A 12-year-old girl presents to your clinic with significant menstrual bleeding at the onset of menarche and is noted to have a hemoglobin of 9.9, although she is not symptomatic from her anemia. Her mother reports that she has a history of epistaxis when she was a child with some episodes lasting 30 minutes and that she also has heavy menstrual bleeding. Which of the following tests will lead to the most likely diagnosis?

Correct Answer: D

Rationale: The correct answer is D: Ristoectin cofactor activity. The scenario describes a young girl with significant menstrual bleeding and a history of prolonged epistaxis, suggesting a bleeding disorder. Given the clinical presentation, the most likely diagnosis is von Willebrand disease (vWD), the most common inherited bleeding disorder. Ristocetin cofactor activity is a specific test for vWD, as it assesses the ability of von Willebrand factor to bind to platelets in the presence of ristocetin. Factors XI, X, and XIII are not typically associated with vWD, making choices A, B, and C incorrect. Testing for Factor VIII/von Willebrand factor antigen levels and vWF multimer analysis may also be considered to confirm the diagnosis.

Correct Answer: A

Rationale: Rationale: 1. Hemoglobin (Hgb) reflects the oxygen-carrying capacity of red blood cells. 2. Severe dietary iron deficiency causes low Hgb levels. 3. Adequate iron treatment should lead to increased Hgb levels. 4. MCV and other parameters may take longer to normalize. Summary: B, C, and D are incorrect because MCV and red cell distribution width may take longer to normalize, and peripheral blood smear changes may persist even after Hgb has returned to normal.

Correct Answer: D

Rationale: The correct answer is D: Yes, because the FISH is positive for KMT2A rearrangement. The presence of KMT2A rearrangement in 68% of cells indicates a specific genetic abnormality associated with acute leukemia. This abnormality is a known marker for acute myeloid leukemia (AML) with recurrent genetic abnormalities. The percentage of blasts in the bone marrow (14%) may not meet the traditional criteria for a diagnosis of acute leukemia based on blast percentage alone, but the presence of KMT2A rearrangement overrides this requirement in this case. Choices A and B are incorrect because blast percentage alone is not the sole determinant of a diagnosis of acute leukemia when specific genetic abnormalities are present. Choice C is incorrect because while the absence of specific cytogenetic abnormalities may be relevant for some cases, the presence of KMT2A rearrangement is sufficient to support a diagnosis of acute leukemia in this context.

Correct Answer: C

Rationale: The correct answer is C because a prothrombin time (PT) of 28 seconds indicates potential issues with blood clotting and can be a sign of bleeding disorders or liver dysfunction, requiring immediate assessment and intervention to prevent complications. Choice A (INR of 2.8) is within the therapeutic range for clients on anticoagulant therapy, so it's not an immediate concern. Choice B (platelet count of 128,000/mm3) is low but not critically low, so it doesn't require immediate assessment. Choice D (red blood cell count of 5.1 million/mcl) is within the normal range and doesn't indicate urgent issues. In summary, the nurse should assess the client with a PT of 28 seconds first due to the potential risk of bleeding or clotting disorders, while the other choices are not as urgent.

Correct Answer: C

Rationale: Rationale: Correct Answer (C): Progressive loss or thinning of hair is an age-related change in the hematologic system due to decreased blood flow to hair follicles. This is commonly observed in the elderly population. Incorrect Choices: A: Dentition deteriorates with more cavities is related to dental health, not the hematologic system. B: Nails being strong and smooth are related to nail health, not the hematologic system. D: Sclerae turning yellow or pale is a sign of jaundice, which is related to liver function, not the hematologic system.