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 prevent unnecessary bleeding. Placing in protective isolation (B) is not necessary for low platelet count. Wearing a mask (C) does not directly address the risk of bleeding. Documenting rectal temperatures (D) is unrelated to 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, which works by specifically inhibiting the activity of factor Xa, a key enzyme in the coagulation cascade. By inhibiting factor Xa, rivaroxaban prevents the formation of thrombin, a crucial enzyme in the blood clotting process. Thrombin is responsible for converting fibrinogen to fibrin, which forms the meshwork of a blood clot. Therefore, by inhibiting thrombin formation, rivaroxaban effectively prevents blood clots from forming. Choice B is incorrect because rivaroxaban does not directly inhibit fibrinogen; it acts upstream by inhibiting factor Xa. Choice C is incorrect because rivaroxaban does not actually "thin" the blood like warfarin or heparin; it specifically targets factor Xa. Choice D is incorrect because rivaroxaban does not work against vitamin K like warfarin
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. 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 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: The correct answer is A: Time to marrow relapse since initial diagnosis. This is because the time to marrow relapse indicates the aggressiveness of the leukemia and how quickly it has returned post-treatment. Quicker relapse indicates more aggressive disease, impacting survival. Choice B, sex, is not a significant factor in survival post-relapse. Choice C, central nervous system involvement, affects treatment but is not the primary factor for survival. Choice D, response to induction therapy, is crucial for initial treatment success but not the most important factor post-relapse survival. Therefore, choice A is the most critical factor for survival after relapse of acute lymphoblastic leukemia.
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 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.