The Hematologic System ATI (drills & post-test) Exam Questions with
Correct Answers and Rationales 2023-2024
1. You are talking to a patient who is about to begin taking liquid ferrous sulfate (Feosol) to treat
iron-deficiency anemia. Which of the following instructions should you include about the drug?
Answer: Drink it through a straw
Dilute it first with water
2. You are caring for a patient who is about to begin taking cyanocobalamin (Nascobal), a
vitamin B12 preparation. You should understand that the drug treats which of the following types
of anemia?
Answer: Pernicious
Cyanocobalamin, a vitamin B12 preparation, treats pernicious anemia. This type of anemia is a
vitamin B12 deficiency due to the lack of intrinsic factor, which the body needs to absorb
vitamin B12.
Cyanocobalamin also treats vitamin B12 deficiency from gastric surgery or enteritis. Sickle cell
anemia is a genetic disease with which RBCs are crescent-shaped and reduced in number. The
sickle cells do not carry oxygen well, and they die prematurely. Aplastic anemia is a disorder
from too few stem cells, which the body needs to produce new blood cells. With iron-deficiency
anemia, too little iron results in too few red blood cells.
3. Folic acid therapeutic use.
Answer: treats megaloblastic anemia due to malabsorption syndrome, alcohol abuse, or hepatic
disease.
4. Factor VIII therapeutic use.
Answer: treats hemophilia A on demand for bleeding episodes or prophylactically to prevent
bleeding.
5. Filgrastim (Neupogen) therapeutic use
Answer: treats severe chronic neutropenia and reduces the infection risk associated with bone
marrow transplantation.
6. Heparin (Lovenox) therapeutic use.
Answer: educes clotting for an evolving CVA, pulmonary embolism, and deep-vein thrombosis.
It prevents postoperative venous thrombosis and treats acute myocardial infarction and
disseminated intravascular coagulation.
7. Before administering IV folic acid, you should explain to the patient that the drug can cause
which of the following adverse effects?
Answer: Flushing
IV folic acid can cause flushing and warmth with injection, so you should tell the patient to
expect these effects. IV folic acid is unlikely to cause nausea. Ferrous sulfate (Feosol) is an
example of a hematologic drug that can cause nausea and constipation. IV folic acid is unlikely
to cause a headache or dizziness. Alteplase (Activase), a thrombolytic, is an example of a
hematologic drug that can cause a headache. Oprelvekin (Interleukin-11), a thrombopoietic
growth factor, is a hematologic drug that can cause dizziness, headache, and nervousness.
8. You are reviewing the history of a patient who is about to begin therapy with Factor VIII
(advate) to treat hemophilia A. Which of the following drugs that the patient takes should alert
you to take further action?
Answer: Aspirin (Ecotrin)
Patients who have hemophilia should not take aspirin or other NSAIDs because they increase the
risk for bleeding. Patients may take albuterol, phenytoin, and phenelzine. A second-generation
NSAID, such as celecoxib (Celebrex), would pose less risk for bleeding.
9. You are caring for a patient who is taking warfarin (Coumadin) to prevent venous thrombosis.
You should explain that taking the drug requires daily blood samples to monitor for which of the
following laboratory tests?
Answer: PT/INR
At the start of warfarin therapy, you should monitor prothrombin time (PT) and international
normalized ratio (INR) daily and adjust the dosage to maintain an INR of 2 to 3. Monitor the
patient for indications of bleeding such as abdominal pain, black tarry stools, or nosebleeds.
Warfarin does not affect fibrinogen level, a parameter to assess prior alteplase (Activase) therapy.
Warfarin does not affect platelets. Aspirin (Ecotrin) is an example of a drug that inhibits platelet
aggregation. Warfarin does not affect fibrinogen level, a parameter to assess prior to alteplase
(Activase) therapy. Warfarin does not affect activated partial thromboplastin time (aPTT), a
parameter to assess every 4 to 6 hr initially and then daily for patients receiving continuous IV
heparin.
