A red-cell unit of 280 mL is running at 20 drops/min through a blood giving set that delivers 15 drops/mL. If the rate is unchanged, how long will the unit take to finish, and is it within the safe limit?

3 hours 30 minutes, within the 4-hour limit

1 hour 45 minutes, within the 4-hour limit

4 hours 40 minutes, beyond the 4-hour limit

2 hours 20 minutes, within the 4-hour limit

Two days after induction chemotherapy for acute lymphoblastic leukaemia, which set of laboratory findings would alert the nurse to tumour lysis syndrome?

High potassium, high phosphate, low calcium, high uric acid

Low potassium, low phosphate, high calcium, low uric acid

Low sodium, low potassium, high calcium, normal uric acid

High sodium, high calcium, low phosphate, high glucose

Ten minutes after a unit of red cells is started, a patient complains of back pain and a burning sensation along the vein, and becomes restless and hypotensive. What is the nurse's first action?

Stop the transfusion and keep the vein open with saline

Send the blood bag and a urine sample to the laboratory

Give the prescribed antihistamine and continue the unit

Slow the transfusion rate and recheck vitals in 15 minutes

A patient receiving external beam radiotherapy to the chest asks how to care for the skin in the treatment area. The nurse should advise the patient to:

Wash with lukewarm water and keep the ink marks

Use a hot water bottle to ease any soreness

Scrub off the ink marks after each session

Apply talcum powder daily to keep the area dry and cool

Haematology, oncology and blood transfusion

22 AIIMS NORCET (Nursing Officer) practice questions on Haematology, oncology and blood transfusion, part of Medical-Surgical Nursing. The first 22 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
A red-cell unit of 280 mL is running at 20 drops/min through a blood giving set that delivers 15 drops/mL. If the rate is unchanged, how long will the unit take to finish, and is it within the safe limit?
1. A1 hour 45 minutes, within the 4-hour limit
2. B3 hours 30 minutes, within the 4-hour limit
3. C4 hours 40 minutes, beyond the 4-hour limit
4. D2 hours 20 minutes, within the 4-hour limit
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Answer: B · 3 hours 30 minutes, within the 4-hour limit
Time (min) = volume (mL) x drop factor / drops per minute. Here 280 x 15 / 20 = 4,200 / 20 = 210 minutes, which is 3 hours 30 minutes. A red-cell unit must be completed within 4 hours of leaving the refrigerator, so this rate is acceptable if the unit was started promptly. Using the wrong drop factor is the commonest error in this calculation.
- A: 1 hour 45 minutes halves the correct time by a slip in the arithmetic.
- C: 4 hours 40 minutes comes from using a 20 drops/mL factor.
- D: 2 hours 20 minutes comes from using a 10 drops/mL factor.
Question 2 · Medium
Two days after induction chemotherapy for acute lymphoblastic leukaemia, which set of laboratory findings would alert the nurse to tumour lysis syndrome?
1. ALow potassium, low phosphate, high calcium, low uric acid
2. BHigh potassium, high phosphate, low calcium, high uric acid
3. CLow sodium, low potassium, high calcium, normal uric acid
4. DHigh sodium, high calcium, low phosphate, high glucose
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Answer: B · High potassium, high phosphate, low calcium, high uric acid
Rapid killing of tumour cells releases intracellular potassium, phosphate and nucleic acids, which are broken down to uric acid. Phosphate binds calcium, so serum calcium falls. The risk is highest with bulky, fast-growing tumours such as ALL and Burkitt lymphoma in the first days of treatment. Prevention is vigorous hydration and allopurinol or rasburicase, with close monitoring of urine output and electrolytes.
- A: Low potassium and phosphate are the reverse of what cell lysis releases.
- C: Potassium rises, not falls, when tumour cells break down.
- D: Hypercalcaemia and hypernatraemia are not features of tumour lysis.
Question 3 · Easy
Pernicious anaemia is a megaloblastic anaemia that results from a lack of:
1. AIntrinsic factor
2. BErythropoietin
3. CTransferrin
4. DDietary folic acid
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Answer: A · Intrinsic factor
