NCLEX-PN Test #14 3 — Questions and Answers
Question 1: A client with sickle cell disease is admitted in vaso-occlusive crisis. Which intervention has the highest priority?
- Schedule for exchange transfusion immediately
- Administer IV fluids, supplemental oxygen, and IV analgesics (Correct answer)
- Apply ice packs to painful extremities to reduce inflammation
- Encourage the client to ambulate to promote circulation
Correct answer: Administer IV fluids, supplemental oxygen, and IV analgesics
Vaso-occlusive (pain) crisis management: (1) IV hydration to reduce blood viscosity, (2) supplemental oxygen to reverse hypoxia and sickling, (3) IV opioid analgesics for pain control. Ice packs are contraindicated as cold causes vasoconstriction, worsening sickling and ischemia. Warmth and hydration are beneficial.
Question 2: The PN is reviewing lab results for a client with suspected hemophilia A. Which finding is consistent with this diagnosis?
- Elevated PT (prothrombin time)
- Prolonged aPTT (activated partial thromboplastin time) with normal PT and platelet count (Correct answer)
- Decreased platelet count with normal clotting times
- Elevated d-dimer with prolonged both PT and aPTT
Correct answer: Prolonged aPTT (activated partial thromboplastin time) with normal PT and platelet count
Hemophilia A is a deficiency of factor VIII, which is part of the intrinsic coagulation pathway (tested by aPTT). The aPTT is prolonged while PT (tests the extrinsic pathway — factors I, II, V, VII, X) and platelet count remain normal. Bleeding time may be normal if platelets are adequate.
Question 3: A client with chronic kidney disease is being treated for anemia with epoetin alfa (Epogen). Which parameter must be closely monitored during therapy?
- Serum calcium and phosphorus levels
- Blood pressure and hematocrit/hemoglobin (Correct answer)
- Blood glucose and HbA1c
- Liver function tests (ALT/AST)
Correct answer: Blood pressure and hematocrit/hemoglobin
Epoetin alfa stimulates red blood cell production and can cause hypertension (from increased blood viscosity and vasoconstriction) and thrombosis. Blood pressure must be monitored at each clinical contact. Hematocrit must not exceed 36% (target Hgb 10–12 g/dL) — exceeding this increases stroke and cardiovascular event risk.
Question 4: A client is diagnosed with disseminated intravascular coagulation (DIC). Which clinical presentation is most characteristic?
- Elevated platelet count with normal clotting times
- Simultaneous bleeding from multiple sites and thrombosis (Correct answer)
- Isolated DVT in the lower extremity only
- Hypertension with no evidence of bleeding
Correct answer: Simultaneous bleeding from multiple sites and thrombosis
DIC is a paradoxical coagulopathy: widespread microvascular thrombi form, consuming clotting factors and platelets, leading to simultaneous bleeding from multiple sites (IV sites, gums, GI tract, skin). Lab findings include: low platelets, prolonged PT/aPTT, elevated d-dimer, and low fibrinogen. Treatment addresses the underlying cause.
Question 5: A client is receiving a transfusion of packed red blood cells and develops fever (38.8°C), chills, and mild headache 45 minutes into the infusion. What type of transfusion reaction does the nurse suspect?
- Acute hemolytic reaction (ABO incompatibility)
- Febrile non-hemolytic transfusion reaction (FNHTR) (Correct answer)
- Transfusion-related acute lung injury (TRALI)
- Anaphylactic reaction
Correct answer: Febrile non-hemolytic transfusion reaction (FNHTR)
FNHTR is the most common transfusion reaction, caused by recipient antibodies against donor leukocyte antigens. It presents with fever, chills, and headache without hypotension, respiratory distress, or signs of hemolysis. Management: stop transfusion, administer acetaminophen, and restart if symptoms resolve. Leukoreduced blood products reduce FNHTR incidence.
Question 6: A client with rheumatoid arthritis (RA) is prescribed methotrexate. Which teaching point is most important?
- Take methotrexate daily for maximum therapeutic effect
- Avoid folic acid supplements as they reduce methotrexate efficacy
- Report signs of infection immediately; take folic acid as prescribed; avoid alcohol and pregnancy (Correct answer)
- NSAIDs are contraindicated and must be discontinued before starting methotrexate
Correct answer: Report signs of infection immediately; take folic acid as prescribed; avoid alcohol and pregnancy
Methotrexate is an immunosuppressant/DMARD used weekly for RA. Key teaching: (1) infection risk — report fever/illness promptly, (2) take folic acid (reduces side effects like mucositis and hepatotoxicity without reducing efficacy), (3) strict contraception required (teratogenic — Category X), (4) avoid alcohol (additive hepatotoxicity). CBC and LFTs monitored regularly.
NCLEX-PN Test #14 3
A client with sickle cell disease is admitted in vaso-occlusive crisis.
Which intervention has the highest priority?