ATI Hematologic System Test

ATI Hematologic System Test Related

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A 9-year-old boy is being treated for standard-risk acute lymphoblastic leukemia. His treatment protocol calls for administration of intravenous methotrexate and intramuscular L-asparaginase during interim maintenance chemotherapy. What is the most appropriate sequence of drug administration?

  • A. Administer L-asparaginase during the methotrexate infusion.
  • B. Administer L-asparaginase immediately after the methotrexate infusion.
  • C. Administer both drugs at the same time to maximize synergistic activity.
  • D. Administer methotrexate 24 hours after the asparaginase.
Correct Answer: B

Rationale: The correct answer is B: Administer L-asparaginase immediately after the methotrexate infusion. This sequence is appropriate because methotrexate can interfere with the activity of L-asparaginase if given concurrently, affecting the efficacy of both drugs. Administering L-asparaginase immediately after the methotrexate infusion allows for optimal therapeutic effects of both medications without compromising their individual actions.

Choice A (Administer L-asparaginase during the methotrexate infusion) is incorrect because it may lead to drug interactions and reduced effectiveness of both drugs. Choice C (Administer both drugs at the same time) is incorrect for the same reason as choice A. Choice D (Administer methotrexate 24 hours after the asparaginase) is incorrect as it does not follow the optimal timing for these medications during treatment.

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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?

  • A. BRAFKIAA1549 fusion
  • B. BRAFV600E mutation
  • C. RELA fusion
  • D. H3K27M mutation
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.

A 77-year-old male is admitted to a unit with a suspected diagnosis of acute myeloid leukemia (AML). When planning this patient's care, the nurse should be aware of what epidemiologic fact?

  • A. Early diagnosis is associated with good outcomes.
  • B. Five-year survival for older adults is approximately 50%.
  • C. Five-year survival for patients over 75 years old is less than 2%.
  • D. Survival rates are wholly dependent on the patient's pre-illness level of health.
Correct Answer: C

Rationale: The correct answer is C: Five-year survival for patients over 75 years old is less than 2%. This is because older age is a significant risk factor for poorer outcomes in acute myeloid leukemia (AML) due to factors such as frailty, comorbidities, and reduced tolerance to aggressive treatments. Older adults are less likely to tolerate intensive chemotherapy and have lower overall survival rates compared to younger patients.

Choice A is incorrect because early diagnosis alone does not guarantee good outcomes in AML, especially in older adults. Choice B is incorrect because the five-year survival rate for older adults with AML is much lower than 50%. Choice D is incorrect because while pre-illness health may influence survival rates, age is a more significant factor in predicting outcomes in older patients with AML.

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?

  • A. Platelet count
  • B. Neutrophil count
  • C. White blood cell count
  • D. Hemoglobin (Hgb) level
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.

Mr XY was found to be anemic. During history taking, he informed his doctor that he was a strict vegetarian who did not consume any meat, fish or milk products.

  • A. Iron deficiency
  • B. Vitamin B12 deficiency
  • C. Defects in erythropoietin production
  • D. Calcium-deficiency
Correct Answer: B

Rationale: The correct answer is B: Vitamin B12 deficiency. As a strict vegetarian who does not consume any meat, fish, or milk products, Mr XY is at risk for Vitamin B12 deficiency. Vitamin B12 is primarily found in animal products and is essential for red blood cell production. Anemia can result from Vitamin B12 deficiency, leading to symptoms such as fatigue and weakness. Iron deficiency (A) is also common in vegetarians, but in this case, the focus is on Vitamin B12 due to the exclusion of all animal products. Defects in erythropoietin production (C) are not related to Mr XY's dietary choices. Calcium-deficiency (D) is not directly related to anemia in this scenario.

A nurse is caring for a client who is scheduled for an outpatient surgical procedure and reports taking aspirin 81 mg daily, including this morning. The nurse should identify that this places the client at risk for which of the following complications?

  • A. Uncontrolled bleeding
  • B. Myocardial infarction
  • C. Respiratory depression
  • D. Decreased renal perfusion
Correct Answer: A

Rationale: The correct answer is A: Uncontrolled bleeding. Aspirin is an antiplatelet medication that inhibits platelet aggregation, leading to decreased clotting ability. This places the client at risk for uncontrolled bleeding during and after surgery. Myocardial infarction (B) is not directly associated with aspirin use. Respiratory depression (C) is not a common complication of aspirin. Decreased renal perfusion (D) is not a typical complication of aspirin use.

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