Med-Surg Exam 2 - Medical-Surgical Nursing Exam Prep, Practice Questions & Verified Answers
A client with a hematological disorder asks the nurse how Ans: C
the body forms blood cells. The nurse understands that Bone marrow is the primary site for hematopoiesis. The liver and spleen may be
this process takes place primarily in which location? involved during embryonic development or when bone marrow is destroyed. The
A. Spleen kidneys release erythropoietin, which stimulates the marrow to increase production
B. Kidneys of RBCs. However, blood cells are not primarily formed in the spleen, kidneys or
C. Bone marrow liver.
D. Liver
A client suffers with a leg wound which causes major blood Ans: A
loss. As a result of the bleeding, the process of primary Primary hemostasis involves the severed vessel constricting and platelets collecting
hemostasis is activated. What will occur during this at the injury site. Secondary hemostasis occurs when thromboplastin is released,
process? prothrombin converts to thrombin, and fibrin is lysed.
A. Severed blood vessels constrict
B. Thromboplastin is released
C. Prothrombin is converted to thrombin
D. Fibrin is lysed
A client has come to the OB/GYN clinic due to heavy Ans. C
menstrual flow. Because of the clients consequent To replace blood loss, the rate of red cell production increases. Iron is incorporated
increase in red cell production, the nurse should into hemoglobin. Vitamin E and D and magnesium do not need to be increased
recommend the client increase which daily intake of what when RBC production is increased.
substance?
A. Vitamin E
B. Vitamin D
C. iron
D. Magnesium
The nurse is planning the care of a client with a nutritional Ans. D
deficit and a diagnosis of megaloblastic anemia. The nurse Vitamin B12 and folate deficiencies are characterized b the production of
should recognize that this client's health problem is due to abnormally large erythrocytes called megaloblasts. Because these cells are
which issue with the red blood cells? abnormal, many are sequestered (trapped) while still in the bone marrow, and their
A. Production of inadequate quantities of RBCs rate of release is decreased. Some of these cells actually die in the marrow before
B. Premature release of immature RBCs they can be released into the circulation. This results in megaloblastic anemia. This
C. Injury to the RBC's in circulation pathologic process does not involve inadequate production, premature release or
D. Abnormalities in the structure and function of RBCs injury to existing RBCs.
A nurse is caring for a client who is undergoing preliminary Ans: D
testing for a hematologic disorder. What sign and symptom The most common indicator of a hematologic disease is extreme fatigue. This is
of a hematological disorder is most common? more common than changes in LOC, infections, or anaphylaxis.
A. Sudden change in LOC
B. recurrent infections
C. Anaphylaxis
D. Severe fatigue
The nurse caring for a client receiving a transfusion notes Ans. B
that 15 minutes after the infusion of PRBCs has begun, the Vascular collapse, bronchospasm, laryngeal edema, shock, fever, chills, and JVD
client is having difficulty breathing and reports severe are severe reactions. The nurse should discontinue the transfusion immediately,
chest tightness. What is the most appropriate initial action monitor the client's v/s, and notify the HCP. The blood container and tubing should
for the nurse to take? be sent to the blood bank. A blood and urine specimen may be needed if a
A. Notify the client's health care provider transfusion reaction or bacterial infection is suspected. The client's IV access
B. Stop the transfusion immediately should not be removed.
C. Remove the client's IV access
D. Assess the client's chest sounds and vital signs
The nurse is describing the role of plasminogen in the Ans: B
clotting cascade. Where in the body is plasminogen Plasminogen, which is present in all body fluids, circulates with fibrinogen.
present? Plasminogen is found in body fluids not tissue.
A. Myocardial muscle tissue
B. All body fluids
C. Cerebral tissue
D. Venous and arterial vessel walls
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,Med-Surg Exam 2 - Medical-Surgical Nursing Exam Prep, Practice Questions & Verified Answers
The nurse is caring for a client who has developed scar Ans: D
tissue in many of the areas that normally produce blood In adults with disease that causes marrow destruction, fibrosis, or scarring, the liver
cells. What organs can become active in blood cell and spleen can also resume production of blood cells by a process known as
production by the process of extramedullary extramedullary hematopoiesis. The kidneys and pancreas do not produce blood
hematopoiesis? cells for the body.
