ATI RN
Hematological System Questions
Question 1 of 5
A patient has a platelet count of 75,000 /mm³. What action should the nurse take to support this patient?
Correct Answer: A
Rationale: The correct action is to restrict blood draws. With a platelet count of 75,000 /mm³, the patient is at risk for bleeding due to thrombocytopenia. Restricting blood draws helps minimize the risk of bleeding from puncture sites. Placing the patient in protective isolation (B) is unnecessary for low platelet count. Wearing a mask (C) is not directly related to platelet count. Documenting rectal temperatures (D) is not a priority when managing thrombocytopenia.
Question 2 of 5
A client is receiving rivaroxaban (Xarelto) and asks the nurse to explain how it works. What response by the nurse is best?
Correct Answer: A
Rationale: The correct answer is A: It inhibits thrombin. Rivaroxaban is a direct factor Xa inhibitor that works by inhibiting thrombin formation, thus preventing blood clots. Thrombin is a key enzyme in the coagulation cascade. Choices B and D are incorrect because rivaroxaban specifically targets factor Xa and not fibrinogen or vitamin K. Choice C is incorrect as rivaroxaban does not actually "thin" the blood; it works by preventing clot formation.
Question 3 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: Assess client fears and coping mechanisms. This is the best action because it allows the nurse to understand the specific concerns and anxieties of the client, enabling personalized support and interventions. It shows empathy and provides a tailored approach to address the client's needs. Summary: - Choice B: Reassuring the client is helpful but may not address the root of the anxiety. - Choice C: Sedating the client may not be necessary if underlying concerns are addressed. - Choice D: Providing false information about being asleep is not ethical and can lead to distrust.
Question 4 of 5
Of the variables listed below, what is the most important factor for survival after relapse of acute lymphoblastic leukemia?
Correct Answer: A
Rationale: Step 1: Time to marrow relapse since initial diagnosis is crucial because early relapse indicates aggressive disease behavior. Step 2: Early relapse implies a higher likelihood of resistance to treatment, leading to poorer survival outcomes. Step 3: Rapid relapse often signifies a more challenging disease course, requiring prompt and aggressive interventions for better prognosis. Summary: - Choice A is correct as early relapse indicates aggressive disease behavior and resistance to treatment. - Choices B, C, and D are incorrect as they do not directly impact the urgency and aggressiveness of treatment needed for survival post-relapse.
Question 5 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 in management because the patient's negative peripheral blood test for Fanconi anemia does not rule out the possibility of having this condition. Skin fibroblast culture testing is more sensitive for detecting Fanconi anemia compared to peripheral blood testing. Given the family history of aplastic anemia and leukemia, along with the sister's poor response to treatment, it is crucial to definitively confirm or rule out Fanconi anemia as the underlying cause. Administering ATG and cyclosporine (choice A) without confirming the diagnosis may not be effective. Searching for a donor for matched unrelated transplant (choice B) is premature without confirming the diagnosis. Sending a bone marrow aspirate for Fanconi anemia testing (choice C) may not be as sensitive as skin fibroblast culture testing.