NUR 265 MEDICAL-SURGICAL NURSING I EXAM 3 2026/2027
| Galen College Complete Solutions | 100% Correct Answers
with Detailed Rationales | GRADED A | Pass Guaranteed
UNIT 1: HEMATOLOGICAL DISORDERS (Questions 1-20)
Q1: A 68-year-old male is admitted with severe fatigue, pallor, and dyspnea on exertion.
Laboratory studies reveal: Hemoglobin 6.8 g/dL, Hematocrit 21%, MCV 72 fL, MCH 24
pg, Ferritin 15 ng/mL, Transferrin saturation 8%. Which nursing intervention is the
priority?
A. Initiate transfusion of 2 units packed red blood cells immediately
B. Administer iron supplements orally with vitamin C [CORRECT]
C. Prepare for emergency bone marrow biopsy
D. Insert large-bore IV for aggressive fluid resuscitation
Correct Answer: B
Rationale: This patient has microcytic, hypochromic anemia consistent with iron
deficiency anemia (IDA). The MCV <80 fL, low MCH, low ferritin, and low transferrin
saturation confirm iron deficiency. The priority nursing intervention is iron
supplementation, which should be administered with vitamin C to enhance absorption.
Oral iron is preferred unless the patient has malabsorption or cannot tolerate oral
preparations.
,Option A is incorrect because transfusion is not indicated for chronic iron deficiency
anemia unless the patient is hemodynamically unstable or has symptomatic coronary
artery disease. This patient has compensated anemia with dyspnea on exertion but no
acute coronary syndrome. Option C is unnecessary because the diagnosis is clear from
iron studies; bone marrow biopsy is reserved for unexplained anemia or when iron
studies are inconclusive. Option D is inappropriate because fluid resuscitation could
dilute hemoglobin further and does not address the underlying iron deficiency.
Q2: [Select All That Apply] A 34-year-old female with sickle cell disease presents with
acute vaso-occlusive crisis (pain crisis). Which nursing interventions are appropriate?
A. Administer morphine 2-4 mg IV every 2-4 hours as needed for pain [CORRECT]
B. Apply warm compresses to painful joints and extremities [CORRECT]
C. Maintain aggressive hydration with D5W at 150 mL/hr [INCORRECT—use normal
saline]
D. Administer oxygen at 2 L/min via nasal cannula to keep SpO₂ >92% [CORRECT]
E. Encourage early ambulation to prevent complications
F. Avoid blood transfusions unless Hb <5 g/dL or acute chest syndrome [CORRECT]
Correct Answers: A, B, D, F
Rationale:
● A: Opioid analgesics (morphine, hydromorphone) are first-line for sickle cell pain
crisis; pain is often severe and requires aggressive management;
patient-controlled analgesia (PCA) preferred.
● B: Warm compresses promote vasodilation and may reduce pain; cold
compresses contraindicated (cause vasoconstriction and worsen sickling).
, ● C: INCORRECT—D5W (dextrose in water) is hypotonic and can cause hemolysis;
normal saline or half-normal saline preferred for hydration; target urine output
1.5-2 mL/kg/hr to prevent dehydration-induced sickling.
● D: Oxygen therapy indicated if hypoxemic; maintain SpO₂ >92% to prevent further
sickling; not routine for all patients.
● E: INCORRECT—early ambulation not encouraged during acute crisis; bed rest
with joint positioning for comfort; mobilization gradual as pain resolves.
● F: Simple transfusions not routine for pain crisis; indicated for acute chest
syndrome, stroke, priapism, or severe anemia (Hb <5 g/dL); exchange transfusion
for severe complications.
Q3: A 58-year-old male with liver cirrhosis presents with prolonged bleeding after dental
extraction. Laboratory studies: PT 18 seconds (control 12), aPTT 42 seconds (control
32), Platelets 85,000/μL, Fibrinogen 120 mg/dL. Which blood product is most
appropriate?
