Knowing a normal range is the easy half; the exam asks what you do about an abnormal one. These questions cover CBC and metabolic panel interpretation, which results are critical and need a call now, how lab trends change a plan of care, and the assessment that should accompany the number.
Question 1
2 of 125. A provider gives a verbal order for "enoxaparin 80 mg subcut now" to a nurse for a patient with new unilateral calf swelling. The patient's platelet count is 85,000/µL, and they take aspirin 81 mg daily. Which response by the nurse is correct?
- A) A) Administer enoxaparin and hold the next aspirin dose
- B) B) Clarify if the provider wants heparin instead of enoxaparin
- C) C) Verify if platelet monitoring was considered before anticoagulation
- D) D) Question the order due to thrombocytopenia and antiplatelet therapy✓
Show rationale
Platelet count <100,000/µL and concurrent aspirin increase bleeding risk with anticoagulants. Option A ignores the contraindication. Option B incorrectly assumes heparin is safer; both require platelet monitoring. Option C delays time-sensitive DVT treatment. Option D appropriately questions the order based on two bleeding risk factors, per anticoagulation safety protocols requiring assessment of thrombocytopenia.
Question 2
67 of 125. A medical-surgical nurse delegates vital sign monitoring to an experienced unlicensed assistive personnel (UAP) for a postoperative total knee replacement patient with chronic heart failure. The UAP reports stable vital signs but omits the patient's new-onset oxygen saturation of 88% on room air. Which feedback approach by the nurse best addresses this oversight while promoting future accuracy?
- A) A) Email the UAP a list of normal vital sign parameters for cardiac patients with a reminder to document all values
- B) B) Privately discuss the omission while reviewing the clinical significance of oxygen saturation changes in heart failure✓
- C) C) Verbally praise the UAP's efficiency but suggest using a checklist for next shift
- D) D) Report the incident to the charge nurse to reinforce unit documentation standards
Show rationale
Private discussion maintains professionalism while addressing the specific clinical oversight (omission of critical O2 saturation) in a patient with heart failure. It educates on why this parameter matters, promoting future clinical judgment. Option A lacks personal engagement and doesn't contextualize the error. Option C prioritizes praise over accountability for the missed critical value. Option D escalates inappropriately before direct feedback, undermining the UAP's experience. CMSRN standards emphasize timely, specific feedback that links actions to patient outcomes (AMSN, 2023).
Question 3
1 of 125. A hospice patient with metastatic bone pain and platelet count of 85,000/mm³ requests warmth for lumbar discomfort. Which method minimizes complication risks?
- A) A) Electric heating pad on low setting beneath the sacrum
- B) B) Circulating water blanket at 102°F with 30-minute limits
- C) C) Microwaveable rice sock applied over clothing hourly✓
- D) D) Warm compress with towel barrier checked every 20 minutes
Show rationale
Thrombocytopenia increases bleeding/burn susceptibility. Option C's indirect application through clothing with limited frequency reduces thermal injury risk. Option A risks pressure ulcers and overheating. Option B's water temperature exceeds safe thresholds for compromised skin. Option D requires frequent staff intervention unrealistic in home hospice. Oncology Nursing Society standards prioritize low-tech, controlled-heat methods for fragile patients.
Question 4
24 of 125. A 55-year-old with rheumatoid arthritis takes warfarin for atrial fibrillation (INR 2.5) and develops acute gout. Which analgesic avoids dangerous interactions?
- A) A) Aspirin 650 mg every 4 hours
- B) B) Indomethacin 50 mg three times daily
- C) C) Acetaminophen 1000 mg every 6 hours✓
- D) D) Ketorolac 30 mg intravenous every 6 hours
Show rationale
Acetaminophen lacks antiplatelet/anticoagulant effects, avoiding bleeding risks with warfarin (INR 2.5). NSAIDs (B, D) increase bleeding via platelet inhibition and gastric erosion, especially problematic with anticoagulation. Aspirin (A) displaces warfarin from proteins, raising INR unpredictably. Indomethacin (B) and ketorolac (D) also impair kidney function in gout. Guidelines (ACCP) prohibit NSAIDs with therapeutic anticoagulation. Distractors overlook warfarin interaction; C addresses both pain and anticoagulation safety.
Question 5
38 of 125. A patient on home TPN presents with dry scaly rash, alopecia, and platelet count of 85,000/μL after 8 weeks without lipid emulsion due to egg allergy. Which lab finding confirms the suspected complication?
- A) A) Serum zinc level of 40 mcg/dL
- B) B) Triene:tetraene ratio of 0.4✓
- C) C) Prealbumin level of 10 mg/dL
- D) D) Serum osmolarity of 320 mOsm/L
Show rationale
Rash, alopecia, and thrombocytopenia suggest essential fatty acid deficiency (EFAD). A triene:tetraene ratio >0.2 confirms EFAD, per ASPEN standards. Lipid avoidance due to allergy caused this. Option A indicates zinc deficiency (rash but no alopecia); option C reflects protein status; option D relates to dehydration. The 8-week cue aligns with EFAD onset in lipid-free TPN.
