,NSG 2610 Exam 3 Adult Health Nursing II Questions And Answers
2026/2027 South College
Q1. A 58-year-old client reports increasing fatigue, shortness of
breath on exertion, and persistent headaches. Laboratory testing
reveals hemoglobin 8.1 g/dL, mean corpuscular volume 68 fL,
ferritin 7 ng/mL, and elevated total iron-binding capacity. Which
interpretation is most appropriate?
A) Anemia associated with inadequate vitamin B12 absorption
B) Hemolytic anemia caused by increased red blood cell destruction
C) Anemia caused exclusively by chronic inflammation
D) Iron-deficiency anemia associated with depleted iron stores
Correct Answer: D) Iron-deficiency anemia associated with depleted iron
stores
Rationale: Iron-deficiency anemia typically produces microcytic red blood
cells, low ferritin, reduced hemoglobin, and increased total iron-binding
capacity. Iron depletion limits hemoglobin synthesis and reduces oxygen-
carrying capacity. In adults, identifying the cause of iron loss, particularly
gastrointestinal bleeding when clinically relevant, is essential.
Q2. A 64-year-old client has progressive fatigue, pallor, and
numbness in both feet. Laboratory results reveal hemoglobin 9.2
g/dL, mean corpuscular volume 118 fL, low vitamin B12, and
elevated methylmalonic acid. Which additional complication should
the nurse monitor for?
A) Neurological dysfunction involving proprioception and gait
B) Excessive iron accumulation as the primary consequence
C) Severe neutrophilia caused by increased DNA synthesis
D) Acute arterial embolism resulting directly from vitamin B12 depletion
Correct Answer: A) Neurological dysfunction involving proprioception and gait
Rationale: Vitamin B12 deficiency impairs DNA synthesis and nervous system
myelin maintenance. Clients may develop peripheral neuropathy, impaired
vibration sensation, reduced proprioception, and gait instability. Prolonged
neurological injury may become irreversible, making timely identification and
replacement important.
,Q3. A 47-year-old client develops sudden fatigue, jaundice, dark
urine, and back discomfort. Laboratory testing demonstrates
elevated indirect bilirubin, increased lactate dehydrogenase, low
haptoglobin, and a positive direct antiglobulin test. Which disorder
is most likely?
A) Iron-deficiency anemia
B) Autoimmune hemolytic anemia
C) Anemia caused by acute blood loss alone
D) Vitamin B12 deficiency
Correct Answer: B) Autoimmune hemolytic anemia
Rationale: Autoimmune hemolytic anemia occurs when antibodies target red
blood cells, accelerating their destruction. Increased bilirubin and lactate
dehydrogenase, reduced haptoglobin, and a positive direct antiglobulin test
support immune-mediated hemolysis. Management depends on the antibody
type, severity, and underlying cause.
Q4. A 70-year-old client with chronic lymphocytic leukemia develops
rapidly worsening anemia. Hemoglobin decreases from 11.0 to 6.8
g/dL, and the reticulocyte count is elevated. The direct antiglobulin
test is positive. Which complication should be suspected?
A) Uncomplicated iron deficiency
B) Acute appendicitis
C) Secondary autoimmune hemolytic anemia
D) Complete bone marrow recovery
Correct Answer: C) Secondary autoimmune hemolytic anemia
Rationale: Chronic lymphocytic leukemia can cause autoimmune
complications, including antibody-mediated red blood cell destruction. A
falling hemoglobin level with reticulocytosis and positive antiglobulin testing
supports immune hemolysis. Severe cases may require immunosuppressive
therapy and supportive transfusion.
Q5. A 52-year-old client presents with petechiae, neurological
changes, acute kidney injury, and severe thrombocytopenia.
Peripheral blood smear reveals schistocytes, and coagulation
studies are near normal. Which intervention is most appropriate?
, A) Emergency therapeutic plasma exchange for suspected thrombotic
thrombocytopenic purpura
B) Routine oral iron supplementation
C) Prophylactic platelet transfusion in every case without assessing clinical
circumstances
D) Observation until spontaneous recovery occurs
Correct Answer: A) Emergency therapeutic plasma exchange for suspected
thrombotic thrombocytopenic purpura
Rationale: Thrombotic thrombocytopenic purpura is associated with severe
deficiency of ADAMTS13 activity, causing widespread platelet-rich
microthrombi. Microangiopathic hemolytic anemia, thrombocytopenia, and
organ dysfunction are characteristic. Plasma exchange and disease-specific
immunotherapy should be initiated rapidly when the diagnosis is strongly
suspected.
Q6. A 61-year-old client with septic shock develops bleeding from
intravenous insertion sites, widespread ecchymoses, and worsening
organ dysfunction. Laboratory results reveal platelets 42,000/mm³,
prolonged prothrombin time, low fibrinogen, and markedly elevated
D-dimer. Which disorder is most likely?
A) Isolated immune thrombocytopenia
B) Disseminated intravascular coagulation
C) Uncomplicated von Willebrand disease
D) Primary iron-deficiency anemia
Correct Answer: B) Disseminated intravascular coagulation
Rationale: Disseminated intravascular coagulation involves systemic
activation of coagulation, causing widespread fibrin formation and
consumption of platelets and clotting factors. Clients may experience both
microvascular thrombosis and serious bleeding. Treatment focuses on
correcting the underlying cause and providing appropriate supportive blood
products when indicated.
