Hematologic Problems with 200 Questions and Answers | Updated
2026 A+ | Instant Download PDF
Table of Contents
1. Anemias and Red Blood Cell Disorders
2. Coagulation and Platelet Disorders
3. Leukemias and Lymphomas
4. Hematologic Emergencies and Clinical Management
1. Anemias and Red Blood Cell Disorders
1. A patient with chronic kidney disease develops fatigue, pallor, and a hemoglobin of 8.4 g/dL;
iron studies show adequate stores. Which intervention should the nurse anticipate?
A. Administration of an erythropoiesis-stimulating agent as prescribed
B. Immediate therapeutic phlebotomy
C. High-dose vitamin K administration
D. Platelet transfusion
Answer: A
Rationale: Reduced renal erythropoietin production causes anemia despite adequate iron
stores.
2. A patient with iron-deficiency anemia reports taking oral ferrous sulfate with breakfast and
coffee each morning; hemoglobin remains low. Which teaching is most appropriate?
A. Take iron with coffee to improve absorption
B. Take iron only when fatigue occurs
C. Take iron separately from coffee and preferably with vitamin C
D. Stop iron when stools become dark
Answer: C
Rationale: Coffee can reduce iron absorption, whereas vitamin C enhances absorption.
3. A patient with pernicious anemia develops numbness, gait instability, and impaired vibration
sensation. Which treatment is the priority?
A. Oral folic acid alone
B. Vitamin B12 replacement
C. Oral iron supplementation
D. Vitamin K replacement
Answer: B
Rationale: Neurologic manifestations of vitamin B12 deficiency require prompt B12
replacement.
4. A patient with macrocytic anemia has a low folate level but normal vitamin B12. Which
intervention is most appropriate?
A. Administer prescribed folic acid
B. Begin lifelong vitamin K therapy
C. Restrict dietary vegetables
D. Administer desmopressin
, Answer: A
Rationale: Isolated folate deficiency is treated with folic acid replacement.
5. A patient with sickle cell disease presents with severe generalized pain after several days of
poor fluid intake. Which nursing intervention has the highest priority?
A. Encourage strenuous exercise
B. Restrict fluids
C. Administer prescribed analgesia and promote hydration
D. Apply prolonged cold therapy
Answer: C
Rationale: Hydration and effective analgesia are central to managing an acute vaso-
occlusive crisis.
6. A patient with sickle cell disease develops sudden chest pain, fever, cough, and hypoxemia.
Which complication should the nurse suspect?
A. Iron overload
B. Acute chest syndrome
C. Pernicious anemia
D. Disseminated intravascular coagulation
Answer: B
Rationale: Chest symptoms, fever, and hypoxemia in sickle cell disease strongly suggest acute
chest syndrome.
7. A patient with sickle cell disease is admitted with an acute vaso-occlusive crisis. Which
assessment finding requires the most urgent response?
A. Chronic joint discomfort
B. Mild fatigue
C. New oxygen saturation of 86% with chest discomfort
D. Decreased appetite
Answer: C
Rationale: Hypoxemia with chest symptoms may indicate acute chest syndrome and requires
immediate evaluation.
8. A patient with thalassemia major receives repeated red blood cell transfusions. Which long-
term complication requires particular monitoring?
A. Hypoglycemia
B. Iron overload
C. Vitamin C deficiency
D. Hyperacute infection
Answer: B
Rationale: Repeated transfusions can cause progressive iron accumulation and organ injury.
9. A patient with iron-deficiency anemia asks why the provider recommends continuing oral
iron after symptoms improve. Which explanation is best?
A. Iron permanently prevents all future anemia
B. Therapy must replenish hemoglobin and body iron stores
C. Iron prevents platelet destruction
D. Iron eliminates gastrointestinal blood loss
Answer: B
Rationale: Treatment continues after symptom improvement to restore depleted iron stores.
,10. A patient with autoimmune hemolytic anemia develops jaundice and dark urine. Which
laboratory pattern would support increased hemolysis?
