ATI RN
Hematological System Questions
Question 1 of 5
A client is having a bone marrow biopsy and is extremely anxious. What action by the nurse is best?
Correct Answer: A
Rationale: The correct answer is A. Assessing client fears and coping mechanisms is the best action because it allows the nurse to understand the client's specific concerns and provide individualized support. This helps address the root cause of anxiety and establish trust. Reassuring the client (B) may not address the underlying fears. Sedating the client (C) without addressing the anxiety may lead to dependency on sedatives. Telling the client they will be asleep (D) may create false expectations and not address the client's emotional needs. Assessing fears and coping mechanisms enables tailored support, promoting trust and comfort.
Question 2 of 5
You examine a 10-year-old boy with severe aplastic anemia. He has no dysmorphic features and is at the 50th percentile for height and weight. Family history includes a sister with aplastic anemia unresponsive to anti-human thymocyte globulin (ATG) and cyclosporine who died early in the course of an unrelated donor hematopoietic stem cell transplant complicated by severe mucositis and transplant-related organ toxicities. There are no other siblings. A cousin died of acute myeloid leukemia at age 5 years. A peripheral blood sample test for Fanconi anemia is negative with no increased chromosomal breaks in response to diepoxybutane or mitomycin C. Which of the following is the most important next step in management?
Correct Answer: D
Rationale: The correct answer is D: Send a skin fibroblast culture for Fanconi anemia testing. This is the most important next step because the patient has a family history suggestive of Fanconi anemia, which is an inherited bone marrow failure syndrome. Aplastic anemia in a child with a family history of bone marrow failure syndromes raises suspicion for inherited causes like Fanconi anemia. Testing for Fanconi anemia involves assessing chromosomal breakage in response to DNA cross-linking agents like diepoxybutane or mitomycin C, which is best done using skin fibroblast culture. This specific test can confirm or rule out Fanconi anemia as the underlying cause of aplastic anemia in this patient. The other choices are incorrect because administering ATG and cyclosporine (Choice A) may not be effective if the underlying cause is Fanconi anemia. Searching for a donor for matched unrelated transplant (Choice B) is premature without confirming the diagnosis.
Question 3 of 5
A 10-year-old girl has had transfusion-dependent anemia since age 6 months. She is found to have an unstable hemoglobin by sequence analysis (Hb Indianapolis). She has jaundice, obvious bony deformity from extramedullary hematopoiesis, and hepatosplenomegaly. Which of the following statements is correct?
Correct Answer: E
Rationale: Step 1: Hb Indianapolis is a rare unstable hemoglobin variant causing severe hemolytic anemia. Step 2: The clinical presentation includes jaundice, bony deformity, hepatosplenomegaly due to extramedullary hematopoiesis. Step 3: None of the choices directly address the specific characteristics of Hb Indianapolis. Step 4: Therefore, the correct answer must provide insight into the unique features of this condition. Step 5: Choice E is correct as it highlights that the clinical presentation of Hb Indianapolis is distinct from other beta-hemoglobinopathies. Step 6: Summary: Choices A, B, C, and D are incorrect as they do not address the specific features of Hb Indianapolis, unlike choice E.
Question 4 of 5
A 15-year-old female presents with 1-month history of fatigue and a 3-day history of chest pain and shortness of breath. Her chest x-ray shows a large mediastinal mass that is greater than 33% of the thoracic diameter at the level of the diaphragm. A biopsy shows diffuse large B-cell lymphoma. Metastatic work-up, including a CT scan of neck, chest, abdomen, and pelvis; bone marrow biopsy; lumbar puncture; and PET scan show no other site of disease. According to the St. Jude (Murphy) staging system, what is the stage of this patient's non-Hodgkin lymphoma (NHL)?
Correct Answer: C
Rationale: The correct answer is C: Stage III. According to the St. Jude (Murphy) staging system for non-Hodgkin lymphoma, Stage III is defined as disease that extends beyond a single region (e.g., thorax) on one side of the diaphragm. In this case, the large mediastinal mass greater than 33% of thoracic diameter indicates involvement beyond a single region. The absence of disease in other sites based on the metastatic work-up rules out Stages IV. Since there is no information provided to suggest involvement on both sides of the diaphragm, Stage III is the most appropriate stage for this patient. Choice A (Stage I) is incorrect as the disease extends beyond a single region. Choice B (Stage II) is incorrect as it implies involvement on both sides of the diaphragm, which is not indicated. Choice D (Stage IV) is incorrect as there is no evidence of distant metastasis in the given scenario.
Question 5 of 5
A 9-year-old child with osteosarcoma is being admitted for cisplatin therapy. What is the best regimen for prevention of chemotherapy-induced nausea and vomiting (CINV)?
Correct Answer: C
Rationale: The correct answer is C: Granisetron, dexamethasone at 50% dosing, and aprepitant. Granisetron is a first-line antiemetic for CINV in chemotherapy. Dexamethasone at 50% dosing is effective in reducing nausea and vomiting. Aprepitant, a neurokinin-1 receptor antagonist, is recommended for moderate to high emetogenic chemotherapy regimens like cisplatin. This combination provides a comprehensive approach targeting different pathways involved in CINV. Choice A is incorrect because olanzapine is not typically used in pediatric patients for CINV prevention. Choice B is incorrect as aprepitant is preferred over olanzapine. Choice D is incorrect because excessive dexamethasone dosing can increase the risk of side effects without additional benefit.