In pernicious anaemia, autoimmune gastritis destroys the parietal cells that secrete intrinsic factor, which is needed to absorb vitamin B12 in the terminal ileum. B12 deficiency causes megaloblastic anaemia and, unlike folate deficiency, neurological damage such as peripheral neuropathy. Because oral B12 cannot be absorbed normally, treatment is lifelong parenteral cyanocobalamin or hydroxocobalamin. The nurse teaches that injections must continue even after the blood count recovers.
- B: Lack of erythropoietin causes the normocytic anaemia of chronic kidney disease.
- C: Transferrin carries iron; its lack does not cause pernicious anaemia.
- D: Folate deficiency also causes megaloblastic anaemia, but pernicious anaemia is a B12 absorption defect.
Question 4 · Medium
Ten minutes after a unit of red cells is started, a patient complains of back pain and a burning sensation along the vein, and becomes restless and hypotensive. What is the nurse's first action?
1. ASend the blood bag and a urine sample to the laboratory
2. BGive the prescribed antihistamine and continue the unit
3. CStop the transfusion and keep the vein open with saline
4. DSlow the transfusion rate and recheck vitals in 15 minutes
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Answer: C · Stop the transfusion and keep the vein open with saline
Back or flank pain, pain along the vein, restlessness and hypotension early in a transfusion suggest an acute haemolytic reaction, usually from ABO incompatibility. Stopping the transfusion at once limits the volume of incompatible blood received. The vein is kept open with normal saline through new tubing so that fluids and drugs can be given. The doctor and blood bank are then informed, and the bag, giving set, blood samples and first urine are sent for investigation.
- A: Specimens are sent after the transfusion is stopped and the patient is stabilised.
- B: Antihistamines treat mild allergic reactions, not haemolysis, and the unit must not continue.
- D: Slowing the rate still infuses incompatible red cells and delays treatment.
Question 5 · Medium
A patient receiving external beam radiotherapy to the chest asks how to care for the skin in the treatment area. The nurse should advise the patient to:
1. AUse a hot water bottle to ease any soreness
2. BWash with lukewarm water and keep the ink marks
3. CScrub off the ink marks after each session
4. DApply talcum powder daily to keep the area dry and cool
Show answerHide answer
Answer: B · Wash with lukewarm water and keep the ink marks
Irradiated skin is fragile and may redden, dry or peel. Gentle washing with lukewarm water and a mild soap, patting dry and loose cotton clothing protect it. The ink marks guide the radiation field and must not be washed off. Powders, perfumed lotions, heat, cold packs and sun exposure are avoided unless a product is prescribed by the radiotherapy team.
- A: Heat increases damage to irradiated skin.
- C: The markings guide treatment and must be kept until the course ends.
- D: Powders can contain metals that increase skin reaction and should be avoided.
Question 6 · Easy
Vincristine is a vesicant vinca alkaloid used in leukaemia and lymphoma. By which route must it never be given, because the error is almost always fatal?
1. AIntravenous infusion through a central venous catheter
2. BShort intravenous infusion through a peripheral cannula
3. CIntravenous push into a fast-running drip
4. DIntrathecal
Answer and explanation in LearnFree account
Question 7 · Hard
A patient on chemotherapy has a total leucocyte count of 2,000/µL, with 20% segmented neutrophils, 5% bands, 65% lymphocytes and 10% monocytes. What is the absolute neutrophil count?
1. A1,300/µL
2. B500/µL
3. C250/µL
4. D400/µL
Answer and explanation in LearnFree account
Question 8 · Medium
In a patient with metastatic prostate cancer, the earliest symptom that should make the nurse suspect spinal cord compression is:
1. AWeakness of both legs with an unsteady, wide gait
2. BA sensory level across the trunk
3. CNew back pain, worse on lying down or coughing
4. DRetention of urine and constipation
Answer and explanation in LearnFree account
Question 9 · Easy
On a ward round, the nurse finds 5% dextrose running into the same cannula as a unit of red cells. The main hazard of this practice is:
1. AHypoglycaemia in the patient
2. BCitrate toxicity
3. CBacterial contamination of the unit
4. DHaemolysis of the red cells
Answer and explanation in LearnFree account
Question 10 · Hard
Within minutes of starting a plasma transfusion, a patient with known IgA deficiency develops wheezing, facial swelling and a BP of 70/40 mmHg. After treating the reaction, which product should be requested for future transfusions?