A. Increased haptoglobin and decreased bilirubin
B. Increased indirect bilirubin and decreased haptoglobin
C. Decreased reticulocytes and increased haptoglobin
D. Decreased lactate dehydrogenase and bilirubin
Answer: B
Rationale: Hemolysis increases indirect bilirubin and consumes circulating haptoglobin.
11. A patient receiving chemotherapy develops severe anemia and thrombocytopenia from
bone marrow suppression. Which finding requires the most immediate action?
A. Hemoglobin of 9.2 g/dL
B. Platelet count of 95,000/mm³
C. New onset of confusion with hypotension
D. Mild exertional fatigue
Answer: C
Rationale: Acute neurologic changes and hypotension may indicate serious bleeding or
inadequate tissue perfusion.
12. A patient with aplastic anemia has pancytopenia and recurrent infections. Which nursing
intervention is most important?
A. Encourage raw foods
B. Implement infection-prevention measures
C. Administer aspirin for fever
D. Encourage contact sports
Answer: B
Rationale: Neutropenia significantly increases the risk of life-threatening infection.
13. A patient with anemia reports worsening fatigue, dyspnea, and palpitations when climbing
stairs. Which nursing interpretation is most appropriate?
A. These findings indicate improved oxygen delivery
B. Reduced oxygen-carrying capacity is increasing cardiovascular workload
C. The patient is developing thrombocytopenia
D. These findings are specific to leukopenia
Answer: B
Rationale: Anemia reduces oxygen delivery and can cause compensatory cardiovascular
responses.
14. A patient with suspected gastrointestinal blood loss has microcytic, hypochromic anemia.
Which additional finding would best support iron deficiency?
A. Elevated ferritin
B. Low ferritin
C. Elevated vitamin B12
D. Increased mean corpuscular volume
Answer: B
Rationale: Low ferritin strongly indicates depleted iron stores.
15. A patient with vitamin B12 deficiency asks why folic acid alone should not be started before
the diagnosis is clarified. What is the best response?
A. Folic acid always causes hemolysis
, B. Folic acid may correct anemia while allowing B12-related neurologic injury to progress
C. Folic acid prevents B12 absorption
D. Folic acid causes thrombocytopenia
Answer: B
Rationale: Folate can improve hematologic abnormalities without correcting the neurologic
consequences of B12 deficiency.
16. A patient with sickle cell disease asks which factor commonly precipitates vaso-occlusive
episodes. Which response is most appropriate?
A. Adequate hydration
B. Dehydration
C. Controlled oxygenation
D. Routine vaccination
Answer: B
Rationale: Dehydration promotes sickling and vascular obstruction.
17. A patient with sickle cell disease develops prolonged priapism. Which action should the
nurse take?
A. Reassure the patient that it is harmless
B. Encourage prolonged bed rest without evaluation
C. Notify the provider promptly for urgent management
D. Restrict all oral fluids
Answer: C
Rationale: Prolonged priapism is a serious vaso-occlusive complication requiring urgent
treatment.
18. A patient with severe anemia is prescribed a red blood cell transfusion. Which assessment is
most important before initiating the transfusion?
A. Nail length
B. Verification of patient identity and blood-product compatibility
C. Dietary preference
D. Last bowel movement
Answer: B
Rationale: Correct patient and blood-product identification is essential to prevent an
incompatible transfusion.
19. During a red blood cell transfusion, a patient develops fever, chills, and flank discomfort.
What should the nurse do first?
A. Increase the infusion rate
B. Continue the transfusion and reassess later
C. Stop the transfusion and maintain IV access with appropriate fluid
D. Administer oral iron
Answer: C
Rationale: These findings may indicate an acute transfusion reaction requiring immediate
discontinuation.
20. A patient with chronic anemia asks why oxygen may be prescribed during an acute
deterioration. Which explanation is most accurate?
