Below are 25 Wolters Kluwer/Next Generation NCLEX (NGN)-style practice questions with
answers and rationales based on Lippincott CoursePoint Enhanced for Brunner & Suddarth’s
Textbook of Medical-Surgical Nursing, 15th Edition. These questions are derived from
Chapters 28 and 29 (Module 9) and incorporate various NGN formats such as
multiple-choice, multiple-response, case studies, enhanced hotspot, cloze, matrix, bowtie, and
trend questions. Each question includes a rationale aligned with the textbook’s evidence-based
content.
Multiple-Choice Questions
1. Question: A 68-year-old client with chronic kidney disease presents with fatigue and
pallor. His hemoglobin is 8.2 g/dL. What is the most likely cause of his anemia?
a) Iron deficiency
b) Decreased erythropoietin production
c) Vitamin B12 deficiency
d) Chronic blood loss
Answer: b) Decreased erythropoietin production
Rationale: The textbook explains that chronic kidney disease impairs erythropoietin
(EPO) production, reducing red blood cell (RBC) synthesis and causing anemia (Chapter
28). Iron deficiency (a), B12 deficiency (c), and blood loss (d) are unrelated to kidney
dysfunction in this context.
2. Question: A patient with polycythemia vera reports headaches and dizziness with a
hematocrit of 58%. What is the nurse’s priority intervention?
a) Administer aspirin
b) Prepare for therapeutic phlebotomy
c) Encourage fluid intake
d) Apply oxygen therapy
Answer: b) Prepare for therapeutic phlebotomy
Rationale: The textbook identifies therapeutic phlebotomy as the primary treatment for
polycythemia vera to reduce hematocrit and blood viscosity, alleviating symptoms and
clot risk (Chapter 28). Aspirin (a) may be adjunctive, while c and d do not address the
underlying issue.
3. Question: A nurse is transfusing packed red blood cells (PRBCs) to a patient with a
hemoglobin of 6.9 g/dL. What is the most critical pre-transfusion step?
a) Obtain baseline vital signs
b) Verify patient identity with another nurse
c) Check the patient’s allergy history
d) Educate the patient about the procedure
Answer: b) Verify patient identity with another nurse
Rationale: The textbook emphasizes that verifying identity and blood compatibility with
a second nurse is the most critical step to prevent life-threatening hemolytic reactions
(Chapter 29). Other steps are important but secondary to ensuring correct blood
administration.
, 4. Question: A patient receiving PRBCs develops chills and a temperature increase of
1.8°F. What is the nurse’s first action?
a) Administer acetaminophen
b) Stop the transfusion
c) Increase the infusion rate
d) Apply a warm blanket
Answer: b) Stop the transfusion
Rationale: The textbook mandates stopping the transfusion immediately at the first sign
of a reaction (e.g., febrile non-hemolytic reaction) to prevent further complications,
followed by provider notification (Chapter 29).
5. Question: A patient with suspected leukemia is scheduled for bone marrow aspiration.
What is the nurse’s priority post-procedure intervention?
a) Monitor for infection
b) Apply pressure to the site
c) Assess pain levels
d) Encourage ambulation
Answer: b) Apply pressure to the site
Rationale: The textbook prioritizes applying pressure post-aspiration to prevent bleeding
at the puncture site (e.g., iliac crest), a key immediate concern (Chapter 29).
Multiple-Response Questions (Select All That Apply)
6. Question: A nurse is assessing a patient with anemia. Which symptoms should the nurse
expect? (Select all that apply.)
a) Fatigue
b) Shortness of breath
c) Warm, flushed skin
d) Pallor
e) Increased energy
Answers: a) Fatigue, b) Shortness of breath, d) Pallor
Rationale: The textbook lists fatigue, shortness of breath, and pallor as classic anemia
symptoms due to reduced oxygen-carrying capacity (Chapter 28). Warm, flushed skin (c)
and increased energy (e) are not associated with anemia.
7. Question: Which laboratory findings should the nurse expect in a patient with vitamin
B12 deficiency anemia? (Select all that apply.)
a) MCV of 110 fL
b) Hypersegmented neutrophils
c) High reticulocyte count
d) Low hemoglobin
e) Target cells
Answers: a) MCV of 110 fL, b) Hypersegmented neutrophils, d) Low hemoglobin
Rationale: The textbook identifies macrocytic anemia (high MCV), hypersegmented
neutrophils on smear, and low hemoglobin as hallmarks of B12 deficiency (Chapter 28).
