RBCs
A client with sickle cell crisis reports chest pain and shortness of breath. O₂ sat is 92% on room air, and breath sounds are diminished at the bases. What is the nurse’s priority action?
A. Notify provider immediately
B. Administer oxygen
C. Obtain ABGs
D. Prepare for a chest x-ray
Administer oxygen
Which lab in leukemia requires immediate attention?
A. WBC 1,200 /µL
B. Platelets 60 K
C. Hgb 8 g/dL
D. Retic 0.5 %
WBC 1,200 /µL
Which symptom in ITP is life-threatening?
A. Nosebleed
B. New severe headache
C. Petechiae on arms
D. Gingival bleeding
New severe headache
Therapeutic aPTT on heparin?
A. 20–30 s
B. 40–50 s
C. 60–80 s
D. >100 s
60–80 s
Transfusion reaction symptoms: chills, back pain, hypotension. First step?
A. Stop transfusion, keep line open with NS
B. Notify provider
C. Send urine to lab
D. Recheck blood ID
Stop transfusion, keep line open with NS
A client with iron deficiency anemia is prescribed ferrous sulfate. Which food should the nurse instruct the client to avoid within 1 hour of taking the medication?
A. Strawberries
B. Eggs
C. Spinach
D. Milk
milk
A client with multiple myeloma is most at risk for:
A. Bone fractures and hypercalcemia
B. Petechiae and epistaxis
C. Jaundice and pruritus
D. Pulmonary embolism
Bone fractures and hypercalcemia
Rationale: Bone destruction releases calcium → fractures + renal failure.
A client with TTP has urine output 8 mL/hr and confusion. Priority action?
A. Prepare for plasma exchange
B. Administer fluids
C. Give platelets
D. Monitor I&O
Prepare for plasma exchange
Therapeutic INR on warfarin?
A. 0.8–1.2
B. 2.0–3.0
C. 4.0–5.0
D. >6.0
2.0-3.0
Crackles and dyspnea during transfusion indicate:
A. TACO
B. Sepsis
C. Hemolysis
D. Anaphylaxis
TACO (circulatory overload)
Which finding confirms vitamin B12 therapy is working for pernicious anemia?
A. Rising hemoglobin level
B. Pink, moist tongue and improved energy
C. Persistent paresthesia
D. Decreased reticulocytes
Pink, moist tongue and improved energy
Which finding is diagnostic of multiple myeloma?
A. Reed–Sternberg cells
B. Bence-Jones proteins in urine
C. Philadelphia chromosome
D. Auer rods
Bence-Jones proteins in urine
A client on heparin develops petechiae; platelets fall from 240 K → 85 K. What should the nurse do first?
A. Stop heparin immediately
B. Give protamine sulfate
C. Notify lab
D. Check aPTT
Stop heparin immediately
aPTT = 120 s while on heparin. Priority action?
A. Stop heparin and give protamine
B. Continue infusion
C. Reduce rate by 50 %
D. Document result
Stop heparin and give protamine
Post-transfusion labs show PT decreased and bleeding stopped. Which product was given?
A. FFP
B. PRBCs
C. Platelets
D. Cryoprecipitate
FFP
A client with aplastic anemia develops a temp of 100.9 °F. What’s the first action?
A. Give acetaminophen
B. Notify the provider
C. Obtain cultures
D. Start antibiotics
Notify the provider
A client receiving chemo for Hodgkin’s lymphoma suddenly develops facial swelling and dyspnea. What’s the cause?
A. Superior vena cava compression
B. Allergic reaction
C. Cardiac tamponade
D. Pleural effusion
Superior vena cava compression
Rationale: Mediastinal mass → venous obstruction → airway compromise.
A trauma client with DIC has oozing from IV sites. Which product should the nurse expect to administer?
A. FFP and cryoprecipitate
B. Platelets only
C. Vitamin K
D. Packed RBCs
FFP and cryoprecipitate
A client on tPA develops severe headache and unequal pupils. First action?
A. Stop infusion
B. Notify provider
C. Assess neuro status
D. Check BP
Stop infusion
Before starting a transfusion, the nurse must:
A. Verify patient + blood with another RN
B. Check vitals after 15 min only
C. Prime tubing with dextrose 5 %
D. Start within 1 hour of pickup
Verify with another RN
A client with polycythemia vera reports severe itching after showers. What should the nurse recommend?
A. Cool baths and antihistamines
B. Hot showers and lotion
C. Aspirin for itching
D. Warm compresses
Cool baths and antihistamines
Rationale: Heat worsens histamine release; cooling reduces pruritus.
A leukemia client post-chemo has uric acid 9.8 mg/dL, K⁺ 6.0 mEq/L, Ca²⁺ 6.5 mg/dL. What’s happening?
A. Tumor lysis syndrome
B. DIC
C. SIADH
D. Hyperparathyroidism
Tumor lysis syndrome
Rationale: Cell breakdown releases uric acid + K⁺ → renal failure risk.
Which medication is safest for anticoagulation in HIT?
A. Argatroban
B. Warfarin
C. Enoxaparin
D. Dabigatran
Argatroban
Massive transfusion causes tingling and muscle cramps. Likely cause?
A. Hypocalcemia from citrate binding
B. Hyperkalemia from cell lysis
C. Hypomagnesemia
D. Hypoglycemia
Hypocalcemia from citrate binding
Post-transfusion: fever 102 °F, tachycardia, hypotension, brown urine. Diagnosis?
A. Acute hemolytic reaction
B. Febrile non-hemolytic reaction
C. Allergic reaction
D. Bacterial contamination
Acute hemolytic reaction