NCLEX-PN Test #14 3

Question 1

A client with sickle cell disease is admitted in vaso-occlusive crisis. Which intervention has the highest priority?

Accepted Answer

Administer IV fluids, supplemental oxygen, and IV analgesics

Answer

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?

Accepted Answer

Prolonged aPTT (activated partial thromboplastin time) with normal PT and platelet count

Answer

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?

Accepted Answer

Blood pressure and hematocrit/hemoglobin

Answer

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?

Accepted Answer

Simultaneous bleeding from multiple sites and thrombosis

Answer

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?

Accepted Answer

Febrile non-hemolytic transfusion reaction (FNHTR)

Answer

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.

NCLEX Practice Test

NCLEX Practice Test

NCLEX-PN Test #14 3