NCLEX-RN Pharmacology Hematologic
System Exam Questions & Rationales |
20 Original NGN Practice MCQs
Question 1
Clinical Scenario
A 68-year-old female is postoperative day 1 following a total knee
arthroplasty. The provider prescribes enoxaparin 40 mg
subcutaneously daily for deep vein thrombosis (DVT) prophylaxis.
Question Stem
Which action by the nurse demonstrates the correct administration
of this medication?
A. Inject into the anterolateral abdominal wall.
B. Aspirate the syringe before injecting the medication.
C. Massage the injection site firmly after administration.
D. Expel the air bubble from the prefilled syringe before injecting.
Correct Answer
A. Inject into the anterolateral abdominal wall.
Detailed Rationale
Enoxaparin is a low-molecular-weight heparin (LMWH) administered
via deep subcutaneous injection. The preferred injection sites are
the anterolateral or posterolateral abdominal wall, which allows for
,consistent absorption and minimizes tissue trauma. The nurse
should not aspirate before injection, as this can cause tissue trauma
and increase the risk of hematoma. Massaging the site after
injection is contraindicated because it increases capillary fragility
and the risk of bruising or bleeding at the site. Finally, the air bubble
in a prefilled enoxaparin syringe is intentionally placed by the
manufacturer to clear the medication from the needle track after
injection, which actually reduces the risk of bruising; therefore, it
should not be expelled. Proper technique is essential to prevent
localized bleeding complications while ensuring therapeutic
efficacy for VTE prophylaxis.
Learning Objective
Identify the correct anatomical sites for subcutaneous enoxaparin
administration.
Recognize improper administration techniques that increase the
risk of hematoma or bruising.
Apply evidence-based practices for safe subcutaneous injection of
anticoagulants.
Medication Safety Focus
Medication administration technique
Question 2
Clinical Scenario
A 24-year-old female is diagnosed with iron deficiency anemia. The
provider prescribes ferrous sulfate 325 mg orally twice daily. The
,nurse is providing discharge education regarding this new
prescription.
Question Stem
Which statement by the client indicates a correct understanding of
the teaching?
A. "I will take this medication with a full glass of milk to protect my
stomach."
B. "I should expect my stools to become dark green or black and
tarry."
C. "I will take this medication on an empty stomach along with my
daily antacid."
D. "I should stop taking the medication immediately if I experience
mild constipation."
Correct Answer
B. "I should expect my stools to become dark green or black and
tarry."
Detailed Rationale
Dark green or black, tarry stools are a harmless, expected side
effect of oral iron supplementation due to the unabsorbed iron being
excreted in the feces. Patients must be educated about this to
prevent unnecessary anxiety or misinterpretation as gastrointestinal
bleeding. Taking iron with milk or antacids is incorrect because
calcium and alkaline environments significantly decrease iron
absorption. While iron is best absorbed on an empty stomach, it is
often taken with food if gastrointestinal distress occurs; however, it
should never be paired with absorption-inhibiting substances. Mild
constipation is a very common side effect of oral iron. The patient
, should be taught to manage this with increased fluid intake, dietary
fiber, and activity, rather than abruptly discontinuing the essential
medication without consulting the provider.
Learning Objective
Identify expected, harmless side effects of oral iron therapy.
Recognize substances that inhibit iron absorption.
Formulate appropriate patient teaching for managing iron-induced
constipation.
Medication Safety Focus
Patient education
Question 3
Clinical Scenario
A 72-year-old male is newly diagnosed with pernicious anemia. The
provider prescribes cyanocobalamin (Vitamin B12) 1,000 mcg
intramuscularly monthly.
Question Stem
Which information is most important for the nurse to include in the
patient’s discharge teaching?
A. "You can transition to a standard over-the-counter oral
supplement after one month."
B. "Your neurological symptoms, such as tingling, will resolve
completely within 24 hours."
C. "You must strictly avoid all green leafy vegetables while on this
therapy."
