NUR 2502
MULTIDIMENSIONAL CARE III
EXAM I
(Rasmussen College)
CONTAINS:
✓ NUR 2502 Medical–Surgical Nursing course material
✓ Exam-style multiple-choice questions
✓ Correct answers clearly identified
✓ Rationales/explanations for each answer
✓ Adult health nursing concepts
✓ Cardiovascular disorders and nursing management
✓ Respiratory disorders and nursing management
✓ Endocrine disorders, including diabetes mellitus
✓ Fluid and electrolyte imbalances
✓ Acid–base balance concepts
✓ Infectious and inflammatory conditions
✓ Nursing assessment and clinical monitoring
✓ Nursing interventions and patient care planning
✓ Patient safety and prioritization of care
✓ Clinical judgment and decision-making questions
✓ NCLEX-style exam preparation aligned with NUR 2502 objectives
,A 45-year-old female patient presents to the clinic with complaints of fatigue, pallor, and shortness of
breath upon exertion. She reports that she is a strict vegetarian. Laboratory results reveal a
hemoglobin of 8.5 g/dL, a hematocrit of 26%, and a mean corpuscular volume (MCV) of 72 fL. Based
on these findings, which type of anemia is the patient most likely experiencing?
A) Pernicious anemia
B) Iron deficiency anemia
C) Aplastic anemia
D) Sickle cell anemia
Correct Answer: B) Iron deficiency anemia
Explanation / Rationale:
The patient’s presentation is classic for iron deficiency anemia (IDA). Key indicators include fatigue,
pallor, and dyspnea, which are symptoms of decreased oxygen-carrying capacity. The strict vegetarian
diet is a significant risk factor due to the lack of heme iron found in meat products. The laboratory
values confirm the diagnosis: the hemoglobin and hematocrit are low, indicating anemia, and the
MCV of 72 fL is below the normal range (80–100 fL), classifying it as microcytic anemia. Iron deficiency
is the most common cause of microcytic anemia.
Option A (Pernicious anemia) is incorrect because it is a macrocytic anemia (elevated MCV) caused by
vitamin B12 deficiency, often due to a lack of intrinsic factor. Option C (Aplastic anemia) is incorrect
because it typically presents with pancytopenia (low red blood cells, white blood cells, and platelets)
and is normocytic or slightly macrocytic. Option D (Sickle cell anemia) is incorrect because it is a
normocytic anemia and is a genetic disorder, not directly caused by dietary habits.
A nurse is caring for a patient with sickle cell disease who is admitted with a vaso-occlusive crisis
(VOC). The patient is reporting severe pain (10/10) in their lower extremities. Which intervention is
the highest priority for the nurse to implement?
A) Administering oxygen via nasal cannula at 2 L/min
B) Applying warm compresses to the affected areas
C) Initiating IV access and administering analgesics as prescribed
D) Encouraging increased oral fluid intake
Correct Answer: C) Initiating IV access and administering analgesics as prescribed
,Explanation / Rationale:
In a vaso-occlusive crisis, the priority nursing intervention is pain management. The sickling of cells
causes ischemia and tissue damage, leading to severe pain. The hallmark of managing VOC is
aggressive, prompt administration of opioids (usually morphine or hydromorphone) via IV for rapid
onset. While Option A (oxygen) is important if the patient is hypoxic (SpO2 < 92%), routine oxygen
administration is not recommended for non-hypoxic patients as it can suppress erythropoietin
production and does not relieve pain caused by vaso-occlusion. Option B (warm compresses) is a
helpful adjunct to promote vasodilation but is secondary to pharmacological pain relief. Option D
(fluids) is also essential to decrease blood viscosity, but IV fluids are required immediately rather than
relying on oral intake, and pain control remains the immediate priority to relieve suffering.
A patient is undergoing chemotherapy for the treatment of acute myeloid leukemia (AML). The nurse
notes the patient’s most recent lab results show a White Blood Cell (WBC) count of 1.2 x 10^9/L and
an absolute neutrophil count (ANC) of 0.4 x 10^9/L. Which dietary instruction is most critical for the
nurse to provide to protect the patient from infection?
A) "You may eat fresh fruits and vegetables, but wash them thoroughly."
B) "Avoid eating raw or undercooked meat, eggs, and unpasteurized dairy."
C) "Increase your intake of red meat to help with anemia."
D) "Drink at least 3 liters of water per day to flush your kidneys."
Correct Answer: B) "Avoid eating raw or undercooked meat, eggs, and unpasteurized dairy."
Explanation / Rationale:
The patient is severely neutropenic (ANC < 0.5 x 10^9/L), placing them at extremely high risk for life-
threatening infections. A neutropenic diet (low-bacterial diet) restricts foods that are likely to harbor
pathogens. This includes avoiding raw or undercooked meats (e.g., steak tartare, sushi), eggs (e.g.,
runny eggs), and unpasteurized dairy products (e.g., soft cheeses like Brie or Camembert).
