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 the client must provide informed consent before undergoing a bone marrow biopsy. Without valid consent, the procedure cannot proceed ethically or legally. Administering pain medication (choice A) or sedatives (choice D) may be important for the client's comfort but obtaining consent is essential. 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 because the patient is in morphologic remission and MRD-negative after the second course of treatment. Given her high-risk AML and lack of HLA-matched siblings, a matched unrelated donor HSCT offers the best chance for long-term remission. Autologous HSCT (choice B) would risk reintroducing leukemic cells. Giving more courses of intensification chemotherapy alone (choice A) may not eradicate the disease. Maintenance chemotherapy alone (choice D) is not sufficient for high-risk AML. Therefore, choice C is the best option for maximizing the chances of a favorable outcome in this case.
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. Individuals with DICER1 syndrome are at increased risk for developing various tumors, including papillary thyroid cancer. This is due to the role of DICER1 gene in regulating cell growth and division. The other choices, B (medullary thyroid cancer), C (pheochromocytoma), and D (renal cell carcinoma), are not typically associated with DICER1 syndrome. Medullary thyroid cancer is commonly linked to RET gene mutations, pheochromocytoma to genes such as SDHB, SDHD, and VHL, and renal cell carcinoma to mutations in genes like VHL and MET.
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. A platelet count of 1,200,000/mm3 suggests thrombocytosis, which can be seen in conditions like essential thrombocythemia. This condition is associated with low von Willebrand factor activity, leading to increased bleeding tendency despite high platelet counts. Numbness, tingling, epistaxis, and splenomegaly are common features of essential thrombocythemia. Elevated C-reactive protein is not typically associated with this condition. Low ferritin is more indicative of iron deficiency anemia, not thrombocytosis. A hypocellular bone marrow is not expected in essential thrombocythemia, as it is characterized by increased platelet production.
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 correct answer is C: Perform emergent leukapheresis plus hydroxyurea. In this scenario, the patient presents with symptoms suggestive of acute myeloid leukemia with hyperleukocytosis and intracerebral hemorrhage. The goal of emergent therapy is to rapidly reduce the high blast count to prevent further complications such as leukostasis and hemorrhage. Leukapheresis can provide immediate reduction in the blast count, while hydroxyurea can further decrease the WBC count. Starting induction chemotherapy immediately can lead to tumor lysis syndrome due to rapid cell destruction. Emergent cranial radiation is not the primary intervention for hyperleukocytosis. Performing leukapheresis alone without adjunctive therapy like hydroxyurea may not adequately control the blast count. Thus, the most appropriate initial therapy is emergent leukapheresis plus hydroxyurea to stabilize the patient before initiating induction chemotherapy.