Exam 2

Question 1

A client admitted to the hospital with abdominal pain, anemia, and bloody stools reports feeling weak and dizzy. The client has rectal pressure and needs to urinate and move their bowels. The nurse should help them:

a) onto the bedpan.
b) to the bathroom

Answer 1

onto the bedpan.

Question 2

An older adult client who is a vegetarian has a hemoglobin of 10.2 gm/dL, vitamin B12 of 68 pg/mL (normal: 200–900 pg/mL), and MCV of 110 cubic micrometers. After interpreting the data, what instruction should the nurse give to the client?

a) Continue with the diet but include more sources of iron.
b) Supplement the diet with vitamin B12.

Answer 2

Supplement the diet with vitamin B12.

Question 3

A nurse is doing a physical examination of a child with sickle cell anemia. When the child asks why the nurse auscultates the lungs and heart, what would be best the response by the nurse?

a) To detect the abnormal sounds suggestive of acute chest syndrome and heart failure
b) to detect evidence of infection, such as fever and tachycardia

Answer 3

To detect the abnormal sounds suggestive of acute chest syndrome and heart failure

Question 4

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia?

a) Erythrocytes that are microcytic and hypochromic
b) Clustering of platelets with sickled red blood cells
c) Erythrocytes that are macrocytic and hyperchromic

Answer 4

Erythrocytes that are microcytic and hypochromic

Question 5

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process due to thrombocytopenia in a client with leukemia?

a) Implementing neutropenic precautions
b) eliminating direct contact with others
c) Applying prolonged pressure to needle sites or other sources of external bleeding

Answer 5

Applying prolonged pressure to needle sites or other sources of external bleeding

Question 6

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?

a) “I will receive parenteral vitamin B12 therapy until my vitamin B12 level returns to normal.”
b) “I will receive parenteral vitamin B12 therapy for the rest of my life.”

Answer 6

“I will receive parenteral vitamin B12 therapy for the rest of my life.”

Question 7

A thin client is prescribed iron dextran intramuscularly. What is most important action taken by the nurse when administering this medication?

a) Employs the Z–track technique
b) rub site
c) inject into the deltoid

Answer 7

Employs the Z–track technique

Question 8

While asessing a client, the nurse will recognize what as the most obvious sign of anemia?

Answer 8

Pallor

Question 9

A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What test would the nurse expect the physician to order?

Answer 9

CBC

Question 10

A patient with sickle cell disease is brought to the emergency department by a parent. The patient has a fever of 101.6°F, heart rate of 116, and a respiratory rate of 32. The nurse auscultates bilateral wheezes in both lung fields. What does the nurse suspect this patient is experiencing?

a) Acute chest syndrome
b) Pulmonary edema

Answer 10

Acute chest syndrome

Question 11

A female client with the beta-thalassemia trait plans to marry a man of Italian ancestry who also has the trait. Which client statement indicates that she understands the teaching provided by the nurse?

a) Thalassemia is treated with iron supplements.
b) I need to learn how to give myself vitamin B12 injections.
c) I’ll see a genetic counselor before starting a family.
d) If my fiancé was of Middle Eastern descent, I wouldn’t be worried about having children.

Answer 11

“I’ll see a genetic counselor before starting a family.”

Question 12

The nurse obtains a unit of blood for the client, Donald D. Smith. The name on the label on the unit of blood reads Donald A. Smith. All the other identifiers are correct. What action should the nurse take?

a) refuse to administer the blood
b) check with the blood bank and obtain permission
c) ask the patient if he knows Donald A. Smith

Answer 12

Refuses to administer the blood

Question 13

A patient has been diagnosed with thrombocytopenia. What are the primary nursing interventions while instituting corticosteroid therapy in this patient?

a) Palpate the lymph nodes and tonsils every shift.
b) Gradually taper the dose and frequency of medication.
c) Eliminate aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).
d) Examine the extremities for redness.

Answer 13

Gradually taper the dose and frequency of medication.

Question 14

A client’s family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC?

a) “DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs.”
b) “DIC is caused when hemolytic processes destroy erythrocytes.”
c) “DIC occurs when the immune system attacks platelets and causes massive bleeding.”
d) “DIC is a complication of an autoimmune disease that attacks the body’s own cells.”

Answer 14

“DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs.”

Question 15

During preparation for bowel surgery, a client receives an antibiotic to reduce intestinal bacteria. The nurse knows that hypoprothrombinemia may occur as a result of antibiotic therapy interfering with synthesis of which vitamin?

Vitamin A
Vitamin D
Vitamin K
Vitamin E

Answer 15

vitamin K

Question 16

When assessing a client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential?

a) age and gender
b) menstrual history
C) health history

Answer 16

Health history, such as bleeding, fatigue, or fainting

Question 17

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called:

Answer 17

megaloblasts.

Question 18

A nurse caring for a client who has hemophilia is getting ready to take the client’s vital signs. What should the nurse do before taking a blood pressure?

a) ask if taking a blood pressure has ever caused bruising in the hand and wrist.
b) Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints.

Answer 18

Ask if taking a blood pressure has ever produced bleeding under the skin or in the arm joints.

Question 19

The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions?

a) Iron may cause indigestion and should be taken with an antacid such as Mylanta.
b) Discontinue the use of iron if your stool turns black.
c) Dilute the liquid preparation with another liquid such as juice and drink with a straw.
d) Do not take medication with orange juice because it will delay absorption of the iron.

Answer 19

Dilute the liquid preparation with another liquid such as juice and drink with a straw.

Question 20

Which medication is the antidote to warfarin?

Answer 20

Vitamin K

Question 21

During a routine assessment of a patient diagnosed with anemia, the nurse observes the patient’s beefy red tongue. The nurse is aware that this is a sign of what kind of anemia?

Answer 21

Megaloblastic

Question 22

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the health care provider immediately because the client probably is experiencing which problem?

a) A hemolytic reaction to Rh-incompatible blood
b) A hemolytic allergic reaction caused by an antigen reaction

Answer 22

A hemolytic allergic reaction caused by an antigen reaction

Question 23

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia?

Answer 23

yspnea, tachycardia, and pallor

Question 24

A patient with End Stage Kidney Disease is taking recombinant erythropoietin for the treatment of anemia. What laboratory study does the nurse understand will have to be assessed at least monthly related to this medication?

Potassium level
Creatinine level
Folate levels
Hemoglobin level

Answer 24

Hemoglobin level

Question 25

A client is treated for anemia. What is the nurse’s best understanding about the correlation between anemia and the client’s iron stores?

a) There is a strong correlation between iron stores and hemoglobin levels.
b) There is a strong correlation between iron stores and hemoglobin characteristics.
c) There is an inverse relationship between iron stores and hemoglobin levels.
d) There is a weak correlation between iron stores and hemoglobin levels.

Answer 25

There is a strong correlation between iron stores and hemoglobin levels.

Question 26

A client with megaloblastic anemia reports mouth and tongue soreness. What instruction will the nurse give the client regarding eating while managing the client’s symptoms?

a) “Eat larger amounts of bland, soft foods less frequently.”
b) “Eat low-fiber blended foods only.”
c) “Eat small amounts of bland, soft foods frequently.”
d) “Eat cold, bland foods with a large amount of water.”

Answer 26

“Eat small amounts of bland, soft foods frequently.”