NUR 242 MED SURG EXAM 4 GALEN COLLEGE OF NURSING |
LATEST ACTUAL EXAM COMPLETE 200 QUESTIONS WITH
CORRECT ANSWERS AND RATIONALES
ALREADY GRADED A+
SECTION A: HEMATOLOGIC DISORDERS (Questions 1–50)
1. A client with anemia has a hemoglobin of 8.0 g/dL. Which assessment finding is
most consistent with this condition?
A. Pallor, fatigue, and tachycardia ✔
B. Hypertension and bounding pulses
C. Flushed skin and fever
D. Weight gain and edema
Rationale: Anemia causes decreased oxygen-carrying capacity, leading to pallor,
fatigue, weakness, tachycardia, and dyspnea on exertion. The body compensates
with increased cardiac output.
2. A client is diagnosed with iron deficiency anemia. Which dietary instruction
should the nurse include?
A. Increase intake of red meat, leafy greens, and vitamin C-rich foods ✔
B. Avoid all iron-rich foods
C. Increase dairy products
D. Decrease fluid intake
Rationale: Iron deficiency anemia is treated with iron-rich foods (red meat, leafy
greens, fortified cereals) and vitamin C (enhances absorption). Dairy products
inhibit iron absorption.
3. A client with pernicious anemia is prescribed vitamin B12 injections. The nurse
understands that this condition is caused by:
A. Lack of intrinsic factor leading to B12 malabsorption ✔
B. Iron deficiency
C. Folate deficiency
D. Hemolysis
1
,Rationale: Pernicious anemia is caused by a lack of intrinsic factor (produced by
the stomach), which is necessary for vitamin B12 absorption. It is treated with
lifelong B12 injections.
4. A client with sickle cell anemia is experiencing a vaso-occlusive crisis. Which
intervention is most important?
A. Hydration and pain management ✔
B. Blood transfusion
C. Antibiotics
D. Anticoagulation
Rationale: Vaso-occlusive crisis is caused by sickled cells blocking blood flow,
leading to pain and ischemia. Hydration and pain management are the priorities.
Blood transfusions may be used but are not the primary intervention.
5. A client with polycythemia vera has an elevated hematocrit. The nurse should
monitor for which complication?
A. Thrombosis and stroke ✔
B. Hemorrhage
C. Anemia
D. Infection
Rationale: Polycythemia vera causes increased blood viscosity, leading to a high
risk of thrombosis (stroke, MI, DVT). Phlebotomy is used to reduce hematocrit.
6. A client with thrombocytopenia (low platelets) has a platelet count of
20,000/mm³. Which nursing intervention is most important?
A. Bleeding precautions (soft toothbrush, avoid IM injections) ✔
B. Administer iron supplements
C. Encourage vigorous exercise
D. Apply heat packs
Rationale: Thrombocytopenia increases the risk of bleeding. Platelet count <
50,000/mm³ requires bleeding precautions. < 20,000/mm³ increases the risk of
spontaneous bleeding.
2
,7. A client with hemophilia A is admitted with joint pain and swelling. The nurse
should prepare to administer:
A. Factor VIII replacement ✔
B. Factor IX replacement
C. Vitamin K
D. Platelet transfusion
Rationale: Hemophilia A is a deficiency of Factor VIII. Treatment includes Factor
VIII replacement. Factor IX is for Hemophilia B.
8. A client with aplastic anemia has pancytopenia (low RBCs, WBCs, and platelets).
Which complication is the client at highest risk for?
A. Infection and bleeding ✔
B. Hypertension
C. Hyperglycemia
D. Fluid overload
Rationale: Pancytopenia causes anemia (fatigue), leukopenia (infection risk), and
thrombocytopenia (bleeding risk). Infection and bleeding are the major concerns.
9. A client with leukemia is receiving chemotherapy. The nurse should monitor for
which complication of tumor lysis syndrome?
