ATI Hematologic System Quizlet

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You are consulted on a 4-year-old girl who is newly diagnosed with standard-risk pre-B acute lymphoblastic leukemia. After reviewing her previous complete blood examinations, you note she has had a platelet count ranging from 80,000 to 100,000 cells/mcL over the past 2 years. Her father mentions that he has also been told he has mild thrombocytopenia. You suspect the child may have a cancer predisposition syndrome. Which sample should you send for analysis, and which gene is most likely implicated?

  • A. Skin fibroblasts to evaluate the RUNX1 gene
  • B. Skin fibroblasts to evaluate the ETV6 gene
  • C. Buccal swab to evaluate the RUNX1 gene
  • D. Buccal swab to evaluate the ETV6 gene
Correct Answer: B

Rationale: The correct answer is B: Skin fibroblasts to evaluate the ETV6 gene. In this scenario, the presence of mild thrombocytopenia in both the father and the child raises suspicion of a genetic predisposition. ETV6 gene mutations are commonly associated with inherited thrombocytopenia and predisposition to leukemia. Skin fibroblasts are ideal for genetic testing due to their stable genetic material. Choice A is incorrect as RUNX1 gene mutations are linked to familial platelet disorder with predisposition to acute myeloid leukemia, not pre-B acute lymphoblastic leukemia. Choices C and D are incorrect as buccal swabs may not provide sufficient genetic material for comprehensive analysis.

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A patient reports severe abdominal cramping and diarrhea. Assessment reveals a temperature of 102°F (38.8°C) and pulse of 82 beats/min. Results of a complete blood count reveal lower than normal segmented and banded neutrophils and higher than normal lymphocytes. Which type of infection does the nurse suspect this patient is most likely experiencing?

  • A. Viral
  • B. Fungal
  • C. Parasitic
  • D. Bacterial
Correct Answer: A

Rationale: The correct answer is A: Viral. The patient's symptoms (abdominal cramping, diarrhea, fever) are consistent with a viral infection, such as gastroenteritis. The lower segmented and banded neutrophils indicate a viral infection, as viruses often target lymphocytes. The higher lymphocyte count is a characteristic response to viral infections. Other choices are incorrect as fungal, parasitic, and bacterial infections typically present with different symptoms and laboratory findings.

Heparin is an anticoagulant produced by the basophils. The most likely mechanism heparin prevents blood clotting is by

  • A. Inhibiting the formation of vitamin K-dependent clotting factors
  • B. Preventing the activation of platelets
  • C. Preventing the aggregation of platelets
  • D. Binding to antithrombin III to inactivate thrombin
Correct Answer: D

Rationale: The correct answer is D because heparin binds to antithrombin III, enhancing its ability to inactivate thrombin. This prevents the conversion of fibrinogen to fibrin, thereby inhibiting blood clot formation. Choices A and B are incorrect because heparin does not affect vitamin K-dependent clotting factors or platelet activation. Choice C is incorrect because heparin does not directly prevent platelet aggregation.

A patient with a diagnosis of acute myeloid leukemia (AML) is being treated with induction therapy on the oncology unit. What nursing action should be prioritized in the patient's care plan?

  • A. Protective isolation and vigilant use of standard precautions
  • B. Provision of a high-calorie, low-texture diet and appropriate oral hygiene
  • C. Including the family in planning the patient's activities of daily living
  • D. Monitoring and treating the patient's pain
Correct Answer: A

Rationale: The correct answer is A: Protective isolation and vigilant use of standard precautions. This is the priority because patients with AML are at high risk for infections due to compromised immune systems. Isolation and strict infection control measures help prevent exposure to pathogens. B is incorrect as the main priority is infection prevention, not diet. C is incorrect as involving the family is important but not the priority. D is incorrect as pain monitoring is important but not the priority in this case.

NADPH is a product of the hexose monophosphate pathway (HMP) in the red blood cell. The NADPH is used for the

  • A. Synthesis of fatty acids
  • B. Reduction of glutathione
  • C. Formation of ATP
  • D. Removal of oxygen radicals
Correct Answer: B

Rationale: The correct answer is B: Reduction of glutathione. In the HMP pathway, glucose-6-phosphate is converted to ribulose-5-phosphate, generating NADPH. NADPH is essential for the reduction of glutathione, which helps in detoxifying reactive oxygen species and protecting red blood cells from oxidative damage. Fatty acid synthesis (choice A) primarily requires NADPH from the pentose phosphate pathway. ATP formation (choice C) is not a direct function of NADPH production in the HMP pathway. NADPH is not directly involved in the removal of oxygen radicals (choice D), as it is the reduced form of NADP+ that participates in antioxidant defense mechanisms.

A 10-year-old patient with aplastic anemia, who is blood type B negative, is receiving a red blood cell transfusion. About 10 minutes after the transfusion starts, the patient develops anxiety and lower back pain. The transfusion continues for another 5 minutes until it is stopped when he develops a temperature of 40 °C with chills and rigors. A transfusion reaction work-up is most likely to reveal what findings?

  • A. Spherocytes on peripheral blood smear
  • B. Gram-negative Bacillus on gram stain of remaining RBC unit
  • C. Chest x-ray with bilateral pulmonary infiltrates that are new compared to an x-ray done last week
  • D. DAT positive for C3
Correct Answer: D

Rationale: The correct answer is D because in this scenario, the patient is experiencing symptoms of a transfusion reaction, likely a hemolytic transfusion reaction due to ABO incompatibility. The presence of a positive Direct Antiglobulin Test (DAT) for C3 indicates complement activation, supporting the diagnosis.

Choice A (Spherocytes on peripheral blood smear) is incorrect as spherocytes are seen in autoimmune hemolytic anemia, not typically in transfusion reactions.

Choice B (Gram-negative Bacillus on gram stain of remaining RBC unit) is unlikely as the symptoms are more indicative of a hemolytic reaction rather than an infection.

Choice C (Chest x-ray with bilateral pulmonary infiltrates) is suggestive of transfusion-related acute lung injury (TRALI), but the symptoms described in the question (fever, chills, rigors) are more indicative of a hemolytic reaction rather than TRALI.

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