A. Spleen and kidneys
B. Kidneys and pancreas
C. Pancreas and liver
D. Liver and spleen
Through the process of hematopoiesis, stem cells Ans: A,D,E
differentiate into either myeloid or lymphoid stem cells. Into Myeloid stem cells differentiate into three broad cell types: erythrocytes, leukocytes,
what do myeloid stem cells further differentiate? SATA and platelets. Natural killer cells and cytokines do not originate as myeloid stem
A. Leukocytes cells.
B. Natural killer cells
C. Cytokines
D. Platelets
E. Erythrocytes
A client's wound has begun to heal and the blood clot Ans: D
which formed is no longer necessary. When a blood clot is The substance plasminogen is required to lyse the fibrin. Plasminogen, which is
no longer needed, the fibrinogen and fibrin will be digested present in all body fluids, circulates with fibrinogen and is therefore incorporated into
by which of the following? the fibrin clot as it forms. When the clot is no longer needed (eg., after an injured
A. Plasminogen blood vessel has healed), the plasminogen is activated to form plasmin. Plasmin
B. Thrombin digests the fibrinogen and fibrin. Prothrombin is converted to thrombin, which in turn
C. Prothrombin catalyzes the the conversion of fibrinogen to fibrin so a clot can form.
D. Plasmin
A client is undergoing a hip replacement has autologous Ans: B
blood on a standby if a transfusion is needed. What is the The primary advantage of autologous transfusions is the prevention of viral
primary advantage of autologous transfusions? infections from another person's blood. Other secondary advantages include safe
A. Safe transfusion for clients with a history of transfusion transfusion for clients with a history of transfusion reactions, prevention of
reactions alloimmunization, and avoidance of complications in clients with alloantibodies.
B. Prevention of viral infections from another person's
blood
C. Avoidance of complications in clients with alloantibodies
D. Prevention of alloimmunization
A client has been diagnosed with a lymphoid stem cell Ans: A
defect. This client has the potential for a problem involving A defect in a myeloid stem cell can cause problems with erythrocyte, leukocyte, and
which of the following? platelet production. In contrast, a defect in the lymphoid stem cell can cause
A. Plasma cells problems with T or B lymphocytes, plasma cells ( a more differentiated form of B
B. Neutrophils lymphocytes), or natural killer cells.
C. Red blood cells
D. Platelets
The nurse is describing normal erythrocyte physiology to a Ans: B
client who has a diagnosis of anemia. The nurse should Mature erythrocytes consist primarily of hemoglobin, which contains iron and makes
explain that erythrocytes consist primarily of which up 95% of the cell mass. Erythrocytes are not made of fibrin or plasminogen.
substance? Hematocrit is a measure of erythrocyte volume in whole blood.
A. Plasminogen
B. Hemoglobin
C. Hematocrit
D. Fibrin
The nurse educating a client with anemia is describing the Ans: D
process of red blood cell production. When the client's If the kidney detects low levels of oxygen, as occurs when fewer red blood cells are
kidneys sense a low level of oxygen in circulating blood, available to bind oxygen (i.e., anemia), erythropoietin levels increase. The body
which physiologic response is initiated? does not compensate with vasoconstriction, decreased respiration, or increased
A. Increased stem cell synthesis stem cell activity.
B. Decreased respiratory rate
C. Arterial vasoconstriction
D. Increased levels of erythropoietin
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, Med-Surg Exam 2 - Medical-Surgical Nursing Exam Prep, Practice Questions & Verified Answers
An older adult client is exhibiting many of the characteristic Ans: A
signs and symptoms of iron deficiency. In addition to a Iron deficiency in the adult generally indicates blood loss (e.g., from bleeding in the
complete blood count, what diagnostic assessment should GI tract or heavy menstrual flow). Bleeding in the GI tract can be preliminary
the nurse anticipate? identified by testing stool for the presence of blood. A bone marrow biopsy would
A. Stool for occult blood not be undertaken for the sole purpose of investigating an iron deficiency. Lumbar
B. Bone marrow biopsy puncture and urinalysis would not be clinically relevant.
C. Lumbar puncture
D. Urinalysis
A client is being treated for the effects of a longstanding Ans: B
vitamin B12 deficiency. Which aspect of the client's health Because vitamin B12 is found only in foods of animal origin, vegans may ingest little
history would most likely predispose the client to this B12. Irregular menstrual periods, marijuana use, and blood donation would not
deficiency? precipitate a vitamin B12 deficiency
A. The client has irregular menstrual periods
B. The client is vegan
C. The client donated blood 60 days ago
D.The client frequently smokes marijuana
The nurse's review of a client's most recent blood work Ans: C
reveals a significant increase in the number of band cells. Ordinarily, band cells account for only a small percentage of circulating
The nurse's subsequent assessment should focus on granulocytes, although their percentage can increase greatly under conditions in
which of the following? which neutrophil production increases, such as infection. This finding is not
