NCLEX-RN Pharmacology Hematologic
System Exam |
20 Original ATI & NGN-Style Practice
Questions with Detailed Rationales |
Nursing Study Guide
Question 1
Clinical Scenario
A nurse is preparing to administer a subcutaneous injection of
heparin to a 65-year-old client with deep vein thrombosis.
Question Stem
Which action should the nurse take when administering this
medication?
A. Aspirate for blood return before injecting the medication.
B. Massage the injection site firmly after administering the
medication.
C. Inject the medication into the abdomen at least 5 cm (2 inches)
from the umbilicus.
D. Use a 22-gauge needle to ensure deep subcutaneous tissue
penetration.
,Correct Answer
Correct Answer: C. Inject the medication into the abdomen at least
5 cm (2 inches) from the umbilicus.
Detailed Rationale
Heparin should be injected into the abdomen, at least 5 cm (2
inches) from the umbilicus, to ensure proper subcutaneous
absorption and minimize bruising. The abdomen provides a
consistent layer of subcutaneous tissue. Aspiration is not
recommended for subcutaneous heparin injections because pulling
back on the plunger can cause tissue trauma, increase pain, and
elevate the risk of hematoma formation at the injection site.
Massaging the site after injection is strictly contraindicated, as it
can cause tissue damage, increase capillary fragility, and lead to
significant bruising or hematoma. Furthermore, a 22-gauge needle
is excessively large for subcutaneous administration; a 25- to 27-
gauge needle (typically 5/8 inch in length) is the standard of care to
minimize tissue trauma and ensure the medication is deposited in
the subcutaneous fat layer rather than muscle.
Learning Objective
• Identify proper administration techniques for subcutaneous
heparin.
• Recognize actions that prevent tissue trauma and hematoma
formation.
Medication Safety Focus
Medication administration
, Question 2
Clinical Scenario
A 28-year-old client who is 12 weeks pregnant is prescribed ferrous
sulfate 325 mg daily for iron deficiency anemia.
Question Stem
Which statement by the client indicates an understanding of the
teaching regarding this medication?
A. "I should expect my stools to become dark green or black while
taking this."
B. "I will take this medication with a glass of milk to prevent stomach
upset."
C. "I will crush the tablet and mix it with applesauce if it is hard to
swallow."
D. "I should stop taking the medication if I experience mild
constipation."
Correct Answer
Correct Answer: A. "I should expect my stools to become dark green
or black while taking this."
Detailed Rationale
Dark green or black stools are a common, harmless, and expected
side effect of oral iron therapy. The nurse should proactively educate
the client about this to prevent unnecessary anxiety or premature
discontinuation of the medication. Milk and other dairy products
contain high levels of calcium, which binds to iron in the
gastrointestinal tract and significantly inhibits its absorption. To
enhance absorption, oral iron should be taken on an empty stomach
with vitamin C-rich fluids, such as orange juice, which creates an
System Exam |
20 Original ATI & NGN-Style Practice
Questions with Detailed Rationales |
Nursing Study Guide
Question 1
Clinical Scenario
A nurse is preparing to administer a subcutaneous injection of
heparin to a 65-year-old client with deep vein thrombosis.
Question Stem
Which action should the nurse take when administering this
medication?
A. Aspirate for blood return before injecting the medication.
B. Massage the injection site firmly after administering the
medication.
C. Inject the medication into the abdomen at least 5 cm (2 inches)
from the umbilicus.
D. Use a 22-gauge needle to ensure deep subcutaneous tissue
penetration.
,Correct Answer
Correct Answer: C. Inject the medication into the abdomen at least
5 cm (2 inches) from the umbilicus.
Detailed Rationale
Heparin should be injected into the abdomen, at least 5 cm (2
inches) from the umbilicus, to ensure proper subcutaneous
absorption and minimize bruising. The abdomen provides a
consistent layer of subcutaneous tissue. Aspiration is not
recommended for subcutaneous heparin injections because pulling
back on the plunger can cause tissue trauma, increase pain, and
elevate the risk of hematoma formation at the injection site.
Massaging the site after injection is strictly contraindicated, as it
can cause tissue damage, increase capillary fragility, and lead to
significant bruising or hematoma. Furthermore, a 22-gauge needle
is excessively large for subcutaneous administration; a 25- to 27-
gauge needle (typically 5/8 inch in length) is the standard of care to
minimize tissue trauma and ensure the medication is deposited in
the subcutaneous fat layer rather than muscle.
Learning Objective
• Identify proper administration techniques for subcutaneous
heparin.
• Recognize actions that prevent tissue trauma and hematoma
formation.
Medication Safety Focus
Medication administration
, Question 2
Clinical Scenario
A 28-year-old client who is 12 weeks pregnant is prescribed ferrous
sulfate 325 mg daily for iron deficiency anemia.
Question Stem
Which statement by the client indicates an understanding of the
teaching regarding this medication?
A. "I should expect my stools to become dark green or black while
taking this."
B. "I will take this medication with a glass of milk to prevent stomach
upset."
C. "I will crush the tablet and mix it with applesauce if it is hard to
swallow."
D. "I should stop taking the medication if I experience mild
constipation."
Correct Answer
Correct Answer: A. "I should expect my stools to become dark green
or black while taking this."
Detailed Rationale
Dark green or black stools are a common, harmless, and expected
side effect of oral iron therapy. The nurse should proactively educate
the client about this to prevent unnecessary anxiety or premature
discontinuation of the medication. Milk and other dairy products
contain high levels of calcium, which binds to iron in the
gastrointestinal tract and significantly inhibits its absorption. To
enhance absorption, oral iron should be taken on an empty stomach
with vitamin C-rich fluids, such as orange juice, which creates an
