ATI Hematologic System Test

ATI Hematologic System Test Related

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An otherwise healthy 18-year-old female is diagnosed with high-risk neuroblastoma after presenting with fatigue and bony pain. Imaging findings demonstrate a left adrenal mass with multiple osseous metastases. She successfully completes standard therapy for high-risk neuroblastoma, but experiences several episodes of disease recurrence and ultimately dies of her disease 10 years after her initial diagnosis. During her treatment, her tumor was sent for molecular analysis. Of the following, what molecular aberration was most likely to have been detected?

  • A. ETV6-NTRK3 gene fusion
  • B. PTPN11 mutation
  • C. ATRX mutation
  • D. WT1 mutation
Correct Answer: C

Rationale: The correct answer is C: ATRX mutation. In neuroblastoma, ATRX mutations are associated with poor prognosis and high-risk disease. ATRX gene mutations are commonly found in cases with aggressive behavior and poor outcomes, such as in this case where the patient experienced disease recurrence and ultimately died. ATRX mutations are linked to chromosomal instability and telomere dysfunction, which can contribute to tumor progression and resistance to therapy.

A: ETV6-NTRK3 gene fusion is more commonly associated with infantile fibrosarcoma and secretory breast carcinoma, not neuroblastoma.

B: PTPN11 mutations are typically seen in juvenile myelomonocytic leukemia and Noonan syndrome, not neuroblastoma.

D: WT1 mutations are more commonly found in Wilms tumor and acute myeloid leukemia, not neuroblastoma.

In summary, the ATRX mutation is the most likely molecular aberration detected in this patient with high-risk neuroblast

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In iron deficiency anemia there is characteristically

  • A. An atrophic gastritis
  • B. A low mean corpuscular volume
  • C. A reduced total iron binding capacity
  • D. Megaloblastic changes in the bone marrow
Correct Answer: B

Rationale: The correct answer is B: A low mean corpuscular volume. In iron deficiency anemia, there is a decreased amount of iron available for hemoglobin synthesis, leading to smaller and paler red blood cells. This results in a low mean corpuscular volume (MCV). Atrophic gastritis (choice A) is associated with vitamin B12 deficiency anemia, not iron deficiency anemia. Choice C (reduced total iron binding capacity) is incorrect because in iron deficiency anemia, there is an increased total iron binding capacity due to the body's attempt to capture more iron. Megaloblastic changes in the bone marrow (choice D) are seen in megaloblastic anemia, not iron deficiency anemia.

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.

A nurse is caring for a patient who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoses on the patient's sacral area and petechiae in her forearms. In addition to informing the patient's primary care provider, the nurse should perform what action?

  • A. Initiate measures to prevent venous thromboembolism (VTE).
  • B. Check the patient's most recent platelet level.
  • C. Place the patient on protective isolation.
  • D. Ambulate the patient to promote circulatory function.
Correct Answer: B

Rationale: Step-by-step rationale for why answer B is correct:
1. Petechiae and ecchymoses indicate potential thrombocytopenia in a leukemia patient.
2. Checking the patient's platelet level will confirm thrombocytopenia and guide treatment.
3. Low platelet levels can lead to bleeding complications, hence the importance of monitoring.
4. Prompt intervention based on platelet level results can prevent worsening complications.

Summary of why other choices are incorrect:
A: Initiating measures to prevent VTE is not directly related to the patient's current presentation of ecchymoses and petechiae.
C: Placing the patient on protective isolation is not indicated for thrombocytopenia.
D: Ambulating the patient may be beneficial for circulation but does not address the underlying issue of potential thrombocytopenia.

A nurse is caring for a client who has renal failure and is receiving epoetin. The nurse should monitor the client for which of the following adverse effects?

  • A. Hypertension
  • B. Muscle pain
  • C. Edema
  • D. Dry mouth
Correct Answer: A

Rationale: The correct answer is A: Hypertension. Epoetin stimulates red blood cell production, increasing blood volume and potentially leading to hypertension. This adverse effect is known as hypertensive crisis. Muscle pain (B), edema (C), and dry mouth (D) are not typically associated with epoetin therapy for renal failure. Thus, they are incorrect choices.

C6PD reflect false normal report in:

  • A. iron def .an.
  • B. hypoplastic an.
  • C. hairy cell leuk.
  • D. shortly after haemolysis
Correct Answer: D

Rationale: The correct answer is D, shortly after hemolysis, because G6PD deficiency leads to a false-normal result due to the presence of reticulocytes in the blood following hemolysis. This is because reticulocytes have normal enzyme activity, masking the underlying deficiency. Iron deficiency anemia (A), hypoplastic anemia (B), and hairy cell leukemia (C) do not involve the same mechanism of false-normal reports in C6PD deficiency as seen in hemolysis.

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