ATI RN
ATI Hematologic System Test Questions
Question 1 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 2 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 3 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
Question 4 of 5
You are seeing a 12-year-old boy in the survivorship program who presented at 2 years old with a desmoplastic nodular medulloblastoma. You note the child recently underwent germline genetic testing and was found to have nevoid basal cell carcinoma syndrome. In which gene is the child most likely to have a pathogenic variant?
Correct Answer: C
Rationale: Rationale: The correct answer is C: SUFU. Nevoid basal cell carcinoma syndrome, also known as Gorlin syndrome, is associated with pathogenic variants in the SUFU gene. SUFU is a tumor suppressor gene involved in the sonic hedgehog signaling pathway, which plays a role in medulloblastoma and basal cell carcinoma development. PTEN (A) is associated with Cowden syndrome, CDKN2A (B) with familial atypical multiple mole melanoma syndrome, and SMARCB1 (D) with rhabdoid tumor predisposition syndrome, but not specifically linked to nevoid basal cell carcinoma syndrome.
Question 5 of 5
A patient is scheduled for upcoming surgery. He is on nonsteroidal anti-inflammatory drugs (NSAIDs) for rheumatoid arthritis. You are being asked what to do with his medications for the surgery. What is the mechanism of action of NSAIDS?
Correct Answer: C
Rationale: Step 1: NSAIDs inhibit cyclooxygenase (COX) enzymes to reduce prostaglandin synthesis. Step 2: Reversible inhibition means the effect is temporary and can be reversed. Step 3: COX-1 inhibition leads to GI side effects, which can be concerning in surgery. Step 4: COX-2 inhibition is more targeted for inflammation but can still pose cardiovascular risks. Step 5: Reversible COX-1 inhibition allows for temporary discontinuation before surgery to minimize bleeding risk. Summary: Choice C is correct as reversible COX-1 inhibition allows for safer management pre-surgery compared to irreversible inhibition in choices A and B, and COX-2 inhibition in choice D.