,NSG 2600 Exam 3 Adult Health Nursing I Questions And Answers
2026/2027 South College
Q1. A 48-year-old client reports increasing fatigue, shortness of
breath during exercise, and difficulty concentrating. Laboratory
results reveal hemoglobin 8.2 g/dL, mean corpuscular volume 69 fL,
ferritin 7 ng/mL, and elevated total iron-binding capacity. Which
condition best explains the findings?
A) Vitamin B12 deficiency anemia
B) Iron-deficiency anemia
C) Hemolytic anemia
D) Aplastic anemia
Correct Answer: B) Iron-deficiency anemia
Rationale: Iron-deficiency anemia commonly produces microcytic,
hypochromic red blood cells because insufficient iron limits hemoglobin
synthesis. Low ferritin reflects depleted iron stores, while total iron-binding
capacity is often elevated. Symptoms result from reduced oxygen-carrying
capacity. The underlying cause of iron deficiency must also be identified.
Q2. A 67-year-old client is diagnosed with iron-deficiency anemia.
The client reports no obvious bleeding, but stool testing reveals
occult blood. Which investigation should the nurse anticipate?
A) Evaluation of the gastrointestinal tract for a possible source of chronic
blood loss
B) Routine observation without identifying the cause
C) Immediate thyroidectomy
D) Pulmonary function testing as the only investigation
Correct Answer: A) Evaluation of the gastrointestinal tract for a possible
source of chronic blood loss
Rationale: Iron-deficiency anemia in older adults may result from chronic
gastrointestinal blood loss, including bleeding ulcers, vascular lesions, or
malignancy. Identifying and treating the source is essential. Depending on
clinical findings, evaluation may include upper and lower gastrointestinal
endoscopy.
,Q3. A client is prescribed oral ferrous sulfate for iron-deficiency
anemia. Which instruction is most appropriate?
A) Take the medication with calcium supplements to maximize absorption.
B) Stop treatment immediately when fatigue improves.
C) Take the medication only once every several weeks.
D) Take iron according to the prescribed schedule and separate it from
substances that reduce absorption, such as calcium-containing products.
Correct Answer: D) Take iron according to the prescribed schedule and
separate it from substances that reduce absorption, such as calcium-
containing products.
Rationale: Oral iron replaces depleted iron stores and supports hemoglobin
synthesis. Calcium-containing products and certain antacids can reduce
absorption. Gastrointestinal discomfort and dark stools are common adverse
effects. Treatment may need to continue after hemoglobin normalization to
replenish iron stores.
Q4. A 59-year-old client presents with fatigue, numbness in the feet,
difficulty maintaining balance, and a smooth, painful tongue.
Laboratory findings reveal hemoglobin 9.1 g/dL and mean
corpuscular volume 115 fL. Which deficiency should the nurse
suspect?
A) Iron deficiency
B) Vitamin C deficiency
C) Vitamin B12 deficiency
D) Vitamin K deficiency
Correct Answer: C) Vitamin B12 deficiency
Rationale: Vitamin B12 deficiency causes impaired DNA synthesis and
megaloblastic anemia, often producing macrocytosis. Neurological
manifestations may include peripheral neuropathy, impaired vibration
sensation, and gait abnormalities. Early recognition is important because
prolonged neurological injury may become irreversible.
Q5. A 64-year-old client has pernicious anemia caused by
autoimmune destruction of gastric parietal cells. Which mechanism
explains the resulting vitamin B12 deficiency?
, A) Reduced intrinsic factor production impairing intestinal vitamin B12
absorption
B) Increased renal elimination of vitamin B12
C) Excessive pancreatic insulin secretion
D) Increased intestinal iron absorption
Correct Answer: A) Reduced intrinsic factor production impairing intestinal
vitamin B12 absorption
Rationale: Intrinsic factor is produced by gastric parietal cells and is required
for efficient vitamin B12 absorption in the terminal ileum. Autoimmune
gastritis can reduce intrinsic factor availability. Long-term vitamin B12
replacement is commonly necessary.
Q6. A 42-year-old client has macrocytic anemia caused by folate
deficiency. The client also reports numbness and impaired balance.
Which nursing consideration is most important?
A) Assume folate deficiency explains all neurological symptoms.
B) Evaluate for concurrent vitamin B12 deficiency before relying on folate
treatment alone.
C) Administer iron as the only treatment.
D) Restrict dietary protein indefinitely.
Correct Answer: B) Evaluate for concurrent vitamin B12 deficiency before
relying on folate treatment alone.
Rationale: Folate deficiency causes megaloblastic anemia but does not
typically produce the neurological abnormalities characteristic of vitamin B12
deficiency. Folate supplementation may improve anemia while an untreated
B12 deficiency continues to cause neurological injury. Differentiation is
therefore clinically important.
Q7. A 35-year-old client develops fatigue, recurrent infections, and
frequent bruising. Laboratory testing reveals hemoglobin 7.6 g/dL,
leukocytes 1,900/mm³, and platelets 28,000/mm³. Bone marrow
biopsy shows markedly reduced hematopoietic cellularity. Which
condition is most likely?