A. Fresh frozen plasma (FFP) 15 mL/kg [CORRECT]
B. Platelet transfusion 6 units
C. Cryoprecipitate 10 units
D. Packed red blood cells 2 units
Correct Answer: A
Rationale: This patient has coagulopathy secondary to liver disease with prolonged PT
(reflecting decreased synthesis of vitamin K-dependent factors II, VII, IX, X) and mildly
prolonged aPTT. The priority is replacement of clotting factors with FFP, which contains
all coagulation factors except platelets. The dose of 15 mL/kg (approximately 4 units in
average adult) is standard for coagulopathy correction.
, Option B (platelets) is not indicated because the platelet count of 85,000/μL, while low,
is generally adequate for hemostasis; platelet transfusion typically reserved for
<10,000/μL or active bleeding with counts <50,000/μL. Option C (cryoprecipitate)
contains fibrinogen, factor VIII, and von Willebrand factor; indicated for
hypofibrinogenemia (<100 mg/dL) or von Willebrand disease; this patient's fibrinogen is
low-normal but not critically low. Option D (PRBCs) does not address the coagulopathy;
indicated for symptomatic anemia, not bleeding diathesis.
Q4: [Ordered Response] Place the following steps in correct priority order for managing
a patient with suspected transfusion-related acute lung injury (TRALI):
1. Stop the transfusion immediately and maintain IV access with normal saline
2. Notify the blood bank and return the blood product with tubing
3. Administer supplemental oxygen and support ventilation as needed
4. Obtain chest X-ray and arterial blood gas
5. Administer diuretics aggressively [CORRECT SEQUENCE: 1, 3, 4, 2, 5]
Correct Sequence: 1 → 3 → 4 → 2 → 5
Rationale:
1. Stop transfusion immediately: TRALI is a medical emergency; any transfusion
reaction requires immediate cessation; maintain IV line with normal saline to
keep access.
2. Oxygen and ventilatory support: TRALI presents as acute respiratory distress
within 6 hours of transfusion; hypoxemia requires immediate oxygen; intubation
and mechanical ventilation may be needed for severe cases.
3. Diagnostic workup: Chest X-ray shows bilateral pulmonary infiltrates
(non-cardiogenic pulmonary edema pattern); ABG confirms hypoxemia
| Galen College Complete Solutions | 100% Correct Answers
with Detailed Rationales | GRADED A | Pass Guaranteed
UNIT 1: HEMATOLOGICAL DISORDERS (Questions 1-20)
Q1: A 68-year-old male is admitted with severe fatigue, pallor, and dyspnea on exertion.
Laboratory studies reveal: Hemoglobin 6.8 g/dL, Hematocrit 21%, MCV 72 fL, MCH 24
pg, Ferritin 15 ng/mL, Transferrin saturation 8%. Which nursing intervention is the
priority?
A. Initiate transfusion of 2 units packed red blood cells immediately
B. Administer iron supplements orally with vitamin C [CORRECT]
C. Prepare for emergency bone marrow biopsy
D. Insert large-bore IV for aggressive fluid resuscitation
Correct Answer: B
Rationale: This patient has microcytic, hypochromic anemia consistent with iron
deficiency anemia (IDA). The MCV <80 fL, low MCH, low ferritin, and low transferrin
saturation confirm iron deficiency. The priority nursing intervention is iron
supplementation, which should be administered with vitamin C to enhance absorption.
Oral iron is preferred unless the patient has malabsorption or cannot tolerate oral
preparations.
,Option A is incorrect because transfusion is not indicated for chronic iron deficiency
anemia unless the patient is hemodynamically unstable or has symptomatic coronary
artery disease. This patient has compensated anemia with dyspnea on exertion but no
acute coronary syndrome. Option C is unnecessary because the diagnosis is clear from
iron studies; bone marrow biopsy is reserved for unexplained anemia or when iron
studies are inconclusive. Option D is inappropriate because fluid resuscitation could
dilute hemoglobin further and does not address the underlying iron deficiency.
Q2: [Select All That Apply] A 34-year-old female with sickle cell disease presents with
acute vaso-occlusive crisis (pain crisis). Which nursing interventions are appropriate?
