MEDSURG 2 EXAM 1: HEMATOLOGY,
MED-SURG 2 EXAM 4: GI ACCESSORY,
MEDSURG 2 EXAM 3: NEURO. EXAM
QUESTIONS AND ANSWERS. VERIFIED
2025/2026.
Anatomy & Physiology of Blood Forming Organs - ANS Blood consists of plasma, solutes,
RBCs, WBCs, and platelets. The hematopoietic (blood-forming) system includes the bone
marrow tissues, where blood cells form, and the lymphoid tissues of the lymph nodes, where
white blood cells mature and circulate. All blood cells originate from cells in the bone marrow
called stem cells, or hemocytoblasts.
What is the nurse's role in blood transfusions? - ANS Obtain patient consent.
Assess for any previous reactions to blood.
Explain the procedure to the patient & answer any questions.
Prepare the IV equipment. Shut off one side of the Y tubing & attach the other side to the saline
solution. Flush the tubing & filter with the saline.
If venous access is not already in place, insert the IV needle (following body substance
precautions, & begin administering the saline.
Using institutional procedure, obtain the blood from the blood bank or lab. Administer the
blood immediately; if this is not possible, return it to the blood bank or lab.
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Check & document that the doner & recipient blood have been tested & are compatible. This
usually involves 2 nurses, each verifying the following:
- An order for blood had been written.
- A type & crossmatch has been done.
- The name of the patient & the name on the blood bag are identical.
- The number assigned to the unit of blood is identical to the one on the requisition for the
blood.
- The blood type & Rh factor are compatible.
- The blood has not exceeded its expiration date.
- The unit of blood is intact & has no bubbles or discoloration.
Identify the patient by reading the armband & asking the patient to tell you their name. Check
the armband against the unit of blood.
Gently invert the blood bag several time to mi the plasma & RBCs.
Take & record vitals as a baseline.
Attach the open side of the Y tubing to the blood unit & begin the transfusion at a slow rate of
about 2ml/minute. (Some trauma patients may have blood infused at a rapid rate. If blood is
infused rapidly, it may need to be warmed prior to administration to prevent hypothermia.) Stay
with the patient for at least the first 15 minutes of the transfusion, monitoring for
manifestations of a reaction & taking the patients vitals.
Continue to monitor the patient during the t
What are signs of a transfusion reaction? - ANS Chills, fever, cough, difficulty breathing, hives,
itching, or changes in circulation.
Discuss blood types. Who can get/give blood to/from who? - ANS See attached table.
What is the nurse's role in management of a transfusion reaction? - ANS - Stop the infusion
of blood immediately & notify the physician. Continue to infuse the saline.
- Take vitals & assess manifestations.
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,- Compare the blood slip with the unit of blood to ensure than an identification error was not
made.
- Save the blood bag & any remaining blood for return to the lab for further tests to determine
the cause of the reaction.
- Follow institutional policy for collecting urine & venous blood samples.
- Continue to monitor the patient & provide prescribed interventions to treat hypersensitivity or
hemolytic manifestations.
RBC Disorders - Anemia: Etiology/Pathophysiology - ANS - Anemia is an abnormally low
number of circulating RBCs, low hemoglobin concentration, or both. A decrease in the number
of circulating RBCs is the usual cause of anemia.
RBC Disorders - Anemia: Risk Factors - ANS - Acute or chronic blood loss, inadequate RBC
production, or increased RBC destruction. Insufficient or defective hemoglobin within RBCs
contributes to anemia.
RBC Disorders - Anemia: Manifestations - ANS - The resulting manifestations depend on the
severity of the anemia, how quickly it develops, & other factors such as age & health status.
RBC Disorders - Anemia: Diagnostic Results - ANS - Complete blood count (CBC) is done to
determine blood cell counts, hemoglobin, hematocrit, & RBC indices. The severity of the
anemia, shape, volume, & iron content of the RBCs can help determine the cause of anemia.
- Iron level & total iron-binding capacity tests are performed to detect iron-deficiency anemia. A
low serum iron concentration & elevated total iron-binding capacity are indicative of iron-
deficiency anemia.
- Serum ferritin is low due to depletion of the total iron reserves available for hemoglobin
synthesis. Ferritin is an iron-storage protein produced by the liver, spleen, & bone marrow.
Ferritin mobilizes stored iron when metabolic needs are higher than dietary intake.