A) Iron-deficiency anemia
2026/2027 South College
Q1. A 48-year-old client reports increasing fatigue, shortness of
breath during exercise, and difficulty concentrating. Laboratory
results reveal hemoglobin 8.2 g/dL, mean corpuscular volume 69 fL,
ferritin 7 ng/mL, and elevated total iron-binding capacity. Which
condition best explains the findings?
A) Vitamin B12 deficiency anemia
B) Iron-deficiency anemia
C) Hemolytic anemia
D) Aplastic anemia
Correct Answer: B) Iron-deficiency anemia
Rationale: Iron-deficiency anemia commonly produces microcytic,
hypochromic red blood cells because insufficient iron limits hemoglobin
synthesis. Low ferritin reflects depleted iron stores, while total iron-binding
capacity is often elevated. Symptoms result from reduced oxygen-carrying
capacity. The underlying cause of iron deficiency must also be identified.
Q2. A 67-year-old client is diagnosed with iron-deficiency anemia.
The client reports no obvious bleeding, but stool testing reveals
occult blood. Which investigation should the nurse anticipate?
A) Evaluation of the gastrointestinal tract for a possible source of chronic
blood loss
B) Routine observation without identifying the cause
C) Immediate thyroidectomy
D) Pulmonary function testing as the only investigation
Correct Answer: A) Evaluation of the gastrointestinal tract for a possible
source of chronic blood loss
Rationale: Iron-deficiency anemia in older adults may result from chronic
gastrointestinal blood loss, including bleeding ulcers, vascular lesions, or
malignancy. Identifying and treating the source is essential. Depending on
clinical findings, evaluation may include upper and lower gastrointestinal
endoscopy.
,Q3. A client is prescribed oral ferrous sulfate for iron-deficiency
anemia. Which instruction is most appropriate?
A) Take the medication with calcium supplements to maximize absorption.
B) Stop treatment immediately when fatigue improves.
C) Take the medication only once every several weeks.
D) Take iron according to the prescribed schedule and separate it from
substances that reduce absorption, such as calcium-containing products.
Correct Answer: D) Take iron according to the prescribed schedule and
separate it from substances that reduce absorption, such as calcium-
containing products.
Rationale: Oral iron replaces depleted iron stores and supports hemoglobin
synthesis. Calcium-containing products and certain antacids can reduce
absorption. Gastrointestinal discomfort and dark stools are common adverse
effects. Treatment may need to continue after hemoglobin normalization to
replenish iron stores.
Q4. A 59-year-old client presents with fatigue, numbness in the feet,
difficulty maintaining balance, and a smooth, painful tongue.
Laboratory findings reveal hemoglobin 9.1 g/dL and mean
corpuscular volume 115 fL. Which deficiency should the nurse
suspect?
A) Iron deficiency
B) Vitamin C deficiency
C) Vitamin B12 deficiency
D) Vitamin K deficiency
Correct Answer: C) Vitamin B12 deficiency
Rationale: Vitamin B12 deficiency causes impaired DNA synthesis and
megaloblastic anemia, often producing macrocytosis. Neurological
manifestations may include peripheral neuropathy, impaired vibration
sensation, and gait abnormalities. Early recognition is important because
prolonged neurological injury may become irreversible.
Q5. A 64-year-old client has pernicious anemia caused by
autoimmune destruction of gastric parietal cells. Which mechanism
explains the resulting vitamin B12 deficiency?
, A) Reduced intrinsic factor production impairing intestinal vitamin B12
absorption
B) Increased renal elimination of vitamin B12
C) Excessive pancreatic insulin secretion
D) Increased intestinal iron absorption
Correct Answer: A) Reduced intrinsic factor production impairing intestinal
vitamin B12 absorption
Rationale: Intrinsic factor is produced by gastric parietal cells and is required
for efficient vitamin B12 absorption in the terminal ileum. Autoimmune
gastritis can reduce intrinsic factor availability. Long-term vitamin B12
replacement is commonly necessary.
Q6. A 42-year-old client has macrocytic anemia caused by folate
deficiency. The client also reports numbness and impaired balance.
Which nursing consideration is most important?
A) Assume folate deficiency explains all neurological symptoms.
B) Evaluate for concurrent vitamin B12 deficiency before relying on folate
treatment alone.
C) Administer iron as the only treatment.
D) Restrict dietary protein indefinitely.
Correct Answer: B) Evaluate for concurrent vitamin B12 deficiency before
relying on folate treatment alone.
Rationale: Folate deficiency causes megaloblastic anemia but does not
typically produce the neurological abnormalities characteristic of vitamin B12
deficiency. Folate supplementation may improve anemia while an untreated
B12 deficiency continues to cause neurological injury. Differentiation is
therefore clinically important.
Q7. A 35-year-old client develops fatigue, recurrent infections, and
frequent bruising. Laboratory testing reveals hemoglobin 7.6 g/dL,
leukocytes 1,900/mm³, and platelets 28,000/mm³. Bone marrow
biopsy shows markedly reduced hematopoietic cellularity. Which
condition is most likely?
A) Iron-deficiency anemia
