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 lack of intrinsic factor, leading to vitamin B12 deficiency. This deficiency can result in neurological symptoms such as numbness and tingling in the extremities. Yellow-tinged sclerae (A) are more indicative of jaundice. A shiny smooth tongue (B) is a characteristic finding in glossitis, not specific to pernicious anemia. Gum bleeding and tenderness (D) are more commonly associated with periodontal disease rather than 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: 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 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: 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 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 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.
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: Rationale for Correct Answer (E): The correct statement is likely about the fact that her hemoglobinopathy, Hb Indianapolis, is associated with ineffective erythropoiesis, leading to anemia, jaundice, and extramedullary hematopoiesis. This is a rare condition and not typically detected on newborn screens. Additionally, splenectomy may not entirely resolve her anemia due to the systemic nature of the disease. Since she has transfusion-dependent anemia, she is at risk for gallstones due to chronic hemolysis. Summary of Incorrect Choices: A: Incorrect because Hb Indianapolis is rare and not typically detected on newborn screens. B: Incorrect because extramedullary hematopoiesis can lead to nucleated red cells in the peripheral blood smear. C: Incorrect because the disease is systemic, and splenectomy may not fully resolve the anemia. D: Incorrect because chronic hemolysis from the disease increases the risk of gallstones despite transf