ATI Hematologic System

ATI Hematologic System Related

Review ATI Hematologic System related questions and content

You receive a phone call that a 3-year-old patient on long-term warfarin therapy for congenital heart disease has an international normalized ratio (INR) of 5.8. On further history, you learn the patient and several family members have had recent gastrointestinal illnesses, but the patient is recovering. His mother reports he is not experiencing bleeding symptoms. Which of the following interventions would be most reasonable in this clinical scenario?

  • A. Hold 1 to 2 doses of warfarin and recheck INR
  • B. Administer oral vitamin K therapy
  • C. Administer fresh frozen plasma (FFP)
  • D. Administer recombinant factor VIIa
Correct Answer: A

Rationale: The correct answer is A: Hold 1 to 2 doses of warfarin and recheck INR. In this scenario, the high INR indicates an increased risk of bleeding due to excess anticoagulation. However, since the patient is asymptomatic and the high INR is likely due to transient factors (gastrointestinal illness), the most appropriate initial step is to temporarily hold warfarin to allow the INR to normalize. Rechecking the INR after holding the doses will guide further management.

Choice B (Administer oral vitamin K therapy) is incorrect because the patient is not experiencing bleeding symptoms and oral vitamin K should be reserved for patients with active bleeding or high INR with bleeding symptoms. Choice C (Administer fresh frozen plasma) is inappropriate as the patient is not actively bleeding and FFP is typically reserved for acute bleeding situations. Choice D (Administer recombinant factor VIIa) is also incorrect as it is reserved for severe bleeding in patients on war

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A nursing student wants to know why clients with chronic obstructive pulmonary disease tend to be polycythemic. What response by the nurse instructor is best?

  • A. It is due to side effects of medications for bronchodilation.
  • B. It is from overactive bone marrow in response to chronic disease.
  • C. It combats the anemia caused by an increased metabolic rate.
  • D. It compensates for tissue hypoxia caused by lung disease.
Correct Answer: D

Rationale: The correct answer is D. In chronic obstructive pulmonary disease (COPD), the lungs are unable to efficiently exchange oxygen and carbon dioxide, leading to tissue hypoxia. The body compensates for this by producing more red blood cells (polycythemia) to increase oxygen-carrying capacity. This helps deliver more oxygen to tissues.

Choice A is incorrect because medications for bronchodilation do not directly cause polycythemia. Choice B is incorrect because overactive bone marrow is not the primary reason for polycythemia in COPD. Choice C is incorrect because polycythemia in COPD is not a response to combat anemia but rather to address tissue hypoxia.

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.

A nurse works in a gerontology clinic. What age-related change(s) related to the hematologic system will the nurse expect during health assessment? (Select all that apply.)

  • A. Dentition deteriorates with more cavities.
  • B. Nail are stron and smooth
  • C. Progressive loss or thinning of hair occurs.
  • D. Sclerae begin to turn yellow or pale.
Correct Answer: C

Rationale: Rationale:
C: Progressive loss or thinning of hair occurs in the geriatric population due to age-related changes in the hair follicles. As individuals age, the hair follicles shrink, leading to hair thinning or loss.
Incorrect Choices:
A: Dentition deteriorating with more cavities is related to oral health, not the hematologic system.
B: Strong and smooth nails are not directly related to age-related changes in the hematologic system.
D: Sclerae turning yellow or pale is indicative of potential liver dysfunction, not a direct age-related change in the hematologic system.

When reviewing the chemistry panel of a newly diagnosed patient with acute lymphoblastic leukemia who is lethargic, complaining of flank pain, and experiencing nausea and vomiting, which of the following would you expect to see?

  • A. Potassium 4.5 mmol/L, phosphorus 8 mg/dL, uric acid 7 mg/dL, calcium 9.0 mg/dL, BUN 12 mg/dL
  • B. Potassium 6.5 mmol/L, phosphorus 8 mg/dL, uric acid 9 mg/dL, calcium 10 mg/dL, BUN 14 mg/dL
  • C. Potassium 4 mmol/L, phosphorus 9 mg/dL, uric acid 10 mg/dL, calcium 10 mg/dL, BUN 10 mg/dL
  • D. Potassium 7 mmol/L, phosphorus 12 mg/dL, uric acid 10 mg/dL, calcium 7 mg/dL, BUN 25 mg/dL
Correct Answer: D

Rationale: Step-by-step rationale:
1. Lethargy, flank pain, nausea, vomiting in leukemia can suggest tumor lysis syndrome (TLS).
2. TLS can cause hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, and elevated BUN.
3. Choice D has the highest potassium, phosphorus, uric acid, and BUN levels, and the lowest calcium level.
4. Therefore, choice D is the most consistent with the expected lab findings in tumor lysis syndrome.

Summary:
- Choice A has normal potassium, phosphorus, uric acid, calcium levels, and lower BUN.
- Choice B has high potassium but normal phosphorus, uric acid, calcium, and slightly elevated BUN.
- Choice C has low potassium, normal phosphorus, and elevated uric acid, calcium, and BUN.
- Choice D aligns most closely with the expected lab findings in tumor lysis syndrome due to the pattern of

Which of the following anemia is associated with splenomegaly:

  • A. chronic renal failure
  • B. aplastic anemia
  • C. hereditary spherocytosis
  • D. sickle cell anaemia
Correct Answer: C

Rationale: Rationale: Hereditary spherocytosis is associated with splenomegaly due to the spleen's increased destruction of abnormal red blood cells. In this condition, red blood cells have a spherical shape, making them more prone to destruction by the spleen. Chronic renal failure (A) is not typically associated with splenomegaly. Aplastic anemia (B) is characterized by bone marrow failure and does not directly involve the spleen. Sickle cell anemia (D) leads to splenomegaly in children but not in adults due to splenic sequestration crises, making it less likely to be the correct choice.

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