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Section A: Hematologic Disorders & Oncology (10 Questions)
Q1: A patient with iron deficiency anemia has a hemoglobin of 7.8 g/dL and reports
fatigue, pallor, and dyspnea on exertion. Which dietary instruction should the nurse
prioritize?
A. Increase calcium-rich foods with each meal
B. Consume iron-rich foods with vitamin C and avoid tea or coffee with meals
[CORRECT]
C. Take iron supplements with antacids to prevent gastric irritation
D. Consume iron-rich foods with dairy products to enhance absorption
Correct Answer: B
Rationale: Vitamin C enhances non-heme iron absorption, while tea and coffee contain
tannins that inhibit iron absorption. Calcium (A) and dairy (D) inhibit iron absorption.
Antacids (C) reduce stomach acid, which is necessary for iron absorption; iron should
be taken on an empty stomach or with vitamin C.
Q2: A patient with sickle cell disease presents with severe joint pain, fever, and
tachycardia. The nurse recognizes this as vaso-occlusive crisis. Which intervention is
the priority?
,A. Apply cold compresses to painful joints
B. Administer opioid analgesics and maintain adequate hydration [CORRECT]
C. Administer aspirin for pain relief
D. Restrict fluid intake to prevent fluid overload
Correct Answer: B
Rationale: Vaso-occlusive crisis management prioritizes aggressive pain control
(opioids are standard) and hydration (3-4 L/day) to reduce blood viscosity and promote
perfusion. Cold compresses (A) cause vasoconstriction and worsen occlusion. Aspirin
(C) is insufficient for severe sickle pain and may cause Reye's syndrome in children.
Fluid restriction (D) worsens sickling.
Q3: A patient with thrombocytopenia has a platelet count of 18,000/mm³. Which nursing
intervention is MOST important?
A. Encourage vigorous exercise to improve circulation
B. Implement bleeding precautions and avoid IM injections [CORRECT]
C. Apply heat therapy to prevent clot formation
D. Administer aspirin for antiplatelet effect
Correct Answer: B
Rationale: Platelet count <20,000/mm³ carries high risk of spontaneous bleeding;
bleeding precautions (soft toothbrush, electric razor, avoid IM injections/rectal temps,
limit venipuncture) are critical. Vigorous exercise (A) increases trauma risk. Heat
, therapy (C) increases blood flow and bleeding risk. Aspirin (D) further impairs platelet
function and is contraindicated.
Q4: A patient receiving chemotherapy has an absolute neutrophil count (ANC) of
450/mm³. Which nursing action is the priority?
A. Encourage outdoor activities for fresh air
B. Implement neutropenic precautions and restrict fresh flowers/fruits [CORRECT]
C. Discontinue all IV medications
D. Administer live vaccines for immunity
Correct Answer: B
Rationale: ANC <500/mm³ indicates severe neutropenia with high infection risk;
neutropenic precautions (private room, HEPA filtration, restricted fresh plants/flowers,
cooked foods only, strict hand hygiene) are essential. Outdoor activities (A) expose the
patient to pathogens. Discontinuing IV meds (C) is not indicated. Live vaccines (D) are
contraindicated in immunocompromised patients.
Q5: A patient with Hodgkin lymphoma has painless lymphadenopathy, night sweats, and
unexplained weight loss. Which finding is pathognomonic for Hodgkin lymphoma?
A. Reed-Sternberg cells on lymph node biopsy [CORRECT]
B. Philadelphia chromosome
C. Bence Jones protein in urine
D. Auer rods in myeloblasts