Q7. A 56-year-old client with disseminated intravascular coagulation
develops active gastrointestinal bleeding. Platelets are 18,000/mm³,
2026/2027 South College
Q1. A 58-year-old client reports increasing fatigue, shortness of
breath on exertion, and persistent headaches. Laboratory testing
reveals hemoglobin 8.1 g/dL, mean corpuscular volume 68 fL,
ferritin 7 ng/mL, and elevated total iron-binding capacity. Which
interpretation is most appropriate?
A) Anemia associated with inadequate vitamin B12 absorption
B) Hemolytic anemia caused by increased red blood cell destruction
C) Anemia caused exclusively by chronic inflammation
D) Iron-deficiency anemia associated with depleted iron stores
Correct Answer: D) Iron-deficiency anemia associated with depleted iron
stores
Rationale: Iron-deficiency anemia typically produces microcytic red blood
cells, low ferritin, reduced hemoglobin, and increased total iron-binding
capacity. Iron depletion limits hemoglobin synthesis and reduces oxygen-
carrying capacity. In adults, identifying the cause of iron loss, particularly
gastrointestinal bleeding when clinically relevant, is essential.
Q2. A 64-year-old client has progressive fatigue, pallor, and
numbness in both feet. Laboratory results reveal hemoglobin 9.2
g/dL, mean corpuscular volume 118 fL, low vitamin B12, and
elevated methylmalonic acid. Which additional complication should
the nurse monitor for?
A) Neurological dysfunction involving proprioception and gait
B) Excessive iron accumulation as the primary consequence
C) Severe neutrophilia caused by increased DNA synthesis
D) Acute arterial embolism resulting directly from vitamin B12 depletion
Correct Answer: A) Neurological dysfunction involving proprioception and gait
Rationale: Vitamin B12 deficiency impairs DNA synthesis and nervous system
myelin maintenance. Clients may develop peripheral neuropathy, impaired
vibration sensation, reduced proprioception, and gait instability. Prolonged
neurological injury may become irreversible, making timely identification and
replacement important.
,Q3. A 47-year-old client develops sudden fatigue, jaundice, dark
urine, and back discomfort. Laboratory testing demonstrates
elevated indirect bilirubin, increased lactate dehydrogenase, low
haptoglobin, and a positive direct antiglobulin test. Which disorder
is most likely?
A) Iron-deficiency anemia
B) Autoimmune hemolytic anemia
C) Anemia caused by acute blood loss alone
D) Vitamin B12 deficiency
Correct Answer: B) Autoimmune hemolytic anemia
Rationale: Autoimmune hemolytic anemia occurs when antibodies target red
blood cells, accelerating their destruction. Increased bilirubin and lactate
dehydrogenase, reduced haptoglobin, and a positive direct antiglobulin test
support immune-mediated hemolysis. Management depends on the antibody
type, severity, and underlying cause.
Q4. A 70-year-old client with chronic lymphocytic leukemia develops
rapidly worsening anemia. Hemoglobin decreases from 11.0 to 6.8
g/dL, and the reticulocyte count is elevated. The direct antiglobulin
test is positive. Which complication should be suspected?
A) Uncomplicated iron deficiency
B) Acute appendicitis
C) Secondary autoimmune hemolytic anemia
D) Complete bone marrow recovery
Correct Answer: C) Secondary autoimmune hemolytic anemia
Rationale: Chronic lymphocytic leukemia can cause autoimmune
complications, including antibody-mediated red blood cell destruction. A
falling hemoglobin level with reticulocytosis and positive antiglobulin testing
supports immune hemolysis. Severe cases may require immunosuppressive
therapy and supportive transfusion.
Q5. A 52-year-old client presents with petechiae, neurological
changes, acute kidney injury, and severe thrombocytopenia.
Peripheral blood smear reveals schistocytes, and coagulation
studies are near normal. Which intervention is most appropriate?
, A) Emergency therapeutic plasma exchange for suspected thrombotic
thrombocytopenic purpura
B) Routine oral iron supplementation
C) Prophylactic platelet transfusion in every case without assessing clinical
circumstances
D) Observation until spontaneous recovery occurs
Correct Answer: A) Emergency therapeutic plasma exchange for suspected
thrombotic thrombocytopenic purpura
Rationale: Thrombotic thrombocytopenic purpura is associated with severe
deficiency of ADAMTS13 activity, causing widespread platelet-rich
microthrombi. Microangiopathic hemolytic anemia, thrombocytopenia, and
organ dysfunction are characteristic. Plasma exchange and disease-specific
immunotherapy should be initiated rapidly when the diagnosis is strongly
suspected.
Q6. A 61-year-old client with septic shock develops bleeding from
intravenous insertion sites, widespread ecchymoses, and worsening
organ dysfunction. Laboratory results reveal platelets 42,000/mm³,
prolonged prothrombin time, low fibrinogen, and markedly elevated
D-dimer. Which disorder is most likely?
A) Isolated immune thrombocytopenia
B) Disseminated intravascular coagulation
C) Uncomplicated von Willebrand disease
D) Primary iron-deficiency anemia
Correct Answer: B) Disseminated intravascular coagulation
Rationale: Disseminated intravascular coagulation involves systemic
activation of coagulation, causing widespread fibrin formation and
consumption of platelets and clotting factors. Clients may experience both
microvascular thrombosis and serious bleeding. Treatment focuses on
correcting the underlying cause and providing appropriate supportive blood
products when indicated.
Q7. A 56-year-old client with disseminated intravascular coagulation
develops active gastrointestinal bleeding. Platelets are 18,000/mm³,
