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: Rationale: A 0.9% normal saline solution is the correct choice for blood transfusion because it is isotonic, which closely matches the osmolarity of blood. This helps prevent hemolysis and maintains the integrity of red blood cells during transfusion. Other choices such as B (dextrose 5% and water), C (dextrose 5% and 0.9% normal saline), and D (dextrose 5% and 0.45% normal saline) are incorrect because they do not provide the necessary isotonic environment for safe blood transfusion, risking hemolysis or other complications.
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. This finding is concerning because supraclavicular nodes are not normally palpable. Enlarged supraclavicular nodes can indicate metastatic cancer. B is incorrect because mobile and nontender axillary nodes are usually benign. C is incorrect as the inability to palpate superficial nodes may be normal. D is incorrect as firm inguinal nodes could indicate a localized infection or inflammation.
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 obtaining informed consent is crucial before any invasive procedure like a bone marrow biopsy. Without valid consent, the procedure cannot proceed legally or ethically. Administering pain medication (choice A) and premedicating with sedatives (choice D) are important for client comfort but are not the priority. 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. In children with diffuse midline gliomas, the most common molecular finding is the H3 K27M mutation. This mutation is associated with a worse prognosis and is commonly found in tumors located in the pons, which is consistent with the MRI findings in this case. Choice A (BRAFKIAA1549 fusion) is incorrect as this fusion is typically associated with pilocytic astrocytomas, which are low-grade tumors and not typically found in the pons. Choice B (Trisomy 21) is incorrect as it is a chromosomal abnormality associated with Down syndrome, not a molecular finding in brain tumors. Choice D (RELA fusion) is incorrect as this fusion is typically found in ependymomas, which are not typically located in the pons.
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: Give one more course of intensification chemotherapy and then perform a matched unrelated donor HSCT. Rationale: 1. The patient achieved morphologic remission and MRD-negative status after the second course of chemotherapy, indicating good response. 2. Given the high-risk AML with negative cytogenetics and molecular markers, HSCT from a matched unrelated donor offers the best chance for long-term remission. 3. HSCT provides a curative option by replacing the patient's diseased bone marrow with healthy donor cells, reducing the risk of relapse. 4. The presence of a large number of potential matched unrelated donors increases the likelihood of finding a suitable donor for the transplant. Summary: - Option A: Giving more courses of intensification chemotherapy may not address the high-risk nature of the disease and may not provide a curative outcome. - Option B: Autologous HSCT uses the patient's own stem cells, which may carry the risk of relapse due