A. Administer morphine 2-4 mg IV every 2-4 hours as needed for pain [CORRECT]
B. Apply warm compresses to painful joints and extremities [CORRECT]
C. Maintain aggressive hydration with D5W at 150 mL/hr [INCORRECT—use normal
saline]
D. Administer oxygen at 2 L/min via nasal cannula to keep SpO₂ >92% [CORRECT]
E. Encourage early ambulation to prevent complications
F. Avoid blood transfusions unless Hb <5 g/dL or acute chest syndrome [CORRECT]
Correct Answers: A, B, D, F
Rationale:
● A: Opioid analgesics (morphine, hydromorphone) are first-line for sickle cell pain
crisis; pain is often severe and requires aggressive management;
patient-controlled analgesia (PCA) preferred.
● B: Warm compresses promote vasodilation and may reduce pain; cold
compresses contraindicated (cause vasoconstriction and worsen sickling).
, ● C: INCORRECT—D5W (dextrose in water) is hypotonic and can cause hemolysis;
normal saline or half-normal saline preferred for hydration; target urine output
1.5-2 mL/kg/hr to prevent dehydration-induced sickling.
● D: Oxygen therapy indicated if hypoxemic; maintain SpO₂ >92% to prevent further
sickling; not routine for all patients.
● E: INCORRECT—early ambulation not encouraged during acute crisis; bed rest
with joint positioning for comfort; mobilization gradual as pain resolves.
● F: Simple transfusions not routine for pain crisis; indicated for acute chest
syndrome, stroke, priapism, or severe anemia (Hb <5 g/dL); exchange transfusion
for severe complications.
Q3: A 58-year-old male with liver cirrhosis presents with prolonged bleeding after dental
extraction. Laboratory studies: PT 18 seconds (control 12), aPTT 42 seconds (control
32), Platelets 85,000/μL, Fibrinogen 120 mg/dL. Which blood product is most
appropriate?
A. Fresh frozen plasma (FFP) 15 mL/kg [CORRECT]
B. Platelet transfusion 6 units
C. Cryoprecipitate 10 units
D. Packed red blood cells 2 units
Correct Answer: A
Rationale: This patient has coagulopathy secondary to liver disease with prolonged PT
(reflecting decreased synthesis of vitamin K-dependent factors II, VII, IX, X) and mildly
prolonged aPTT. The priority is replacement of clotting factors with FFP, which contains
all coagulation factors except platelets. The dose of 15 mL/kg (approximately 4 units in
average adult) is standard for coagulopathy correction.
, Option B (platelets) is not indicated because the platelet count of 85,000/μL, while low,
is generally adequate for hemostasis; platelet transfusion typically reserved for
<10,000/μL or active bleeding with counts <50,000/μL. Option C (cryoprecipitate)
contains fibrinogen, factor VIII, and von Willebrand factor; indicated for
hypofibrinogenemia (<100 mg/dL) or von Willebrand disease; this patient's fibrinogen is
low-normal but not critically low. Option D (PRBCs) does not address the coagulopathy;
indicated for symptomatic anemia, not bleeding diathesis.
Q4: [Ordered Response] Place the following steps in correct priority order for managing
a patient with suspected transfusion-related acute lung injury (TRALI):
1. Stop the transfusion immediately and maintain IV access with normal saline
2. Notify the blood bank and return the blood product with tubing
3. Administer supplemental oxygen and support ventilation as needed
4. Obtain chest X-ray and arterial blood gas
5. Administer diuretics aggressively [CORRECT SEQUENCE: 1, 3, 4, 2, 5]
Correct Sequence: 1 → 3 → 4 → 2 → 5
Rationale:
1. Stop transfusion immediately: TRALI is a medical emergency; any transfusion
reaction requires immediate cessation; maintain IV line with normal saline to
keep access.
2. Oxygen and ventilatory support: TRALI presents as acute respiratory distress
within 6 hours of transfusion; hypoxemia requires immediate oxygen; intubation
and mechanical ventilation may be needed for severe cases.
3. Diagnostic workup: Chest X-ray shows bilateral pulmonary infiltrates
(non-cardiogenic pulmonary edema pattern); ABG confirms hypoxemia