10. You are caring for a patient who is receiving alteplase (Activase) to dissolve a thrombosis.
Which of the following should you include in the care plan for the patient?
Answer:
• Monitor blood pressure.
• Limit venipunctures.
• Check level of consciousness.
• Apply pressure to oozing sites.
11. Filgrastim (Neupogen) pharmacologic action.
Answer: a leukopoietic growth factor, stimulates leukocyte (WBC) production for patients who
are myelo suppressed due to chemotherapy or disease.
12. Alteplase (Activase) pharmacologic action.
Answer: thrombolytic drug, dissolves a thrombi or blood clot that is already formed.
13. Epoetin alfa (Procrit) pharmacologic action.
Answer: stimulates RBC production in the bone marrow. It treats anemia from renal failure,
malignancies, or AIDS.
14. Clopidogrel (Plavix) pharmacologic action.
Answer: an antiplatelet drug, inhibits platelet aggregation and reduces thrombus formation.
15. You are caring for a patient who is about to begin taking clopidogrel (Plavix) to prevent
transient ischemic attacks. You should tell the patient to report which of the following adverse
effects?
Answer:
• Petechiae.
• Weakness.
• Vision changes
16. You are caring for a patient who is about to begin taking oprelvekin (Neumega) for
thrombocytopenia. To evaluate the potential for adverse effects, you should monitor which of the
following during drug therapy? ECG.
Answer: ECG
Oprelvekin, a thrombopoietic growth factor, can cause cardiac dysrhythmias, such as atrial
fibrillation, atrial flutter, and tachycardia. You should monitor the patient's vital signs, heart rate,
and ECG carefully. The patient should be told to report palpitations, rapid pulse, or dizziness.
Oprelvekin can cause peripheral edema and fluid retention, but it is unlikely to alter liver
function. Oprelvekin can affect vision, but it is unlikely to affect hearing. It is unlikely to affect
level of consciousness, although it can cause insomnia and dizziness.
17. A provider prescribes IV heparin for this patient. Which of the following parameters should
you monitor for in regard to determining if a therapeutic dose is being administered?
Answer: aPTT, one and a half to two times the patient's baseline
You check the patient's activated partial thromboplastin time, or aPTT, every 4 to 6 hours for
initial continuous IV heparin therapy. The goal is an aPTT of one and a half to two times the
patient's baseline for therapeutic anticoagulation. Prothrombin time, or PT, and international
normalized ratio, or INR, are parameters that are monitored when patients are on warfarin
(Coumadin) therapy, not heparin therapy. A therapeutic INR for warfarin is between 2 and 3 and
is not based on the patient's baseline. The expected reference range for PT is from 11 to 12.5
seconds with an increase in this time expected during anticoagulant therapy; however, the INR is
the parameter of choice for warfarin. Platelet counts below 100,000/mm3 warrant discontinuation
of heparin therapy.
18. Which of the following drugs should you have ready in case of heparin overdose?
Answer: Protamine
Protamine reverses the effects of heparin. For an overdose, the health care professional should
stop heparin and administer protamine no faster than 20 mg/min. Aminocaproic acid, a
coagulator, acts by inhibiting fibrinolysin. It can stop excessive bleeding due to alteplase
(Activase). A chelating agent, such as deferoxamine, treats iron toxicity. Vitamin K reverses the
effects of warfarin (Coumadin).
19. You should monitor a patient throughout continuous heparin therapy for which of the
following adverse reactions? (Select all that apply)
Answer:
• Thrombocytopenia
• Hypotension
• Deep-vein thrombosis
• Fever
20. While the patient is still receiving continuous IV heparin, the provider prescribes oral
warfarin (Coumadin). This is because
Answer: warfarin takes 3 to 5 days to achieve therapeutic effects.
Warfarin takes 3 to 5 days to achieve its therapeutic effects. Once it provides effective
anticoagulation, with an INR of 2 to 3, the provider should discontinue heparin therapy. IV
heparin is effective as an anticoagulant, but becomes impractical and costly for the patient to
receive at home. Stopping heparin therapy does not increase the risk for thrombocytopenia. It
actually decreases the risk in this case, because thrombocytopenia is not an adverse effect of
warfarin. Similar to heparin, however, warfarin can cause bleeding.