- Sickle cell test is a screening test to evaluate hemolytic anemia & detect HbS.
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, - Hemoglobin electrophoresis separates normal hemoglobin from abnormal forms. It is used to
evaluate hemolytic anemia, diagnose thalassemia, & differentiate sickle cell trait from sickle cell
disease.
- Schilling test measures vitamin B12 absorption before & after intrinsic factor administration to
differentiate between pernicious anemia & intestinal malabsorption of the vitamin. A 24-hour
urine sample is collected following administration of radioactive vitamin B12. Lower-than-
normal levels of the tagged B12 when intrinsic factor is given concurrently indicate
malabsorption rather than pernicious anemia.
- Bone marrow exam is done to diagnose aplastic anemia. In aplastic anemia, normal marrow
elements are significantly decreased as they are replaced by fat cells.
- Quantitative assay of G6PD may be performed to confirm a diagnosis of G6PD deficiency.
RBC Disorders - Anemia: Medical/Surgical Management - ANS - Ensuring adequate tissue
oxygenation is the priority of care in treating anemia.
- Specific therapy is determined by the underlying cause of the disorder. Usual treatments
include medications, dietary modifications, blood replacement, or supportive interventions.
RBC Disorders - Anemia: Medications - ANS - Medications used to treat anemia depend on its
cause.
- Iron replacement therapy is ordered for iron-deficiency anemia.
- Parenteral vitamin B12 is given when malabsorption or lack of intrinsic factor leads to vitamin
B12-deficiency anemia.
- Folic acid is ordered for women of childbearing age, pregnant women, & patients with folic
acid deficiency or sickle cell disease to meet the increased demands of the bone marrow.
- Hydroxyurea, a drug that promotes fetal hemoglobin production, may be prescribed for
patients with sickle cell disease, particularly those with frequent crises or severe disease.
- Erythropoietin may be ordered for patients with low erythropoietin levels (i.e. patients with
chronic renal failure) & people with anemia associated with other chronic diseases.
- Immunosuppressive therapy with antithymocyte globulin (ATG), corticosteroids, &
cyclosporine may be used to treat aplastic anemia. Androgens may stimulate blood cell
production in some patients with aplastic anemia.
4 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
MED-SURG 2 EXAM 4: GI ACCESSORY,
MEDSURG 2 EXAM 3: NEURO. EXAM
QUESTIONS AND ANSWERS. VERIFIED
2025/2026.
Anatomy & Physiology of Blood Forming Organs - ANS Blood consists of plasma, solutes,
RBCs, WBCs, and platelets. The hematopoietic (blood-forming) system includes the bone
marrow tissues, where blood cells form, and the lymphoid tissues of the lymph nodes, where
white blood cells mature and circulate. All blood cells originate from cells in the bone marrow
called stem cells, or hemocytoblasts.
What is the nurse's role in blood transfusions? - ANS Obtain patient consent.
Assess for any previous reactions to blood.
Explain the procedure to the patient & answer any questions.
Prepare the IV equipment. Shut off one side of the Y tubing & attach the other side to the saline
solution. Flush the tubing & filter with the saline.
If venous access is not already in place, insert the IV needle (following body substance
precautions, & begin administering the saline.
Using institutional procedure, obtain the blood from the blood bank or lab. Administer the
blood immediately; if this is not possible, return it to the blood bank or lab.
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Check & document that the doner & recipient blood have been tested & are compatible. This
usually involves 2 nurses, each verifying the following:
- An order for blood had been written.
- A type & crossmatch has been done.
- The name of the patient & the name on the blood bag are identical.
- The number assigned to the unit of blood is identical to the one on the requisition for the
blood.
- The blood type & Rh factor are compatible.
- The blood has not exceeded its expiration date.
- The unit of blood is intact & has no bubbles or discoloration.
Identify the patient by reading the armband & asking the patient to tell you their name. Check
the armband against the unit of blood.
Gently invert the blood bag several time to mi the plasma & RBCs.
Take & record vitals as a baseline.
Attach the open side of the Y tubing to the blood unit & begin the transfusion at a slow rate of
about 2ml/minute. (Some trauma patients may have blood infused at a rapid rate. If blood is
infused rapidly, it may need to be warmed prior to administration to prevent hypothermia.) Stay
with the patient for at least the first 15 minutes of the transfusion, monitoring for
manifestations of a reaction & taking the patients vitals.
