NCLEX-RN Pharmacology Hematologic
System Practice Questions |
5 ATI & NGN-Style MCQs with Detailed
Rationales, Clinical Judgment &
Medication Safety
Question 1
Difficulty: Easy
Clinical Scenario
A 68-year-old female client is being discharged with a new
prescription for ferrous sulfate 325 mg orally twice daily to treat iron
deficiency anemia. She has a history of osteoarthritis and takes
occasional over-the-counter antacids for heartburn.
Question Stem
Which statement by the client indicates an understanding of the
patient teaching regarding ferrous sulfate administration?
A. "I will take this medication with a glass of milk to prevent stomach
upset."
B. "I should take this medication with a glass of orange juice."
C. "I will call my provider immediately if my stools become dark and
tarry."
,D. "I can take my antacid at the same time as my iron supplement to
prevent nausea."
Correct Answer
Correct Answer: B. "I should take this medication with a glass of
orange juice."
Detailed Rationale
Ferrous sulfate is an oral iron supplement used to treat iron
deficiency anemia. Vitamin C (ascorbic acid), found in orange juice,
creates an acidic environment in the stomach that significantly
enhances the absorption of oral iron. Therefore, taking it with a
source of vitamin C is a key patient teaching point. Option A is
incorrect because dairy products, calcium, and antacids decrease
iron absorption and should be avoided within 1 to 2 hours of taking
the supplement. Option C is incorrect because dark, greenish-black
stools are an expected, harmless side effect of oral iron therapy, not
a sign of gastrointestinal bleeding (which would present as black,
tarry, foul-smelling melena). Option D is incorrect because antacids
increase gastric pH, which decreases iron solubility and absorption.
The nurse should teach the client to separate antacid and iron
doses by at least 2 hours. Taking iron with food can reduce
gastrointestinal distress, though it may slightly decrease absorption;
however, milk and antacids are specifically contraindicated
concurrently.
Learning Objective
Identify dietary factors that enhance or inhibit oral iron absorption.
Differentiate between expected side effects and adverse effects of
iron supplementation.
,Educate patients on proper timing of medication administration to
maximize therapeutic efficacy.
Medication Safety Focus
Patient education
Question 2
Difficulty: Easy
Clinical Scenario
A 55-year-old male client is receiving a continuous intravenous
infusion of unfractionated heparin for a deep vein thrombosis (DVT).
The client suddenly develops hematemesis and a drop in blood
pressure from 128/78 mm Hg to 90/50 mm Hg. The heparin infusion
is immediately stopped.
Question Stem
Which medication should the nurse anticipate administering to
reverse the effects of the heparin?
A. Vitamin K
B. Aminocaproic acid
C. Protamine sulfate
D. Idarucizumab
Correct Answer
Correct Answer: C. Protamine sulfate
Detailed Rationale
Protamine sulfate is the specific antidote for unfractionated
heparin. It works by binding to heparin to form a stable, inactive salt,
, rapidly reversing its anticoagulant effects in cases of life-threatening
bleeding or overdose. Option A, Vitamin K (phytonadione), is the
antidote for warfarin, not heparin. Option B, aminocaproic acid, is
an antifibrinolytic agent used to reverse thrombolytic therapy (e.g.,
alteplase) or treat bleeding associated with excessive fibrinolysis,
not heparin toxicity. Option D, idarucizumab, is a specific reversal
agent for dabigatran, a direct thrombin inhibitor. In this clinical
scenario, the client is experiencing a life-threatening hemorrhagic
complication from unfractionated heparin, making protamine
sulfate the priority, evidence-based intervention. The nurse should
also prepare for volume resuscitation and monitor coagulation
studies (aPTT) closely after administration.
Learning Objective
Identify the specific antidote for unfractionated heparin.
Differentiate between reversal agents for various classes of
anticoagulants.
Prioritize nursing interventions during an acute hemorrhagic
emergency.