21. The provider discharges the patient to home with a prescription for warfarin (Coumadin).
You should advise the patient to do which of the following? (Select all that apply.)
Answer: Avoid taking NSAIDs.
Brush his teeth with a soft toothbrush.
Ask the provider before taking over-the-counter drugs.
Check bowel movements for signs of bleeding.
22. A healthcare professional is caring for a patient who is about to begin taking folic acid to
treat megaloblastic anemia. The healthcare professional should monitor which of the following
laboratory values?
Answer: Reticulocyte count
A reticulocyte count measures the amount of immature RBCs. Folic acid, also called folate, is
essential for erythropoiesis. Patients who have a folic acid deficiency require a baseline
reticulocyte count, as well as a serum folate, Hgb, Hct, and RBC count and periodic monitoring
during folic acid therapy to determine effectiveness.
23. I healthcare professional is preparing to administer the prescribed dose of filgrastim
(Neupogen) to a patient. The patient's laboratory results indicate that the patient has a white
blood count of 12,000 mm3 of the following actions should the healthcare professional tonight?
Answer: Clarify prescription with provider
Leukocytosis can occur with filgrastim therapy. It is essential to monitor CBC twice per week
and reduce the dosage or stop therapy for a WBC count above 10,000/mm 3. The health care
professional should notify the provider of the patient's current WBC count and clarify the
prescription prior to administration.
24. A healthcare professional is caring for a patient who is about to begin iron dextran (INFed)
therapy. When administering the drug IM, the healthcare professional should take which of the
following actions? (Select all that apply.)
Answer: Administer a test dose-Iron dextran can cause a hypersensitivity reaction. It is essential
to administer a test dose to determine hypersensitivity prior to giving the full dosage initially and
to allow 1 hr for identifying any adverse reactions.
Monitor blood pressure-Iron dextran can cause hypotension and hypersensitivity reactions, so it
is important to monitor blood pressure.
Have epinephrine available-Iron dextran can cause a hypersensitivity reaction. It is essential to
have epinephrine and resuscitation equipment available and to monitor for skin rash, fever, and
chills.
Use the Z-track technique-Health care professionals giving the drug IM should use the Z-track
technique to make sure to deposit it deep into the buttocks. Superficial injection can cause
abscesses and brown discoloration of the skin.
25. A healthcare professional is caring for a patient who is about to begin taking filgrastim
(Neupogen) to treat neutropenia. The healthcare professional should assess the patient for which
of the following adverse effects?
Answer: enlarged spleen
With long-term use, filgrastim, a leukopoietic growth factor, can cause an enlarged spleen.
Health care professionals should tell patients taking the drug to monitor and report abdominal
pain or fullness.
26. A healthcare professional is caring for a patient who is about to begin taking warfarin
(Coumadin). The healthcare professional should caution the patient about taking which of the
following over-the-counter drugs?
Answer: Ibuprofen (Motrin)
NSAIDs, such as ibuprofen and especially aspirin, can increase the risk of bleeding for patients
taking warfarin, an anticoagulant.
27. A patient is about to begin therapy with recombinant factor IX (BeneFix) to treat hemophilia
B. The patient asks the health care professional about the risk of disease transmission with
recombinant factor IX, as compared with plasma-derived factor IX. The health care professional
should explain that recombinant factor IX illuminates the risk for which of the following?
Answer: Creutzfeldt-Jakob disease
Recombinant factor IX is safer than the plasma-derived formulation because of the risk of
Creutzfeldt-Jakob disease, a prion-transmitted infection, from human sources. Plasma-derived
products also carry a minimal risk of acquiring hepatitis A and parvovirus B19.
28. A healthcare professional should assess a patient who has megaloblastic anemia for
indications of which of the following vitamin deficiencies?
Answer: vitamin B12
Patients who have megaloblastic anemia have a deficiency of vitamin B12, folic acid, or both.