Continue to monitor the patient during the t
What are signs of a transfusion reaction? - ANS Chills, fever, cough, difficulty breathing, hives,
itching, or changes in circulation.
Discuss blood types. Who can get/give blood to/from who? - ANS See attached table.
What is the nurse's role in management of a transfusion reaction? - ANS - Stop the infusion
of blood immediately & notify the physician. Continue to infuse the saline.
- Take vitals & assess manifestations.
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,- Compare the blood slip with the unit of blood to ensure than an identification error was not
made.
- Save the blood bag & any remaining blood for return to the lab for further tests to determine
the cause of the reaction.
- Follow institutional policy for collecting urine & venous blood samples.
- Continue to monitor the patient & provide prescribed interventions to treat hypersensitivity or
hemolytic manifestations.
RBC Disorders - Anemia: Etiology/Pathophysiology - ANS - Anemia is an abnormally low
number of circulating RBCs, low hemoglobin concentration, or both. A decrease in the number
of circulating RBCs is the usual cause of anemia.
RBC Disorders - Anemia: Risk Factors - ANS - Acute or chronic blood loss, inadequate RBC
production, or increased RBC destruction. Insufficient or defective hemoglobin within RBCs
contributes to anemia.
RBC Disorders - Anemia: Manifestations - ANS - The resulting manifestations depend on the
severity of the anemia, how quickly it develops, & other factors such as age & health status.
RBC Disorders - Anemia: Diagnostic Results - ANS - Complete blood count (CBC) is done to
determine blood cell counts, hemoglobin, hematocrit, & RBC indices. The severity of the
anemia, shape, volume, & iron content of the RBCs can help determine the cause of anemia.
- Iron level & total iron-binding capacity tests are performed to detect iron-deficiency anemia. A
low serum iron concentration & elevated total iron-binding capacity are indicative of iron-
deficiency anemia.
- Serum ferritin is low due to depletion of the total iron reserves available for hemoglobin
synthesis. Ferritin is an iron-storage protein produced by the liver, spleen, & bone marrow.
Ferritin mobilizes stored iron when metabolic needs are higher than dietary intake.
- Sickle cell test is a screening test to evaluate hemolytic anemia & detect HbS.
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, - Hemoglobin electrophoresis separates normal hemoglobin from abnormal forms. It is used to
evaluate hemolytic anemia, diagnose thalassemia, & differentiate sickle cell trait from sickle cell
disease.
- Schilling test measures vitamin B12 absorption before & after intrinsic factor administration to
differentiate between pernicious anemia & intestinal malabsorption of the vitamin. A 24-hour
urine sample is collected following administration of radioactive vitamin B12. Lower-than-
normal levels of the tagged B12 when intrinsic factor is given concurrently indicate
malabsorption rather than pernicious anemia.
- Bone marrow exam is done to diagnose aplastic anemia. In aplastic anemia, normal marrow
elements are significantly decreased as they are replaced by fat cells.
- Quantitative assay of G6PD may be performed to confirm a diagnosis of G6PD deficiency.
RBC Disorders - Anemia: Medical/Surgical Management - ANS - Ensuring adequate tissue
oxygenation is the priority of care in treating anemia.
- Specific therapy is determined by the underlying cause of the disorder. Usual treatments
include medications, dietary modifications, blood replacement, or supportive interventions.
RBC Disorders - Anemia: Medications - ANS - Medications used to treat anemia depend on its
cause.
- Iron replacement therapy is ordered for iron-deficiency anemia.
- Parenteral vitamin B12 is given when malabsorption or lack of intrinsic factor leads to vitamin
B12-deficiency anemia.
- Folic acid is ordered for women of childbearing age, pregnant women, & patients with folic
acid deficiency or sickle cell disease to meet the increased demands of the bone marrow.
- Hydroxyurea, a drug that promotes fetal hemoglobin production, may be prescribed for
patients with sickle cell disease, particularly those with frequent crises or severe disease.
- Erythropoietin may be ordered for patients with low erythropoietin levels (i.e. patients with
chronic renal failure) & people with anemia associated with other chronic diseases.
- Immunosuppressive therapy with antithymocyte globulin (ATG), corticosteroids, &
cyclosporine may be used to treat aplastic anemia. Androgens may stimulate blood cell
production in some patients with aplastic anemia.
4 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