1. ALeucoreduced red cells
2. BIrradiated red cells
3. CCMV-negative red cells
4. DWashed red cells
Answer and explanation in LearnFree account
Question 11 · Medium
A patient with aplastic anaemia has a platelet count of 15,000/µL. Which instruction is most appropriate for the nurse to give?
1. AUse a soft toothbrush and an electric razor
2. BBlow the nose firmly to clear any clots
3. CUse floss daily to keep gums healthy
4. DTake aspirin whenever a headache develops
Answer and explanation in LearnFree account
Question 12 · Hard
A 58-year-old man in the ICU with Gram-negative septicaemia from a urinary source begins bleeding from his cannula sites and nasogastric tube. Results: platelets 40,000/µL (150,000-400,000), PT 24 s (control 13 s), aPTT 62 s (25-35), fibrinogen 90 mg/dL (200-400), D-dimer markedly raised. The most likely diagnosis is:
1. AVitamin K deficiency
2. BDisseminated intravascular coagulation
3. CHaemophilia A
4. DImmune thrombocytopenic purpura
Answer and explanation in LearnFree account
Question 13 · Medium
A patient receiving chemotherapy has an absolute neutrophil count of 300/µL. Which order should the nurse question before carrying it out?
1. APlace the patient in a single room
2. BGive the prescribed G-CSF injection daily
3. COffer only cooked and peeled foods
4. DCheck rectal temperature every 4 hours
Answer and explanation in LearnFree account
Question 14 · Medium
During a peripheral infusion of doxorubicin, the patient reports stinging and the nurse sees swelling around the cannula. What should the nurse do first?
1. ARemove the cannula and massage the swollen area
2. BFlush the cannula with saline to dilute the drug in the tissue
3. CStop the infusion and aspirate through the cannula
4. DApply a warm compress and restart the infusion slowly
Answer and explanation in LearnFree account
Question 15 · Easy
In the 'CAUTION' list of seven warning signals of cancer, the letter 'A' stands for:
1. AUrinary frequency at night
2. BUnexplained fever
3. CUnusual weight gain
4. DA sore that does not heal
Answer and explanation in LearnFree account
Question 16 · Hard
A patient's blood group is A Rh-positive, and fresh frozen plasma is ordered. Which plasma group can be issued if group A plasma is not available?
1. AB
2. BAB
3. CO
4. DO Rh-negative
Answer and explanation in LearnFree account
Question 17 · Medium
A 76-year-old with heart failure is receiving her second unit of red cells. She becomes breathless, with basal crackles, distended neck veins and a blood pressure that has risen from 130/80 to 168/96 mmHg. What should the nurse do first?
1. AGive paracetamol and continue the unit
2. BStop the transfusion and sit her upright
3. CIncrease the rate to finish the unit sooner
4. DLay her flat and raise both legs
Answer and explanation in LearnFree account
Question 18 · Easy
Folinic acid (leucovorin) is given on a fixed schedule after high-dose methotrexate in order to:
1. ARescue normal cells from methotrexate toxicity
2. BIncrease the uptake of methotrexate by tumour cells
3. CPrevent the nausea and vomiting caused by methotrexate
4. DAlkalinise the urine and prevent crystal formation
Answer and explanation in LearnFree account
Question 19 · Medium
Which practice protects the nurse when reconstituting a cytotoxic drug for infusion?
1. ARecapping the needle by hand after drawing up the drug
2. BExpelling air from the syringe into a gauze swab beside the patient
3. CPreparing it in a biological safety cabinet with double chemotherapy gloves
4. DPreparing it in the open ward treatment room using one pair of gloves
Answer and explanation in LearnFree account
Question 20 · Easy
Once a unit of packed red cells has been taken out of the blood bank refrigerator, the transfusion should be completed within:
1. A8 hours
2. B24 hours
3. C30 minutes
4. D4 hours
Answer and explanation in LearnFree account
Question 21 · Medium
A 14-year-old with sickle cell disease is admitted in a painful vaso-occlusive crisis. Which nursing measure is the priority?
1. AIV hydration with regular opioid analgesia
2. BCold compresses on the painful joints
3. CFluid restriction to prevent circulatory overload
4. DEarly ambulation to improve circulation
Answer and explanation in LearnFree account
Question 22 · Medium
A young man with haemophilia A asks which tablet he can safely take for a mild headache. The nurse should recommend:
1. AIbuprofen
2. BMefenamic acid
3. CParacetamol
4. DAspirin
Answer and explanation in LearnFree account