Cyanocobalamin (Nascobal) treats moderate vitamin B12 deficiencies. Patients who have a
severe vitamin B12 deficiency should take cyanocobalamin and folic acid.
29. A patient who is taking ferrous sulfate (Feosol) to treat iron-deficiency anemia develop
severe nausea and vomiting due to iron toxicity. Which of the following drugs should a
healthcare professional use to treat this complication?
Answer: Deferoxamine (Desferal)
Indications of iron toxicity include nausea, vomiting, and diarrhea. Iron toxicity can lead to
acidosis and shock. A chelating agent, such as deferoxamine, binds to the iron to reduce toxicity.
30. A healthcare professional is caring for a patient who is about to begin alteplase (Activase)
therapy to treat pulmonary embolism. Which of the following drugs should the healthcare
professional have available in the event of a severe adverse reaction?
Answer: Aminocaproic acid (amicar)
A coagulator, inhibits fibrinolysis and stops fibrinolytic bleeding. For severe bleeding, patients
often require blood replacement.
31. A healthcare professional is caring for a patient who is about to begin taking alteplase
(Activase) to treat acute myocardial infarction. The healthcare professional should understand
the drug is most effective when the patient receives it...
Answer: within 3 hr of symptom onset
Alteplase, a thrombolytic drug, is most effective in treating acute myocardial infarction if the
patient receives it as soon as possible after the onset of symptoms.
32. A healthcare professional asking for a patient who is about to begin taking oprelvekin
(Neumega) to treat thrombocytopenia. The healthcare professional should tell the patient to
report which of the following indications of an adverse reaction? (Select all that apply.)
Answer: Conjunctivitis-Oprelvekin, a thrombopoietic growth factor, can cause conjunctivitis,
blurred vision, and papilledema.
Patients should report eye redness or blurred vision.
Swollen ankles-Oprelvekin, a thrombopoietic growth factor, can cause fluid retention. The health
care professional should monitor I&O and patients should report edema or difficulty breathing.
Palpitations-Oprelvekin, a thrombopoietic growth factor, can cause cardiac dysrhythmias.
Patients should report palpitations or dizziness.
33. A healthcare professional is caring for a patient who is about to begin taking epoetin alfa
(Epogen). Which of the following laboratory values should increase with effective therapy?
Answer: hgb
Epoetin alfa, an erythropoietic growth factor, increases the production of RBCs for patients who
have anemia due to chronic renal failure or chemotherapy. Hgb and Hct should increase with
effective therapy.
34. A healthcare professional is caring for a patient who has a known sensitivity to E. coli
derived proteins. This sensitivity is a contraindication for which of the following drugs?
Answer: Filgrastim (Neupogen)
Patients who are sensitive to Escherichia coli-derived proteins or have acute respiratory distress
syndrome should not receive filgrastim, a leukopoietic growth factor.
35. A healthcare professional is caring for a patient who is undergoing bone marrow transplant
patient following high-dose chemotherapy which of the following drug should a healthcare
professional expect the primary care provider to prescribe to reduce the patient's risk of
infection?
Answer: Filgrastim (Neupogen)
Filgrastim, a leukopoietic growth factor, stimulates production of neutrophils in the bone
marrow. It helps reduce the risk for infection due to bone marrow transplantation, severe chronic
neutropenia, and myelosuppressive chemotherapy.
36. A healthcare professional is caring for a patient who is about to begin taking oprelvekin
(Neumega). The healthcare professional should explain to the patient that they drug has which of
the following effects?
Answer: increases platelet production
Oprelvekin, a thrombopoietic growth factor, increases platelet production. It treats
thrombocytopenia that is associated with myelosuppression.
37. A healthcare professional administers epoetin alpha (Epogen) subcutaneously to patient who
has renal failure. The healthcare professional should monitor the patient for which of the
following adverse effects?
Answer: hypertension
Epoetin alfa, an erythropoietic growth factor, can cause hypertension. The health care
professional should monitor blood pressure and regulate it prior to initiating epoetin alfa therapy,
then monitor it during therapy. For elevations, recommend a reduced dosage or antihypertensive
drug therapy.
