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NCLEX RN Exam Bank: Hematologic and Oncologic
Emergencies, Transfusion, Tumor Lysis Syndrome
Table of Contents
Subtopic 1: Blood Transfusion Reactions—Recognition, Intervention, and Prevention........ 2
Subtopic 2: Tumor Lysis Syndrome—Identification, Risk Management, and Electrolyte
Imbalance .................................................................................................................. 10
Subtopic 3: Febrile Neutropenia and Infection Control in Oncology Patients ................... 19
Subtopic 4: Disseminated Intravascular Coagulation (DIC) in Oncology and Hematologic
Disorders ................................................................................................................... 27
Subtopic 5: Disseminated Intravascular Coagulation (DIC) and Hematologic Crisis in
Oncology Patients ....................................................................................................... 36
Subtopic 6: Disseminated Intravascular Coagulation (DIC) and Thrombocytopenia
Emergencies............................................................................................................... 45
Subtopic 7: Spinal Cord Compression, Brain Metastases & Intracranial Hemorrhage ....... 53
Subtopic 8: Disseminated Intravascular Coagulation (DIC) and Hematologic Monitoring . 61
Subtopic 8: Graft-Versus-Host Disease (GVHD) & Immunosuppressive Therapy
Complications ............................................................................................................ 69
Subtopic 9: Superior Vena Cava Syndrome (SVCS) and Oncologic Compression Syndromes
.................................................................................................................................. 78
Subtopic 10: Hematologic Support in Palliative and End-of-Life Oncology Care (Q181–
Q200) ......................................................................................................................... 86
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Subtopic 1: Blood Transfusion Reactions—Recognition,
Intervention, and Prevention
(Questions 1–20)
Question 1
A patient receiving a unit of packed red blood cells suddenly develops chills, fever, and
back pain 15 minutes into the transfusion. What is the nurse’s first action?
A. Notify the healthcare provider
B. Administer acetaminophen for fever
C. Stop the transfusion immediately
D. Send the blood bag to the lab for analysis
Correct Answer: C. Stop the transfusion immediately
Rationale: Immediate discontinuation of the transfusion is critical to prevent further
infusion of the incompatible blood product. Then the provider is notified, and appropriate
diagnostic steps are taken.
Question 2
Which blood product requires the nurse to monitor for signs of citrate toxicity during rapid
massive transfusion?
A. Platelets
B. Fresh frozen plasma
C. Albumin
D. Cryoprecipitate
Correct Answer: B. Fresh frozen plasma
, 3
Rationale: FFP contains citrate as an anticoagulant, which can bind calcium during rapid
infusions and lead to hypocalcemia.
Question 3
A nurse notices urticaria and pruritus 10 minutes into a transfusion. Which type of
transfusion reaction is this most likely?
A. Mild allergic reaction
B. Febrile non-hemolytic reaction
C. Acute hemolytic reaction
D. Anaphylactic reaction
Correct Answer: A. Mild allergic reaction
Rationale: Urticaria and itching are classic signs of a mild allergic reaction and may
respond to antihistamines.
Question 4
Which of the following patients is at greatest risk for circulatory overload during a
transfusion?
A. 30-year-old trauma patient
B. 82-year-old with heart failure
C. 25-year-old with sickle cell crisis
D. 40-year-old post-operative patient
Correct Answer: B. 82-year-old with heart failure
Rationale: Older adults with cardiac conditions are especially susceptible to fluid overload
during transfusion.
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Question 5
What is the purpose of using a leukocyte-reduced blood product?
A. To prevent hemolysis
B. To reduce febrile non-hemolytic reactions
C. To increase clotting factors
D. To prevent infection
Correct Answer: B. To reduce febrile non-hemolytic reactions
Rationale: Leukocyte-reduced blood removes white cells that may cause immune-
mediated febrile responses.
Question 6
A patient experiences shortness of breath and elevated blood pressure during the
transfusion. What should the nurse do next?
A. Call rapid response
B. Slow or stop the transfusion and assess for fluid overload
C. Increase the transfusion rate
D. Administer diphenhydramine
Correct Answer: B. Slow or stop the transfusion and assess for fluid overload
Rationale: Dyspnea and hypertension may indicate circulatory overload, and the infusion
should be stopped or slowed.
Question 7
What is the proper gauge needle size for administering packed red blood cells in adults?
