Galen College NU 189 Exam 2 (pdf) | 2026/2027 | Med-Surg II Q&A |
Medical-Surgical Nursing
1. The nurse is teaching a client with iron-deficiency anemia about dietary
choices. Which meal selection is most appropriate to improve iron intake?
A) Grilled cheese sandwich and tomato soup
B) Roast beef and spinach
C) Chicken nuggets and French fries
D) Macaroni and cheese
Correct Answer: Roast beef and spinach
Rationale: Roast beef provides heme iron, which is highly absorbable, while
spinach provides non-heme iron. Together they help correct iron deficiency
better than foods low in iron. The other options contain minimal iron and
would not be effective for improving iron status.
2. Which laboratory value is most indicative of iron-deficiency anemia?
A) Elevated serum ferritin
B) Low serum ferritin
C) Elevated vitamin B12
D) Normal total iron-binding capacity
Correct Answer: Low serum ferritin
Rationale: Ferritin reflects stored iron; low levels confirm iron deficiency.
Elevated ferritin is seen in inflammation or iron overload, and B12 is normal
in iron deficiency anemia.
,3. The nurse is assessing a client with suspected iron-deficiency anemia.
Which clinical manifestation would the nurse expect to find?
A) Spoon-shaped nails (koilonychia)
B) Jaundiced sclera
C) Petechiae on the extremities
D) Smooth, red tongue
Correct Answer: Spoon-shaped nails (koilonychia)
Rationale: Koilonychia (spoon-shaped nails) is a classic clinical manifestation
of iron-deficiency anemia. Jaundice is associated with hemolytic anemia,
petechiae with thrombocytopenia, and a smooth, red tongue with vitamin
B12 deficiency.
4. A client with pernicious anemia is unable to absorb vitamin B12 due to a
lack of intrinsic factor. Which treatment is most appropriate?
A) Oral vitamin B12 supplements
B) Intramuscular or subcutaneous vitamin B12 injections
C) Dietary changes only
D) Iron supplementation
Correct Answer: Intramuscular or subcutaneous vitamin B12 injections
Rationale: Pernicious anemia is caused by a lack of intrinsic factor, which is
necessary for vitamin B12 absorption in the gastrointestinal tract. Treatment
requires lifelong vitamin B12 injections bypassing the GI tract.
5. A client with sickle cell disease is experiencing a vaso-occlusive crisis.
Which nursing intervention is most important?
,A) Administering iron supplements
B) Providing oxygen and pain management
C) Restricting fluids to prevent fluid overload
D) Placing the client in a supine position
Correct Answer: Providing oxygen and pain management
Rationale: Vaso-occlusive crisis in sickle cell disease is caused by sickled red
blood cells blocking blood vessels, leading to ischemia and severe pain.
Treatment focuses on pain management, hydration, and oxygen therapy.
6. The nurse is caring for a client with thrombocytopenia. Which finding is
most concerning?
A) Bruising and petechiae
B) Headache and confusion
C) Fever and chills
D) Nausea and vomiting
Correct Answer: Bruising and petechiae
Rationale: Thrombocytopenia is a low platelet count, which increases the risk
of bleeding. The nurse should monitor for signs of bleeding, including
bruising, petechiae (pinpoint red spots), purpura, and bleeding from mucous
membranes.
7. Which of the following is a classic sign of disseminated intravascular
coagulation (DIC)?
A) Erythema marginatum
B) Petechiae and oozing from venipuncture sites
, C) Vesicular rash in a dermatomal pattern
D) Non-blanchable erythema over bony prominences
Correct Answer: Petechiae and oozing from venipuncture sites
Rationale: DIC consumes platelets and clotting factors, causing widespread
microvascular thrombosis and paradoxical bleeding. Petechiae, purpura, and
oozing from puncture sites are hallmark signs of DIC.
8. A client with neutropenia is at increased risk for infection. Which nursing
intervention is most important?
A) Placing the client in reverse isolation and monitoring for fever
B) Administering prophylactic antibiotics
C) Restricting visitors completely
D) Encouraging the client to ambulate frequently
Correct Answer: Placing the client in reverse isolation and monitoring for
fever
Rationale: Neutropenia (low neutrophil count) increases the risk of infection.
Reverse isolation (protective precautions) and monitoring for signs of
infection such as fever are essential. Fever in a neutropenic patient is a
medical emergency.
9. The nurse is teaching a client about the administration of epoetin alfa
(Epogen) for anemia. Which statement by the client indicates understanding?
A) "This medication will work immediately to increase my red blood cells."
B) "I should expect my hemoglobin to rise within 2 to 6 weeks of starting
therapy."
