MED SURG. EXAM 3 __ PRACTICE QUESTIONS AND CORRECT ANSWERS

MED SURG. EXAM 3 __ PRACTICE
QUESTIONS AND CORRECT ANSWERS
InA2aA2severelyA2anemicA2patient,A2theA2nurseA2wouldA2expectA2toA2find

a.A2dyspneaA2andA2tachycardia.
b.A2cyanosisA2andA2pulmonaryA2edema.
c.A2cardiomegalyA2andA2pulmonaryA2fibrosis.
d.A2ventricularA2dysrhythmiasA2andA2wheezing.A2-A2Ans--a



Rationale:A2PatientsA2withA2severeA2anemiaA2(HgbA2levelA2lessA2thanA26A2g/
dL)A2exhibitA2theA2followingA2cardiovascularA2andA2pulmonaryA2manifestations:A2tachycar
dia,A2increasedA2pulseA2pressure,A2systolicA2murmurs,A2intermittentA2claudication,A2angin
a,A2heartA2failure,A2myocardialA2infarction,A2tachypnea,A2orthopnea,A2andA2dyspneaA2atA2r
est.

WhenA2obtainingA2assessmentA2dataA2fromA2aA2patientA2withA2aA2microcytic,A2hypochromi
cA2anemia,A2theA2nurseA2wouldA2questionA2theA2patientA2about

a.A2folicA2acidA2intake.
b.A2dietaryA2intakeA2ofA2iron.
c.A2aA2historyA2ofA2gastricA2surgery.
d.A2aA2historyA2ofA2sickleA2cellA2anemia.A2-A2Ans--b


Rationale:A2Iron-deficiencyA2anemiaA2isA2aA2microcytic,A2hypochromicA2anemia.

NursingA2interventionsA2forA2aA2patientA2withA2severeA2anemiaA2relatedA2toA2pepticA2ulcerA
2diseaseA2includeA2(selectA2allA2thatA2apply)


a.A2instructionsA2forA2high-ironA2diet.
b.A2takingA2vitalA2signsA2everyA28A2hours.
c.A2monitoringA2stoolsA2forA2occultA2blood.
d.A2teachingA2self-injectionA2ofA2erythropoietin.
e.A2administrationA2ofA2cobalaminA2(vitaminA2B12)A2injections.A2-A2Ans--a,A2c


Rationale:A2StoolA2occultA2bloodA2testA2isA2performedA2toA2determineA2theA2causeA2ofA2iro
n-
deficiencyA2anemiaA2thatA2isA2relatedA2toA2gastrointestinalA2bleeding.A2IronA2isA2increased
A2inA2theA2diet.A2TeachA2theA2patientA2whichA2foodsA2areA2goodA2sourcesA2ofA2iron.A2IfA2nut
ritionA2isA2alreadyA2adequate,A2increasingA2ironA2intakeA2byA2dietaryA2meansA2mayA2notA2b

,eA2practical.A2TheA2patientA2withA2ironA2deficiencyA2relatedA2toA2acuteA2bloodA2lossA2mayA2
requireA2aA2transfusionA2ofA2packedA2redA2bloodA2cellsA2(RBCs).

TheA2nursingA2managementA2ofA2aA2patientA2inA2sickleA2cellA2crisisA2includesA2(selectA2allA
2thatA2apply)


a.A2monitoringA2CBC.
b.A2optimalA2painA2managementA2andA2O2A2therapy.
c.A2bloodA2transfusionsA2ifA2requiredA2andA2ironA2chelation.
d.A2restA2asA2neededA2andA2deepA2veinA2thrombosisA2prophylaxis.
e.A2administrationA2ofA2IVA2ironA2andA2dietA2highA2inA2ironA2content.A2-A2Ans--a,A2b,A2c,A2d


Rationale:A2CompleteA2bloodA2countA2(CBC)A2isA2monitored.A2InfectionsA2areA2commonA2
withA2elevatedA2WBCA2counts,A2andA2anemiaA2mayA2occurA2withA2lowA2hemoglobinA2level
sA2andA2lowA2RBCA2counts.A2O2A2mayA2beA2administeredA2toA2treatA2hypoxiaA2andA2contr
olA2sickling.A2RestA2mayA2beA2institutedA2toA2reduceA2metabolicA2requirements,A2andA2pro
phylaxisA2forA2deepA2veinA2thrombosisA2(withA2anticoagulants)A2isA2prescribed.A2Transfusi
onA2therapyA2isA2indicatedA2whenA2anA2aplasticA2crisisA2occurs.A2PatientsA2mayA2requireA2i
ronA2chelationA2therapyA2toA2reduceA2transfusion-
producedA2ironA2overload.A2PainA2occurringA2duringA2anA2acuteA2crisisA2isA2usuallyA2under
treated;A2patientsA2shouldA2haveA2optimalA2painA2controlA2withA2opioidA2analgesics,A2nons
teroidalA2antiinflammatoryA2agents,A2antineuropathicA2painA2medications,A2localA2anesthe
tics,A2orA2nerveA2blocks.

