PCCN PCCN Hematology and Immunology 1 — Questions and Answers
Question 1: A progressive care patient has a platelet count of 18,000/mm³. Which intervention is the highest priority?
- Administer aspirin for pain
- Initiate bleeding precautions (Correct answer)
- Encourage ambulation
- Apply compression stockings
Correct answer: Initiate bleeding precautions
A platelet count below 20,000/mm³ carries a high risk of spontaneous bleeding, requiring immediate bleeding precautions.
Question 2: Which laboratory finding is most consistent with disseminated intravascular coagulation (DIC)?
- Elevated fibrinogen and low D-dimer
- Elevated platelets and normal PT
- Low fibrinogen and elevated D-dimer (Correct answer)
- Normal PTT and low INR
Correct answer: Low fibrinogen and elevated D-dimer
DIC is characterized by consumption of clotting factors and fibrinogen, along with elevated D-dimer from fibrinolysis.
Question 3: A patient receiving a blood transfusion develops fever, chills, and flank pain 15 minutes after initiation. What is the nurse's first action?
- Slow the transfusion rate
- Administer acetaminophen
- Stop the transfusion immediately (Correct answer)
- Obtain a repeat type and crossmatch
Correct answer: Stop the transfusion immediately
Signs of a hemolytic transfusion reaction require immediate cessation of the transfusion to prevent life-threatening complications.
Question 4: Which finding indicates a patient with sickle cell crisis is developing acute chest syndrome?
- Hemoglobin of 10 g/dL
- New infiltrate on chest X-ray with hypoxia (Correct answer)
- WBC of 12,000/mm³
- Pain localized to the lower back
Correct answer: New infiltrate on chest X-ray with hypoxia
Acute chest syndrome is diagnosed by a new pulmonary infiltrate on imaging combined with respiratory symptoms such as hypoxia.
Question 5: A patient with neutropenia (ANC < 500) develops a temperature of 38.5°C. The nurse should anticipate which intervention first?
- Oral antipyretics only
- Blood cultures and broad-spectrum antibiotics (Correct answer)
- Isolation and observation for 24 hours
- Antifungal prophylaxis
Correct answer: Blood cultures and broad-spectrum antibiotics
Febrile neutropenia is a medical emergency; blood cultures must be obtained and broad-spectrum antibiotics started promptly.
Question 6: Which blood product is most appropriate for a patient with hemophilia A experiencing an acute bleed?
- Packed red blood cells
- Platelets
- Fresh frozen plasma
- Cryoprecipitate or Factor VIII concentrate (Correct answer)
Correct answer: Cryoprecipitate or Factor VIII concentrate
Hemophilia A is caused by Factor VIII deficiency; cryoprecipitate or recombinant Factor VIII concentrate replaces the missing factor.
PCCN PCCN Hematology and Immunology 1
A progressive care patient has a platelet count of 18,000/mm³.
Which intervention is the highest priority?