and risk of gastric polyps are associated with pernicious anemia, but not hyperchlorhydria. Therefore, choice A is the correct answer as it does not align with the typical symptoms and characteristics of pernicious anemia.

A 19-year-old freshman in college presents with 'lumps' on the right side of his neck and in the right axilla. He had a fever to 39 °C 1 day in the past week. On physical exam, there are firm anterior cervical and axillary nodes, all greater than 2 cm in diameter. A chest x-ray shows a large mediastinal mass. A biopsy of the axillary node reveals classic Hodgkin lymphoma. Which of the following symptoms revealed during the history is a B symptom?

  • A. Fever to 39 °C
  • B. 10% weight loss in past 6 months
  • C. Fatigue
  • D. Alcohol-induced pain
Correct Answer: B

Rationale: The correct answer is B. In Hodgkin lymphoma, B symptoms are systemic symptoms associated with poor prognosis. Weight loss of ≥10% in the past 6 months is a B symptom. This indicates a more aggressive disease. Fever (choice A) is a general symptom. Fatigue (choice C) is common but nonspecific. Alcohol-induced pain (choice D) is not a recognized B symptom in Hodgkin lymphoma. Weight loss is a key indicator of disease severity and is classified as a B symptom.

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