The patient is a 6-year-old boy referred to a hematologist for thrombocytopenia. He has no bleeding history or family history of bleeding. His only other past medical history is mild high-frequency hearing loss. What gene is responsible for these findings?
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ATI RN · Hematological System
Question 2 of 51
You examine a 10-year-old boy with severe aplastic anemia. He has no dysmorphic features and is at the 50th percentile for height and weight. Family history includes a sister with aplastic anemia unresponsive to anti-human thymocyte globulin (ATG) and cyclosporine who died early in the course of an unrelated donor hematopoietic stem cell transplant complicated by severe mucositis and transplant-related organ toxicities. There are no other siblings. A cousin died of acute myeloid leukemia at age 5 years. A peripheral blood sample test for Fanconi anemia is negative with no increased chromosomal breaks in response to diepoxybutane or mitomycin C. Which of the following is the most important next step in management?
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ATI RN · Hematological System
Question 3 of 51
A 9-year-old child with osteosarcoma is being admitted for cisplatin therapy. What is the best regimen for prevention of chemotherapy-induced nausea and vomiting (CINV)?
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ATI RN · Hematological System
Question 4 of 51
Gum bleeding is characteristic of all except:
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Question 5 of 51
The vector of visceral leishmaniasis has geographical variations. In the Asian region, the main vector is
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ATI RN · Hematological System
Question 6 of 51
A patient is prescribed to receive 2 units of packed red blood cells. What approach should the nurse use to ensure that the correct blood will be provided to this patient?
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ATI RN · Hematological System
Question 7 of 51
A nurse practitioner is assessing a patient who has a fever, malaise, and a white blood cell count that is elevated. Which of the following principles should guide the nurse's management of the patient's care?
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ATI RN · Hematological System
Question 8 of 51
Which of the following sign is associated with anaemia?
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Question 9 of 51
Myelodysplastic syndromes are a group of clonal stem cell disorders. Which of the following type has the poorest prognosis according to the FAB system of classifications?
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Question 10 of 51
A nurse should assess a client who has a megaloblastic anemia for indications of which of the following vitamin deficiencies?
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ATI RN · Hematological System
Question 11 of 51
Decrease iron &decrease iron binding capacity are seen in:
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ATI RN · Hematological System
Question 12 of 51
A nurse is caring for a client who is taking ferrous sulfate to treat iron deficiency anemia and develops iron toxicity. Which of the following drugs should the nurse expect to use to treat this complication?
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ATI RN · Hematological System
Question 13 of 51
A patient has a platelet count of 75,000 /mm³. What action should the nurse take to support this patient?
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ATI RN · Hematological System
Question 14 of 51
A 15-year-old girl with a history of osteosarcoma presents to survivor clinic for her first evaluation. Her mother complains that she does not listen well and is wondering if she may have trouble hearing. Which of the follow is true regarding platinum-associated hearing loss?
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ATI RN · Hematological System
Question 15 of 51
The nurse is assessing an older client for any potential hematologic health problem. Which assessment finding is the most significant and would be reported to the primary health care provider?
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ATI RN · Hematological System
Question 16 of 51
A peripheral blood smear showing increase in numbers of neutrophils, band cells, metamyelocytes, myelocytes, basophils, eosinophils, and platelets is most suggestive
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ATI RN · Hematological System
Question 17 of 51
A patient who underwent lymphangiography the day before asks the licensed practical nurse (LPN), “Why does my urine look blue?†What should the LPN respond to this patient's concern?
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ATI RN · Hematological System
Question 18 of 51
All may complicate BM transplantation except:
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Question 19 of 51
You are asked to evaluate a 2-day-old boy in the newborn nursery with petechiae who has a platelet count of 8,000/mcL. On further questioning, you learn that he had a maternal uncle who died of intracerebral hemorrhage as a toddler. There is no eczema on physical examination. Review of the smear shows anisocytosis; poikilocytosis; normal white blood cell morphology; and small, infrequent platelets. The neonatologists have sent human platelet antigen (HPA)-1a testing from both parents, which is pending. Which of the following is the most likely diagnosis?