Question 6
102 of 125. An oncology patient receiving chemotherapy has a temperature of 39.1°C (102.4°F), BP 100/62, and severe mucositis. White blood cell count is 0.8 K/µL. Which finding warrants rapid escalation of care?
- A) A) Oral pain rated 8/10 on numeric scale
- B) B) Dry oral mucosa with cracked lips
- C) C) Systolic BP drop of 20 mmHg when standing✓
- D) D) Mild erythema at IV catheter site
Show rationale
Orthostatic hypotension in neutropenic fever signals sepsis-induced fluid loss or distributive shock, requiring urgent fluid resuscitation per IDSA guidelines. While mucositis pain (A) and dryness (B) need management, they don't indicate hemodynamic instability. IV site erythema (D) suggests possible infection but is less critical than hypotension in this immunocompromised patient with fever and severe neutropenia.
Question 7
13 of 125. A diabetic patient with cirrhosis (Child-Pugh B) and an INR of 2.3 is prescribed subcutaneous heparin 5,000 units twice daily for VTE prophylaxis. Which assessment finding warrants immediate nursing intervention?
- A) A) Hemoglobin decrease from 12.8 to 11.2 g/dL over 48 hours✓
- B) B) Platelet count drop from 180,000 to 150,000/mm³ post-dose
- C) C) Bruising at injection site measuring 3 cm in diameter
- D) D) Activated partial thromboplastin time (aPTT) of 45 seconds
Show rationale
Heparin is high-alert due to bleeding risks. Option A suggests occult hemorrhage requiring investigation in this high-risk patient (elevated INR from liver disease). ISMP standards mandate monitoring for hemoglobin drops >2 g/dL. Option B shows expected mild platelet decrease, not HIT (requires >50% drop). Option C describes minor local reaction. Option D reflects therapeutic prophylactic aPTT (35-45 sec). The cirrhosis/INR elevates bleeding risk; acute Hb decline indicates possible internal bleeding over trivial signs.
Question 8
77 of 125. A 68-year-old patient with end-stage renal disease on hemodialysis reports persistent nausea. The patient has thrombocytopenia (platelets 45,000/µL) and requests non-pharmacological options. Which intervention should the nurse implement?
- A) A) Apply acupressure to P6 point using wristbands for 5 minutes✓
- B) B) Perform acupuncture at ST36 point with sterile needles
- C) C) Administer ginger root supplements orally between meals
- D) D) Instruct in diaphragmatic breathing exercises twice daily
Show rationale
Acupressure at P6 is evidence-based for nausea, non-invasive, and safe with thrombocytopenia. Acupuncture (B) risks bleeding with low platelets. Ginger supplements (C) may interact with medications and alter electrolyte balance in renal disease. Breathing exercises (D) help anxiety but lack direct antiemetic efficacy. The P6 acupressure aligns with safety (no bleeding risk) and symptom-specific effectiveness, per Oncology Nursing Society guidelines for medically fragile patients.
Question 9
120 of 125. During interdisciplinary rounds, a case manager learns a diabetic patient with stage 3 pressure injuries refuses recommended wound care due to transportation barriers. The patient's hemoglobin A1c is 9.2% and they live 30 miles from the clinic. Which action aligns with the case manager's advocacy role?
- A) A) Documenting the patient's noncompliance in the medical record per facility policy
- B) B) Collaborating with social work to arrange medical transportation services✓
- C) C) Educating the patient about diabetic complications of untreated wounds
- D) D) Contacting the physician to discuss alternative treatment options
Show rationale
Transportation barriers directly cause care refusal, making systemic support (B) the advocacy priority over documentation (A) or re-education (C). While discussing alternatives (D) might help, it doesn't resolve the access barrier. Case managers address social determinants per AMSN guidelines by mobilizing resources. The high A1c and remote location heighten urgency for practical solutions to enable care adherence.
Question 10
21 of 125. A patient with cirrhosis (MELD 18) and hepatic encephalopathy exhibits asterixis and confusion. Ammonia is 95 μmol/L. Lactulose was started 12 hours ago. Which assessment finding requires dose adjustment?
- A) A) Two bowel movements since lactulose initiation✓
- B) B) Persistent asterixis on upper extremity assessment
- C) C) Serum ammonia level of 95 μmol/L
- D) D) Intermittent disorientation to time and place
Show rationale
Lactulose aims for 3-5 soft stools/day to reduce ammonia. Only 2 stools (A) in 12 hours indicates inadequate dosing per AASLD guidelines, necessitating increase. Asterixis (B) and confusion (D) are expected in encephalopathy and should improve with effective treatment. Ammonia levels (C) correlate poorly with symptoms and aren’t used for dose titration. Correct choice focuses on the therapeutic target (bowel movements) rather than neurological signs or lab values for medication adjustment.
