NCLEX-RN Pharmacology: 20 Original
Hematologic System Practice Questions
with Detailed Rationales |
ATI & NGN Style MCQs
Question 1
Clinical Scenario
A 28-year-old female client at 24 weeks gestation is diagnosed with
iron-deficiency anemia. The healthcare provider prescribes oral
ferrous sulfate 325 mg twice daily. The client asks the nurse how to
take the medication to maximize its absorption and minimize
gastrointestinal discomfort.
Question Stem
Which statement by the client indicates an understanding of the
teaching regarding ferrous sulfate administration?
Options
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 on an
empty stomach."
C. "I will take this medication at the same time as my prenatal
vitamin."
,D. "I should chew the tablet thoroughly before swallowing to help it
dissolve faster."
Correct Answer
Correct Answer: B. "I should take this medication with a glass of
orange juice on an empty stomach."
Detailed Rationale
Ferrous sulfate is best absorbed in an acidic environment. Taking it
on an empty stomach with a source of vitamin C, such as orange
juice, significantly enhances iron absorption. While iron can cause
gastrointestinal upset, taking it with milk (Option A) is incorrect
because calcium inhibits iron absorption. Taking it with a prenatal
vitamin (Option C) is also incorrect, as many prenatal vitamins
contain calcium or antacids that will decrease iron absorption; they
should be spaced at least 2 hours apart. Ferrous sulfate tablets
should be swallowed whole, not chewed (Option D), as chewing can
cause temporary staining of the teeth and does not improve
absorption. The nurse should also teach the client that dark, tarry
stools are an expected, harmless side effect of oral iron therapy, but
they should report severe constipation or abdominal pain.
Learning Objective
Identify factors that enhance and inhibit oral iron absorption.
Educate pregnant clients on the proper administration of ferrous
sulfate.
Recognize expected versus adverse gastrointestinal effects of iron
supplements.
,Medication Safety Focus
Patient education
Question 2
Clinical Scenario
A 65-year-old male client is prescribed enoxaparin 40 mg
subcutaneously once daily for deep vein thrombosis (DVT)
prophylaxis following orthopedic surgery. The nurse is preparing to
administer the medication.
Question Stem
Which action should the nurse take when administering
enoxaparin?
Options
A. Aspirate the syringe before injecting to ensure the needle is not in
a blood vessel.
B. Massage the injection site firmly for 30 seconds after
administration to promote absorption.
C. Inject the medication into the anterolateral or posterolateral
abdominal wall.
D. Expel the air bubble from the prefilled syringe before injection to
prevent tissue irritation.
Correct Answer
Correct Answer: C. Inject the medication into the anterolateral or
posterolateral abdominal wall.
Detailed Rationale
Enoxaparin, a low-molecular-weight heparin (LMWH), should be
, administered via deep subcutaneous injection into the "love handle"
areas (anterolateral or posterolateral abdominal wall) to ensure
proper absorption and minimize bruising. The nurse should not
aspirate (Option A) or massage the site (Option B), as both actions
increase the risk of tissue trauma, hematoma formation, and
bleeding. Additionally, the air bubble in a prefilled enoxaparin
syringe should not be expelled (Option D); the air bubble is
intentionally included to act as a plug, sealing the medication in the
subcutaneous tissue and preventing leakage into the subcutaneous
track, which reduces bruising. The nurse should also rotate injection
sites and avoid injecting within 2 inches of the umbilicus.
Learning Objective
Demonstrate proper subcutaneous injection technique for low-
molecular-weight heparins.
Identify actions to prevent hematoma and bleeding at injection
sites.
Explain the purpose of the air bubble in prefilled enoxaparin
syringes.
Medication Safety Focus
Medication administration
Question 3
Clinical Scenario
A 72-year-old client with a mechanical heart valve is taking warfarin
5 mg daily. The client's INR has been stable at 2.8 for the past 3
Hematologic System Practice Questions
with Detailed Rationales |
ATI & NGN Style MCQs
Question 1
Clinical Scenario
A 28-year-old female client at 24 weeks gestation is diagnosed with
iron-deficiency anemia. The healthcare provider prescribes oral
ferrous sulfate 325 mg twice daily. The client asks the nurse how to
take the medication to maximize its absorption and minimize
gastrointestinal discomfort.
Question Stem
Which statement by the client indicates an understanding of the
teaching regarding ferrous sulfate administration?
Options
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 on an
empty stomach."
C. "I will take this medication at the same time as my prenatal
vitamin."
,D. "I should chew the tablet thoroughly before swallowing to help it
dissolve faster."
Correct Answer
Correct Answer: B. "I should take this medication with a glass of
orange juice on an empty stomach."
Detailed Rationale
Ferrous sulfate is best absorbed in an acidic environment. Taking it
on an empty stomach with a source of vitamin C, such as orange
juice, significantly enhances iron absorption. While iron can cause
gastrointestinal upset, taking it with milk (Option A) is incorrect
because calcium inhibits iron absorption. Taking it with a prenatal
vitamin (Option C) is also incorrect, as many prenatal vitamins
contain calcium or antacids that will decrease iron absorption; they
should be spaced at least 2 hours apart. Ferrous sulfate tablets
should be swallowed whole, not chewed (Option D), as chewing can
cause temporary staining of the teeth and does not improve
absorption. The nurse should also teach the client that dark, tarry
stools are an expected, harmless side effect of oral iron therapy, but
they should report severe constipation or abdominal pain.
Learning Objective
Identify factors that enhance and inhibit oral iron absorption.
Educate pregnant clients on the proper administration of ferrous
sulfate.
Recognize expected versus adverse gastrointestinal effects of iron
supplements.
,Medication Safety Focus
Patient education
Question 2
Clinical Scenario
A 65-year-old male client is prescribed enoxaparin 40 mg
subcutaneously once daily for deep vein thrombosis (DVT)
prophylaxis following orthopedic surgery. The nurse is preparing to
administer the medication.
Question Stem
Which action should the nurse take when administering
enoxaparin?
Options
A. Aspirate the syringe before injecting to ensure the needle is not in
a blood vessel.
B. Massage the injection site firmly for 30 seconds after
administration to promote absorption.
C. Inject the medication into the anterolateral or posterolateral
abdominal wall.
D. Expel the air bubble from the prefilled syringe before injection to
prevent tissue irritation.
Correct Answer
Correct Answer: C. Inject the medication into the anterolateral or
posterolateral abdominal wall.
Detailed Rationale
Enoxaparin, a low-molecular-weight heparin (LMWH), should be
, administered via deep subcutaneous injection into the "love handle"
areas (anterolateral or posterolateral abdominal wall) to ensure
proper absorption and minimize bruising. The nurse should not
aspirate (Option A) or massage the site (Option B), as both actions
increase the risk of tissue trauma, hematoma formation, and
bleeding. Additionally, the air bubble in a prefilled enoxaparin
syringe should not be expelled (Option D); the air bubble is
intentionally included to act as a plug, sealing the medication in the
subcutaneous tissue and preventing leakage into the subcutaneous
track, which reduces bruising. The nurse should also rotate injection
sites and avoid injecting within 2 inches of the umbilicus.
Learning Objective
Demonstrate proper subcutaneous injection technique for low-
molecular-weight heparins.
Identify actions to prevent hematoma and bleeding at injection
sites.
Explain the purpose of the air bubble in prefilled enoxaparin
syringes.
Medication Safety Focus
Medication administration
Question 3
Clinical Scenario
A 72-year-old client with a mechanical heart valve is taking warfarin
5 mg daily. The client's INR has been stable at 2.8 for the past 3
