ATI RN
Anatomy of Hematologic System Questions
Question 1 of 5
The nurse is assisting with the preparation of a blood transfusion for a patient. Which type of fluid should the nurse select to transfuse with the blood?
Correct Answer: A
Rationale: The correct answer is A: 0.9% normal saline. When preparing a blood transfusion, it is essential to select a compatible fluid that will not cause hemolysis of the red blood cells. Normal saline is isotonic and compatible with blood, making it the ideal choice. Dextrose solutions can cause hemolysis and should not be used for blood transfusions. Choice B and C contain dextrose, which is not suitable for blood transfusions. Choice D contains a lower concentration of normal saline, which may not be as effective in maintaining the osmotic balance of the blood cells. Therefore, selecting 0.9% normal saline ensures the safety and integrity of the transfused blood.
Question 2 of 5
The nurse examines the lymph nodes of a patient during a physical assessment. Which assessment finding would be of most concern to the nurse?
Correct Answer: A
Rationale: The correct answer is A. A 2-cm nontender supraclavicular node is of most concern as supraclavicular nodes are not normally palpable, and their enlargement can indicate underlying malignancy, such as metastatic cancer. B: A 1-cm mobile and nontender axillary node is within normal limits. C: Inability to palpate superficial lymph nodes may be due to factors like obesity or normal variation. D: Firm inguinal nodes in a patient with an infected foot are expected as a local response to infection.
Question 3 of 5
A client is having a bone marrow biopsy today. What action by the nurse takes priority?
Correct Answer: B
Rationale: The correct answer is B: Ensure valid consent is on the chart. This is the priority because the client must provide informed consent before undergoing a bone marrow biopsy. Without valid consent, the procedure cannot proceed ethically or legally. Administering pain medication (choice A) or sedatives (choice D) may be important for the client's comfort but obtaining consent is essential. Having the client shower in the morning (choice C) is not directly related to the immediate safety or success of the biopsy.
Question 4 of 5
A 5-year-old boy presents with a 3-week history of his right eye “not moving to the right side.†The remainder of his neurologic exam is normal with the exception of a weak gag. MRI of the brain reveals a diffusely infiltrative mass in the pons. If this patient were to undergo a stereotactic biopsy, what would be the most likely molecular finding?
Correct Answer: C
Rationale: The correct answer is C: H3 K27M mutation. This mutation is most commonly associated with diffuse intrinsic pontine gliomas (DIPG), which are high-grade brain tumors typically found in children. The presence of a diffusely infiltrative mass in the pons in a 5-year-old boy with neurological symptoms points towards a DIPG. Stereotactic biopsy of the mass would likely reveal the H3 K27M mutation, which is a key molecular finding in DIPG. Choice A (BRAFKIAA1549 fusion) is incorrect as this fusion is typically associated with pilocytic astrocytomas, not DIPGs. Choice B (Trisomy 21) is incorrect as it is not a molecular finding commonly associated with DIPGs. Choice D (RELA fusion) is also incorrect as this fusion is more commonly seen in ependymomas, not DIPGs.
Question 5 of 5
A 13-year-old girl presents with acute myeloid leukemia (AML) and a WBC count of 120,000/mm3. Cytogenetics reveals a normal karyotype, and fluorescence in situ hybridization (FISH) tests for inv(16), t(8;21), t(15;17); 11q23 abnormalities; monosomy 7; and 5q deletion are negative. Molecular testing is negative for mutations in FLT3, NPM1, and CEBPA. She is treated with 10 days of daunorubicin, AraC, and gemtuzumab for induction therapy. On day 30, she recovers counts, and a bone marrow aspiration shows 2.2% leukemic blasts by flow cytometry. She receives a second course of treatment with daunorubicin and AraC, and her marrow is now in morphologic remission and is MRD-negative by flow cytometry. She has no HLA-matched siblings, but an unrelated donor search reveals a large number of potential matches. Which course of treatment is most likely to result in the best outcome?
Correct Answer: C
Rationale: The correct answer is C because the patient is in morphologic remission and MRD-negative after the second course of treatment. Given her high-risk AML and lack of HLA-matched siblings, a matched unrelated donor HSCT offers the best chance for long-term remission. Autologous HSCT (choice B) would risk reintroducing leukemic cells. Giving more courses of intensification chemotherapy alone (choice A) may not eradicate the disease. Maintenance chemotherapy alone (choice D) is not sufficient for high-risk AML. Therefore, choice C is the best option for maximizing the chances of a favorable outcome in this case.