Rn 202 med surg UPDATED ACTUAL
Exam Questions and CORRECT Answers
What are the normal values of WBC - CORRECT ANSWER - 5000-10,000/μL (5-10 ×
109/L)
What are the normal values of Hemoglobin (Hgb) - CORRECT ANSWER - Female: 12-
16 g/dL (120-160 g/L) Male: 14-18 g/dL (140-180 g/L)
What are the normal values of Hematocrit (Hct) - CORRECT ANSWER - Female: 37%-
47% (0.37-0.47)
Male: 42%-52% (0.42-0.52)
What are the normal values of platelet count - CORRECT ANSWER - 150,000-400,000 ×
103/L (150-400 × 109/L)
What are the nursing responsibilities for a bone marrow aspiration - CORRECT
ANSWER - For bone marrow aspiration, the skin over the puncture site is cleansed with a
bactericidal agent. The skin, subcutaneous tissue, and periosteum are injected with a local
anesthetic agent. Once the area is anesthetized, a bone marrow needle is inserted through the
cortex of the bone. The stylet of the needle is then removed, the hub is attached to a 10-mL
syringe, and 0.2 to 0.5 mL of the fluid marrow is aspirated
Monitor the patient's vital signs until stable and assess the site for excess drainage or bleeding. If
bleeding is present, have the patient lie on that side for 30 to 60 minutes to keep pressure on the
site. If the bed is too soft, have the patient lie on a rolled towel to provide more pressure. You
may give analgesics for postprocedure pain.
What are the nursing responsibilities for bone marrow biospy - CORRECT ANSWER -
Before: Explain procedure to patient. Obtain signed consent form. Perform a surgical time-out
before procedure. Analgesics may be given to enhance patient comfort and cooperation.
,After: Apply pressure dressing. Assess biopsy site for bleeding and apply pressure as needed.
Tenderness at the puncture site for a few days may be normal. Assess for infection.
What are the normal value for activated partial thromboplastin time (aPTT) and which
medications can cause it to increase - CORRECT ANSWER - Assesses intrinsic
coagulation by measuring factors I, II, V, VIII, IX, X, XI, XII. Higher in patients receiving
heparin
Reference interval
30-40 sec
What does a "shift to the left" indicate on a CBC differential and what clinical findings would
you expect to find? - CORRECT ANSWER - An increased need for neutrophils, as with
an acute bacterial infection, will cause an increase in both the total number of mature neutrophils
and the less mature bands or stabs to respond to the infection. The term "shift to the left" is often
used when determining if a patient has an inflammatory process such as acute appendicitis or
cholecystitis
Today, the term "shift to the left" means that the bands or stabs have increased, indicating an
infection in progress.
For example, a patient with acute appendicitis might have a "WBC count of 15,000 with 65% of
the cells being mature neutrophils and an increase in stabs or band cells to 10%". This report is
typical of a "shift to the left", and will be taken into consideration along with history and
physical findings, to determine how the patient's appendicitis will be treated.
What are clinical manifestations of pernicious anemia (select all that apply) - CORRECT
ANSWER - GI manifestations include a sore, red, beefy, and shiny tongue; anorexia,
nausea, and vomiting; and abdominal pain.
Typical neuromuscular manifestations include weakness, paresthesias of the feet and hands,
reduced vibratory and position senses, ataxia, muscle weakness, and impaired thought processes
ranging from confusion to dementia. Because cobalamin deficiency-related anemia has an
insidious onset, it may take several months for manifestations to develop
, In polycythemia, what laboratory values do you expect to see? - CORRECT ANSWER -
(1) high hemoglobin and RBC count with microcytosis;
(2) low to normal EPO level (secondary polycythemia has a high level);
(3) high WBC count with basophilia and neutrophilia;
(4) high platelet count (thrombocytosis) and platelet dysfunction;
(5) high leukocyte alkaline phosphatase, uric acid, and cobalamin levels; and
(6) high histamine levels.3 Bone marrow examination in polycythemia vera shows
hypercellularity of RBCs, WBCs, and platelets.
What are the causes of secondary polycythemia and what history would you assess the patient
for? - CORRECT ANSWER - Secondary polycythemia can be either hypoxia driven or
hypoxia independent. In hypoxia-driven secondary polycythemia, hypoxia stimulates
erythropoietin (EPO) production in the kidneys, which in turn stimulates RBC production.
The need for O2 may result from high altitude, lung disease, cardiovascular disease, alveolar
hypoventilation, defective O2 transport, or tissue hypoxia. EPO levels may return to normal once
the hemoglobin stabilizes at a higher level. In this situation, secondary polycythemia is a
physiologic response in which the body tries to compensate for a problem, rather than a
pathologic response.
In hypoxia-independent secondary polycythemia, cancer or benign tumor tissue makes EPO.
Serum EPO levels often stay increased in these situations.
What are the clinical manifestations of anemia and what lab values you would expect to be order
to assess the severity of the anemia - CORRECT ANSWER - The manifestations of
anemia are caused by the body's response to tissue hypoxia. Specific manifestations vary
depending on how fast the anemia has evolved, its severity, and any coexisting disease.
We often use hemoglobin (Hgb) levels to determine the severity of anemia
Mild anemia (Hgb 10 to 12 g/dL [100 to 120 g/L]) may exist without causing symptoms. If
symptoms develop, it is because the patient has an underlying disease or has a compensatory
response to heavy exercise. Symptoms include palpitations, dyspnea, and mild fatigue.