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ATI RN · Hematological System
Question 20 of 51
All may cause abdominal pain in thalassemia major except:
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ATI RN · Hematological System
Question 21 of 51
A 7-year-old Hispanic male is referred to the hematology consult service by his pediatrician because of concern for hemoglobinopathy. In his records, you find a hemoglobin electrophoresis performed last year which shows hemoglobin A 78% and hemoglobin F 22%. His complete blood count is normal, and he has normal growth and development. Which of the following is true for this patient?
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ATI RN · Hematological System
Question 22 of 51
Which is associated with prolonged bleeding time:
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Question 23 of 51
The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect?
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ATI RN · Hematological System
Question 24 of 51
A nurse in an emergency department is assessing a client who has been taking warfarin and is experiencing rectal bleeding. Which of the following drugs should the nurse expect to administer to the client?
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ATI RN · Hematological System
Question 25 of 51
Which of the following is a vitamin K-dependent coagulation factor?.
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Question 26 of 51
Which of the following is not a good prognostic factor in patient with acute lymphoblastic leukemia?
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Question 27 of 51
A patient is presented with pallor, fatigue and dyspnea. Physical examination shows koilonychias and angular cheilitis. Which of the following is not expected in the laboratory finding of this patient?
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ATI RN · Hematological System
Question 28 of 51
A nurse is teaching a client who is starting treatment with warfarin. The nurse should plan to include information on which of the following topics to promote the effectiveness of the drug?
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ATI RN · Hematological System
Question 29 of 51
A 15-year-old female presents with 1-month history of fatigue and a 3-day history of chest pain and shortness of breath. Her chest x-ray shows a large mediastinal mass that is greater than 33% of the thoracic diameter at the level of the diaphragm. A biopsy shows diffuse large B-cell lymphoma. Metastatic work-up, including a CT scan of neck, chest, abdomen, and pelvis; bone marrow biopsy; lumbar puncture; and PET scan show no other site of disease. According to the St. Jude (Murphy) staging system, what is the stage of this patient's non-Hodgkin lymphoma (NHL)?
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Question 30 of 51
A client is receiving rivaroxaban (Xarelto) and asks the nurse to explain how it works. What response by the nurse is best?
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Question 31 of 51
Which of the following is a lympho-morphologic change in reactive states?
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Question 32 of 51
A healthy 17-year-old African American male presents with a thrombosis of the right upper extremity. His past medical history is remarkable only for sickle cell trait. The history is negative for recent risk factors for thrombosis (illness, surgery, immobility). He is the pitcher for his high school baseball team. Imaging confirms anatomical compression/narrowing of the right subclavian vein. Which of the following interventions is most likely to decrease this patient's long-term risk of recurrent thrombosis?
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Question 33 of 51
An avid 16-year-old triathlete was in a bike accident and developed cellulitis, which was treated with Bactrim. While still on antibiotics, he moved with his family from Houston to Denver, and during the car trip he developed fever, pharyngitis, and malaise. Upon arriving in Denver he presented to the emergency department and was noted to have significant lymphocytosis with some atypical lymphocytes. What is the most likely cause of the white blood cell abnormalities?
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Question 34 of 51
Iron-refractory iron deficiency anemia (IRIDA) is a rare inherited condition characterized by congenital iron deficiency anemia, poor response to oral iron, and partial but incomplete response to intravenous iron therapy. Which is the genetic mutation associated with IRIDA?
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Question 35 of 51
A 13-year-old girl presents with acute myeloid leukemia (AML) and a WBC count of 120,000/mm3. Cytogenetics reveals a normal karyotype, and fluorescence in situ hybridization (FISH) tests for inv(16), t(8;21), t(15;17); 11q23 abnormalities; monosomy 7; and 5q deletion are negative. Molecular testing is negative for mutations in FLT3, NPM1, and CEBPA. She is treated with 10 days of daunorubicin, AraC, and gemtuzumab for induction therapy. On day 30, she recovers counts, and a bone marrow aspiration shows 2.2% leukemic blasts by flow cytometry. She receives a second course of treatment with daunorubicin and AraC, and her marrow is now in morphologic remission and is MRD-negative by flow cytometry. She has no HLA-matched siblings, but an unrelated donor search reveals a large number of potential matches. Which course of treatment is most likely to result in the best outcome?
