The Hematologic System ATI

The Hematologic System ATI Related

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Diagnostic testing has resulted in a diagnosis of acute myeloid leukemia (AML) in an adult patient who is otherwise healthy. The patient and the care team have collaborated and the patient will soon begin induction therapy. The nurse should prepare the patient for which of the following?

  • A. Daily treatment with targeted treatment medications
  • B. Radiation therapy on a daily basis
  • C. Hematopoietic stem cell transplantation
  • D. An aggressive course of chemotherapy
Correct Answer: D

Rationale: The correct answer is D: An aggressive course of chemotherapy. In the treatment of AML, induction therapy typically involves a combination of chemotherapy drugs to achieve remission. Chemotherapy targets rapidly dividing cancer cells in the bone marrow. This approach aims to eradicate leukemic cells and allow normal blood cell production to resume. Daily treatment with targeted medications (choice A) is not typically the first-line approach for AML. Radiation therapy (choice B) is not commonly used in the induction phase of AML treatment. Hematopoietic stem cell transplantation (choice C) is a treatment option for certain cases of AML but is usually considered after achieving remission with chemotherapy. Therefore, the most appropriate preparation for the patient in this scenario is to expect an aggressive course of chemotherapy to begin induction therapy.

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A patient has an altered level of T and B cells. The nurse realizes that these cells are members of which cell type?

  • A. Platelets
  • B. Eosinophils
  • C. Lymphocytes
  • D. Red blood cells
Correct Answer: C

Rationale: The correct answer is C: Lymphocytes. T and B cells are types of lymphocytes, a crucial component of the immune system responsible for fighting infections. T cells regulate immune responses, while B cells produce antibodies. Platelets (A), eosinophils (B), and red blood cells (D) are not involved in immune responses and do not possess the functions of T and B cells. Platelets are involved in blood clotting, eosinophils are a type of white blood cell involved in allergic reactions, and red blood cells are responsible for oxygen transport.

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.

A 50-year-old male who had frequent infections of his upper respiratory tract manifested with subcutaneous petechiae over his arms and legs. Investigations revealed low hemoglobin and a dry tap marrow. The most likely condition the patient is suffering from

  • A. Iron deficiency anemia
  • B. Megaloblastic anemia
  • C. Hemolytic anemia
  • D. Aplastic anemia
Correct Answer: D

Rationale: The correct answer is D: Aplastic anemia. This condition is characterized by pancytopenia, which includes low hemoglobin (anemia), low platelets (manifested as petechiae), and low white blood cells (frequent infections). Dry tap marrow is a classic finding in aplastic anemia due to bone marrow failure. Iron deficiency anemia (choice A) typically presents with microcytic hypochromic anemia without pancytopenia. Megaloblastic anemia (choice B) is characterized by macrocytic anemia with hypersegmented neutrophils and is usually caused by deficiencies in vitamin B12 or folate. Hemolytic anemia (choice C) presents with anemia due to increased destruction of red blood cells, which does not explain the low platelets and white blood cells seen in this patient.

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 the most likely causative agent of acute viral hemorrhagic fever following a tick bite due to its association with tick transmission. Crimean Congo virus is a tick-borne virus that causes severe hemorrhagic fever in humans. The other options, Hantavirus, Rift Valley virus, and Marburg virus, are not typically transmitted by ticks. Hantavirus is spread through rodent feces, Rift Valley virus is transmitted by mosquitoes, and Marburg virus is transmitted through direct contact with infected animals or their bodily fluids. Therefore, based on the history of tick bite, Crimean Congo virus is the most probable causative agent.

You are consulting on a 10-year-old male with severe persistent neutropenia, a history of recurrent infections, and warts. The rest of the peripheral blood count is normal. His mother also has neutropenia. Bone marrow examination shows a hypercellular marrow and retained myeloid cells with vacuolated cytoplasm. There are no abnormalities in the red cells or platelet precursors. Cytogenetics are 46XY. You start granulocyte colony stimulating factor therapy and the neutrophil count increases. A mutation in which of the following genes is most likely to have caused this familial inherited bone marrow failure syndrome?

  • A. CXCR4
  • B. ELANE
  • C. GATA 2
  • D. Mitochondrial DNA
Correct Answer: A

Rationale: The correct answer is A: CXCR4. In this case, the patient presents with severe neutropenia, recurrent infections, and warts, suggestive of WHIM syndrome, where CXCR4 mutations are often involved. CXCR4 plays a crucial role in immune cell trafficking and retention in the bone marrow. The hypercellular marrow and vacuolated myeloid cells are consistent with WHIM syndrome. The absence of abnormalities in red cells or platelet precursors rules out other syndromes. Mutations in ELANE are commonly associated with congenital neutropenia, not familial inherited bone marrow failure syndromes. GATA2 mutations are linked to familial myelodysplastic syndromes, not typically presenting with neutropenia and warts. Mitochondrial DNA mutations are more related to mitochondrial disorders, which usually manifest with multi-system involvement, not specific to bone marrow failure syndromes.

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