38. A patient who is taking warfarin (Coumadin) arrives to the emergency department and reports
rectal bleeding. Which of the following drugs should healthcare professional have available?
Answer: Vitamin K
Vitamin K reverses the effects of warfarin by promoting the synthesis of coagulation factors VI,
IX, X, and prothrombin.
39. A healthcare professional is caring for a patient who is about to begin taking (Plavix) to
prevent thrombus formation. The healthcare professional should question the use of clopidogrel
by a patient who has which of the following?
Answer: peptic ulcer disease
Patients who have peptic ulcer disease should not take clopidogrel because it can cause gastric
bleeding.
40. A healthcare professional is caring for a patient who is about to begin factor VIII (Advate)
therapy to treat hemophilia A. When administering factor VIII, which of the following actions
should the healthcare professional take?
Answer: have emergency equipment ready Factor VIII can cause a hypersensitive reaction and
anaphylaxis. The health care professional should monitor for hives, fever, wheezing, and
difficulty breathing, and have emergency equipment and drugs readily available.
41. A healthcare professional is caring for a patient who is about to begin taking ferrous sulfate
(Feosol) to treat iron-deficiency anemia. When talking with the patient about the drug, the
healthcare professional should include which of the following instructions? (Select all that
apply.)
Answer: Eat iron-enriched foods-Patients who have iron deficiency anemia should increase iron
intake with foods such as egg yolks, wheat germ, meat, and fish to supplement ferrous sulfate.
Spread the dosage across each day-Spreading out the iron intake throughout patients' waking
hours allows the bone marrow to maximize the production of RBCs.
Take the drug on an empty stomach-Food reduces the absorption of ferrous sulfate. Patients
should take the drug on an empty stomach to increase drug absorption. If GI effects are
troublesome, patients can take the drug with food.
Increase dietary fiber intake-. Ferrous sulfate can cause constipation. Patients should increase
fiber and fluid intake and exercise more often or more intensely.
42. A healthcare professional is caring for a patient who has mild hemophilia A and is about to
begin taking desmopressin DDAVP to prevent bleeding the healthcare professional should
monitor for which of the following adverse reactions?
Answer: edema
Desmopressin, an antidiuretic hormone, can cause fluid retention and edema. Health care
professionals should monitor fluid intake and output for patients receiving the drug therapy.
43. A healthcare professional is caring for a patient who is about to begin taking clopidogrel
(Plavix) to prevent stent stenosis. The healthcare professional should monitor the patient for
which of the following adverse reactions?
Answer: thrombocytopenia
Clopidogrel, an antiplatelet drug, can cause thrombotic thrombocytopenic purpura. The health
care professional should monitor platelet count, bruising, bleeding gums, and petechiae.
44. A healthcare professional is caring for a patient who is about to begin alteplase (Activase)
therapy. The health care professional should monitor the patient for which of the following
indications of the possible adverse effect?
Answer: headache
Alteplase, a thrombolytic drug, can cause intracranial bleeding. Monitor patients receiving the
drug for changes in level of consciousness, headache, one-sided weakness, and other indications
of intracranial bleeding.
45. A healthcare professional is caring for a patient who is about to begin taking aspirin (Ecotrin)
to reduce the risk of a cardiovascular event. The healthcare professional should understand that
the drug inhibits platelet aggregation by which of the following mechanisms?
Answer: Inhibiting cyclooxygenase action in platelets
Salicylates, such as aspirin, work by inhibiting platelet aggregation. They do this by blocking the
action of cyclooxygenase on platelets. As a result, activation of thromboxane A2 does not occur.
46. A healthcare professional is administering epoetin alpha (Epogen) subcutaneously to patient
has renal failure. The healthcare professional should take which of the following actions?
Answer: Insert the needle into the vial once.
Instructions for administering the drug include inserting the needle into the vial only once.
Health care professionals should also examine the solution and discard it if it is cloudy or
discolored.