C) "I can stop taking this medication once I feel better."
Medical-Surgical Nursing
1. The nurse is teaching a client with iron-deficiency anemia about dietary
choices. Which meal selection is most appropriate to improve iron intake?
A) Grilled cheese sandwich and tomato soup
B) Roast beef and spinach
C) Chicken nuggets and French fries
D) Macaroni and cheese
Correct Answer: Roast beef and spinach
Rationale: Roast beef provides heme iron, which is highly absorbable, while
spinach provides non-heme iron. Together they help correct iron deficiency
better than foods low in iron. The other options contain minimal iron and
would not be effective for improving iron status.
2. Which laboratory value is most indicative of iron-deficiency anemia?
A) Elevated serum ferritin
B) Low serum ferritin
C) Elevated vitamin B12
D) Normal total iron-binding capacity
Correct Answer: Low serum ferritin
Rationale: Ferritin reflects stored iron; low levels confirm iron deficiency.
Elevated ferritin is seen in inflammation or iron overload, and B12 is normal
in iron deficiency anemia.
,3. The nurse is assessing a client with suspected iron-deficiency anemia.
Which clinical manifestation would the nurse expect to find?
A) Spoon-shaped nails (koilonychia)
B) Jaundiced sclera
C) Petechiae on the extremities
D) Smooth, red tongue
Correct Answer: Spoon-shaped nails (koilonychia)
Rationale: Koilonychia (spoon-shaped nails) is a classic clinical manifestation
of iron-deficiency anemia. Jaundice is associated with hemolytic anemia,
petechiae with thrombocytopenia, and a smooth, red tongue with vitamin
B12 deficiency.
4. A client with pernicious anemia is unable to absorb vitamin B12 due to a
lack of intrinsic factor. Which treatment is most appropriate?
A) Oral vitamin B12 supplements
B) Intramuscular or subcutaneous vitamin B12 injections
C) Dietary changes only
D) Iron supplementation
Correct Answer: Intramuscular or subcutaneous vitamin B12 injections
Rationale: Pernicious anemia is caused by a lack of intrinsic factor, which is
necessary for vitamin B12 absorption in the gastrointestinal tract. Treatment
requires lifelong vitamin B12 injections bypassing the GI tract.
5. A client with sickle cell disease is experiencing a vaso-occlusive crisis.
Which nursing intervention is most important?
,A) Administering iron supplements
B) Providing oxygen and pain management
C) Restricting fluids to prevent fluid overload
D) Placing the client in a supine position
Correct Answer: Providing oxygen and pain management
Rationale: Vaso-occlusive crisis in sickle cell disease is caused by sickled red
blood cells blocking blood vessels, leading to ischemia and severe pain.
Treatment focuses on pain management, hydration, and oxygen therapy.
6. The nurse is caring for a client with thrombocytopenia. Which finding is
most concerning?
A) Bruising and petechiae
B) Headache and confusion
C) Fever and chills
D) Nausea and vomiting
Correct Answer: Bruising and petechiae
Rationale: Thrombocytopenia is a low platelet count, which increases the risk
of bleeding. The nurse should monitor for signs of bleeding, including
bruising, petechiae (pinpoint red spots), purpura, and bleeding from mucous
membranes.
7. Which of the following is a classic sign of disseminated intravascular
coagulation (DIC)?
A) Erythema marginatum
B) Petechiae and oozing from venipuncture sites
, C) Vesicular rash in a dermatomal pattern
D) Non-blanchable erythema over bony prominences
Correct Answer: Petechiae and oozing from venipuncture sites
Rationale: DIC consumes platelets and clotting factors, causing widespread
microvascular thrombosis and paradoxical bleeding. Petechiae, purpura, and
oozing from puncture sites are hallmark signs of DIC.
8. A client with neutropenia is at increased risk for infection. Which nursing
intervention is most important?
A) Placing the client in reverse isolation and monitoring for fever
B) Administering prophylactic antibiotics
C) Restricting visitors completely
D) Encouraging the client to ambulate frequently
Correct Answer: Placing the client in reverse isolation and monitoring for
fever
Rationale: Neutropenia (low neutrophil count) increases the risk of infection.
Reverse isolation (protective precautions) and monitoring for signs of
infection such as fever are essential. Fever in a neutropenic patient is a
medical emergency.
9. The nurse is teaching a client about the administration of epoetin alfa
(Epogen) for anemia. Which statement by the client indicates understanding?
A) "This medication will work immediately to increase my red blood cells."
B) "I should expect my hemoglobin to rise within 2 to 6 weeks of starting
therapy."
C) "I can stop taking this medication once I feel better."