Exam Questions and CORRECT Answers
What are the normal values of WBC - CORRECT ANSWER - 5000-10,000/μL (5-10 ×
109/L)
What are the normal values of Hemoglobin (Hgb) - CORRECT ANSWER - Female: 12-
16 g/dL (120-160 g/L) Male: 14-18 g/dL (140-180 g/L)
What are the normal values of Hematocrit (Hct) - CORRECT ANSWER - Female: 37%-
47% (0.37-0.47)
Male: 42%-52% (0.42-0.52)
What are the normal values of platelet count - CORRECT ANSWER - 150,000-400,000 ×
103/L (150-400 × 109/L)
What are the nursing responsibilities for a bone marrow aspiration - CORRECT
ANSWER - For bone marrow aspiration, the skin over the puncture site is cleansed with a
bactericidal agent. The skin, subcutaneous tissue, and periosteum are injected with a local
anesthetic agent. Once the area is anesthetized, a bone marrow needle is inserted through the
cortex of the bone. The stylet of the needle is then removed, the hub is attached to a 10-mL
syringe, and 0.2 to 0.5 mL of the fluid marrow is aspirated
Monitor the patient's vital signs until stable and assess the site for excess drainage or bleeding. If
bleeding is present, have the patient lie on that side for 30 to 60 minutes to keep pressure on the
site. If the bed is too soft, have the patient lie on a rolled towel to provide more pressure. You
may give analgesics for postprocedure pain.
What are the nursing responsibilities for bone marrow biospy - CORRECT ANSWER -
Before: Explain procedure to patient. Obtain signed consent form. Perform a surgical time-out
before procedure. Analgesics may be given to enhance patient comfort and cooperation.
,After: Apply pressure dressing. Assess biopsy site for bleeding and apply pressure as needed.
Tenderness at the puncture site for a few days may be normal. Assess for infection.
What are the normal value for activated partial thromboplastin time (aPTT) and which
medications can cause it to increase - CORRECT ANSWER - Assesses intrinsic
coagulation by measuring factors I, II, V, VIII, IX, X, XI, XII. Higher in patients receiving
heparin
Reference interval
30-40 sec
What does a "shift to the left" indicate on a CBC differential and what clinical findings would
you expect to find? - CORRECT ANSWER - An increased need for neutrophils, as with
an acute bacterial infection, will cause an increase in both the total number of mature neutrophils
and the less mature bands or stabs to respond to the infection. The term "shift to the left" is often
used when determining if a patient has an inflammatory process such as acute appendicitis or
cholecystitis
Today, the term "shift to the left" means that the bands or stabs have increased, indicating an
infection in progress.
For example, a patient with acute appendicitis might have a "WBC count of 15,000 with 65% of
the cells being mature neutrophils and an increase in stabs or band cells to 10%". This report is
typical of a "shift to the left", and will be taken into consideration along with history and
physical findings, to determine how the patient's appendicitis will be treated.
What are clinical manifestations of pernicious anemia (select all that apply) - CORRECT
ANSWER - GI manifestations include a sore, red, beefy, and shiny tongue; anorexia,
nausea, and vomiting; and abdominal pain.
Typical neuromuscular manifestations include weakness, paresthesias of the feet and hands,
reduced vibratory and position senses, ataxia, muscle weakness, and impaired thought processes
ranging from confusion to dementia. Because cobalamin deficiency-related anemia has an
insidious onset, it may take several months for manifestations to develop
, In polycythemia, what laboratory values do you expect to see? - CORRECT ANSWER -
(1) high hemoglobin and RBC count with microcytosis;
(2) low to normal EPO level (secondary polycythemia has a high level);
(3) high WBC count with basophilia and neutrophilia;
(4) high platelet count (thrombocytosis) and platelet dysfunction;
(5) high leukocyte alkaline phosphatase, uric acid, and cobalamin levels; and
(6) high histamine levels.3 Bone marrow examination in polycythemia vera shows
hypercellularity of RBCs, WBCs, and platelets.
What are the causes of secondary polycythemia and what history would you assess the patient
for? - CORRECT ANSWER - Secondary polycythemia can be either hypoxia driven or
hypoxia independent. In hypoxia-driven secondary polycythemia, hypoxia stimulates
erythropoietin (EPO) production in the kidneys, which in turn stimulates RBC production.
The need for O2 may result from high altitude, lung disease, cardiovascular disease, alveolar
hypoventilation, defective O2 transport, or tissue hypoxia. EPO levels may return to normal once
the hemoglobin stabilizes at a higher level. In this situation, secondary polycythemia is a
physiologic response in which the body tries to compensate for a problem, rather than a
pathologic response.
In hypoxia-independent secondary polycythemia, cancer or benign tumor tissue makes EPO.
Serum EPO levels often stay increased in these situations.
What are the clinical manifestations of anemia and what lab values you would expect to be order
to assess the severity of the anemia - CORRECT ANSWER - The manifestations of
anemia are caused by the body's response to tissue hypoxia. Specific manifestations vary
depending on how fast the anemia has evolved, its severity, and any coexisting disease.
We often use hemoglobin (Hgb) levels to determine the severity of anemia
Mild anemia (Hgb 10 to 12 g/dL [100 to 120 g/L]) may exist without causing symptoms. If
symptoms develop, it is because the patient has an underlying disease or has a compensatory
response to heavy exercise. Symptoms include palpitations, dyspnea, and mild fatigue.