A. Oxygen increases red blood cell production immediately
B. Oxygen can improve oxygen availability to tissues while the underlying cause is treated
2026 A+ | Instant Download PDF
Table of Contents
1. Anemias and Red Blood Cell Disorders
2. Coagulation and Platelet Disorders
3. Leukemias and Lymphomas
4. Hematologic Emergencies and Clinical Management
1. Anemias and Red Blood Cell Disorders
1. A patient with chronic kidney disease develops fatigue, pallor, and a hemoglobin of 8.4 g/dL;
iron studies show adequate stores. Which intervention should the nurse anticipate?
A. Administration of an erythropoiesis-stimulating agent as prescribed
B. Immediate therapeutic phlebotomy
C. High-dose vitamin K administration
D. Platelet transfusion
Answer: A
Rationale: Reduced renal erythropoietin production causes anemia despite adequate iron
stores.
2. A patient with iron-deficiency anemia reports taking oral ferrous sulfate with breakfast and
coffee each morning; hemoglobin remains low. Which teaching is most appropriate?
A. Take iron with coffee to improve absorption
B. Take iron only when fatigue occurs
C. Take iron separately from coffee and preferably with vitamin C
D. Stop iron when stools become dark
Answer: C
Rationale: Coffee can reduce iron absorption, whereas vitamin C enhances absorption.
3. A patient with pernicious anemia develops numbness, gait instability, and impaired vibration
sensation. Which treatment is the priority?
A. Oral folic acid alone
B. Vitamin B12 replacement
C. Oral iron supplementation
D. Vitamin K replacement
Answer: B
Rationale: Neurologic manifestations of vitamin B12 deficiency require prompt B12
replacement.
4. A patient with macrocytic anemia has a low folate level but normal vitamin B12. Which
intervention is most appropriate?
A. Administer prescribed folic acid
B. Begin lifelong vitamin K therapy
C. Restrict dietary vegetables
D. Administer desmopressin
, Answer: A
Rationale: Isolated folate deficiency is treated with folic acid replacement.
5. A patient with sickle cell disease presents with severe generalized pain after several days of
poor fluid intake. Which nursing intervention has the highest priority?
A. Encourage strenuous exercise
B. Restrict fluids
C. Administer prescribed analgesia and promote hydration
D. Apply prolonged cold therapy
Answer: C
Rationale: Hydration and effective analgesia are central to managing an acute vaso-
occlusive crisis.
6. A patient with sickle cell disease develops sudden chest pain, fever, cough, and hypoxemia.
Which complication should the nurse suspect?
A. Iron overload
B. Acute chest syndrome
C. Pernicious anemia
D. Disseminated intravascular coagulation
Answer: B
Rationale: Chest symptoms, fever, and hypoxemia in sickle cell disease strongly suggest acute
chest syndrome.
7. A patient with sickle cell disease is admitted with an acute vaso-occlusive crisis. Which
assessment finding requires the most urgent response?
A. Chronic joint discomfort
B. Mild fatigue
C. New oxygen saturation of 86% with chest discomfort
D. Decreased appetite
Answer: C
Rationale: Hypoxemia with chest symptoms may indicate acute chest syndrome and requires
immediate evaluation.
8. A patient with thalassemia major receives repeated red blood cell transfusions. Which long-
term complication requires particular monitoring?
A. Hypoglycemia
B. Iron overload
C. Vitamin C deficiency
D. Hyperacute infection
Answer: B
Rationale: Repeated transfusions can cause progressive iron accumulation and organ injury.
9. A patient with iron-deficiency anemia asks why the provider recommends continuing oral
iron after symptoms improve. Which explanation is best?
A. Iron permanently prevents all future anemia
B. Therapy must replenish hemoglobin and body iron stores
C. Iron prevents platelet destruction
D. Iron eliminates gastrointestinal blood loss
Answer: B
Rationale: Treatment continues after symptom improvement to restore depleted iron stores.
,10. A patient with autoimmune hemolytic anemia develops jaundice and dark urine. Which
laboratory pattern would support increased hemolysis?