AA2complicationA2ofA2theA2hyperviscosityA2ofA2polycythemiaA2is

a.A2thrombosis.
b.A2cardiomyopathy.
c.A2pulmonaryA2edema.
d.A2disseminatedA2intravascularA2coagulationA2(DIC).A2-A2Ans--a


Rationale:A2TheA2patientA2withA2polycythemiaA2mayA2experienceA2angina,A2heartA2failure,
A2intermittentA2claudication,A2andA2thrombophlebitis,A2whichA2mayA2beA2complicatedA2byA2
embolization.A2TheseA2manifestationsA2areA2causedA2byA2bloodA2vesselA2distention,A2imp
airedA2bloodA2flow,A2circulatoryA2stasis,A2thrombosis,A2andA2tissueA2hypoxia,A2whichA2isA2c
ausedA2byA2theA2hypervolemiaA2andA2hyperviscosity.A2TheA2mostA2commonA2seriousA2ac
uteA2complicationA2isA2stroke,A2causedA2byA2thrombosis.

WhenA2caringA2forA2aA2patientA2withA2thrombocytopenia,A2theA2nurseA2instructsA2theA2pati
entA2to

a.A2dabA2hisA2orA2herA2noseA2insteadA2ofA2blowing.
b.A2beA2carefulA2whenA2shavingA2withA2aA2safetyA2razor.
c.A2continueA2withA2physicalA2activitiesA2toA2stimulateA2thrombopoiesis.

, d.A2avoidA2aspirinA2becauseA2itA2mayA2maskA2theA2feverA2thatA2occursA2withA2thrombocyto
penia.A2-A2Ans--a


Rationale:A2PatientsA2withA2thrombocytopeniaA2shouldA2avoidA2aspirinA2becauseA2itA2redu
cesA2plateletA2adhesiveness,A2whichA2contributesA2toA2bleeding.A2PatientsA2shouldA2notA2
performA2vigorousA2exerciseA2orA2liftA2weights.A2IfA2aA2patientA2isA2weakA2andA2atA2riskA2for
A2falling,A2superviseA2theA2patientA2whenA2heA2orA2sheA2isA2outA2ofA2bed.A2BlowingA2theA2n
oseA2forcefullyA2shouldA2beA2avoided.A2TheA2patientA2shouldA2gentlyA2patA2theA2noseA2wit
hA2aA2tissueA2ifA2needed.A2InstructA2patientsA2notA2toA2shaveA2withA2aA2blade;A2anA2electric
A2razorA2shouldA2beA2used.


TheA2nurseA2wouldA2anticipateA2thatA2aA2patientA2withA2vonA2WillebrandA2diseaseA2underg
oingA2surgeryA2wouldA2beA2treatedA2withA2administrationA2ofA2vWFA2and

a.A2thrombin.
b.A2factorA2VI.
c.A2factorA2VII.
d.A2factorA2VIII.A2-A2Ans--d


Rationale:A2vonA2WillebrandA2diseaseA2involvesA2deficiencyA2ofA2theA2vonA2WillebrandA2c
oagulationA2protein,A2variableA2factorA2VIIIA2deficiencies,A2andA2plateletA2dysfunction.A2Tr
eatmentA2includesA2administrationA2ofA2vonA2WillebrandA2factorA2andA2factorA2VIII.

DICA2isA2aA2disorderA2inA2which

a.A2theA2coagulationA2pathwayA2isA2geneticallyA2altered,A2leadingA2toA2thrombusA2formatio
nA2inA2allA2majorA2bloodA2vessels.
b.A2anA2underlyingA2diseaseA2depletesA2hemolyticA2factorsA2inA2theA2blood,A2leadingA2toA2
diffuseA2thromboticA2episodesA2andA2infarcts.
c.A2aA2diseaseA2processA2stimulatesA2coagulationA2processesA2withA2resultantA2thrombosi
s,A2asA2wellA2asA2depletionA2ofA2clottingA2factors,A2leadingA2toA2diffuseA2clottingA2andA2he
morrhage.
d.A2anA2inheritedA2predispositionA2causesA2aA2deficiencyA2ofA2clottingA2factorsA2thatA2lead
sA2toA2overstimulationA2ofA2coagulationA2processesA2inA2theA2vasculature.A2-A2Ans--c


Rationale:A2InA2disseminatedA2intravascularA2coagulationA2(DIC),A2theA2coagulationA2proc
essA2isA2stimulated,A2withA2resultantA2thrombosisA2andA2depletionA2ofA2clottingA2factors,A2
whichA2leadsA2toA2diffuseA2clottingA2andA2hemorrhage.A2TheA2paradoxA2ofA2thisA2condition
A2isA2characterizedA2byA2theA2profuseA2bleedingA2thatA2resultsA2fromA2theA2depletionA2ofA2
plateletsA2andA2clottingA2factors.