Medication Safety Focus
High-alert medication / Antidote availability
Question 3
Difficulty: Easy
Clinical Scenario
A 72-year-old female client with atrial fibrillation is prescribed
System Practice Questions |
5 ATI & NGN-Style MCQs with Detailed
Rationales, Clinical Judgment &
Medication Safety
Question 1
Difficulty: Easy
Clinical Scenario
A 68-year-old female client is being discharged with a new
prescription for ferrous sulfate 325 mg orally twice daily to treat iron
deficiency anemia. She has a history of osteoarthritis and takes
occasional over-the-counter antacids for heartburn.
Question Stem
Which statement by the client indicates an understanding of the
patient teaching regarding ferrous sulfate administration?
A. "I will take this medication with a glass of milk to prevent stomach
upset."
B. "I should take this medication with a glass of orange juice."
C. "I will call my provider immediately if my stools become dark and
tarry."
,D. "I can take my antacid at the same time as my iron supplement to
prevent nausea."
Correct Answer
Correct Answer: B. "I should take this medication with a glass of
orange juice."
Detailed Rationale
Ferrous sulfate is an oral iron supplement used to treat iron
deficiency anemia. Vitamin C (ascorbic acid), found in orange juice,
creates an acidic environment in the stomach that significantly
enhances the absorption of oral iron. Therefore, taking it with a
source of vitamin C is a key patient teaching point. Option A is
incorrect because dairy products, calcium, and antacids decrease
iron absorption and should be avoided within 1 to 2 hours of taking
the supplement. Option C is incorrect because dark, greenish-black
stools are an expected, harmless side effect of oral iron therapy, not
a sign of gastrointestinal bleeding (which would present as black,
tarry, foul-smelling melena). Option D is incorrect because antacids
increase gastric pH, which decreases iron solubility and absorption.
The nurse should teach the client to separate antacid and iron
doses by at least 2 hours. Taking iron with food can reduce
gastrointestinal distress, though it may slightly decrease absorption;
however, milk and antacids are specifically contraindicated
concurrently.
Learning Objective
Identify dietary factors that enhance or inhibit oral iron absorption.
Differentiate between expected side effects and adverse effects of
iron supplementation.
,Educate patients on proper timing of medication administration to
maximize therapeutic efficacy.
Medication Safety Focus
Patient education
Question 2
Difficulty: Easy
Clinical Scenario
A 55-year-old male client is receiving a continuous intravenous
infusion of unfractionated heparin for a deep vein thrombosis (DVT).
The client suddenly develops hematemesis and a drop in blood
pressure from 128/78 mm Hg to 90/50 mm Hg. The heparin infusion
is immediately stopped.
Question Stem
Which medication should the nurse anticipate administering to
reverse the effects of the heparin?
A. Vitamin K
B. Aminocaproic acid
C. Protamine sulfate
D. Idarucizumab
Correct Answer
Correct Answer: C. Protamine sulfate
Detailed Rationale
Protamine sulfate is the specific antidote for unfractionated
heparin. It works by binding to heparin to form a stable, inactive salt,
, rapidly reversing its anticoagulant effects in cases of life-threatening
bleeding or overdose. Option A, Vitamin K (phytonadione), is the
antidote for warfarin, not heparin. Option B, aminocaproic acid, is
an antifibrinolytic agent used to reverse thrombolytic therapy (e.g.,
alteplase) or treat bleeding associated with excessive fibrinolysis,
not heparin toxicity. Option D, idarucizumab, is a specific reversal
agent for dabigatran, a direct thrombin inhibitor. In this clinical
scenario, the client is experiencing a life-threatening hemorrhagic
complication from unfractionated heparin, making protamine
sulfate the priority, evidence-based intervention. The nurse should
also prepare for volume resuscitation and monitor coagulation
studies (aPTT) closely after administration.
Learning Objective
Identify the specific antidote for unfractionated heparin.
Differentiate between reversal agents for various classes of
anticoagulants.
Prioritize nursing interventions during an acute hemorrhagic
emergency.
Medication Safety Focus
High-alert medication / Antidote availability
Question 3
Difficulty: Easy
Clinical Scenario
A 72-year-old female client with atrial fibrillation is prescribed
