Hematology/Immune
The nurse is assessing a patient with suspected anemia. Which clinical findings would support this diagnosis? (Select all that apply)
A. Shortness of breath on exertion
B. Bright red blood in stool
C. Brittle nails and pale skin
D. Fatigue and generalized weakness
E. Yellowing of the sclera
Answers: A, C, D
Rationale:
A, C, D are classic signs of anemia (↓ oxygen-carrying capacity → SOB, fatigue, brittle nails, pallor).
B suggests GI bleeding but is not specific to anemia.
E may indicate hemolysis or liver disease, not typical of all anemias.
What are the clinical manifestations for Left vs Right-sided heart failure? What are the acronyms?
Madison has flashcards
Left-sided: DROWNING
Right-sided: SWELLING
Atherosclerosis vs arteriosclerosis
Atherosclerosis “PASTE” + “Hardening"
Stiffness & loss of elasticity
One form of arteriosclerosis
Buildup of LDL in the arterial wall
Arteriosclerosis “Artery” + “Hardening”
Three main causes:
Calcium deposits
Smaller arteries thicken
Atherosclerosis**
Signs and symptoms of hyperthyroidism vs. hypothyroidism
Hyperthyroidism- “High and fast” metabolism – excess thyroid hormones.
weight loss despite increased appetite, heat intolerance, sweating, anxiety, irritability, palpitations, tremors, diarrhea, and insomnia. Patients often have warm, moist skin and may present with exophthalmos (bulging eyes) if caused by Graves’ disease.
Hypothyroidism- “Low and slow” metabolism – insufficient thyroid hormones
fatigue, weight gain, cold intolerance, dry skin, depression, constipation, bradycardia, and menstrual irregularities. Patients may have coarse hair, puffy face, and slowed mental processes, and they often feel sluggish or mentally foggy.
What do these mean in ECGs?
P wave:
PR interval:
QRS complex:
ST segment:
T wave:
QT interval:
P wave: Depolarization (contraction) of the atria
PR interval: TIME, Delay in the AV node to allow the atria to contract
QRS complex: Depolarization (contraction) of the ventricle
ST segment: TIME, represents early phase of ventricular muscle recovery
T wave: Repolarization (relaxation) or resting phase of the ventricle
QT interval: TIME, represents the total time for ventricular depolarization and repolarization. It should be no longer than ½ of the R-R interval (time between two R waves aka one full cardiac cycle)
The nurse is reviewing a patient’s lab results: Hgb 8.2 g/dL, Hct 25%, and platelets 300,000. The patient is scheduled for surgery. What is the nurse’s priority action?
A. Cancel the surgery and notify the provider
B. Administer a unit of platelets
C. Assess for signs of oxygenation issues and notify the provider
D. Recheck labs in 4 hours before acting
Answer: C
Rationale: The patient has anemia (low Hgb/Hct), but normal platelets. The priority is to assess for oxygenation issues (fatigue, SOB, tachycardia) and alert the provider. Platelet transfusion isn’t needed, and surgery decisions depend on clinical symptoms and provider judgment.
What is happening within the heart in L vs R-sided heart failure?
Left-sided heart failure:
The left ventricle cannot effectively pump blood out to the systemic circulation, causing blood to back up into the lungs. This results in pulmonary congestion, leading to symptoms like shortness of breath and crackles.
Right-sided heart failure:
The right ventricle fails to pump blood efficiently into the pulmonary arteries, causing blood to back up into the systemic venous system. This leads to peripheral edema, jugular vein distention, and abdominal swelling.
Non-modifiable vs modifiable risk factors for literally all the heart problems
Non-modifiable: Age, Race, Genetics/Family hx
Modifiable: Smoking, diet, obesity, physical inactivity, alcohol consumption
DI vs SIADH
DI causes low ADH, leading to excessive urine output, dehydration, and high sodium levels. You'll see low urine specific gravity and high serum osmolality. Nurses assess for dehydration, monitor I&Os, neuro status, and ensure fluid replacement.
SIADH causes too much ADH, leading to fluid retention and low sodium. Urine is concentrated (high specific gravity), and serum sodium and osmolality are low. Nurses assess for fluid overload, confusion, and seizures, and manage with fluid restriction and neuro checks.
Intrinsic Pacemakers of the Heart. Name the three and their bpm.
