ATI RN
ATI Hematologic System Quizlet Questions
Question 1 of 5
A 3-year-old boy is referred to you for evaluation of right leukocoria. Funduscopic examination under anesthesia reveals a large amelanotic mass occupying more than two-thirds of the vitreous space in his right eye, with massive retinal detachment, consistent with group E retinoblastoma. The left eye is normal. An MRI confirms the funduscopic findings and shows no extraocular disease. What is the most appropriate next step in the management of this child's disease?
Correct Answer: A
Rationale: The correct answer is A: Enucleation. In this case, the child has a group E retinoblastoma in the right eye, with massive retinal detachment. Enucleation, or surgical removal of the eye, is the most appropriate next step as the tumor is extensive and poses a risk of metastasis. Enucleation helps prevent spread of the cancer to other parts of the body and provides the best chance for cure. Systemic chemotherapy (B) and brachytherapy (C) are not ideal for such advanced cases due to the high risk of metastasis. Needle biopsy (D) is not recommended as the diagnosis is already confirmed by funduscopic examination and MRI.
Question 2 of 5
A 12-year-old patient with localized osteosarcoma is being treated with cisplatin, doxorubicin, and high-dose methotrexate. The pain at his primary site rapidly resolves after initiation of chemotherapy. After tumor resection, pathology reveals the tumor was greater than 95% necrotic. You want to continue cisplatin, doxorubicin, and high-dose methotrexate. Which of the following is the best answer regarding the evaluations that should be performed to monitor for toxicity in patients receiving cisplatin, doxorubicin, and high-dose methotrexate?
Correct Answer: C
Rationale: The correct answer is C: Complete blood count, creatinine, serum magnesium, audiogram, and echocardiogram. This choice includes essential monitoring tests for potential toxicities associated with cisplatin, doxorubicin, and high-dose methotrexate. Here's the rationale: 1. Complete blood count: To monitor for hematologic toxicities such as anemia, neutropenia, and thrombocytopenia. 2. Creatinine: To assess renal function, as cisplatin can cause nephrotoxicity. 3. Serum magnesium: Methotrexate can cause hypomagnesemia, necessitating monitoring. 4. Audiogram: Doxorubicin can lead to hearing loss, thus an audiogram is needed for early detection. 5. Echocardiogram: Doxorubicin can cause cardiotoxicity, so an echocardiogram helps in monitoring cardiac function. Each of the other choices lacks one or more essential monitoring tests
Question 3 of 5
Which of the following characteristics are similar with respect to Factor VIII and von Willebrand factor (vWF)?
Correct Answer: C
Rationale: Step-by-step rationale: 1. Factor VIII and vWF are present in normal to high relative amounts in newborns due to the physiological adaptation to the low levels at birth. 2. Both Factor VIII and vWF play crucial roles in the coagulation cascade, but their levels decrease after birth. 3. The other choices are incorrect because: - A: Factor VIII is primarily made in endothelial cells and vWF is made in endothelial cells and platelets, not megakaryocytes. - B: Thrombin activates Factor VIII but not vWF, which is activated by shear stress. - D: Factor VIII is stored in Weibel-Palade bodies, but vWF is stored in platelets and endothelial cells, not in the Weibel-Palade bodies.
Question 4 of 5
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?
Correct Answer: D
Rationale: The correct answer is D: DAT positive for C3. This finding suggests complement-mediated hemolysis, which is consistent with a transfusion reaction known as transfusion-related acute lung injury (TRALI). TRALI presents with respiratory distress, fever, and chills due to immune complexes activating the complement system. A: Spherocytes indicate hemolysis, which is not specific to TRALI. B: Gram-negative Bacillus suggests bacterial contamination, leading to sepsis, not TRALI. C: Bilateral pulmonary infiltrates are seen in transfusion-associated circulatory overload (TACO), not TRALI.
Question 5 of 5
The pathophysiology of venous thrombosis is often explained by Virchow's triad, which includes hypercoagulability, endothelial injury, and venous stasis. Based on Virchow's triad and your knowledge of risk factors for thrombosis, which of the following pediatric patients has the greatest risk of hospital-acquired venous thromboembolism?
Correct Answer: C
Rationale: The correct answer is C because the ex-28 week premature infant requiring NICU-level care for necrotizing enterocolitis has the greatest risk of hospital-acquired venous thromboembolism. Premature infants have inherent hypercoagulability due to immature coagulation factors and increased risk of endothelial injury from central lines or catheters. Necrotizing enterocolitis further increases the risk of venous stasis due to decreased gut perfusion. Choice A: The 3-day-old full-term infant admitted for hyperbilirubinemia is less likely to have significant risk factors for thrombosis compared to a premature infant with necrotizing enterocolitis. Choice B: The 6-month-old male admitted for respiratory syncytial virus is less likely to have prolonged immobilization or other significant risk factors compared to a premature infant in the NICU. Choice D: The 7-year-old male with acute lymphoblastic leukemia has a higher risk of thromb