A patient's complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding?

Correct Answer: B

Rationale: The correct answer is B: Do you have any history of lung disease? A high hemoglobin and hematocrit could indicate polycythemia, which can be secondary to chronic hypoxia from lung disease. Asking about lung disease helps determine if there is an underlying cause of the elevated levels. Incorrect Choices: A: Recent weight loss is more relevant for anemia. C: Dark or bloody stools are more indicative of gastrointestinal bleeding and iron deficiency anemia. D: Dietary intake of meats and protein is not directly related to the elevated hemoglobin and hematocrit levels.

Correct Answer: C

Rationale: The correct answer is C. A presurgical spine MRI revealing bulky tumor in the spine classifies the patient as high-risk due to leptomeningeal spread. This indicates dissemination of the tumor cells beyond the primary site, leading to a poorer prognosis. Choice A is incorrect as AFP and beta-HCG markers are associated with germ cell tumors, not medulloblastomas. Choice B is incorrect as WNT subgrouping is associated with better outcomes. Choice D is incorrect because the absence of residual tumor postoperatively does not necessarily indicate high-risk disease.

Correct Answer: D

Rationale: The correct answer is D, Hypodiploidy with a modal chromosome number of 34. In pediatric pre-B-cell acute lymphoblastic leukemia, hypodiploidy with fewer than 44 chromosomes is associated with a poor prognosis. This cytogenetic abnormality is commonly seen in cases of NCI Standard Risk acute pre-B-cell ALL. A: t(1;19) is typically associated with T-cell ALL, not pre-B-cell ALL. B: CRLF2 rearrangement with a JAK2 mutation is more commonly seen in high-risk B-cell ALL. C: KMT24 rearrangement is not a recognized cytogenetic abnormality in ALL. In summary, the presence of hypodiploidy with a modal chromosome number of 34 is the most likely cytogenetic abnormality in this patient based on her clinical presentation and family history.

Correct Answer: B

Rationale: The correct answer is B: Skin fibroblasts to evaluate the ETV6 gene. In this scenario, the child's history of persistent thrombocytopenia and the father's mild thrombocytopenia suggest a possible familial predisposition to hematologic disorders. ETV6 gene mutations are associated with inherited thrombocytopenia and predisposition to hematologic malignancies such as acute lymphoblastic leukemia. Skin fibroblasts are typically used for genetic testing, as they contain the individual's complete genetic information. Choice A is incorrect because the RUNXI gene is not typically associated with thrombocytopenia or leukemia predisposition. Choices C and D are incorrect because buccal swabs may not provide sufficient genetic material for comprehensive analysis, and the ETV6 gene is more relevant in this context.

Correct Answer: E

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.