A nurse is caring for a client who is being tested for chronic myelogenous leukemia (CML). Which of the following diagnostic tests should the nurse anticipate being prescribed?(Select All that Apply.)

Total iron binding capacity (TIBC)

Fluorescence in situ hybridization test (FISH)

Cytogenic analysis

Reticulocyte count

Reverse transcription-polymerase change reaction (RT-PCR)

Answer and Explanation

Correct Answer : B,C,E

A.   This test measures the blood's capacity to bind iron with transferrin, and it is primarily used to evaluate iron metabolism and diagnose iron deficiency anemia. It is not specifically used for diagnosing CML. Therefore, this option is not typically relevant for CML testing.
B.   This test is used to detect specific genetic abnormalities associated with CML, particularly the Philadelphia chromosome, which results from a translocation between chromosomes 9 and 22. FISH is a valuable diagnostic tool for identifying the presence of this genetic marker, making this a relevant test for CML.
C.   This test examines the chromosomes in cells and is crucial for diagnosing CML. It allows for the detection of chromosomal abnormalities, including the Philadelphia chromosome. Cytogenetic analysis is a standard diagnostic tool in identifying CML and monitoring treatment response.
D.   A reticulocyte count measures the number of young red blood cells in the blood and is used to assess bone marrow function. While it can provide some information about bone marrow activity, it is not specific for diagnosing CML. Therefore, it is not a primary diagnostic test for this condition.
E.   RT-PCR is a highly sensitive test that detects the BCR-ABL fusion gene, which is characteristic of CML. This test is used not only for diagnosis but also for monitoring treatment response. It is a critical test in the management of CML.

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Correct Answer is D

Explanation

A. A white blood cell (WBC) count of 8,000/mm³ is within the normal range (typically 4,000- 11,000/mm³). This value does not indicate any immediate concern and does not need to be reported to the provider.
B. A PTT of 65 seconds is elevated, as the therapeutic range for PTT when on heparin is typically 1.5 to
2.5 times the normal range (usually around 25-35 seconds). An elevated PTT increases the risk of bleeding, and this should be reported to the provider for potential adjustment of heparin dosage or further evaluation.
C. A hematocrit of 45% is within the normal range for adult females (typically around 37-47%) and males (around 42-52%). This value does not indicate a concern that needs reporting to the provider.
D. A platelet count of 74,000/mm³ is low (thrombocytopenia), as the normal range is typically 150,000- 450,000/mm³. This finding is significant, especially in the context of heparin therapy, as low platelet counts can increase the risk of bleeding.

A. Neutropenic B. Bleeding C. Droplet D. Contact

Correct Answer is B

Explanation

A. Neutropenic precautions are necessary for patients with low white blood cell counts (neutrophils), which increases the risk of infections. However, in this scenario, the child has a critically low platelet count, not necessarily low white blood cells.
B. This option refers to implementing bleeding precautions, which are critical for a child with low platelet counts (thrombocytopenia). This includes measures to prevent injury and bleeding, such as avoiding invasive procedures, using soft toothbrushes, and ensuring a safe environment.
C. Droplet precautions are used to prevent the spread of infections transmitted through respiratory droplets, such as influenza or COVID-19. While important for specific infections, this does not apply directly to the child's condition regarding leukemia and low platelets unless there is a concern for a respiratory illness.
D. Contact precautions are used to prevent the spread of infections through direct contact with the patient or their environment. This is important for infections that can be spread by touch. However, it is not the primary concern for a child with low platelet counts unless there is a known infectious risk.

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A nurse is caring for a client who is being tested for chronic myelogenous leukemia (CML). Which of the following diagnostic tests should the nurse anticipate being prescribed?(Select All that Apply.)

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