MED SURG. EXAM 3 __ PRACTICE QUESTIONS AND
RIGHT ACTUAL ANSWERS.
In a severely anemic patient, the nurse would expect to find
a. dyspnea and tachycardia.
b. cyanosis and pulmonary edema.
c. cardiomegaly and pulmonary fibrosis.
d. ventricular dysrhythmias and wheezing. ANS - a
Rationale: Patients with severe anemia (Hgb level less than 6 g/dL) exhibit the following cardiovascular
and pulmonary manifestations: tachycardia, increased pulse pressure, systolic murmurs, intermittent
claudication, angina, heart failure, myocardial infarction, tachypnea, orthopnea, and dyspnea at rest.
When obtaining assessment data from a patient with a microcytic, hypochromic anemia, the nurse
would question the patient about
a. folic acid intake.
b. dietary intake of iron.
c. a history of gastric surgery.
d. a history of sickle cell anemia. ANS - b
Rationale: Iron-deficiency anemia is a microcytic, hypochromic anemia.
Nursing interventions for a patient with severe anemia related to peptic ulcer disease include (select all
that apply)
a. instructions for high-iron diet.
,b. taking vital signs every 8 hours.
c. monitoring stools for occult blood.
d. teaching self-injection of erythropoietin.
e. administration of cobalamin (vitamin B12) injections. ANS - a, c
Rationale: Stool occult blood test is performed to determine the cause of iron-deficiency anemia that is
related to gastrointestinal bleeding. Iron is increased in the diet. Teach the patient which foods are good
sources of iron. If nutrition is already adequate, increasing iron intake by dietary means may not be
practical. The patient with iron deficiency related to acute blood loss may require a transfusion of
packed red blood cells (RBCs).
The nursing management of a patient in sickle cell crisis includes (select all that apply)
a. monitoring CBC.
b. optimal pain management and O2 therapy.
c. blood transfusions if required and iron chelation.
d. rest as needed and deep vein thrombosis prophylaxis.
e. administration of IV iron and diet high in iron content. ANS - a, b, c, d
Rationale: Complete blood count (CBC) is monitored. Infections are common with elevated WBC counts,
and anemia may occur with low hemoglobin levels and low RBC counts. O2 may be administered to
treat hypoxia and control sickling. Rest may be instituted to reduce metabolic requirements, and
prophylaxis for deep vein thrombosis (with anticoagulants) is prescribed. Transfusion therapy is
indicated when an aplastic crisis occurs. Patients may require iron chelation therapy to reduce
transfusion-produced iron overload. Pain occurring during an acute crisis is usually undertreated;
patients should have optimal pain control with opioid analgesics, nonsteroidal antiinflammatory agents,
antineuropathic pain medications, local anesthetics, or nerve blocks.
A complication of the hyperviscosity of polycythemia is
a. thrombosis.
, b. cardiomyopathy.
c. pulmonary edema.
d. disseminated intravascular coagulation (DIC). ANS - a
Rationale: The patient with polycythemia may experience angina, heart failure, intermittent
claudication, and thrombophlebitis, which may be complicated by embolization. These manifestations
are caused by blood vessel distention, impaired blood flow, circulatory stasis, thrombosis, and tissue
hypoxia, which is caused by the hypervolemia and hyperviscosity. The most common serious acute
complication is stroke, caused by thrombosis.
When caring for a patient with thrombocytopenia, the nurse instructs the patient to
a. dab his or her nose instead of blowing.
b. be careful when shaving with a safety razor.
c. continue with physical activities to stimulate thrombopoiesis.
d. avoid aspirin because it may mask the fever that occurs with thrombocytopenia. ANS - a
Rationale: Patients with thrombocytopenia should avoid aspirin because it reduces platelet
adhesiveness, which contributes to bleeding. Patients should not perform vigorous exercise or lift
weights. If a patient is weak and at risk for falling, supervise the patient when he or she is out of bed.
Blowing the nose forcefully should be avoided. The patient should gently pat the nose with a tissue if
needed. Instruct patients not to shave with a blade; an electric razor should be used.
The nurse would anticipate that a patient with von Willebrand disease undergoing surgery would be
treated with administration of vWF and
a. thrombin.
b. factor VI.
c. factor VII.
d. factor VIII. ANS - d
RIGHT ACTUAL ANSWERS.