A. Respiratory function suggestive of problems with oxygenation and subsequent activity intolerance.
B. Evidence of decreased tissue perfusion
C. Signs and symptoms of infection
D. Recent changes in activity tolerance
A nurse is educating a client about the role of B Ans: D
lymphocytes. The nurse's description will include which of B lymphocytes are capable of differentiating into plasma cells. Plasma cells, in turn,
the following physiologic processes? produce antibodies. Cytokines are produced by natural killer cells. Stem cell
A. Stem cell differentiation differentiation greatly precedes B lymphocyte production.
B. Cytokine production
C. Phagocytosis
D. Antibody production
A client's most recent blood work reveals low levels of Ans: A
albumin. This assessment finding should suggest the Albumin is particularly important for the maintenance of fluid balance within the
possibility of what nursing diagnosis? vascular system. Deficiencies nearly always manifest as fluid imbalances. Tissue
A. Risk for imbalanced fluid volume related to low albumin oxygenation and skin integrity are not normally affected. Low albumin does not
B. Risk for infection related to low albumin constitute a risk for infection.
C. Ineffective tissue perfusion related to low albumin
D. Impaired skin integrity related to low albumin
A client has sustained a cut to the hand, immediately Ans: B
initiating the process of hemostasis. Following Following vasoconstriction, circulating platelets aggregate at the site and adhere to
vasoconstriction, which event in the process of hemostasis the vessel and to one another, forming an unstable hemostatic plug. events
will take place? involved in the clotting cascade take place subsequent to this initial platelet action.
A. Fibrin will be activated at the bleeding site
B. Platelets will aggregate at the injury site
C. Thromboplastin will form a clot
D. Prothrombin will be converted to thrombin
The nurse is providing care for a 73-year-old client who Ans: B
has a hematologic disorder. Which change in hematologic Due to a variety of factors, when an older person needs more blood cells, the bone
function is age-related? marrow may not be able to increase production of these cells adequately. Stem cell
A. Bone-marrow in older adults produces a smaller activity continues throughout the lifespan, although at a somewhat decreased rate.
proportion of healthy, functional blood cells The proportion of functional cells does not greatly decrease, and the relative volume
B. Older adults are less able to increase blood cell of plasma does not change significantly.
production when demand suddenly increases
C. Stem cells in older adults eventually lose their ability to
differentiate
D. The ratio of plasma to erythrocytes and lymphocytes
increase with age
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A client with a hematological disorder asks the nurse how Ans: C
the body forms blood cells. The nurse understands that Bone marrow is the primary site for hematopoiesis. The liver and spleen may be
this process takes place primarily in which location? involved during embryonic development or when bone marrow is destroyed. The
A. Spleen kidneys release erythropoietin, which stimulates the marrow to increase production
B. Kidneys of RBCs. However, blood cells are not primarily formed in the spleen, kidneys or
C. Bone marrow liver.
D. Liver
A client suffers with a leg wound which causes major blood Ans: A
loss. As a result of the bleeding, the process of primary Primary hemostasis involves the severed vessel constricting and platelets collecting
hemostasis is activated. What will occur during this at the injury site. Secondary hemostasis occurs when thromboplastin is released,
process? prothrombin converts to thrombin, and fibrin is lysed.
A. Severed blood vessels constrict
B. Thromboplastin is released
C. Prothrombin is converted to thrombin
D. Fibrin is lysed
A client has come to the OB/GYN clinic due to heavy Ans. C
menstrual flow. Because of the clients consequent To replace blood loss, the rate of red cell production increases. Iron is incorporated
increase in red cell production, the nurse should into hemoglobin. Vitamin E and D and magnesium do not need to be increased
recommend the client increase which daily intake of what when RBC production is increased.
substance?
A. Vitamin E
B. Vitamin D
C. iron
D. Magnesium
The nurse is planning the care of a client with a nutritional Ans. D
deficit and a diagnosis of megaloblastic anemia. The nurse Vitamin B12 and folate deficiencies are characterized b the production of
should recognize that this client's health problem is due to abnormally large erythrocytes called megaloblasts. Because these cells are
which issue with the red blood cells? abnormal, many are sequestered (trapped) while still in the bone marrow, and their
A. Production of inadequate quantities of RBCs rate of release is decreased. Some of these cells actually die in the marrow before
B. Premature release of immature RBCs they can be released into the circulation. This results in megaloblastic anemia. This
C. Injury to the RBC's in circulation pathologic process does not involve inadequate production, premature release or
D. Abnormalities in the structure and function of RBCs injury to existing RBCs.
A nurse is caring for a client who is undergoing preliminary Ans: D
testing for a hematologic disorder. What sign and symptom The most common indicator of a hematologic disease is extreme fatigue. This is
of a hematological disorder is most common? more common than changes in LOC, infections, or anaphylaxis.