SA Node: 60-100 bpm
AV Node: 40-60 bpm
Purkinje Fibers: 20-40 bpm (ventricles)
A nurse is explaining the difference between the intrinsic and extrinsic pathways of the clotting cascade to a nursing student. Which statement by the student indicates correct understanding?
A. “The intrinsic pathway is activated by trauma to blood vessels and is assessed by the PT/INR test.”
B. “The extrinsic pathway begins with exposure to collagen and is monitored by the aPTT test.”
C. “The intrinsic pathway is slower and triggered by damage inside the vessel; it is assessed with the aPTT test.”
D. “The extrinsic pathway is activated by endothelial damage and is evaluated using the aPTT test.”
Answer: C
Rationale:
The intrinsic pathway is triggered by damage within the blood vessel (e.g., exposed collagen), is slower, and is monitored by the aPTT.
Extrinsic = PT, trauma, faster
How would you explain ejection fraction to a patient?
Ejection fraction is the percentage of blood your heart pumps out of the main pumping chamber (the left ventricle) with each heartbeat. It’s normal for your heart to not push out 100% of the blood — typically, a healthy EF is between 40% and 70%. Knowing your EF helps doctors understand how well your heart is working and guides treatment decisions.
What is intermittent claudication and what disease process has this symptom?
Intermittent claudication is a cramping or aching pain in the legs, thighs, or buttocks that occurs during activity (like walking) and is relieved by rest.
It’s a hallmark symptom of Peripheral Arterial Disease (PAD) — a condition where narrowed or blocked arteries reduce blood flow to the limbs, usually due to atherosclerosis. The pain happens because the leg muscles don’t get enough oxygen during exertion, but symptoms ease with rest when oxygen demand decreases.
6. A patient with Cushing’s syndrome is admitted with new-onset confusion and generalized weakness. What lab value would the nurse expect to find?
A. Serum sodium 128 mEq/L
B. Blood glucose 62 mg/dL
C. Potassium 2.9 mEq/L
D. WBC count 3,000/mm³
Answer: C. Potassium 2.9 mEq/L
Rationale: Cushing’s syndrome causes hyperaldosteronism, leading to sodium retention and potassium excretion. Hypokalemia can lead to weakness and confusion. Hyponatremia and low glucose are more common in Addison’s
General rules for ECGs
Rhythm
Regular or irregular?
Rate
Calculate the rate. Too fast, too slow, just right?
P waves
Present?
Upright?
1 in front of each QRS?
PR Interval .12-.20, 3-5 boxes
QRS complex
Narrow, look the same
Measurement < .12, less than 3 boxes
ST segment
Isoelectric?
QT Interval
.34 - .44
HIV Stages CD4 T cell count
Stage 1:
Stage 2:
Stage 3:
Stage 1: CD4 T cell count is at least 500
Stage 2: CD4 T cell count is 200-499
Stage 3: CD4 T cell count less than 200
A patient with chronic heart failure reports increasing shortness of breath and swelling in the legs. Which lab test should the nurse anticipate being ordered to evaluate the severity of the patient’s heart failure?
A. B-type natriuretic peptide (BNP)
B. Serum potassium
C. Troponin I
D. D-dimer
Answer: A
Rationale: BNP is released in response to ventricular stretch and is a sensitive marker for heart failure severity. Troponin is for myocardial injury, potassium is monitored for medication effects, and D-dimer is for clot detection.
Q3. A nurse is preparing to give the initial medications for a patient suspected of having an MI. Which set of interventions follows current best practice for early management?
A. Oxygen, acetaminophen, IV fluids, nitro patch
B. Aspirin (chewed), oxygen, sublingual nitro, IV morphine
C. Albuterol, IV antibiotics, aspirin, oxygen
D. Nitro IV, digoxin, oral aspirin, morphine IM
Correct Answer: B. Aspirin (chewed), oxygen, sublingual nitro, IV morphine
Rationale: This follows MONA (Morphine, Oxygen, Nitro, Aspirin) in acute coronary syndrome. Aspirin is chewed for fast absorption, and nitro is given sublingually to relieve chest pain.
