Hematology, Oncology & Immunology NCLEX Practice Questions

Acute hemolytic reaction: most dangerous, fever, chills, flank/back pain, hemoglobinuria — STOP transfusion immediately, infuse NS, notify provider. Febrile non-hemolytic: fever and chills, premedicate with acetaminophen. Allergic reaction: urticaria and itching — stop transfusion, administer antihistamine. Anaphylactic: bronchospasm, hypotension — administer epinephrine.

Neutropenic precautions (ANC <1,000 cells/mm3): private room preferred, HEPA filtration if available, restrict raw/unwashed fruits and vegetables, no fresh flowers or plants, meticulous hand hygiene, mask for visitors with respiratory illness, and monitor for subtle infection signs — neutropenic patients may not produce fever reliably.

Sickle cell crisis (vaso-occlusive): severe pain, organ damage from blocked blood flow. Priority nursing actions: aggressive IV hydration, pain management (often requires opioids — do not undertreat), oxygen therapy, warmth to affected areas (cold causes vasoconstriction and worsens sickling), and monitoring for complications including acute chest syndrome, splenic sequestration, and stroke. Triggers to avoid: dehydration, infection, high altitude, extreme temperatures, and stress.

Chemotherapy is a hazardous drug — nurses must wear PPE (double gloving, gown, eye protection) during preparation and administration. Use Luer-lock connections to prevent leaks. If a spill occurs, use a spill kit — do not use bare hands. Dispose of chemotherapy waste in designated containers. Client teaching: report fever immediately (even low-grade), avoid crowds and sick contacts, practice meticulous oral hygiene (soft toothbrush), avoid rectal temperatures and suppositories, and expect alopecia with many agents (reassure it is usually temporary).

Iron deficiency anemia: fatigue, pallor, tachycardia, pica (craving non-food items). Treatment: oral iron with vitamin C (enhances absorption), take on empty stomach, expect black stools. Pernicious anemia (B12 deficiency): neurological symptoms (paresthesias, balance issues), requires lifelong B12 injections. Aplastic anemia: pancytopenia from bone marrow failure. Folic acid deficiency: similar to iron deficiency but without neurological symptoms, common in pregnancy and alcoholism.

DIC involves simultaneous excessive clotting and bleeding — a life-threatening paradox. Labs: decreased platelets and fibrinogen, elevated D-dimer, prolonged PT/PTT. Clinical signs: petechiae, oozing from IV sites and wounds, hematuria, and organ damage from microthrombi. Priority nursing actions: treat the underlying cause (sepsis, obstetric emergency, malignancy), administer blood products as ordered (platelets, FFP, cryoprecipitate), monitor for hemorrhage, and protect the client from injury.