ATI RN
ATI Hematologic System Test Questions
Question 1 of 5
The nurse is reviewing the activated partial thromboplastin time for a patient receiving heparin. Which value indicates that the medication is within the therapeutic range?
Correct Answer: C
Rationale: The correct answer is C (1.5 to 2.0 times normal) because the therapeutic range for heparin is typically considered to be 1.5 to 2.5 times the normal value of activated partial thromboplastin time (aPTT). This range ensures adequate anticoagulation without increasing the risk of bleeding. Options A, B, and D are incorrect because they do not accurately reflect the therapeutic range for heparin. Option A provides a range in minutes, which is not a standard unit for aPTT measurement. Option B provides a range in seconds, which is too narrow for the therapeutic range of heparin. Option D provides a range in multiples of normal, but the upper limit of 3.0 times normal is higher than the typical upper limit of the therapeutic range for heparin.
Question 2 of 5
When assessing a newly admitted patient, the nurse notes pallor of the skin and nail beds. The nurse should ensure that which laboratory test has been ordered?
Correct Answer: D
Rationale: The correct answer is D: Hemoglobin (Hgb) level. Pallor of the skin and nail beds indicates possible anemia, which is a decrease in red blood cells or hemoglobin. Checking the hemoglobin level will confirm if the patient is anemic. Platelet count (A) assesses for clotting ability, not anemia. Neutrophil count (B) and White blood cell count (C) are indicators of infection or inflammation, not anemia. Therefore, ensuring the hemoglobin level has been ordered is crucial for assessing the patient's pallor.
Question 3 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 4 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 5 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