NCLEX-RN Pharmacology Practice Questions:
Hematologic System | 20 High-Yield MCQs with
Rationales | ATI & NGN-Style Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old male with a history of atrial fibrillation and
hypertension is admitted to the medical-surgical unit with acute
shortness of breath and fatigue. His admission laboratory
results reveal hemoglobin 7.8 g/dL, hematocrit 23.4%, and MCV
72 fL. The provider orders ferrous sulfate 325 mg orally three
times daily. The patient has a history of chronic constipation
and takes docusate sodium 100 mg daily. The patient asks the
nurse, "Why do I need this iron pill when I already take a stool
softener?"
Question Stem
Which response by the nurse is most appropriate?
,Options
A. "The stool softener will help prevent the constipation that
iron can cause, so you should continue taking both
medications."
B. "Iron supplements can cause black, tarry stools, but this is a
normal and expected side effect."
C. "You should take the iron with milk or an antacid to reduce
stomach upset."
D. "The iron will be better absorbed if you take it with a glass of
orange juice or another source of vitamin C."
Correct Answer: D. "The iron will be better absorbed if you
take it with a glass of orange juice or another source of
vitamin C."
Detailed Rationale
The correct answer is D because vitamin C (ascorbic acid)
enhances the absorption of non-heme iron by reducing ferric
iron (Fe³⁺) to the more absorbable ferrous form (Fe²⁺). This is
critical information for patient teaching when administering oral
iron supplements. Option A is incorrect because while docusate
sodium is a stool softener that may help prevent constipation,
,the nurse's primary response should address the patient's
question about why the iron is needed and provide accurate
administration instructions. The patient's low hemoglobin and
hematocrit with microcytic (low MCV) red blood cells indicate
iron deficiency anemia, and the iron supplement is prescribed
to replenish iron stores and support erythropoiesis. Option B
contains a partial truth but is inaccurate: iron supplements can
cause dark green or black stools, but these are typically
described as dark or blackish-green, not specifically "black,
tarry" which would suggest gastrointestinal bleeding. More
importantly, the nurse should not dismiss this change without
proper patient education about what to expect. Option C is
incorrect because calcium and antacids interfere with iron
absorption by increasing gastric pH and competing for
absorption sites. The nurse should teach the patient to take iron
supplements on an empty stomach or with vitamin C-rich
foods/juices for optimal absorption, and to separate iron
administration from calcium-containing products or antacids by
at least 1-2 hours. This question emphasizes the importance of
medication administration teaching and understanding factors
that affect drug absorption.
Learning Objective
After completing this question, the learner should be able to:
, • Identify factors that enhance and inhibit oral iron
absorption.
• Educate patients on proper administration of iron
supplements.
• Recognize normal and adverse gastrointestinal effects of
iron therapy.
Medication Safety Focus: Medication administration and
patient education
Question 2
Clinical Scenario
A 72-year-old female with a history of deep vein thrombosis
(DVT) and pulmonary embolism is prescribed warfarin 5 mg
daily. She is being discharged to a skilled nursing facility. The
patient's current INR is 2.8, and her target INR range is 2.0-3.0.
The patient has a history of osteoarthritis and takes over-the-
counter ibuprofen 400 mg occasionally for joint pain. She asks
the nurse, "Is it okay if I keep taking my ibuprofen for my
arthritis?"
Question Stem
Which response by the nurse is most appropriate?
Options
Hematologic System | 20 High-Yield MCQs with
Rationales | ATI & NGN-Style Nursing Exam Prep
Question 1
Clinical Scenario
A 68-year-old male with a history of atrial fibrillation and
hypertension is admitted to the medical-surgical unit with acute
shortness of breath and fatigue. His admission laboratory
results reveal hemoglobin 7.8 g/dL, hematocrit 23.4%, and MCV
72 fL. The provider orders ferrous sulfate 325 mg orally three
times daily. The patient has a history of chronic constipation
and takes docusate sodium 100 mg daily. The patient asks the
nurse, "Why do I need this iron pill when I already take a stool
softener?"
Question Stem
Which response by the nurse is most appropriate?
,Options
A. "The stool softener will help prevent the constipation that
iron can cause, so you should continue taking both
medications."
B. "Iron supplements can cause black, tarry stools, but this is a
normal and expected side effect."
C. "You should take the iron with milk or an antacid to reduce
stomach upset."
D. "The iron will be better absorbed if you take it with a glass of
orange juice or another source of vitamin C."
Correct Answer: D. "The iron will be better absorbed if you
take it with a glass of orange juice or another source of
vitamin C."
Detailed Rationale
The correct answer is D because vitamin C (ascorbic acid)
enhances the absorption of non-heme iron by reducing ferric
iron (Fe³⁺) to the more absorbable ferrous form (Fe²⁺). This is
critical information for patient teaching when administering oral
iron supplements. Option A is incorrect because while docusate
sodium is a stool softener that may help prevent constipation,
,the nurse's primary response should address the patient's
question about why the iron is needed and provide accurate
administration instructions. The patient's low hemoglobin and
hematocrit with microcytic (low MCV) red blood cells indicate
iron deficiency anemia, and the iron supplement is prescribed
to replenish iron stores and support erythropoiesis. Option B
contains a partial truth but is inaccurate: iron supplements can
cause dark green or black stools, but these are typically
described as dark or blackish-green, not specifically "black,
tarry" which would suggest gastrointestinal bleeding. More
importantly, the nurse should not dismiss this change without
proper patient education about what to expect. Option C is
incorrect because calcium and antacids interfere with iron
absorption by increasing gastric pH and competing for
absorption sites. The nurse should teach the patient to take iron
supplements on an empty stomach or with vitamin C-rich
foods/juices for optimal absorption, and to separate iron
administration from calcium-containing products or antacids by
at least 1-2 hours. This question emphasizes the importance of
medication administration teaching and understanding factors
that affect drug absorption.
Learning Objective
After completing this question, the learner should be able to:
, • Identify factors that enhance and inhibit oral iron
absorption.
• Educate patients on proper administration of iron
supplements.
• Recognize normal and adverse gastrointestinal effects of
iron therapy.
Medication Safety Focus: Medication administration and
patient education
Question 2
Clinical Scenario
A 72-year-old female with a history of deep vein thrombosis
(DVT) and pulmonary embolism is prescribed warfarin 5 mg
daily. She is being discharged to a skilled nursing facility. The
patient's current INR is 2.8, and her target INR range is 2.0-3.0.
The patient has a history of osteoarthritis and takes over-the-
counter ibuprofen 400 mg occasionally for joint pain. She asks
the nurse, "Is it okay if I keep taking my ibuprofen for my
arthritis?"
Question Stem
Which response by the nurse is most appropriate?
Options
