ATI RN
Anatomy of Hematologic System Questions
Question 1 of 5
A client is having a bone marrow biopsy today. What action by the nurse takes priority?
Correct Answer: B
Rationale: The correct answer is B: Ensure valid consent is on the chart. This is the priority because obtaining informed consent is crucial before any invasive procedure like a bone marrow biopsy. Without valid consent, the procedure cannot proceed legally or ethically. Administering pain medication (choice A) and premedicating with sedatives (choice D) are important for client comfort but are not the priority. Having the client shower in the morning (choice C) is not directly related to the immediate safety or success of the biopsy.
Question 2 of 5
A 13-year-old girl presents with acute myeloid leukemia (AML) and a WBC count of 120,000/mm3. Cytogenetics reveals a normal karyotype, and fluorescence in situ hybridization (FISH) tests for inv(16), t(8;21), t(15;17); 11q23 abnormalities; monosomy 7; and 5q deletion are negative. Molecular testing is negative for mutations in FLT3, NPM1, and CEBPA. She is treated with 10 days of daunorubicin, AraC, and gemtuzumab for induction therapy. On day 30, she recovers counts, and a bone marrow aspiration shows 2.2% leukemic blasts by flow cytometry. She receives a second course of treatment with daunorubicin and AraC, and her marrow is now in morphologic remission and is MRD-negative by flow cytometry. She has no HLA-matched siblings, but an unrelated donor search reveals a large number of potential matches. Which course of treatment is most likely to result in the best outcome?
Correct Answer: C
Rationale: The correct answer is C: Give one more course of intensification chemotherapy and then perform a matched unrelated donor HSCT. Rationale: 1. The patient achieved morphologic remission and MRD-negative status after the second course of chemotherapy, indicating good response. 2. Given the high-risk AML with negative cytogenetics and molecular markers, HSCT from a matched unrelated donor offers the best chance for long-term remission. 3. HSCT provides a curative option by replacing the patient's diseased bone marrow with healthy donor cells, reducing the risk of relapse. 4. The presence of a large number of potential matched unrelated donors increases the likelihood of finding a suitable donor for the transplant. Summary: - Option A: Giving more courses of intensification chemotherapy may not address the high-risk nature of the disease and may not provide a curative outcome. - Option B: Autologous HSCT uses the patient's own stem cells, which may carry the risk of relapse due
Question 3 of 5
A 10-year-old girl is a long-term survivor of type II pleuropulmonary blastoma (PPB). You suspect she has a cancer predisposition syndrome and perform genetic testing, which confirms she has DICER1 syndrome. Which other cancer is she predisposed to?
Correct Answer: A
Rationale: The correct answer is A: Papillary thyroid cancer. DICER1 syndrome is associated with an increased risk of developing various tumors, including papillary thyroid cancer. This is due to the role of DICER1 gene mutation in dysregulating cell growth and division. Other choices like B: Medullary thyroid cancer, C: Pheochromocytoma, and D: Renal cell carcinoma are not typically associated with DICER1 syndrome. Medullary thyroid cancer is more commonly linked to RET gene mutations, pheochromocytoma to RET or SDHB/C/D gene mutations, and renal cell carcinoma to VHL gene mutations. Therefore, based on the genetic mechanism and known associations, papillary thyroid cancer is the most likely cancer this patient is predisposed to.
Question 4 of 5
A 17-year-old patient is referred to you for a platelet count of 1,200,000/mm3. On history, she notes that she often has numbness and tingling in her hands and feet and has frequent epistaxis. She is otherwise well-appearing and has no recent infections. On her exam, you note splenomegaly. What do you expect to see on further evaluation?
Correct Answer: D
Rationale: The correct answer is D: Low von Willebrand factor activity. This patient likely has Essential Thrombocythemia, a disorder characterized by excessive production of platelets by the bone marrow. This condition can lead to abnormal bleeding and clotting. The patient's symptoms of numbness, tingling, epistaxis, and splenomegaly are consistent with this diagnosis. Low von Willebrand factor activity is expected in Essential Thrombocythemia due to platelet dysfunction. Elevated C-reactive protein, low ferritin, and a hypocellular bone marrow are not typically associated with Essential Thrombocythemia and are less likely to be seen in this patient.
Question 5 of 5
A 13-year-old boy presents to the emergency department with complaints of headache and visual changes. History reveals progressive dyspnea on exertion, generalized fatigue, and increased bruising. His labs are significant for a WBC of 350,000/mcL, of which 80% are reported to be blasts and appear to be myeloblasts without the presence of Auer rods. His hemoglobin is 7.2 g/dL, and his platelets are 18,000/mcL. A CT scan of the head shows a small intracerebral hemorrhage. His coags are normal. Which of the following is the most appropriate therapy?
Correct Answer: C
Rationale: The most appropriate therapy in this scenario is emergent leukapheresis plus hydroxyurea (Choice C). Leukapheresis is needed to rapidly reduce the high white blood cell count, preventing further complications such as leukostasis and hyperviscosity syndrome. Hydroxyurea can help further control the rapid proliferation of blasts. Induction chemotherapy (Choice A) may lead to tumor lysis syndrome due to the high tumor burden. Performing leukapheresis alone without a subsequent therapy (Choice B) may not adequately address the underlying disease. Providing cranial radiation (Choice D) is not the initial management for acute myeloid leukemia.