In a severely anemic patient, the nurse would expect to find
a. dyspnea and tachycardia.
b. cyanosis and pulmonary edema.
c. cardiomegaly and pulmonary fibrosis.
d. ventricular dysrhythmias and wheezing. ANS - a
Rationale: Patients with severe anemia (Hgb level less than 6 g/dL) exhibit the following cardiovascular
and pulmonary manifestations: tachycardia, increased pulse pressure, systolic murmurs, intermittent
claudication, angina, heart failure, myocardial infarction, tachypnea, orthopnea, and dyspnea at rest.
When obtaining assessment data from a patient with a microcytic, hypochromic anemia, the nurse
would question the patient about
a. folic acid intake.
b. dietary intake of iron.
c. a history of gastric surgery.
d. a history of sickle cell anemia. ANS - b
Rationale: Iron-deficiency anemia is a microcytic, hypochromic anemia.
Nursing interventions for a patient with severe anemia related to peptic ulcer disease include (select all
that apply)
a. instructions for high-iron diet.
,b. taking vital signs every 8 hours.
c. monitoring stools for occult blood.
d. teaching self-injection of erythropoietin.
e. administration of cobalamin (vitamin B12) injections. ANS - a, c
Rationale: Stool occult blood test is performed to determine the cause of iron-deficiency anemia that is
related to gastrointestinal bleeding. Iron is increased in the diet. Teach the patient which foods are good
sources of iron. If nutrition is already adequate, increasing iron intake by dietary means may not be
practical. The patient with iron deficiency related to acute blood loss may require a transfusion of
packed red blood cells (RBCs).
The nursing management of a patient in sickle cell crisis includes (select all that apply)
a. monitoring CBC.
b. optimal pain management and O2 therapy.
c. blood transfusions if required and iron chelation.
d. rest as needed and deep vein thrombosis prophylaxis.
e. administration of IV iron and diet high in iron content. ANS - a, b, c, d
Rationale: Complete blood count (CBC) is monitored. Infections are common with elevated WBC counts,
and anemia may occur with low hemoglobin levels and low RBC counts. O2 may be administered to
treat hypoxia and control sickling. Rest may be instituted to reduce metabolic requirements, and
prophylaxis for deep vein thrombosis (with anticoagulants) is prescribed. Transfusion therapy is
indicated when an aplastic crisis occurs. Patients may require iron chelation therapy to reduce
transfusion-produced iron overload. Pain occurring during an acute crisis is usually undertreated;
patients should have optimal pain control with opioid analgesics, nonsteroidal antiinflammatory agents,
antineuropathic pain medications, local anesthetics, or nerve blocks.
A complication of the hyperviscosity of polycythemia is
a. thrombosis.
, b. cardiomyopathy.
c. pulmonary edema.
d. disseminated intravascular coagulation (DIC). ANS - a
Rationale: The patient with polycythemia may experience angina, heart failure, intermittent
claudication, and thrombophlebitis, which may be complicated by embolization. These manifestations
are caused by blood vessel distention, impaired blood flow, circulatory stasis, thrombosis, and tissue
hypoxia, which is caused by the hypervolemia and hyperviscosity. The most common serious acute
complication is stroke, caused by thrombosis.
When caring for a patient with thrombocytopenia, the nurse instructs the patient to
a. dab his or her nose instead of blowing.
b. be careful when shaving with a safety razor.
c. continue with physical activities to stimulate thrombopoiesis.
d. avoid aspirin because it may mask the fever that occurs with thrombocytopenia. ANS - a
Rationale: Patients with thrombocytopenia should avoid aspirin because it reduces platelet
adhesiveness, which contributes to bleeding. Patients should not perform vigorous exercise or lift
weights. If a patient is weak and at risk for falling, supervise the patient when he or she is out of bed.
Blowing the nose forcefully should be avoided. The patient should gently pat the nose with a tissue if
needed. Instruct patients not to shave with a blade; an electric razor should be used.
The nurse would anticipate that a patient with von Willebrand disease undergoing surgery would be
treated with administration of vWF and
a. thrombin.
b. factor VI.
c. factor VII.
d. factor VIII. ANS - d
