Medical-Surgical Nursing: Hematology Practice Questions
Test yourself on Hematology with 12 original NCLEX-RN practice questions. Pick an answer to see instant feedback and a full explanation.
Free original practice questions for study purposes. Open Exam Prep is an independent study resource and is not affiliated with, endorsed by, or sponsored by the makers of NCLEX-RN.
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Answer the questions below — you get instant feedback and a full explanation for each.
1. A client receiving a packed red blood cell transfusion develops chills, back pain, and shortness of breath 15 minutes after the transfusion begins. What should the nurse do first?
Explanation. Chills, back pain, and respiratory symptoms shortly after a transfusion begins suggest a possible acute transfusion reaction. The priority is to stop the blood, maintain IV access with normal saline using new tubing per policy, assess the client, and notify the provider and blood bank.
2. The nurse is teaching a client with iron-deficiency anemia about taking oral ferrous sulfate. Which instruction is most appropriate?
Explanation. Vitamin C can improve iron absorption. Milk, calcium, and some antacids can reduce absorption. Dark stools are an expected effect of oral iron, but black tarry stool with symptoms should be reported. Missed doses should not be doubled unless specifically prescribed.
3. A client receiving chemotherapy has an absolute neutrophil count of 420/mm3. Which nursing action is the priority?
Explanation. An absolute neutrophil count below 500/mm3 indicates severe neutropenia and high infection risk. Protective precautions, hand hygiene, avoiding sick contacts and fresh flowers, and prompt reporting of fever are priorities.
4. A client has a platelet count of 18,000/mm3. Which intervention should the nurse include in the plan of care?
Explanation. Severe thrombocytopenia increases bleeding risk. Bleeding precautions include using an electric razor, soft toothbrush, avoiding unnecessary injections and rectal temperatures, and avoiding medications that increase bleeding risk unless prescribed.
5. A client with sickle cell disease is admitted with severe pain in the legs and back. Which intervention is most appropriate early in care?
Explanation. A vaso-occlusive crisis requires prompt pain control, hydration as prescribed, oxygen if needed, and assessment for triggers or complications. Delaying analgesia or using prolonged cold can worsen distress or vasoconstriction.
6. The nurse is assessing a client with suspected deep vein thrombosis in the left leg. Which finding is most concerning?
Explanation. Sudden shortness of breath and chest pain can indicate pulmonary embolism, a life-threatening complication of venous thrombosis. Calf warmth, tenderness, and swelling are relevant DVT findings, but respiratory symptoms require immediate escalation.
7. A client taking warfarin has an INR of 6.2 and reports bleeding gums. Which action should the nurse anticipate?
Explanation. A markedly elevated INR with bleeding signs increases hemorrhage risk. The nurse should hold the medication according to protocol or prescription parameters, notify the provider, and anticipate further orders such as vitamin K depending on severity.
8. The nurse is caring for a client receiving heparin therapy. Which laboratory value is most directly used to monitor unfractionated heparin effect?
Explanation. Activated partial thromboplastin time is commonly used to monitor unfractionated heparin therapy. Some facilities use anti-Xa levels. Hemoglobin and platelets are also monitored for bleeding or heparin-induced thrombocytopenia, but aPTT reflects anticoagulant effect.
9. A client with pernicious anemia asks why vitamin B12 injections are prescribed. Which response is best?
Explanation. Pernicious anemia involves impaired absorption of vitamin B12, often related to lack of intrinsic factor. B12 is needed for red blood cell formation and neurologic function, so parenteral replacement may be prescribed.
10. A client with hemophilia A has swelling and pain in the knee after a minor fall. What is the priority nursing action?
Explanation. Joint bleeding is a serious concern in hemophilia. The nurse should assess, protect the joint, notify the provider, and anticipate factor VIII replacement as prescribed. Massage, weight-bearing, and delayed assessment can worsen bleeding or joint damage.
11. A client with chronic anemia reports fatigue and shortness of breath with activity. Which nursing goal is most appropriate?
Explanation. Anemia reduces oxygen-carrying capacity, so activity intolerance is common. Care focuses on pacing activities, rest periods, monitoring symptoms, and reporting worsening shortness of breath, chest pain, dizziness, or palpitations.
12. The nurse is reviewing discharge teaching for a client prescribed apixaban for atrial fibrillation. Which statement indicates the client needs more teaching?
Explanation. Anticoagulants should not be stopped without provider guidance because stopping can increase clot or stroke risk. Reporting bleeding, informing healthcare providers, and checking before new over-the-counter medicines are appropriate safety behaviors.
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FAQ
What hematology topics are highest yield for NCLEX med-surg?
Prioritize transfusion reactions, anemia teaching, neutropenia precautions, thrombocytopenia bleeding precautions, anticoagulant safety, sickle cell crisis care, DVT and pulmonary embolism warning signs, and hemophilia joint bleeding.
How should I answer hematology priority questions?
Look first for airway or breathing changes, shock signs, active bleeding, severe infection risk, and clot complications. Shortness of breath during a transfusion, chest pain with possible embolism, fever in neutropenia, or bleeding with high anticoagulation levels usually outrank stable teaching needs.
Which lab values matter most in hematology practice questions?
Common NCLEX-style cues include hemoglobin and hematocrit for anemia or bleeding, platelets for bleeding risk, absolute neutrophil count for infection risk, INR for warfarin, aPTT for unfractionated heparin, and type and crossmatch details before transfusion.