A. Hyperkalemia, hyperuricemia, and acute kidney injury ✔
B. Hypokalemia and hypocalcemia
C. Hypernatremia and hypokalemia
D. Hypercalcemia and hypophosphatemia
Rationale: Tumor lysis syndrome occurs with rapid cell destruction
(chemotherapy), releasing potassium, uric acid, and phosphorus. This can cause
hyperkalemia, hyperuricemia, acute kidney injury, and hypocalcemia.
10. A client with lymphoma is scheduled for a bone marrow biopsy. The nurse
should provide which post-procedure instruction?
A. "Apply pressure to the site for several minutes and monitor for bleeding." ✔
3
, B. "You can get up and walk immediately."
C. "You will need to fast for 24 hours."
D. "You will need to avoid all fluids."
Rationale: After a bone marrow biopsy, pressure should be applied to prevent
bleeding, and the client should lie flat for a short time. Vital signs and the
puncture site should be monitored.
11. A client with immune thrombocytopenic purpura (ITP) is prescribed
corticosteroids. The nurse understands that the purpose of this medication is to:
A. Increase platelet production
B. Decrease platelet destruction by the immune system ✔
C. Increase white blood cell count
D. Decrease inflammation only
Rationale: ITP is an autoimmune disorder in which antibodies destroy platelets.
Corticosteroids suppress the immune response and reduce platelet destruction.
12. A client with acute leukemia is at risk for infection due to neutropenia. Which
precaution should the nurse implement?
A. Protective isolation (neutropenic precautions) ✔
B. Contact precautions
C. Droplet precautions
D. Airborne precautions
Rationale: Neutropenia (low WBCs) increases infection risk. Protective isolation
includes private room, strict hand hygiene, avoiding fresh flowers/fruits, and
screening visitors for infections.
13. A client with sickle cell anemia is admitted with a fever and chest pain. The
nurse should suspect:
A. Acute chest syndrome ✔
B. A vaso-occlusive crisis
C. Infection only
D. Pulmonary embolism
4
LATEST ACTUAL EXAM COMPLETE 200 QUESTIONS WITH
CORRECT ANSWERS AND RATIONALES
ALREADY GRADED A+
SECTION A: HEMATOLOGIC DISORDERS (Questions 1–50)
1. A client with anemia has a hemoglobin of 8.0 g/dL. Which assessment finding is
most consistent with this condition?
A. Pallor, fatigue, and tachycardia ✔
B. Hypertension and bounding pulses
C. Flushed skin and fever
D. Weight gain and edema
Rationale: Anemia causes decreased oxygen-carrying capacity, leading to pallor,
fatigue, weakness, tachycardia, and dyspnea on exertion. The body compensates
with increased cardiac output.
2. A client is diagnosed with iron deficiency anemia. Which dietary instruction
should the nurse include?
A. Increase intake of red meat, leafy greens, and vitamin C-rich foods ✔
B. Avoid all iron-rich foods
C. Increase dairy products
D. Decrease fluid intake
Rationale: Iron deficiency anemia is treated with iron-rich foods (red meat, leafy
greens, fortified cereals) and vitamin C (enhances absorption). Dairy products
inhibit iron absorption.
3. A client with pernicious anemia is prescribed vitamin B12 injections. The nurse
understands that this condition is caused by:
A. Lack of intrinsic factor leading to B12 malabsorption ✔
B. Iron deficiency
C. Folate deficiency
D. Hemolysis
1
,Rationale: Pernicious anemia is caused by a lack of intrinsic factor (produced by
the stomach), which is necessary for vitamin B12 absorption. It is treated with
lifelong B12 injections.
4. A client with sickle cell anemia is experiencing a vaso-occlusive crisis. Which
intervention is most important?
A. Hydration and pain management ✔
B. Blood transfusion
C. Antibiotics
D. Anticoagulation
Rationale: Vaso-occlusive crisis is caused by sickled cells blocking blood flow,
leading to pain and ischemia. Hydration and pain management are the priorities.
