ATI Hematologic System

ATI Hematologic System Related

Review ATI Hematologic System related questions and content

You have a new 7-year-old female patient with a WBC count of 6,000/mm3, hemoglobin of 7.2 g/dL, and platelet count of 30,000/mm3. A bone marrow aspirate reveals 14% blasts with a monocytic morphologic appearance that are surface marker positive for CD33. You receive a call from the fluorescence in situ hybridization (FISH) lab that the bone marrow is positive for KMT2A rearrangement in 68% of cells. Your staff asks whether this represents a diagnosis of acute leukemia in the current classification scheme for this type of hematologic malignancy. What would you say?

  • A. No, because for a diagnosis of acute leukemia you must have 30% or more blasts in the marrow.
  • B. No, because for a diagnosis of acute leukemia you must have 20% or more blasts in the marrow.
  • C. No, because the cytogenetics do not include +21, monosomy 7, or trisomy 8.
  • D. Yes, because the FISH is positive for KMT2A rearrangement.
Correct Answer: D

Rationale: The correct answer is D: Yes, because the FISH is positive for KMT2A rearrangement. The presence of KMT2A rearrangement in 68% of cells indicates a specific genetic abnormality associated with acute leukemia. This abnormality is a known marker for acute myeloid leukemia (AML) with recurrent genetic abnormalities. The percentage of blasts in the bone marrow (14%) may not meet the traditional criteria for a diagnosis of acute leukemia based on blast percentage alone, but the presence of KMT2A rearrangement overrides this requirement in this case. Choices A and B are incorrect because blast percentage alone is not the sole determinant of a diagnosis of acute leukemia when specific genetic abnormalities are present. Choice C is incorrect because while the absence of specific cytogenetic abnormalities may be relevant for some cases, the presence of KMT2A rearrangement is sufficient to support a diagnosis of acute leukemia in this context.

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A 12-year-old girl presents to your clinic with significant menstrual bleeding at the onset of menarche and is noted to have a hemoglobin of 9.9, although she is not symptomatic from her anemia. Her mother reports that she has a history of epistaxis when she was a child with some episodes lasting 30 minutes and that she also has heavy menstrual bleeding. Which of the following tests will lead to the most likely diagnosis?

  • A. Factor XI level
  • B. Factor X level
  • C. Factor XIII level
  • D. Ristoectin cofactor activity
Correct Answer: D

Rationale: The correct answer is D: Ristoectin cofactor activity. This patient's history of significant menstrual bleeding, epistaxis, and low hemoglobin suggests a congenital bleeding disorder. Ristoectin cofactor activity is a test for von Willebrand disease (VWD), a common inherited bleeding disorder characterized by a deficiency or dysfunction of von Willebrand factor. VWD typically presents with mucocutaneous bleeding, such as epistaxis and menorrhagia.

Choice A: Factor XI level is not the most likely diagnosis as Factor XI deficiency (Hemophilia C) typically presents with bleeding after surgery or trauma, not mucocutaneous bleeding.

Choice B: Factor X level is not the most likely diagnosis as Factor X deficiency presents with bleeding that is more severe and can cause hemarthrosis, not typically seen in this patient.

Choice C: Factor XIII level is not the most likely diagnosis as Factor XIII deficiency leads to delayed wound healing and poor clot formation,

An adult patient has presented to the health clinic with a complaint of a firm, painless cervical lymph node. The patient denies any recent infectious diseases. What is the nurse's most appropriate response to the patient's complaint?

  • A. Call 911.
  • B. Promptly refer the patient for medical assessment.
  • C. Facilitate a radiograph of the patient's neck and have the results forwarded to the patient's primary care provider.
  • D. Encourage the patient to track the size of the lymph node and seek care in 1 week.
Correct Answer: B

Rationale: The correct answer is B: Promptly refer the patient for medical assessment. A firm, painless cervical lymph node in an adult without recent infectious diseases raises concerns for potential underlying serious conditions such as malignancy. Referring the patient for medical assessment allows for further evaluation, including physical examination, laboratory tests, and imaging studies if necessary, to determine the cause of the lymphadenopathy. This prompt referral is crucial for timely diagnosis and appropriate management.

Summary:
A: Calling 911 is not warranted as the patient is stable and does not have an emergency medical condition.
C: Facilitating a radiograph may not provide sufficient information for evaluating the lymph node and delays definitive assessment.
D: Encouraging the patient to wait and track the lymph node size can lead to delayed diagnosis and potentially worsening of the underlying condition.

A nurse should identify that clopidogrel is contraindicated for clients who have which of the following conditions?

  • A. Myocardial infarction
  • B. Peptic ulcer disease
  • C. Pancreatitis
  • D. Myasthenia gravis
Correct Answer: B

Rationale: Clopidogrel is an antiplatelet medication that can increase the risk of bleeding. Patients with peptic ulcer disease are at a higher risk of gastrointestinal bleeding, so clopidogrel is contraindicated. Myocardial infarction, pancreatitis, and myasthenia gravis are not contraindications for clopidogrel use.

The nurse is explaining the role of red blood cells with oxygen transport in the body with a nursing student. Which term should the nurse use to describe hemoglobin that has given up its oxygen to the body's cells?

  • A. Reduced
  • B. Detached
  • C. Oxyhemoglobin
  • D. Hypoxyhemoglobin
Correct Answer: A

Rationale: The correct term to describe hemoglobin that has given up its oxygen to the body's cells is "Reduced." When hemoglobin releases oxygen to the body's cells, it becomes deoxygenated or reduced hemoglobin. This term accurately reflects the chemical state of the hemoglobin molecule after oxygen release.

Summary of other choices:
- B: "Detached" does not accurately describe the process of oxygen release by hemoglobin.
- C: "Oxyhemoglobin" refers to hemoglobin bound to oxygen, not after it has given up oxygen.
- D: "Hypoxyhemoglobin" refers to hemoglobin with low oxygen levels, not after it has given up oxygen.

A nurse is monitoring a client who is undergoing anticoagulant therapy with heparin. Which of the following findings should the nurse identify as a possible indication of hemorrhage?

  • A. Rapid pulse
  • B. Yellowing of the sclera
  • C. Elevated blood pressure
  • D. Pale-colored stools
Correct Answer: A

Rationale: The correct answer is A: Rapid pulse. Hemorrhage is a potential complication of anticoagulant therapy with heparin due to the increased risk of bleeding. A rapid pulse can indicate hypovolemia from blood loss, a common sign of hemorrhage. Yellowing of the sclera (choice B) is a sign of jaundice, not directly related to hemorrhage. Elevated blood pressure (choice C) is not typically associated with hemorrhage. Pale-colored stools (choice D) can be indicative of liver or gallbladder issues, but not specifically hemorrhage. Overall, a rapid pulse is the most relevant finding to indicate possible hemorrhage in a client on heparin therapy.

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