Option A (fresh fruits and vegetables) is generally restricted in strict neutropenic protocols because
raw produce can harbor bacteria and fungi on the skin, even after washing. Cooked vegetables and
peeled fruits are usually preferred. Option C is a nutritional intervention for anemia but does not
address the immediate life-threatening risk of infection. Option D is good general advice for
chemotherapy patients to prevent tumor lysis syndrome or nephrotoxicity but is not the primary
dietary protection against infection in neutropenia.
, A 30-year-old female patient presents with symptoms of fatigue, tingling in her hands and feet, and
difficulty walking. She states she has had a "sore tongue" recently. A complete blood count (CBC)
reveals macrocytic anemia. The nurse should anticipate the provider to order which diagnostic test to
confirm the suspected diagnosis of pernicious anemia?
A) Schilling test
B) Iron studies
C) Bone marrow biopsy
D) Coombs test
Correct Answer: A) Schilling test
Explanation / Rationale:
Pernicious anemia is caused by a lack of intrinsic factor (IF), leading to an inability to absorb vitamin
B12. The Schilling test was historically the gold standard for diagnosing malabsorption of B12 to
differentiate between pernicious anemia (lack of IF) and other causes of B12 deficiency (such as
intestinal malabsorption). While the Schilling test is less commonly used today due to the availability
of B12 and intrinsic factor antibody testing, it remains the classic exam answer associated with
confirming the mechanism of B12 malabsorption.
Option B (Iron studies) would be used for iron deficiency anemia. Option C (Bone marrow biopsy)
might show megaloblastic changes but is not specific to the cause and is more invasive. Option D
(Coombs test) is used to diagnose autoimmune hemolytic anemia.
A patient with disseminated intravascular coagulation (DIC) has the following laboratory values:
Platelet count 40,000/mm³, Fibrinogen 80 mg/dL, and PT/PTT prolonged. The nurse observes active
bleeding from the patient's IV site and gums. Based on the pathophysiology of DIC, what is the
primary treatment goal?
A) Administering fresh frozen plasma (FFP) and cryoprecipitate
B) Administering heparin to stop clotting
C) Administering large doses of IV steroids
D) Performing immediate splenectomy
Correct Answer: A) Administering fresh frozen plasma (FFP) and cryoprecipitate
MULTIDIMENSIONAL CARE III
EXAM I
(Rasmussen College)
CONTAINS:
✓ NUR 2502 Medical–Surgical Nursing course material
✓ Exam-style multiple-choice questions
✓ Correct answers clearly identified
✓ Rationales/explanations for each answer
✓ Adult health nursing concepts
✓ Cardiovascular disorders and nursing management
✓ Respiratory disorders and nursing management
✓ Endocrine disorders, including diabetes mellitus
✓ Fluid and electrolyte imbalances
✓ Acid–base balance concepts
✓ Infectious and inflammatory conditions
✓ Nursing assessment and clinical monitoring
✓ Nursing interventions and patient care planning
✓ Patient safety and prioritization of care
✓ Clinical judgment and decision-making questions
✓ NCLEX-style exam preparation aligned with NUR 2502 objectives
,A 45-year-old female patient presents to the clinic with complaints of fatigue, pallor, and shortness of
breath upon exertion. She reports that she is a strict vegetarian. Laboratory results reveal a
hemoglobin of 8.5 g/dL, a hematocrit of 26%, and a mean corpuscular volume (MCV) of 72 fL. Based
on these findings, which type of anemia is the patient most likely experiencing?
A) Pernicious anemia
B) Iron deficiency anemia
C) Aplastic anemia
D) Sickle cell anemia
Correct Answer: B) Iron deficiency anemia
Explanation / Rationale:
The patient’s presentation is classic for iron deficiency anemia (IDA). Key indicators include fatigue,
pallor, and dyspnea, which are symptoms of decreased oxygen-carrying capacity. The strict vegetarian
diet is a significant risk factor due to the lack of heme iron found in meat products. The laboratory
values confirm the diagnosis: the hemoglobin and hematocrit are low, indicating anemia, and the
MCV of 72 fL is below the normal range (80–100 fL), classifying it as microcytic anemia. Iron deficiency
is the most common cause of microcytic anemia.
Option A (Pernicious anemia) is incorrect because it is a macrocytic anemia (elevated MCV) caused by
vitamin B12 deficiency, often due to a lack of intrinsic factor. Option C (Aplastic anemia) is incorrect
because it typically presents with pancytopenia (low red blood cells, white blood cells, and platelets)
and is normocytic or slightly macrocytic. Option D (Sickle cell anemia) is incorrect because it is a
normocytic anemia and is a genetic disorder, not directly caused by dietary habits.