Blood transfusions may be used but are not the primary intervention.
5. A client with polycythemia vera has an elevated hematocrit. The nurse should
monitor for which complication?
A. Thrombosis and stroke ✔
B. Hemorrhage
C. Anemia
D. Infection
Rationale: Polycythemia vera causes increased blood viscosity, leading to a high
risk of thrombosis (stroke, MI, DVT). Phlebotomy is used to reduce hematocrit.
6. A client with thrombocytopenia (low platelets) has a platelet count of
20,000/mm³. Which nursing intervention is most important?
A. Bleeding precautions (soft toothbrush, avoid IM injections) ✔
B. Administer iron supplements
C. Encourage vigorous exercise
D. Apply heat packs
Rationale: Thrombocytopenia increases the risk of bleeding. Platelet count <
50,000/mm³ requires bleeding precautions. < 20,000/mm³ increases the risk of
spontaneous bleeding.
2
,7. A client with hemophilia A is admitted with joint pain and swelling. The nurse
should prepare to administer:
A. Factor VIII replacement ✔
B. Factor IX replacement
C. Vitamin K
D. Platelet transfusion
Rationale: Hemophilia A is a deficiency of Factor VIII. Treatment includes Factor
VIII replacement. Factor IX is for Hemophilia B.
8. A client with aplastic anemia has pancytopenia (low RBCs, WBCs, and platelets).
Which complication is the client at highest risk for?
A. Infection and bleeding ✔
B. Hypertension
C. Hyperglycemia
D. Fluid overload
Rationale: Pancytopenia causes anemia (fatigue), leukopenia (infection risk), and
thrombocytopenia (bleeding risk). Infection and bleeding are the major concerns.
9. A client with leukemia is receiving chemotherapy. The nurse should monitor for
which complication of tumor lysis syndrome?
A. Hyperkalemia, hyperuricemia, and acute kidney injury ✔
B. Hypokalemia and hypocalcemia
C. Hypernatremia and hypokalemia
D. Hypercalcemia and hypophosphatemia
Rationale: Tumor lysis syndrome occurs with rapid cell destruction
(chemotherapy), releasing potassium, uric acid, and phosphorus. This can cause
hyperkalemia, hyperuricemia, acute kidney injury, and hypocalcemia.
10. A client with lymphoma is scheduled for a bone marrow biopsy. The nurse
should provide which post-procedure instruction?
A. "Apply pressure to the site for several minutes and monitor for bleeding." ✔
3
, B. "You can get up and walk immediately."
C. "You will need to fast for 24 hours."
D. "You will need to avoid all fluids."
Rationale: After a bone marrow biopsy, pressure should be applied to prevent
bleeding, and the client should lie flat for a short time. Vital signs and the
puncture site should be monitored.
11. A client with immune thrombocytopenic purpura (ITP) is prescribed
corticosteroids. The nurse understands that the purpose of this medication is to:
A. Increase platelet production
B. Decrease platelet destruction by the immune system ✔
C. Increase white blood cell count
D. Decrease inflammation only
Rationale: ITP is an autoimmune disorder in which antibodies destroy platelets.
Corticosteroids suppress the immune response and reduce platelet destruction.
12. A client with acute leukemia is at risk for infection due to neutropenia. Which
precaution should the nurse implement?
A. Protective isolation (neutropenic precautions) ✔
B. Contact precautions
C. Droplet precautions
D. Airborne precautions
Rationale: Neutropenia (low WBCs) increases infection risk. Protective isolation
includes private room, strict hand hygiene, avoiding fresh flowers/fruits, and
screening visitors for infections.
13. A client with sickle cell anemia is admitted with a fever and chest pain. The
nurse should suspect:
A. Acute chest syndrome ✔
B. A vaso-occlusive crisis
C. Infection only
D. Pulmonary embolism
4