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Question 36 of 51
A nurse is planning the care of a patient who has been admitted to the medical unit with a diagnosis of multiple myeloma. In the patient's care plan, the nurse has identified a diagnosis of Risk for Injury. What pathophysiologic effect of multiple myeloma most contributes to this risk?
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Question 37 of 51
A patient diagnosed with acute myelogenous leukemia has just been admitted to the oncology unit. When writing this patient's care plan, what potential complication should the nurse address?
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Question 38 of 51
Which of the following subtypes of Hodgkin's lymphoma is common in young women and has good prognosis?
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ATI RN · Hematological System
Question 39 of 51
Sideroblastic anemia may be treated by all except:
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Question 40 of 51
A newborn male has severe bleeding after circumcision, resulting in the need for a blood transfusion. You are called to consult on this child, and you diagnose him with severe hemophilia A. Upon taking a family history, you note that no other family members have hemophilia, other bleeding disorders, or a bleeding diathesis. Which of the following is the most likely outcome of genotyping the Factor VIII gene?
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ATI RN · Hematological System
Question 41 of 51
Spherocytosis is a common cause of inherited hemolytic anemia. The most likely cause for spherocytosis is
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ATI RN · Hematological System
Question 42 of 51
The nurse is caring for a patient having a bone marrow biopsy. What nursing action is the most important following the biopsy?
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ATI RN · Hematological System
Question 43 of 51
A 5-year-old girl with a previously normal CBC now presents in your office with a hemoglobin of 8.5 g/dL, corrected reticulocyte count of 0.1%, and mean corpuscular volume of 80 fl. White cells and platelets are normal in number and morphology. Bilirubin, LDH, BUN, creatinine, and urinalysis are normal. Direct and indirect antiglobulin tests are negative. Workup for infection, including parvovirus, is negative. Occult blood in her stools is negative. Physical examination is unremarkable. She has had no restriction in her energy or activities and the family agrees she is 'fine.' What is the most appropriate next step in management?
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Question 44 of 51
A 3-year-old nonsyndromic, well-appearing male with no significant past medical history presents with an abdominal mass palpated by his mother when giving him a bath. CT imaging reveals a 9-cm right renal mass without involvement of the inferior vena cava (IVC) and no evidence of tumor thrombus by ultrasound. The left kidney appears normal, and there is no imaging evidence of tumor rupture or adherence to surrounding organs. There are diffuse, bilateral pulmonary metastases from which he is asymptomatic with a normal respiratory rate and no supplemental oxygen requirement. Following the National Wilms Tumor Study Group (NWTS)/Children's Oncology Group (COG) approach to pediatric renal tumors, which of the following are appropriate next steps?
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Question 45 of 51
A patient is admitted to determine why red blood cells are being quickly destructed in the body. What finding should the nurse associate with this patient's health problem?
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ATI RN · Hematological System
Question 46 of 51
A client is having a bone marrow aspiration and biopsy and is extremely anxious. What action by the nurse is the most appropriate?
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ATI RN · Hematological System
Question 47 of 51
A 3-year-old boy with X-linked chronic granulomatosis disease is day +25 after haploidentical bone marrow transplant (father donor) using posttransplant cyclophosphamide as graft-versus-host disease (GVHD) prophylaxis. He engrafted on day +16 and was preparing for discharge when cytomegalovirus (CMV) was noted to be positive on PCR, and he developed a fever and mild rash. His counts have fallen to a WBC of 0.1 and he remains transfusion dependent. What diagnostic evaluations/treatments should you pursue?
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Question 48 of 51
A patient has been found to have an indolent neoplasm. The nurse should recognize what implication of this condition?
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ATI RN · Hematological System
Question 49 of 51
A client is having a bone marrow biopsy and is extremely anxious. What action by the nurse is best?
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Question 50 of 51
Of the variables listed below, what is the most important factor for survival after relapse of acute lymphoblastic leukemia?
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ATI RN · Hematological System
Question 51 of 51
Which of the following is not associated with thrombotic thrombocytopenic purpura?
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