ATI RN
ATI Hematologic System Test Questions
Question 1 of 5
The nurse assesses a patient who has numerous petechiae on both arms. Which question should the nurse ask the patient?
Correct Answer: A
Rationale: Correct Answer: A: Do you take salicylates? Rationale: 1. Petechiae are tiny red or purple spots caused by bleeding under the skin. 2. Salicylates (like aspirin) can cause bleeding issues leading to petechiae. 3. Asking about salicylate use helps identify a potential cause for the petechiae. Summary of Incorrect Choices: B: Oral contraceptives are not typically associated with petechiae. C: Antiseizure drugs do not commonly cause petechiae. D: Antihypertensive drugs are not known to be a common cause of petechiae.
Question 2 of 5
A hospitalized client has a platelet count of 58,000/mm³. What action by the nurse is best?
Correct Answer: D
Rationale: The correct answer is D: Place the client on safety precautions. A platelet count of 58,000/mm³ indicates thrombocytopenia, increasing the risk of bleeding. Placing the client on safety precautions will minimize the risk of injury and bleeding. Encouraging high-protein foods (choice A) is not directly related to managing thrombocytopenia. Neutropenic precautions (choice B) are for clients with low neutrophil counts, not low platelet counts. Limiting visitors to healthy adults (choice C) is important for infection control, not addressing the risk of bleeding.
Question 3 of 5
An 8-year-old boy undergoes a resection of a tumor in the right cerebrum next to the lateral ventricle (supratentorial). The pathologist feels the histology is most consistent with an ependymoma. The tumor is sent for advanced molecular and genetic testing. Which of the following findings would further support a diagnosis of ependymoma?
Correct Answer: C
Rationale: The correct answer is C: RELA fusion. Ependymomas are known to have specific genetic alterations, including RELA fusions. The fusion of RELA gene is a hallmark genetic abnormality observed in certain subtypes of ependymomas, aiding in the diagnosis. Conversely, choices A, B, and D are associated with other types of brain tumors such as pilocytic astrocytoma (A), melanoma (B), and diffuse intrinsic pontine glioma (D), respectively. These genetic alterations are not characteristic of ependymomas, making them incorrect choices in this context.
Question 4 of 5
A 13-year-old Hispanic girl is found to have a WBC count of 6,500/mm3 with 40% Auer rod–containing granular blasts that, by flow cytometry, express very bright CD33 but are negative for human leukocyte antigen–DR isotype (HLA-DR). She is oozing blood around her peripheral IV site. Coagulation studies reveal an international normalized ratio (INR) of 3.4, a fibrinogen of 170, and a markedly elevated D-dimer. Marrow aspirate shows nearly 90% blasts with a similar morphology. You send the marrow to the fluorescence in situ hybridization (FISH) lab and request STAT testing for the most likely recurrent genetic abnormality based on the clinical presentation. How do you plan to initiate therapy?
Correct Answer: B
Rationale: The correct answer is B: Begin therapy with all-trans retinoic acid (ATRA) immediately while aggressively managing coagulopathy with blood product support. The patient's presentation is consistent with acute promyelocytic leukemia (APL), indicated by the presence of Auer rod-containing blasts, very bright CD33 expression, and coagulopathy (elevated INR, low fibrinogen, elevated D-dimer). APL is associated with a specific genetic abnormality involving the PML-RARA fusion gene. ATRA is the mainstay of induction therapy for APL as it induces differentiation of leukemic promyelocytes. Aggressive management of coagulopathy is crucial to prevent life-threatening bleeding complications. Incorrect answers: A: Performing a lumbar puncture is not necessary at this stage as the patient's symptoms and laboratory findings point towards APL, not central nervous system involvement. C: Dexamethasone and hydroxyurea are not
Question 5 of 5
You are seeing a 12-year-old boy in the survivorship program who presented at 2 years old with a desmoplastic nodular medulloblastoma. You note the child recently underwent germline genetic testing and was found to have nevoid basal cell carcinoma syndrome. In which gene is the child most likely to have a pathogenic variant?
Correct Answer: C
Rationale: Rationale: 1. Nevoid basal cell carcinoma syndrome is also known as Gorlin syndrome, caused by mutations in SUFU. 2. SUFU gene regulates the Hedgehog signaling pathway, implicated in medulloblastoma development. 3. Desmoplastic nodular medulloblastoma is commonly seen in Gorlin syndrome. 4. PTEN is associated with Cowden syndrome, CDKN2A with melanoma, and SMARCB1 with rhabdoid tumors, not typically seen in Gorlin syndrome.