ATI RN
Hematological System Questions
Question 1 of 5
The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect?
Correct Answer: C
Rationale: The correct answer is C: Numbness of the extremities. Pernicious anemia is caused by a deficiency in vitamin B12, leading to nerve damage. Numbness in the extremities is a common symptom due to neurological complications. Yellow-tinged sclerae (A) are seen in jaundice, not pernicious anemia. A shiny smooth tongue (B) is characteristic of glossitis, not pernicious anemia. Gum bleeding and tenderness (D) are more indicative of periodontal disease or vitamin C deficiency, not pernicious anemia.
Question 2 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 3 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 4 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.
Question 5 of 5
A 10-year-old girl has had transfusion-dependent anemia since age 6 months. She is found to have an unstable hemoglobin by sequence analysis (Hb Indianapolis). She has jaundice, obvious bony deformity from extramedullary hematopoiesis, and hepatosplenomegaly. Which of the following statements is correct?
Correct Answer: E
Rationale: Step 1: Hb Indianapolis is a rare unstable hemoglobin variant causing severe hemolytic anemia. Step 2: The clinical presentation includes jaundice, bony deformity, hepatosplenomegaly due to extramedullary hematopoiesis. Step 3: None of the choices directly address the specific characteristics of Hb Indianapolis. Step 4: Therefore, the correct answer must provide insight into the unique features of this condition. Step 5: Choice E is correct as it highlights that the clinical presentation of Hb Indianapolis is distinct from other beta-hemoglobinopathies. Step 6: Summary: Choices A, B, C, and D are incorrect as they do not address the specific features of Hb Indianapolis, unlike choice E.