A. Sudden change in LOC
B. recurrent infections
C. Anaphylaxis
D. Severe fatigue
The nurse caring for a client receiving a transfusion notes Ans. B
that 15 minutes after the infusion of PRBCs has begun, the Vascular collapse, bronchospasm, laryngeal edema, shock, fever, chills, and JVD
client is having difficulty breathing and reports severe are severe reactions. The nurse should discontinue the transfusion immediately,
chest tightness. What is the most appropriate initial action monitor the client's v/s, and notify the HCP. The blood container and tubing should
for the nurse to take? be sent to the blood bank. A blood and urine specimen may be needed if a
A. Notify the client's health care provider transfusion reaction or bacterial infection is suspected. The client's IV access
B. Stop the transfusion immediately should not be removed.
C. Remove the client's IV access
D. Assess the client's chest sounds and vital signs
The nurse is describing the role of plasminogen in the Ans: B
clotting cascade. Where in the body is plasminogen Plasminogen, which is present in all body fluids, circulates with fibrinogen.
present? Plasminogen is found in body fluids not tissue.
A. Myocardial muscle tissue
B. All body fluids
C. Cerebral tissue
D. Venous and arterial vessel walls
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,Med-Surg Exam 2 - Medical-Surgical Nursing Exam Prep, Practice Questions & Verified Answers
The nurse is caring for a client who has developed scar Ans: D
tissue in many of the areas that normally produce blood In adults with disease that causes marrow destruction, fibrosis, or scarring, the liver
cells. What organs can become active in blood cell and spleen can also resume production of blood cells by a process known as
production by the process of extramedullary extramedullary hematopoiesis. The kidneys and pancreas do not produce blood
hematopoiesis? cells for the body.
A. Spleen and kidneys
B. Kidneys and pancreas
C. Pancreas and liver
D. Liver and spleen
Through the process of hematopoiesis, stem cells Ans: A,D,E
differentiate into either myeloid or lymphoid stem cells. Into Myeloid stem cells differentiate into three broad cell types: erythrocytes, leukocytes,
what do myeloid stem cells further differentiate? SATA and platelets. Natural killer cells and cytokines do not originate as myeloid stem
A. Leukocytes cells.
B. Natural killer cells
C. Cytokines
D. Platelets
E. Erythrocytes
A client's wound has begun to heal and the blood clot Ans: D
which formed is no longer necessary. When a blood clot is The substance plasminogen is required to lyse the fibrin. Plasminogen, which is
no longer needed, the fibrinogen and fibrin will be digested present in all body fluids, circulates with fibrinogen and is therefore incorporated into
by which of the following? the fibrin clot as it forms. When the clot is no longer needed (eg., after an injured
A. Plasminogen blood vessel has healed), the plasminogen is activated to form plasmin. Plasmin
B. Thrombin digests the fibrinogen and fibrin. Prothrombin is converted to thrombin, which in turn
C. Prothrombin catalyzes the the conversion of fibrinogen to fibrin so a clot can form.
D. Plasmin
A client is undergoing a hip replacement has autologous Ans: B
blood on a standby if a transfusion is needed. What is the The primary advantage of autologous transfusions is the prevention of viral
primary advantage of autologous transfusions? infections from another person's blood. Other secondary advantages include safe
A. Safe transfusion for clients with a history of transfusion transfusion for clients with a history of transfusion reactions, prevention of
reactions alloimmunization, and avoidance of complications in clients with alloantibodies.
B. Prevention of viral infections from another person's
blood
C. Avoidance of complications in clients with alloantibodies
D. Prevention of alloimmunization
A client has been diagnosed with a lymphoid stem cell Ans: A
defect. This client has the potential for a problem involving A defect in a myeloid stem cell can cause problems with erythrocyte, leukocyte, and
which of the following? platelet production. In contrast, a defect in the lymphoid stem cell can cause
A. Plasma cells problems with T or B lymphocytes, plasma cells ( a more differentiated form of B
B. Neutrophils lymphocytes), or natural killer cells.
C. Red blood cells
D. Platelets
The nurse is describing normal erythrocyte physiology to a Ans: B
client who has a diagnosis of anemia. The nurse should Mature erythrocytes consist primarily of hemoglobin, which contains iron and makes
explain that erythrocytes consist primarily of which up 95% of the cell mass. Erythrocytes are not made of fibrin or plasminogen.
substance? Hematocrit is a measure of erythrocyte volume in whole blood.
