ATI RN
ASCP Hematology Questions Questions
Question 1 of 5
Which of the following tests measures the step from fibrinogen to fibrin conversion?
Correct Answer: D
Rationale: Thrombin time (D) directly assesses fibrinogen to fibrin conversion.
Question 2 of 5
A 6-year- old boy presented three hours after receiving blood transfusion with urticaria, pruritus, maculopapular rash, progressively developed facial edema, and respiratory distress. Of the following, the MOST likely diagnosis is
Correct Answer: C
Rationale: Allergic reaction (C) fits urticaria, edema, and respiratory distress post-transfusion.
Question 3 of 5
A 22-year-old man is admitted to the hospital for an elective cholecystectomy. You are asked to see him because he had anemia on preoperative testing. He tells you that he has always been told by his physicians that he has mild anemia; his medical history is otherwise unremarkable. His vital signs are normal. His conjunctivae are mildly icteric, and the spleen is palpable in the left upper quadrant. Findings on the remainder of the physical examination are normal. Diagnostic testing results are shown in Table 9.Q3. Which of the following tests would most likely help confirm the diagnosis?
Correct Answer: B
Rationale: Lifelong mild anemia, icterus, splenomegaly, microspherocytes, and elevated reticulocytes (4%) suggest hereditary spherocytosis, confirmed by osmotic fragility test showing membrane defect. Hemoglobin electrophoresis (A) diagnoses hemoglobinopathies, not spherocytosis. Coombs tests (C) identify autoimmune hemolysis, unlikely given chronicity. Bone marrow biopsy (D) is unnecessary with adequate reticulocyte response.
Question 4 of 5
A 62-year-old man underwent right total knee replacement 8 days ago. Swelling has developed in his right lower extremity, and Doppler ultrasonography confirms the presence of a right superficial femoral vein thrombosis. His current medications include oxycodone and subcutaneous unfractionated heparin. Results of preoperative tests, including a complete blood cell count and liver and kidney function, were normal. Other laboratory data include the following: hemoglobin 12.2 g/dL, leukocyte count 8.5 × 10^9/L, and platelet count 60 × 10^9/L. In addition to stopping the use of subcutaneous heparin, what is the next most appropriate step in management of this patient?
Correct Answer: C
Rationale: Postoperative DVT and thrombocytopenia (platelet count 60 × 10^9/L) 8 days after heparin suggest heparin-induced thrombocytopenia (HIT) type II. Stopping heparin and starting a direct thrombin inhibitor (e.g., argatroban) is appropriate. Other heparins (A, B) are contraindicated. Aspirin (D) is insufficient for HIT-related thrombosis.
Question 5 of 5
A 72-year-old man with chronic atrial fibrillation has been receiving dabigatran 75 mg twice daily for the past 6 months. He has not had any thrombotic or hemorrhagic complications. He has a history of colon polyps, for which he needs to undergo a colonoscopy with possible polypectomy. Apart from an irregular pulse, his physical examination findings are normal. Results were normal for a complete blood cell count and tests of renal and liver function. The calculated creatinine clearance is 28 mL/min. For how long should dabigatran use be discontinued before the colonoscopy?
Correct Answer: D
Rationale: Dabigatran’s prolonged half-life with creatinine clearance <30 mL/min requires discontinuation 3 days before procedures with bleeding risk (e.g., polypectomy), balancing thrombosis and hemorrhage risks. Shorter times (B, C) or none (A) risk bleeding; 7 days (E) is excessive.