A. Increased haptoglobin and decreased bilirubin
B. Increased indirect bilirubin and decreased haptoglobin
C. Decreased reticulocytes and increased haptoglobin
D. Decreased lactate dehydrogenase and bilirubin
Answer: B
Rationale: Hemolysis increases indirect bilirubin and consumes circulating haptoglobin.
11. A patient receiving chemotherapy develops severe anemia and thrombocytopenia from
bone marrow suppression. Which finding requires the most immediate action?
A. Hemoglobin of 9.2 g/dL
B. Platelet count of 95,000/mm³
C. New onset of confusion with hypotension
D. Mild exertional fatigue
Answer: C
Rationale: Acute neurologic changes and hypotension may indicate serious bleeding or
inadequate tissue perfusion.
12. A patient with aplastic anemia has pancytopenia and recurrent infections. Which nursing
intervention is most important?
A. Encourage raw foods
B. Implement infection-prevention measures
C. Administer aspirin for fever
D. Encourage contact sports
Answer: B
Rationale: Neutropenia significantly increases the risk of life-threatening infection.
13. A patient with anemia reports worsening fatigue, dyspnea, and palpitations when climbing
stairs. Which nursing interpretation is most appropriate?
A. These findings indicate improved oxygen delivery
B. Reduced oxygen-carrying capacity is increasing cardiovascular workload
C. The patient is developing thrombocytopenia
D. These findings are specific to leukopenia
Answer: B
Rationale: Anemia reduces oxygen delivery and can cause compensatory cardiovascular
responses.
14. A patient with suspected gastrointestinal blood loss has microcytic, hypochromic anemia.
Which additional finding would best support iron deficiency?
A. Elevated ferritin
B. Low ferritin
C. Elevated vitamin B12
D. Increased mean corpuscular volume
Answer: B
Rationale: Low ferritin strongly indicates depleted iron stores.
15. A patient with vitamin B12 deficiency asks why folic acid alone should not be started before
the diagnosis is clarified. What is the best response?
A. Folic acid always causes hemolysis
, B. Folic acid may correct anemia while allowing B12-related neurologic injury to progress
C. Folic acid prevents B12 absorption
D. Folic acid causes thrombocytopenia
Answer: B
Rationale: Folate can improve hematologic abnormalities without correcting the neurologic
consequences of B12 deficiency.
16. A patient with sickle cell disease asks which factor commonly precipitates vaso-occlusive
episodes. Which response is most appropriate?
A. Adequate hydration
B. Dehydration
C. Controlled oxygenation
D. Routine vaccination
Answer: B
Rationale: Dehydration promotes sickling and vascular obstruction.
17. A patient with sickle cell disease develops prolonged priapism. Which action should the
nurse take?
A. Reassure the patient that it is harmless
B. Encourage prolonged bed rest without evaluation
C. Notify the provider promptly for urgent management
D. Restrict all oral fluids
Answer: C
Rationale: Prolonged priapism is a serious vaso-occlusive complication requiring urgent
treatment.
18. A patient with severe anemia is prescribed a red blood cell transfusion. Which assessment is
most important before initiating the transfusion?
A. Nail length
B. Verification of patient identity and blood-product compatibility
C. Dietary preference
D. Last bowel movement
Answer: B
Rationale: Correct patient and blood-product identification is essential to prevent an
incompatible transfusion.
19. During a red blood cell transfusion, a patient develops fever, chills, and flank discomfort.
What should the nurse do first?
A. Increase the infusion rate
B. Continue the transfusion and reassess later
C. Stop the transfusion and maintain IV access with appropriate fluid
D. Administer oral iron
Answer: C
Rationale: These findings may indicate an acute transfusion reaction requiring immediate
discontinuation.
20. A patient with chronic anemia asks why oxygen may be prescribed during an acute
deterioration. Which explanation is most accurate?
A. Oxygen increases red blood cell production immediately
B. Oxygen can improve oxygen availability to tissues while the underlying cause is treated