System Exam Questions & Rationales |
20 Original NGN Practice MCQs
Question 1
Clinical Scenario
A 68-year-old female is postoperative day 1 following a total knee
arthroplasty. The provider prescribes enoxaparin 40 mg
subcutaneously daily for deep vein thrombosis (DVT) prophylaxis.
Question Stem
Which action by the nurse demonstrates the correct administration
of this medication?
A. Inject into the anterolateral abdominal wall.
B. Aspirate the syringe before injecting the medication.
C. Massage the injection site firmly after administration.
D. Expel the air bubble from the prefilled syringe before injecting.
Correct Answer
A. Inject into the anterolateral abdominal wall.
Detailed Rationale
Enoxaparin is a low-molecular-weight heparin (LMWH) administered
via deep subcutaneous injection. The preferred injection sites are
the anterolateral or posterolateral abdominal wall, which allows for
,consistent absorption and minimizes tissue trauma. The nurse
should not aspirate before injection, as this can cause tissue trauma
and increase the risk of hematoma. Massaging the site after
injection is contraindicated because it increases capillary fragility
and the risk of bruising or bleeding at the site. Finally, the air bubble
in a prefilled enoxaparin syringe is intentionally placed by the
manufacturer to clear the medication from the needle track after
injection, which actually reduces the risk of bruising; therefore, it
should not be expelled. Proper technique is essential to prevent
localized bleeding complications while ensuring therapeutic
efficacy for VTE prophylaxis.
Learning Objective
Identify the correct anatomical sites for subcutaneous enoxaparin
administration.
Recognize improper administration techniques that increase the
risk of hematoma or bruising.
Apply evidence-based practices for safe subcutaneous injection of
anticoagulants.
Medication Safety Focus
Medication administration technique
Question 2
Clinical Scenario
A 24-year-old female is diagnosed with iron deficiency anemia. The
provider prescribes ferrous sulfate 325 mg orally twice daily. The
,nurse is providing discharge education regarding this new
prescription.
Question Stem
Which statement by the client indicates a correct understanding of
the teaching?
A. "I will take this medication with a full glass of milk to protect my
stomach."
B. "I should expect my stools to become dark green or black and
tarry."
C. "I will take this medication on an empty stomach along with my
daily antacid."
D. "I should stop taking the medication immediately if I experience
mild constipation."
Correct Answer
B. "I should expect my stools to become dark green or black and
tarry."
Detailed Rationale
Dark green or black, tarry stools are a harmless, expected side
effect of oral iron supplementation due to the unabsorbed iron being
excreted in the feces. Patients must be educated about this to
prevent unnecessary anxiety or misinterpretation as gastrointestinal
bleeding. Taking iron with milk or antacids is incorrect because
calcium and alkaline environments significantly decrease iron
absorption. While iron is best absorbed on an empty stomach, it is
often taken with food if gastrointestinal distress occurs; however, it
should never be paired with absorption-inhibiting substances. Mild
constipation is a very common side effect of oral iron. The patient
, should be taught to manage this with increased fluid intake, dietary
fiber, and activity, rather than abruptly discontinuing the essential
medication without consulting the provider.
Learning Objective
Identify expected, harmless side effects of oral iron therapy.
Recognize substances that inhibit iron absorption.
Formulate appropriate patient teaching for managing iron-induced
constipation.
Medication Safety Focus
Patient education
Question 3
Clinical Scenario
A 72-year-old male is newly diagnosed with pernicious anemia. The
provider prescribes cyanocobalamin (Vitamin B12) 1,000 mcg
intramuscularly monthly.
Question Stem
Which information is most important for the nurse to include in the
patient’s discharge teaching?
A. "You can transition to a standard over-the-counter oral
supplement after one month."
B. "Your neurological symptoms, such as tingling, will resolve
completely within 24 hours."
C. "You must strictly avoid all green leafy vegetables while on this
therapy."
