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 therapy is typically considered to be 1.5 to 2.0 times the normal control value for activated partial thromboplastin time (aPTT). This range ensures adequate anticoagulation to prevent clot formation without increasing the risk of bleeding. Options A, B, and D are incorrect because they provide ranges that are either too short or too long for the therapeutic goal of heparin therapy. Option A (2.5 to 9.5 minutes) and Option D (2.0 to 3.0 times normal) are outside the typical therapeutic range for heparin, indicating subtherapeutic and supratherapeutic levels, respectively. Option B (9.5 to 11.3 seconds) is also incorrect as it reflects a range for prothrombin time (PT) rather than aPTT.
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 condition characterized by low levels of hemoglobin. Thus, checking the hemoglobin level is crucial to confirm the suspicion of anemia. Platelet count (choice A) assesses for clotting ability, neutrophil count (choice B) and white blood cell count (choice C) are indicators of infection or inflammation, which are not directly related to pallor. Hemoglobin level directly correlates with the observed symptom of pallor, making it the most appropriate laboratory test to order.
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. Safety precautions aim to prevent injury and minimize bleeding risks. Encouraging high-protein foods (choice A) is not directly related to managing thrombocytopenia. Instituting neutropenic precautions (choice B) is for clients with low white blood cell counts, not platelet counts. Limiting visitors to healthy adults (choice C) is important for infection control, not specifically for thrombocytopenia. In summary, placing the client on safety precautions is the best action to prevent bleeding complications.
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 molecular characteristics, with RELA fusion being a common genetic alteration associated with these tumors. The fusion of RELA gene is a key genetic event in the pathogenesis of supratentorial ependymomas. This fusion leads to the activation of the NF-κB signaling pathway, which is important in the development and progression of ependymomas. Now, let's summarize why the other choices are incorrect: A: BRAFKIAA1549 fusion - This fusion is typically associated with pilocytic astrocytomas, not ependymomas. B: BRAFV600E mutation - This mutation is commonly found in other types of brain tumors like pleomorphic xanthoastrocytomas and gangliogliomas, not ependymomas. D: H3K27M mutation - This mutation is typically seen in diffuse midline gliomas, such as diffuse
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. Rationale: 1. The clinical presentation describes acute promyelocytic leukemia (APL), characterized by Auer rod-containing blasts, coagulopathy (elevated INR, D-dimer), and CD33 positivity. ATRA is the standard treatment for APL. 2. ATRA induces differentiation of leukemic promyelocytes, reducing the risk of disseminated intravascular coagulation (DIC) and bleeding. 3. Aggressively managing the coagulopathy with blood product support is crucial to prevent hemorrhagic complications. Summary: A: Not needed as the clinical presentation already suggests APL. Lumbar puncture is not indicated for APL diagnosis. C: Dexamethasone and hydroxyurea are not standard treatments for APL. Immediate ATRA therapy is preferred. D