ATI RN
ATI Hematologic System Questions
Question 1 of 5
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. This patient's history of significant menstrual bleeding, epistaxis, and low hemoglobin suggests a congenital bleeding disorder. Ristoectin cofactor activity is a test for von Willebrand disease (VWD), a common inherited bleeding disorder characterized by a deficiency or dysfunction of von Willebrand factor. VWD typically presents with mucocutaneous bleeding, such as epistaxis and menorrhagia. Choice A: Factor XI level is not the most likely diagnosis as Factor XI deficiency (Hemophilia C) typically presents with bleeding after surgery or trauma, not mucocutaneous bleeding. Choice B: Factor X level is not the most likely diagnosis as Factor X deficiency presents with bleeding that is more severe and can cause hemarthrosis, not typically seen in this patient. Choice C: Factor XIII level is not the most likely diagnosis as Factor XIII deficiency leads to delayed wound healing and poor clot formation,
Question 2 of 5
Assuming that adherence has been excellent, which of the following should have returned to normal 6 weeks following appropriate oral iron treatment for a child with severe dietary iron deficiency (hemoglobin [Hgb] 5.0 g/dL and mean corpuscular volume [MCV] 48 fL at the beginning of therapy)?
Correct Answer: A
Rationale: Rationale for Correct Answer (A): Hgb concentration reflects the amount of hemoglobin in the blood, which is directly affected by iron levels. After 6 weeks of appropriate oral iron treatment, the child's severe iron deficiency should have improved, leading to an increase in Hgb concentration back to normal levels. Explanation of Incorrect Choices: B: MCV measures the size of red blood cells, which is affected by iron deficiency anemia. However, it may take longer than 6 weeks for MCV to return to normal. C: Red cell distribution width indicates the variation in red blood cell sizes and is not directly related to iron levels. It may not necessarily return to normal within 6 weeks. D: Peripheral blood smear provides information on the morphology of red blood cells but does not directly reflect iron levels. It may not show significant changes within 6 weeks of iron treatment.
Question 3 of 5
You have a new 7-year-old female patient with a WBC count of 6,000/mm3, hemoglobin of 7.2 g/dL, and platelet count of 30,000/mm3. A bone marrow aspirate reveals 14% blasts with a monocytic morphologic appearance that are surface marker positive for CD33. You receive a call from the fluorescence in situ hybridization (FISH) lab that the bone marrow is positive for KMT2A rearrangement in 68% of cells. Your staff asks whether this represents a diagnosis of acute leukemia in the current classification scheme for this type of hematologic malignancy. What would you say?
Correct Answer: D
Rationale: The correct answer is D: Yes, because the FISH is positive for KMT2A rearrangement. Rationale: 1. KMT2A rearrangement is a genetic abnormality commonly associated with acute leukemia. 2. Presence of blasts (14%) with monocytic appearance and positive for CD33 also supports the diagnosis. 3. The percentage of blasts (14%) is not below the threshold for acute leukemia diagnosis. 4. The specific cytogenetic findings mentioned in choice C are not absolute requirements for diagnosing acute leukemia. In summary, the presence of KMT2A rearrangement, along with morphologic and flow cytometry findings, supports the diagnosis of acute leukemia in this case, making choice D the correct answer.
Question 4 of 5
A nurse is caring for four clients. After reviewing today's laboratory results, which client would the nurse assess first?
Correct Answer: C
Rationale: The correct answer is C: Client with a prothrombin time (PT) of 28 seconds. A PT measures the time it takes for blood to clot, indicating the client's clotting ability. A PT of 28 seconds is prolonged, suggesting a potential bleeding risk. This client should be assessed first to prevent any complications related to inadequate clotting. A: Client with an international normalized ratio of 2.8 - Although an elevated INR indicates a risk of bleeding, it is not as time-sensitive as a prolonged PT. B: Client with a platelet count of 128,000/mm3 - While low platelets can lead to bleeding, a prolonged PT is more critical for immediate assessment. D: Client with a red blood cell count of 5.1 million/mcl - This value is within normal range and does not indicate an urgent issue related to clotting.
Question 5 of 5
A nurse works in a gerontology clinic. What age-related change(s) related to the hematologic system will the nurse expect during health assessment? (Select all that apply.)
Correct Answer: C
Rationale: Rationale: C: Progressive loss or thinning of hair occurs in the geriatric population due to age-related changes in the hair follicles. As individuals age, the hair follicles shrink, leading to hair thinning or loss. Incorrect Choices: A: Dentition deteriorating with more cavities is related to oral health, not the hematologic system. B: Strong and smooth nails are not directly related to age-related changes in the hematologic system. D: Sclerae turning yellow or pale is indicative of potential liver dysfunction, not a direct age-related change in the hematologic system.