High reticulocyte count (c) indicates hemolysis, and target cells (e) suggest liver disease.
answers and rationales based on Lippincott CoursePoint Enhanced for Brunner & Suddarth’s
Textbook of Medical-Surgical Nursing, 15th Edition. These questions are derived from
Chapters 28 and 29 (Module 9) and incorporate various NGN formats such as
multiple-choice, multiple-response, case studies, enhanced hotspot, cloze, matrix, bowtie, and
trend questions. Each question includes a rationale aligned with the textbook’s evidence-based
content.
Multiple-Choice Questions
1. Question: A 68-year-old client with chronic kidney disease presents with fatigue and
pallor. His hemoglobin is 8.2 g/dL. What is the most likely cause of his anemia?
a) Iron deficiency
b) Decreased erythropoietin production
c) Vitamin B12 deficiency
d) Chronic blood loss
Answer: b) Decreased erythropoietin production
Rationale: The textbook explains that chronic kidney disease impairs erythropoietin
(EPO) production, reducing red blood cell (RBC) synthesis and causing anemia (Chapter
28). Iron deficiency (a), B12 deficiency (c), and blood loss (d) are unrelated to kidney
dysfunction in this context.
2. Question: A patient with polycythemia vera reports headaches and dizziness with a
hematocrit of 58%. What is the nurse’s priority intervention?
a) Administer aspirin
b) Prepare for therapeutic phlebotomy
c) Encourage fluid intake
d) Apply oxygen therapy
Answer: b) Prepare for therapeutic phlebotomy
Rationale: The textbook identifies therapeutic phlebotomy as the primary treatment for
polycythemia vera to reduce hematocrit and blood viscosity, alleviating symptoms and
clot risk (Chapter 28). Aspirin (a) may be adjunctive, while c and d do not address the
underlying issue.
3. Question: A nurse is transfusing packed red blood cells (PRBCs) to a patient with a
hemoglobin of 6.9 g/dL. What is the most critical pre-transfusion step?
a) Obtain baseline vital signs
b) Verify patient identity with another nurse
c) Check the patient’s allergy history
d) Educate the patient about the procedure
Answer: b) Verify patient identity with another nurse
Rationale: The textbook emphasizes that verifying identity and blood compatibility with
a second nurse is the most critical step to prevent life-threatening hemolytic reactions
(Chapter 29). Other steps are important but secondary to ensuring correct blood
administration.
, 4. Question: A patient receiving PRBCs develops chills and a temperature increase of
1.8°F. What is the nurse’s first action?
a) Administer acetaminophen
b) Stop the transfusion
c) Increase the infusion rate
d) Apply a warm blanket
Answer: b) Stop the transfusion
Rationale: The textbook mandates stopping the transfusion immediately at the first sign
of a reaction (e.g., febrile non-hemolytic reaction) to prevent further complications,
followed by provider notification (Chapter 29).
5. Question: A patient with suspected leukemia is scheduled for bone marrow aspiration.
What is the nurse’s priority post-procedure intervention?
a) Monitor for infection
b) Apply pressure to the site
c) Assess pain levels
d) Encourage ambulation
Answer: b) Apply pressure to the site
Rationale: The textbook prioritizes applying pressure post-aspiration to prevent bleeding
at the puncture site (e.g., iliac crest), a key immediate concern (Chapter 29).
Multiple-Response Questions (Select All That Apply)
6. Question: A nurse is assessing a patient with anemia. Which symptoms should the nurse
expect? (Select all that apply.)
a) Fatigue
b) Shortness of breath
c) Warm, flushed skin
d) Pallor
e) Increased energy
Answers: a) Fatigue, b) Shortness of breath, d) Pallor
Rationale: The textbook lists fatigue, shortness of breath, and pallor as classic anemia
symptoms due to reduced oxygen-carrying capacity (Chapter 28). Warm, flushed skin (c)
and increased energy (e) are not associated with anemia.
7. Question: Which laboratory findings should the nurse expect in a patient with vitamin
B12 deficiency anemia? (Select all that apply.)
a) MCV of 110 fL
b) Hypersegmented neutrophils
c) High reticulocyte count
d) Low hemoglobin
e) Target cells
Answers: a) MCV of 110 fL, b) Hypersegmented neutrophils, d) Low hemoglobin
Rationale: The textbook identifies macrocytic anemia (high MCV), hypersegmented
neutrophils on smear, and low hemoglobin as hallmarks of B12 deficiency (Chapter 28).
High reticulocyte count (c) indicates hemolysis, and target cells (e) suggest liver disease.