A. 25-gauge
B. 18-gauge
NCLEX RN Exam Bank: Hematologic and Oncologic
Emergencies, Transfusion, Tumor Lysis Syndrome
Table of Contents
Subtopic 1: Blood Transfusion Reactions—Recognition, Intervention, and Prevention........ 2
Subtopic 2: Tumor Lysis Syndrome—Identification, Risk Management, and Electrolyte
Imbalance .................................................................................................................. 10
Subtopic 3: Febrile Neutropenia and Infection Control in Oncology Patients ................... 19
Subtopic 4: Disseminated Intravascular Coagulation (DIC) in Oncology and Hematologic
Disorders ................................................................................................................... 27
Subtopic 5: Disseminated Intravascular Coagulation (DIC) and Hematologic Crisis in
Oncology Patients ....................................................................................................... 36
Subtopic 6: Disseminated Intravascular Coagulation (DIC) and Thrombocytopenia
Emergencies............................................................................................................... 45
Subtopic 7: Spinal Cord Compression, Brain Metastases & Intracranial Hemorrhage ....... 53
Subtopic 8: Disseminated Intravascular Coagulation (DIC) and Hematologic Monitoring . 61
Subtopic 8: Graft-Versus-Host Disease (GVHD) & Immunosuppressive Therapy
Complications ............................................................................................................ 69
Subtopic 9: Superior Vena Cava Syndrome (SVCS) and Oncologic Compression Syndromes
.................................................................................................................................. 78
Subtopic 10: Hematologic Support in Palliative and End-of-Life Oncology Care (Q181–
Q200) ......................................................................................................................... 86
, 2
Subtopic 1: Blood Transfusion Reactions—Recognition,
Intervention, and Prevention
(Questions 1–20)
Question 1
A patient receiving a unit of packed red blood cells suddenly develops chills, fever, and
back pain 15 minutes into the transfusion. What is the nurse’s first action?
A. Notify the healthcare provider
B. Administer acetaminophen for fever
C. Stop the transfusion immediately
D. Send the blood bag to the lab for analysis
Correct Answer: C. Stop the transfusion immediately
Rationale: Immediate discontinuation of the transfusion is critical to prevent further
infusion of the incompatible blood product. Then the provider is notified, and appropriate
diagnostic steps are taken.
Question 2
Which blood product requires the nurse to monitor for signs of citrate toxicity during rapid
massive transfusion?
A. Platelets
B. Fresh frozen plasma
C. Albumin
D. Cryoprecipitate
Correct Answer: B. Fresh frozen plasma
, 3
Rationale: FFP contains citrate as an anticoagulant, which can bind calcium during rapid
infusions and lead to hypocalcemia.
Question 3
A nurse notices urticaria and pruritus 10 minutes into a transfusion. Which type of
transfusion reaction is this most likely?
A. Mild allergic reaction
B. Febrile non-hemolytic reaction
C. Acute hemolytic reaction
D. Anaphylactic reaction
Correct Answer: A. Mild allergic reaction
Rationale: Urticaria and itching are classic signs of a mild allergic reaction and may
respond to antihistamines.
Question 4
Which of the following patients is at greatest risk for circulatory overload during a
transfusion?
A. 30-year-old trauma patient
B. 82-year-old with heart failure
C. 25-year-old with sickle cell crisis
D. 40-year-old post-operative patient
Correct Answer: B. 82-year-old with heart failure
Rationale: Older adults with cardiac conditions are especially susceptible to fluid overload
during transfusion.
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Question 5
What is the purpose of using a leukocyte-reduced blood product?
A. To prevent hemolysis
B. To reduce febrile non-hemolytic reactions
C. To increase clotting factors
D. To prevent infection
Correct Answer: B. To reduce febrile non-hemolytic reactions
Rationale: Leukocyte-reduced blood removes white cells that may cause immune-
mediated febrile responses.
Question 6
A patient experiences shortness of breath and elevated blood pressure during the
transfusion. What should the nurse do next?
A. Call rapid response
B. Slow or stop the transfusion and assess for fluid overload
C. Increase the transfusion rate
D. Administer diphenhydramine
Correct Answer: B. Slow or stop the transfusion and assess for fluid overload
Rationale: Dyspnea and hypertension may indicate circulatory overload, and the infusion
should be stopped or slowed.
Question 7
What is the proper gauge needle size for administering packed red blood cells in adults?
A. 25-gauge
B. 18-gauge