2. A nurse is caring for a patient post-thyroidectomy. Which priority item should be kept at the bedside?
A. NG tube
B. Suction equipment
C. Tracheostomy tray
D. Incentive spirometer
Answer: C. Tracheostomy tray
Rationale: Due to the risk of airway obstruction from swelling or hematoma formation, a tracheostomy tray must be at the bedside to secure the airway in an emergency. Suction and incentive spirometry are important but not the priority in airway emergencies.
Describe what atrial fibrillation looks like.
Atrial fibrillation is the chaotic depolarization of the atria. The result is a very disorganized ECG rhythm
Rhythm – always irregular
Rate – variable
P Waves – isoelectric line appears to be undulating, chaotic, no organized or identifiable wave forms, no P wave
PR and QT interval – not measurable
QRS Complex - ≤.12
A nurse is caring for a postoperative patient with a MRSA-infected surgical wound that is erythematous, swollen, warm, and draining purulent fluid. The patient is also scheduled for a physical therapy session outside the room. Which of the following nursing actions demonstrates the best infection control practice while balancing patient mobility needs?
A. Allow the patient to attend physical therapy without precautions since the wound is covered by a dressing.
B. Ensure the patient wears a clean gown over the wound area and staff don gown and gloves during transport and therapy.
C. Restrict the patient to bed rest until the wound is no longer draining.
D. Place a surgical mask on the patient during transport and have staff wear masks and gloves.
Answer: B
Rationale:
B is correct: MRSA is transmitted by contact with infected wounds or contaminated surfaces. Even with dressings, the patient’s skin and environment may harbor bacteria. Wearing a clean gown helps contain drainage; staff wearing gown and gloves prevents transmission during transport and therapy.
A is incorrect: Dressings reduce but do not eliminate risk; no precautions during transport increase risk of spreading MRSA.
C is impractical and may delay recovery; mobility is important but must be balanced with infection control.
D is incorrect: MRSA is primarily spread by contact, not airborne, so masks are not required for routine care or transport; gloves and gowns are essential.
A nurse is teaching a patient with heart failure about diet modifications. Which statement by the patient indicates the need for further teaching?
A. “I will limit my sodium intake to reduce fluid buildup.”
B. “I can drink as much water as I want if I take my medications.”
C. “I should avoid processed foods high in salt.”
D. “I will aim to walk daily to help my heart health.”
Answer: B
Rationale: Patients with heart failure often need to restrict fluids to prevent fluid overload. Drinking unlimited water can worsen symptoms, even if medications are taken.
Q5. A nurse is caring for a post-cardiac catheterization patient. Which action is most appropriate to reduce the risk of bleeding from the femoral site?
A. Encourage early ambulation
B. Keep the head of bed at 45 degrees
C. Elevate the affected leg
D. Maintain the leg straight and flat
Correct Answer: D. Maintain the leg straight and flat
Rationale: Keeping the leg straight and flat helps reduce movement at the femoral insertion site, minimizing the risk for bleeding or hematoma formation.
A nurse is reviewing discharge instructions with a patient newly diagnosed with heart failure. The patient nods and smiles throughout the teaching but later asks, “So… do I stop taking my water pill if I feel okay?” Which of the following actions should the nurse take first?
A. Ask the patient to repeat the instructions in their own words.
B. Reinforce that medications should be taken as prescribed.
C. Provide a printed medication schedule with pictures.
D. Notify the provider that the patient may not be adherent.
Answer:
A. Ask the patient to repeat the instructions in their own words.
Rationale:
This is an example of using the "teach-back" method, a key strategy in assessing and promoting health literacy. The patient's question suggests a gap in understanding, despite appearing engaged. Teach-back allows the nurse to assess comprehension in a nonjudgmental way before reinforcing or modifying education. The other options may be appropriate later, but first, the nurse must determine what the patient actually understood.
A patient in the emergency room suddenly becomes unresponsive and pulseless. The cardiac monitor shows chaotic, irregular waves with no identifiable QRS complexes. What is the nurse’s priority action?
A. Start CPR immediately and prepare to defibrillate
B. Administer IV epinephrine and wait for pulse return
C. Place the patient in Trendelenburg position
D. Give oxygen via nasal cannula and monitor closely
Answer: A. Start CPR immediately and prepare to defibrillate
Rationale: VFib is a lethal arrhythmia with no effective heartbeat, requiring immediate CPR and defibrillation to restore a perfusing rhythm.