ATI Hematologic System

ATI Hematologic System Related

Review ATI Hematologic System related questions and content

Assuming that adherence has been excellent, which of the following should have returned to normal 6 weeks following appropriate oral iron treatment for a child with severe dietary iron deficiency (hemoglobin [Hgb] 5.0 g/dL and mean corpuscular volume [MCV] 48 fL at the beginning of therapy)?

  • A. Hgb concentration
  • B. MCV
  • C. Red cell distribution width
  • D. Peripheral blood smear
Correct Answer: A

Rationale: Rationale for Correct Answer (A): Hgb concentration reflects the amount of hemoglobin in the blood, which is directly affected by iron levels. After 6 weeks of appropriate oral iron treatment, the child's severe iron deficiency should have improved, leading to an increase in Hgb concentration back to normal levels.

Explanation of Incorrect Choices:
B: MCV measures the size of red blood cells, which is affected by iron deficiency anemia. However, it may take longer than 6 weeks for MCV to return to normal.
C: Red cell distribution width indicates the variation in red blood cell sizes and is not directly related to iron levels. It may not necessarily return to normal within 6 weeks.
D: Peripheral blood smear provides information on the morphology of red blood cells but does not directly reflect iron levels. It may not show significant changes within 6 weeks of iron treatment.

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A 15-year-old female presents with 1 month of fatigue and 3 days of chest pain and shortness of breath. Her physical exam is unremarkable. A chest x-ray shows a large mediastinal mass that is greater than 33% of the diameter of her chest cavity. A biopsy shows nodular sclerosing, classic Hodgkin lymphoma (cHL). Metastatic workup at diagnosis, including CT scan of neck, chest, abdomen, and pelvis and PET scan, shows no other site of disease. According to the Ann Arbor staging system, the patient has which stage of cHL?

  • A. Stage I
  • B. Stage II
  • C. Stage III
  • D. Stage IV
Correct Answer: A

Rationale: The correct answer is A: Stage I. In the Ann Arbor staging system for Hodgkin lymphoma, Stage I indicates involvement of a single lymph node region or a single extralymphatic organ or site. In this case, the patient's disease is limited to the mediastinum without involvement of other lymph nodes or organs. The large mediastinal mass is considered as a single site of disease. The absence of disease involvement in other areas based on the metastatic workup supports the classification as Stage I. The other choices (B, C, D) are incorrect because they represent more extensive disease involving multiple lymph node regions or extralymphatic organs, which is not the case in this patient.

After seven days of treatment with sulfonamides, a patient's hemoglobin had decreased from 14.7 gm/100ml to 10gm/100ml. The most likely cause of hemolysis in this patient is

  • A. Sickle cell disease
  • B. Thalassemia minor
  • C. Hereditary spherocytosis
  • D. Glucose 6-phosphate dehydrogenase deficiency (G6PD)
Correct Answer: D

Rationale: The correct answer is D: Glucose 6-phosphate dehydrogenase deficiency (G6PD). Sulfonamides can trigger hemolysis in patients with G6PD deficiency due to oxidative stress on red blood cells. G6PD enzyme deficiency impairs the ability of red blood cells to combat oxidative damage, leading to hemolysis. In this case, the patient's hemoglobin decreased significantly after sulfonamide treatment, indicating red blood cell destruction. The other choices (A: Sickle cell disease, B: Thalassemia minor, C: Hereditary spherocytosis) are not directly associated with sulfonamide-induced hemolysis and would not explain the observed decrease in hemoglobin levels after treatment.

A female patient's hematocrit level is 50% and oxygen saturation is 98% on room air. What should the nurse suspect as being the cause for this patient's hematocrit level?

  • A. Dehydration
  • B. Chronic renal failure
  • C. Bone marrow suppression
  • D. Bleeding esophageal varices
Correct Answer: A

Rationale: The correct answer is A: Dehydration. Dehydration can lead to hemoconcentration, resulting in an elevated hematocrit level. When a person is dehydrated, the plasma volume decreases, causing an increase in the proportion of red blood cells in the blood, leading to a higher hematocrit level. In this case, the patient's high hematocrit level of 50% is likely due to dehydration rather than the other options. Oxygen saturation being 98% on room air indicates adequate oxygenation, ruling out chronic renal failure, bone marrow suppression, and bleeding esophageal varices as potential causes for the high hematocrit level in this patient.

An older adult patient is undergoing diagnostic testing for chronic lymphocytic leukemia (CLL). What assessment finding is certain to be present if the patient has CLL?

  • A. Increased numbers of blast cells
  • B. Increased lymphocyte levels
  • C. Intractable bone pain
  • D. Thrombocytopenia with no evidence of bleeding
Correct Answer: B

Rationale: Step-by-step rationale:
1. CLL is characterized by the proliferation of abnormal lymphocytes.
2. Increased lymphocyte levels are a hallmark of CLL due to the accumulation of these abnormal cells.
3. Lymphocytosis is a key diagnostic feature in CLL.
4. Other choices are incorrect because blast cells are characteristic of acute leukemia, bone pain is more common in multiple myeloma, and thrombocytopenia with no bleeding is not a specific finding in CLL.

Summary: Increased lymphocyte levels are certain to be present in a patient with CLL due to the abnormal proliferation of lymphocytes. Other choices are incorrect as they do not align with the characteristic features of CLL.

A nurse is caring for four clients. After reviewing today's laboratory results, which client would the nurse assess first?

  • A. Client with an international normalized ratio of 2.8
  • B. Client with a platelet count of 128,000/mm3 (128 x 109/L).
  • C. Client with a prothrombin time (PT) of 28 seconds
  • D. Client with a red blood cell count of 5.1 million/mcl. (5.1 x 1012/L)
Correct Answer: C

Rationale: The correct answer is C: Client with a prothrombin time (PT) of 28 seconds. A PT measures the time it takes for blood to clot, indicating the client's clotting ability. A PT of 28 seconds is prolonged, suggesting a potential bleeding risk. This client should be assessed first to prevent any complications related to inadequate clotting.

A: Client with an international normalized ratio of 2.8 - Although an elevated INR indicates a risk of bleeding, it is not as time-sensitive as a prolonged PT.
B: Client with a platelet count of 128,000/mm3 - While low platelets can lead to bleeding, a prolonged PT is more critical for immediate assessment.
D: Client with a red blood cell count of 5.1 million/mcl - This value is within normal range and does not indicate an urgent issue related to clotting.

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