Med Surg. Exam 3 __ Practice Questions with Answers Rated A
a
In a severely anemic patient, the nurse would expect to
find
Rationale: Patients with severe anemia (Hgb level less
a. dyspnea and tachycardia. than 6 g/dL) exhibit the following cardiovascular and
b. cyanosis and pulmonary edema. pulmonary manifestations: tachycardia, increased pulse
c. cardiomegaly and pulmonary fibrosis. pressure, systolic murmurs, intermittent claudication,
d. ventricular dysrhythmias and wheezing. angina, heart failure, myocardial infarction, tachypnea, or-
thopnea, and dyspnea at rest.
When obtaining assessment data from a patient with a
microcytic, hypochromic anemia, the nurse would ques-
b
tion the patient about
a. folic acid intake.
Rationale: Iron-deficiency anemia is a microcytic,
b. dietary intake of iron.
hypochromic anemia.
c. a history of gastric surgery.
d. a history of sickle cell anemia.
a, c
Nursing interventions for a patient with severe anemia re-
lated to peptic ulcer disease include (select all that apply) Rationale: Stool occult blood test is performed to deter-
mine the cause of iron-deficiency anemia that is related
a. instructions for high-iron diet.
to gastrointestinal bleeding. Iron is increased in the diet.
b. taking vital signs every 8 hours.
Teach the patient which foods are good sources of iron.
c. monitoring stools for occult blood.
If nutrition is already adequate, increasing iron intake
d. teaching self-injection of erythropoietin.
by dietary means may not be practical. The patient with
e. administration of cobalamin (vitamin B12) injections.
iron deficiency related to acute blood loss may require a
transfusion of packed red blood cells (RBCs).
The nursing management of a patient in sickle cell crisis
includes (select all that apply)
a. monitoring CBC.
b. optimal pain management and O2 therapy.
,a, b, c, d
Rationale: Complete blood count (CBC) is monitored. In-
fections are common with elevated WBC counts, and ane-
mia may occur with low hemoglobin levels and low RBC
counts. O2 may be administered to treat hypoxia and con-
trol sickling. Rest may be instituted to reduce metabolic
requirements, and prophylaxis for deep vein thrombosis
(with anticoagulants) is prescribed. Transfusion therapy
is indicated when an aplastic crisis occurs. Patients may
require iron chelation therapy to reduce transfusion-pro-
duced iron overload. Pain occurring during an acute crisis
is usually undertreated; patients should have optimal pain
control with opioid analgesics, nonsteroidal antiinflam-
matory agents, antineuropathic pain medications, local
anesthetics, or nerve blocks.
a
A complication of the hyperviscosity of polycythemia is Rationale: The patient with polycythemia may experi-
ence angina, heart failure, intermittent claudication, and
a. thrombosis.
thrombophlebitis, which may be complicated by em-
b. cardiomyopathy.
bolization. These manifestations are caused by blood
c. pulmonary edema.
vessel distention, impaired blood flow, circulatory stasis,
d. disseminated intravascular coagulation (DIC).
thrombosis, and tissue hypoxia, which is caused by the hy-
pervolemia and hyperviscosity. The most common serious
acute complication is stroke, caused by thrombosis.
a
When caring for a patient with thrombocytopenia, the
nurse instructs the patient to
Rationale: Patients with thrombocytopenia should avoid
, aspirin because it reduces platelet adhesiveness, which
contributes to bleeding. Patients should not perform vig-
a. dab his or her nose instead of blowing.
orous exercise or lift weights. If a patient is weak and at
b. be careful when shaving with a safety razor.
risk for falling, supervise the patient when he or she is out
c. continue with physical activities to stimulate throm-
of bed. Blowing the nose forcefully should be avoided. The
bopoiesis.
patient should gently pat the nose with a tissue if needed.
d. avoid aspirin because it may mask the fever that occurs
Instruct patients not to shave with a blade; an electric razor
with thrombocytopenia.
should be used.
The nurse would anticipate that a patient with von Wille-
d
brand disease undergoing surgery would be treated with
administration of vWF and
Rationale: von Willebrand disease involves deficiency of
a. thrombin.
the von Willebrand coagulation protein, variable factor VIII
b. factor VI.
deficiencies, and platelet dysfunction. Treatment includes
c. factor VII.
administration of von Willebrand factor and factor VIII.
d. factor VIII.
DIC is a disorder in which
a. the coagulation pathway is genetically altered, leading c
to thrombus formation in all major blood vessels.
b. an underlying disease depletes hemolytic factors in
the blood, leading to dittuse thrombotic episodes and Rationale: In disseminated intravascular coagulation
infarcts. (DIC), the coagulation process is stimulated, with resultant
c. a disease process stimulates coagulation processes with thrombosis and depletion of clotting factors, which leads
resultant thrombosis, as well as depletion of clotting fac- to dittuse clotting and hemorrhage. The paradox of this
tors, leading to dittuse clotting and hemorrhage. condition is characterized by the profuse bleeding that
d. an inherited predisposition causes a deficiency of clot- results from the depletion of platelets and clotting factors.
ting factors that leads to overstimulation of coagulation
processes in the vasculature.
a, b, c, d
a
In a severely anemic patient, the nurse would expect to
find
Rationale: Patients with severe anemia (Hgb level less
a. dyspnea and tachycardia. than 6 g/dL) exhibit the following cardiovascular and
b. cyanosis and pulmonary edema. pulmonary manifestations: tachycardia, increased pulse
c. cardiomegaly and pulmonary fibrosis. pressure, systolic murmurs, intermittent claudication,
d. ventricular dysrhythmias and wheezing. angina, heart failure, myocardial infarction, tachypnea, or-
thopnea, and dyspnea at rest.