A. Plasminogen
B. Hemoglobin
C. Hematocrit
D. Fibrin
The nurse educating a client with anemia is describing the Ans: D
process of red blood cell production. When the client's If the kidney detects low levels of oxygen, as occurs when fewer red blood cells are
kidneys sense a low level of oxygen in circulating blood, available to bind oxygen (i.e., anemia), erythropoietin levels increase. The body
which physiologic response is initiated? does not compensate with vasoconstriction, decreased respiration, or increased
A. Increased stem cell synthesis stem cell activity.
B. Decreased respiratory rate
C. Arterial vasoconstriction
D. Increased levels of erythropoietin
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, Med-Surg Exam 2 - Medical-Surgical Nursing Exam Prep, Practice Questions & Verified Answers
An older adult client is exhibiting many of the characteristic Ans: A
signs and symptoms of iron deficiency. In addition to a Iron deficiency in the adult generally indicates blood loss (e.g., from bleeding in the
complete blood count, what diagnostic assessment should GI tract or heavy menstrual flow). Bleeding in the GI tract can be preliminary
the nurse anticipate? identified by testing stool for the presence of blood. A bone marrow biopsy would
A. Stool for occult blood not be undertaken for the sole purpose of investigating an iron deficiency. Lumbar
B. Bone marrow biopsy puncture and urinalysis would not be clinically relevant.
C. Lumbar puncture
D. Urinalysis
A client is being treated for the effects of a longstanding Ans: B
vitamin B12 deficiency. Which aspect of the client's health Because vitamin B12 is found only in foods of animal origin, vegans may ingest little
history would most likely predispose the client to this B12. Irregular menstrual periods, marijuana use, and blood donation would not
deficiency? precipitate a vitamin B12 deficiency
A. The client has irregular menstrual periods
B. The client is vegan
C. The client donated blood 60 days ago
D.The client frequently smokes marijuana
The nurse's review of a client's most recent blood work Ans: C
reveals a significant increase in the number of band cells. Ordinarily, band cells account for only a small percentage of circulating
The nurse's subsequent assessment should focus on granulocytes, although their percentage can increase greatly under conditions in
which of the following? which neutrophil production increases, such as infection. This finding is not
A. Respiratory function suggestive of problems with oxygenation and subsequent activity intolerance.
B. Evidence of decreased tissue perfusion
C. Signs and symptoms of infection
D. Recent changes in activity tolerance
A nurse is educating a client about the role of B Ans: D
lymphocytes. The nurse's description will include which of B lymphocytes are capable of differentiating into plasma cells. Plasma cells, in turn,
the following physiologic processes? produce antibodies. Cytokines are produced by natural killer cells. Stem cell
A. Stem cell differentiation differentiation greatly precedes B lymphocyte production.
B. Cytokine production
C. Phagocytosis
D. Antibody production
A client's most recent blood work reveals low levels of Ans: A
albumin. This assessment finding should suggest the Albumin is particularly important for the maintenance of fluid balance within the
possibility of what nursing diagnosis? vascular system. Deficiencies nearly always manifest as fluid imbalances. Tissue
A. Risk for imbalanced fluid volume related to low albumin oxygenation and skin integrity are not normally affected. Low albumin does not
B. Risk for infection related to low albumin constitute a risk for infection.
C. Ineffective tissue perfusion related to low albumin
D. Impaired skin integrity related to low albumin
A client has sustained a cut to the hand, immediately Ans: B
initiating the process of hemostasis. Following Following vasoconstriction, circulating platelets aggregate at the site and adhere to
vasoconstriction, which event in the process of hemostasis the vessel and to one another, forming an unstable hemostatic plug. events
will take place? involved in the clotting cascade take place subsequent to this initial platelet action.
A. Fibrin will be activated at the bleeding site
B. Platelets will aggregate at the injury site
C. Thromboplastin will form a clot
D. Prothrombin will be converted to thrombin
The nurse is providing care for a 73-year-old client who Ans: B
has a hematologic disorder. Which change in hematologic Due to a variety of factors, when an older person needs more blood cells, the bone
function is age-related? marrow may not be able to increase production of these cells adequately. Stem cell
A. Bone-marrow in older adults produces a smaller activity continues throughout the lifespan, although at a somewhat decreased rate.
proportion of healthy, functional blood cells The proportion of functional cells does not greatly decrease, and the relative volume
B. Older adults are less able to increase blood cell of plasma does not change significantly.
production when demand suddenly increases
C. Stem cells in older adults eventually lose their ability to
differentiate
D. The ratio of plasma to erythrocytes and lymphocytes
increase with age
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