Haematology, oncology and blood transfusion

A red-cell unit of 280 mL is running at 20 drops/min through a blood giving set that delivers 15 drops/mL. If the rate is unchanged, how long will the unit take to finish, and is it within the safe limit?

Two days after induction chemotherapy for acute lymphoblastic leukaemia, which set of laboratory findings would alert the nurse to tumour lysis syndrome?

Pernicious anaemia is a megaloblastic anaemia that results from a lack of:

Ten minutes after a unit of red cells is started, a patient complains of back pain and a burning sensation along the vein, and becomes restless and hypotensive. What is the nurse's first action?

A patient receiving external beam radiotherapy to the chest asks how to care for the skin in the treatment area. The nurse should advise the patient to:

Vincristine is a vesicant vinca alkaloid used in leukaemia and lymphoma. By which route must it never be given, because the error is almost always fatal?

A patient on chemotherapy has a total leucocyte count of 2,000/µL, with 20% segmented neutrophils, 5% bands, 65% lymphocytes and 10% monocytes. What is the absolute neutrophil count?

In a patient with metastatic prostate cancer, the earliest symptom that should make the nurse suspect spinal cord compression is:

On a ward round, the nurse finds 5% dextrose running into the same cannula as a unit of red cells. The main hazard of this practice is:

Within minutes of starting a plasma transfusion, a patient with known IgA deficiency develops wheezing, facial swelling and a BP of 70/40 mmHg. After treating the reaction, which product should be requested for future transfusions?

A patient with aplastic anaemia has a platelet count of 15,000/µL. Which instruction is most appropriate for the nurse to give?

A patient receiving chemotherapy has an absolute neutrophil count of 300/µL. Which order should the nurse question before carrying it out?

During a peripheral infusion of doxorubicin, the patient reports stinging and the nurse sees swelling around the cannula. What should the nurse do first?

In the 'CAUTION' list of seven warning signals of cancer, the letter 'A' stands for:

A patient's blood group is A Rh-positive, and fresh frozen plasma is ordered. Which plasma group can be issued if group A plasma is not available?

A 76-year-old with heart failure is receiving her second unit of red cells. She becomes breathless, with basal crackles, distended neck veins and a blood pressure that has risen from 130/80 to 168/96 mmHg. What should the nurse do first?

Folinic acid (leucovorin) is given on a fixed schedule after high-dose methotrexate in order to:

Which practice protects the nurse when reconstituting a cytotoxic drug for infusion?

Once a unit of packed red cells has been taken out of the blood bank refrigerator, the transfusion should be completed within:

A 14-year-old with sickle cell disease is admitted in a painful vaso-occlusive crisis. Which nursing measure is the priority?

A young man with haemophilia A asks which tablet he can safely take for a mild headache. The nurse should recommend: