ATI RN
Hematological System Questions
Question 1 of 5
A 7-year-old Hispanic male is referred to the hematology consult service by his pediatrician because of concern for hemoglobinopathy. In his records, you find a hemoglobin electrophoresis performed last year which shows hemoglobin A 78% and hemoglobin F 22%. His complete blood count is normal, and he has normal growth and development. Which of the following is true for this patient?
Correct Answer: D
Rationale: The correct answer is D: Hereditary persistence of fetal hemoglobin results in pancellular hemoglobin F distribution. In this case, the patient's elevated hemoglobin F level (22%) is indicative of hereditary persistence of fetal hemoglobin. This condition is characterized by the continued presence of fetal hemoglobin into adulthood, leading to a pancellular distribution of hemoglobin F. This explains the high hemoglobin F percentage despite the patient's age. Choice A is incorrect because the elevated hemoglobin F level is not normal in a 7-year-old child. Choice B is incorrect because delta-beta thalassemia typically presents with a different hemoglobin electrophoresis pattern. Choice C is incorrect because delta-beta thalassemia can indeed cause microcytosis due to ineffective erythropoiesis.
Question 2 of 5
A healthy 17-year-old African American male presents with a thrombosis of the right upper extremity. His past medical history is remarkable only for sickle cell trait. The history is negative for recent risk factors for thrombosis (illness, surgery, immobility). He is the pitcher for his high school baseball team. Imaging confirms anatomical compression/narrowing of the right subclavian vein. Which of the following interventions is most likely to decrease this patient's long-term risk of recurrent thrombosis?
Correct Answer: D
Rationale: The correct answer is D: Resection of right first rib. The patient's presentation with thrombosis of the right upper extremity, anatomical compression/narrowing of the right subclavian vein, and being a high school baseball pitcher suggests Paget-Schroetter syndrome (effort thrombosis). The first rib can compress the subclavian vein in people with certain anatomical variations, leading to thrombosis. Resection of the right first rib (first rib resection) is the definitive treatment for this condition, as it removes the mechanical compression, reducing the risk of recurrent thrombosis. A: Systemic thrombolysis involves using medications to dissolve blood clots throughout the body and is not the first-line treatment for Paget-Schroetter syndrome. B: Catheter-directed thrombolysis is not indicated for anatomical compression/narrowing as seen in this patient. C: Extended anticoagulation with LMWH does not address the underlying mechanical
Question 3 of 5
Iron-refractory iron deficiency anemia (IRIDA) is a rare inherited condition characterized by congenital iron deficiency anemia, poor response to oral iron, and partial but incomplete response to intravenous iron therapy. Which is the genetic mutation associated with IRIDA?
Correct Answer: C
Rationale: Correct Answer: C (TMPRSS6) Rationale: 1. TMPRSS6 gene encodes matriptase-2, a negative regulator of hepcidin, which controls iron absorption. 2. Mutations in TMPRSS6 lead to elevated hepcidin levels, causing iron-refractory iron deficiency anemia. 3. TFR2, H63D, and EPOR are not directly involved in hepcidin regulation or iron absorption. Summary: A (TFR2), B (H63D), and D (EPOR) are not associated with the pathophysiology of IRIDA, which is primarily linked to mutations in the TMPRSS6 gene affecting hepcidin regulation and iron absorption.
Question 4 of 5
The nurse is assessing an older client for any potential hematologic health problem. Which assessment finding is the most significant and would be reported to the primary health care provider?
Correct Answer: B
Rationale: The correct answer is B, multiple petechiae and large bruises. This finding is indicative of potential hematologic health problems such as thrombocytopenia or clotting disorders, which can be serious and require immediate medical attention. Petechiae are small, pinpoint hemorrhages under the skin, and large bruises suggest abnormal bleeding. Poor skin turgor (choice A) is more indicative of dehydration. Dry, flaky skin (choice C) may be related to skin conditions or inadequate hydration. Decreased body hair distribution (choice D) could be related to hormonal imbalances or aging, but it is not as concerning as signs of abnormal bleeding.
Question 5 of 5
A client is having a bone marrow aspiration and biopsy and is extremely anxious. What action by the nurse is the most appropriate?
Correct Answer: A
Rationale: The correct answer is A because assessing the client's fears and coping mechanisms allows the nurse to provide individualized support and interventions to address the client's anxiety effectively. By understanding the client's specific concerns, the nurse can provide tailored information, emotional support, and coping strategies to help the client feel more comfortable during the procedure. Option B is incorrect as simply reassuring the client may not address the underlying anxieties and fears. Option C is inappropriate as sedation should only be used if absolutely necessary and after other non-pharmacological interventions have been exhausted. Option D is incorrect because bone marrow aspiration and biopsy are typically performed with local anesthesia, so the client will not be asleep during the procedure.