ATI RN
ATI Hematologic System Quizlet Questions
Question 1 of 5
Your patient with relapsed high-risk neuroblastoma returns to your care after travelling to an outside institution for [131]I-MIBG therapy. In the weeks following [131]I-MIBG therapy, what adverse events directly attributable to this therapy will the patient most likely encounter?
Correct Answer: A
Rationale: Rationale for Correct Answer (A): Myelosuppression requiring growth factor and blood product support is the most likely adverse event following [131]I-MIBG therapy due to its impact on bone marrow. The therapy targets neuroblastoma cells, but can also affect normal bone marrow function, leading to myelosuppression. Growth factors and blood products are often needed to support hematopoiesis. Summary of Incorrect Answers: B: Severe mucositis: Not a common adverse event associated with [131]I-MIBG therapy, as it primarily affects the bone marrow. C: Hemorrhagic cystitis: Not directly related to [131]I-MIBG therapy, which does not typically cause bladder toxicity. D: Symptomatic hypothyroidism: While [131]I-MIBG therapy can affect thyroid function, symptomatic hypothyroidism is not the most likely adverse event following this therapy.
Question 2 of 5
Which of the following characteristics are similar with respect to Factor VIII and von Willebrand factor (vWF)?
Correct Answer: C
Rationale: Rationale: - Factor VIII and vWF are present in normal to high amounts in newborns due to the physiological immaturity of the hemostatic system. - Choice A is incorrect as vWF is mainly produced in endothelial cells while Factor VIII is produced in both endothelial cells and liver. - Choice B is incorrect as Factor VIII is activated by thrombin, but vWF is not. - Choice D is incorrect as vWF is stored in Weibel-Palade bodies, but Factor VIII is not.
Question 3 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 because in this scenario, the patient is experiencing symptoms of a transfusion reaction, likely a hemolytic transfusion reaction due to ABO incompatibility. The presence of a positive Direct Antiglobulin Test (DAT) for C3 indicates complement activation, supporting the diagnosis. Choice A (Spherocytes on peripheral blood smear) is incorrect as spherocytes are seen in autoimmune hemolytic anemia, not typically in transfusion reactions. Choice B (Gram-negative Bacillus on gram stain of remaining RBC unit) is unlikely as the symptoms are more indicative of a hemolytic reaction rather than an infection. Choice C (Chest x-ray with bilateral pulmonary infiltrates) is suggestive of transfusion-related acute lung injury (TRALI), but the symptoms described in the question (fever, chills, rigors) are more indicative of a hemolytic reaction rather than TRALI.
Question 4 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 are at higher risk due to their immature coagulation system and prolonged immobility. Necrotizing enterocolitis further increases the risk due to inflammation and endothelial injury. Hypercoagulability is common in premature infants. Choices A, B, and D have lower risk as they do not have the same combination of risk factors as the premature infant in choice C.
Question 5 of 5
You are treating a patient with localized osteosarcoma of the distal femur with methotrexate, doxorubicin, and cisplatin (MAP) chemotherapy. At week 10 of treatment, the patient undergoes complete resection of the tumor. Pathology demonstrates 40% necrosis. Which of the following represents the most appropriate further therapy?
Correct Answer: D
Rationale: Rationale: The correct answer is D, continuing with MAP chemotherapy. The 40% necrosis rate indicates a good response to the current regimen. Continuing MAP ensures completion of the planned therapy and maximizes the benefit of the initial treatment's response. Choice A (Ifosfamide and etoposide) and B (MAPIE) are not indicated as the response to MAP was favorable. Choice C (Gemcitabine docetaxel) is not the standard of care for osteosarcoma. Continuing with MAP is the most appropriate option for this patient.