A nurse is caring for a patient with sickle cell disease who is admitted with a vaso-occlusive crisis
(VOC). The patient is reporting severe pain (10/10) in their lower extremities. Which intervention is
the highest priority for the nurse to implement?
A) Administering oxygen via nasal cannula at 2 L/min
B) Applying warm compresses to the affected areas
C) Initiating IV access and administering analgesics as prescribed
D) Encouraging increased oral fluid intake
Correct Answer: C) Initiating IV access and administering analgesics as prescribed
,Explanation / Rationale:
In a vaso-occlusive crisis, the priority nursing intervention is pain management. The sickling of cells
causes ischemia and tissue damage, leading to severe pain. The hallmark of managing VOC is
aggressive, prompt administration of opioids (usually morphine or hydromorphone) via IV for rapid
onset. While Option A (oxygen) is important if the patient is hypoxic (SpO2 < 92%), routine oxygen
administration is not recommended for non-hypoxic patients as it can suppress erythropoietin
production and does not relieve pain caused by vaso-occlusion. Option B (warm compresses) is a
helpful adjunct to promote vasodilation but is secondary to pharmacological pain relief. Option D
(fluids) is also essential to decrease blood viscosity, but IV fluids are required immediately rather than
relying on oral intake, and pain control remains the immediate priority to relieve suffering.
A patient is undergoing chemotherapy for the treatment of acute myeloid leukemia (AML). The nurse
notes the patient’s most recent lab results show a White Blood Cell (WBC) count of 1.2 x 10^9/L and
an absolute neutrophil count (ANC) of 0.4 x 10^9/L. Which dietary instruction is most critical for the
nurse to provide to protect the patient from infection?
A) "You may eat fresh fruits and vegetables, but wash them thoroughly."
B) "Avoid eating raw or undercooked meat, eggs, and unpasteurized dairy."
C) "Increase your intake of red meat to help with anemia."
D) "Drink at least 3 liters of water per day to flush your kidneys."
Correct Answer: B) "Avoid eating raw or undercooked meat, eggs, and unpasteurized dairy."
Explanation / Rationale:
The patient is severely neutropenic (ANC < 0.5 x 10^9/L), placing them at extremely high risk for life-
threatening infections. A neutropenic diet (low-bacterial diet) restricts foods that are likely to harbor
pathogens. This includes avoiding raw or undercooked meats (e.g., steak tartare, sushi), eggs (e.g.,
runny eggs), and unpasteurized dairy products (e.g., soft cheeses like Brie or Camembert).
Option A (fresh fruits and vegetables) is generally restricted in strict neutropenic protocols because
raw produce can harbor bacteria and fungi on the skin, even after washing. Cooked vegetables and
peeled fruits are usually preferred. Option C is a nutritional intervention for anemia but does not
address the immediate life-threatening risk of infection. Option D is good general advice for
chemotherapy patients to prevent tumor lysis syndrome or nephrotoxicity but is not the primary
dietary protection against infection in neutropenia.
, A 30-year-old female patient presents with symptoms of fatigue, tingling in her hands and feet, and
difficulty walking. She states she has had a "sore tongue" recently. A complete blood count (CBC)
reveals macrocytic anemia. The nurse should anticipate the provider to order which diagnostic test to
confirm the suspected diagnosis of pernicious anemia?
A) Schilling test
B) Iron studies
C) Bone marrow biopsy
D) Coombs test
Correct Answer: A) Schilling test
Explanation / Rationale:
Pernicious anemia is caused by a lack of intrinsic factor (IF), leading to an inability to absorb vitamin
B12. The Schilling test was historically the gold standard for diagnosing malabsorption of B12 to
differentiate between pernicious anemia (lack of IF) and other causes of B12 deficiency (such as
intestinal malabsorption). While the Schilling test is less commonly used today due to the availability
of B12 and intrinsic factor antibody testing, it remains the classic exam answer associated with
confirming the mechanism of B12 malabsorption.
Option B (Iron studies) would be used for iron deficiency anemia. Option C (Bone marrow biopsy)
might show megaloblastic changes but is not specific to the cause and is more invasive. Option D
(Coombs test) is used to diagnose autoimmune hemolytic anemia.
A patient with disseminated intravascular coagulation (DIC) has the following laboratory values:
Platelet count 40,000/mm³, Fibrinogen 80 mg/dL, and PT/PTT prolonged. The nurse observes active
bleeding from the patient's IV site and gums. Based on the pathophysiology of DIC, what is the
primary treatment goal?
A) Administering fresh frozen plasma (FFP) and cryoprecipitate
B) Administering heparin to stop clotting
C) Administering large doses of IV steroids
D) Performing immediate splenectomy
Correct Answer: A) Administering fresh frozen plasma (FFP) and cryoprecipitate
