ATI RN
Anatomy of Hematologic System Questions
Question 1 of 5
A nurse reviews the laboratory data for an older patient. The nurse would be most concerned about which finding?
Correct Answer: D
Rationale: The correct answer is D because a low WBC count of 2800/L indicates leukopenia, which can compromise the immune system in older adults, leading to increased susceptibility to infections. This finding is concerning as it can pose serious health risks. A: A hematocrit of 35% is within the normal range for older adults and not a cause for concern. B: A hemoglobin level of 11.8 g/dL is slightly lower but still within an acceptable range for older adults and unlikely to be a major concern. C: A platelet count of 400000/L is within the normal range and would not be a significant worry for the nurse. In summary, a low WBC count can indicate a weakened immune system, making it the most concerning finding among the choices given.
Question 2 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 3 of 5
A 5-year-old boy presents with a 3-week history of his right eye “not moving to the right side.†The remainder of his neurologic exam is normal with the exception of a weak gag. MRI of the brain reveals a diffusely infiltrative mass in the pons. If this patient were to undergo a stereotactic biopsy, what would be the most likely molecular finding?
Correct Answer: C
Rationale: The correct answer is C: H3 K27M mutation. In children with diffuse midline gliomas, the most common molecular finding is the H3 K27M mutation. This mutation is associated with a worse prognosis and is commonly found in tumors located in the pons, which is consistent with the MRI findings in this case. Choice A (BRAFKIAA1549 fusion) is incorrect as this fusion is typically associated with pilocytic astrocytomas, which are low-grade tumors and not typically found in the pons. Choice B (Trisomy 21) is incorrect as it is a chromosomal abnormality associated with Down syndrome, not a molecular finding in brain tumors. Choice D (RELA fusion) is incorrect as this fusion is typically found in ependymomas, which are not typically located in the pons.
Question 4 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 5 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.