When obtaining assessment data from a patient with a
microcytic, hypochromic anemia, the nurse would ques-
b
tion the patient about
a. folic acid intake.
Rationale: Iron-deficiency anemia is a microcytic,
b. dietary intake of iron.
hypochromic anemia.
c. a history of gastric surgery.
d. a history of sickle cell anemia.
a, c
Nursing interventions for a patient with severe anemia re-
lated to peptic ulcer disease include (select all that apply) Rationale: Stool occult blood test is performed to deter-
mine the cause of iron-deficiency anemia that is related
a. instructions for high-iron diet.
to gastrointestinal bleeding. Iron is increased in the diet.
b. taking vital signs every 8 hours.
Teach the patient which foods are good sources of iron.
c. monitoring stools for occult blood.
If nutrition is already adequate, increasing iron intake
d. teaching self-injection of erythropoietin.
by dietary means may not be practical. The patient with
e. administration of cobalamin (vitamin B12) injections.
iron deficiency related to acute blood loss may require a
transfusion of packed red blood cells (RBCs).
The nursing management of a patient in sickle cell crisis
includes (select all that apply)
a. monitoring CBC.
b. optimal pain management and O2 therapy.
,a, b, c, d
Rationale: Complete blood count (CBC) is monitored. In-
fections are common with elevated WBC counts, and ane-
mia may occur with low hemoglobin levels and low RBC
counts. O2 may be administered to treat hypoxia and con-
trol sickling. Rest may be instituted to reduce metabolic
requirements, and prophylaxis for deep vein thrombosis
(with anticoagulants) is prescribed. Transfusion therapy
is indicated when an aplastic crisis occurs. Patients may
require iron chelation therapy to reduce transfusion-pro-
duced iron overload. Pain occurring during an acute crisis
is usually undertreated; patients should have optimal pain
control with opioid analgesics, nonsteroidal antiinflam-
matory agents, antineuropathic pain medications, local
anesthetics, or nerve blocks.
a
A complication of the hyperviscosity of polycythemia is Rationale: The patient with polycythemia may experi-
ence angina, heart failure, intermittent claudication, and
a. thrombosis.
thrombophlebitis, which may be complicated by em-
b. cardiomyopathy.
bolization. These manifestations are caused by blood
c. pulmonary edema.
vessel distention, impaired blood flow, circulatory stasis,
d. disseminated intravascular coagulation (DIC).
thrombosis, and tissue hypoxia, which is caused by the hy-
pervolemia and hyperviscosity. The most common serious
acute complication is stroke, caused by thrombosis.
a
When caring for a patient with thrombocytopenia, the
nurse instructs the patient to
Rationale: Patients with thrombocytopenia should avoid
, aspirin because it reduces platelet adhesiveness, which
contributes to bleeding. Patients should not perform vig-
a. dab his or her nose instead of blowing.
orous exercise or lift weights. If a patient is weak and at
b. be careful when shaving with a safety razor.
risk for falling, supervise the patient when he or she is out
c. continue with physical activities to stimulate throm-
of bed. Blowing the nose forcefully should be avoided. The
bopoiesis.
patient should gently pat the nose with a tissue if needed.
d. avoid aspirin because it may mask the fever that occurs
Instruct patients not to shave with a blade; an electric razor
with thrombocytopenia.
should be used.
The nurse would anticipate that a patient with von Wille-
d
brand disease undergoing surgery would be treated with
administration of vWF and
Rationale: von Willebrand disease involves deficiency of
a. thrombin.
the von Willebrand coagulation protein, variable factor VIII
b. factor VI.
deficiencies, and platelet dysfunction. Treatment includes
c. factor VII.
administration of von Willebrand factor and factor VIII.
d. factor VIII.
DIC is a disorder in which
a. the coagulation pathway is genetically altered, leading c
to thrombus formation in all major blood vessels.
b. an underlying disease depletes hemolytic factors in
the blood, leading to dittuse thrombotic episodes and Rationale: In disseminated intravascular coagulation
infarcts. (DIC), the coagulation process is stimulated, with resultant
c. a disease process stimulates coagulation processes with thrombosis and depletion of clotting factors, which leads
resultant thrombosis, as well as depletion of clotting fac- to dittuse clotting and hemorrhage. The paradox of this
tors, leading to dittuse clotting and hemorrhage. condition is characterized by the profuse bleeding that
d. an inherited predisposition causes a deficiency of clot- results from the depletion of platelets and clotting factors.
ting factors that leads to overstimulation of coagulation
processes in the vasculature.
a, b, c, d
