NCLEX HEMATOLOGY FINAL EXAM LATEST
UPDATE
1. In a severely anemic patient, you expect to find
A. dyspnea and tachycardia.
B. cyanosis and pulmonary edema.
C. cardiomegaly and pulmonary fibrosis.
D. ventricular dysrhythmias and wheezing. (correct answers)A. dyspnea and tachycardia.
2. Patients with severe anemia (hemoglobin <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,
dyspnea at rest.
3. When obtaining assessment data from a patient with a microcytic, hypochromic anemia, you
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. (correct answers)B. dietary intake of iron.
4. Iron deficiency anemia is a type of microcytic, hypochromic anemia.
5. When caring for a patient with metastatic cancer, you note a hemoglobin level of 8.7 g/dL and
hematocrit of 26%. You place highest priority on initiating interventions that can reduce
A. thirst.
B. fatigue.
C. headache.
D. abdominal pain. (correct answers)B. fatigue.
6. The patient with a low hemoglobin level and hematocrit is anemic and is most likely to
experience fatigue. Fatigue develops because of the lowered oxygen-carrying capacity that leads
to reduced tissue oxygenation with which to carry out cellular functions.
7. You are caring for a patient with a diagnosis of iron-deficiency anemia. Which clinical
manifestations are you most likely to observe when assessing this patient?
A. Convex nails, bright red gums, and alopecia
B. Brittle nails; smooth, shiny tongue; and cheilosis
C. Tenting of the skin, sunken eyes, and complaints of diarrhea
D. Pale pink tongue; dull, brittle hair; and blue mucous membranes (correct answers)B.
Brittle nails; smooth, shiny tongue; and cheilosis
8. Specific clinical manifestations may be related to iron-deficiency anemia. Pallor is the most
common finding, and glossitis (inflammation of the tongue) is the second most common;
another finding is cheilitis (inflammation of the lips). The patient may report headache,
, paresthesias, and a burning sensation of the tongue, all of which are caused by lack of iron in
the tissues.
9. When providing teaching for the patient with iron-deficiency anemia who has been prescribed
iron supplements, you should include taking the iron with which beverage?
A. Milk
B. Ginger ale
C. Orange juice
D. Water (correct answers)C. Orange juice
10. Taking iron with vitamin C (ascorbic acid) or orange juice, which contains ascorbic acid, also
enhances iron absorption. Milk may interfere with iron absorption. Ginger ale and water do not
facilitate iron absorption.
11. The primary pathophysiology underlying thalassemia is
A. erythropoietin deficiency.
B. abnormal hemoglobin synthesis.
C. autoimmunity.
D. S-shaped hemoglobin. (correct answers)B. abnormal hemoglobin synthesis.
12. Thalassemia is a group of autosomal recessive diseases that involve inadequate production of
normal hemoglobin. Hemolysis also occurs in thalassemia, but insufficient production of normal
hemoglobin is the predominant problem. Erythropoietin deficiency is associated with a renal
disorder, and S-shaped hemoglobin is associated with sickle cell disease.
13. You anticipate the onset of manifestations related to thalessemia to occur by
A. 6 months of age.
B. age 1 year.
C. age 2 year.
D. adolescence. (correct answers)C. age 2 year.
14. The manifestations, including growth and developmental deficits, develop in childhood by 2
years of age.
15. Which individual is at high risk for a cobalamin (vitamin B12) deficiency anemia?
A. A 47-year-old man who had a gastrectomy (removal of the stomach)
B. A 54-year-old man with a history of irritable bowel disease and ulcerative colitis
C. A 26-year-old woman who complains of heavy menstrual periods
D. A 15-year-old girl who is a vegetarian (correct answers)A. A 47-year-old man who had a
gastrectomy (removal of the stomach)
16. There are many causes of cobalamin deficiency. The most common cause is pernicious anemia,
a disease in which the gastric mucosa is not secreting intrinsic factor (IF) because of antibodies
being directed against the gastric parietal cells or IF itself. Other causes of cobalamin deficiency
include gastrectomy, gastritis, nutritional deficiency, chronic alcoholism, and hereditary
enzymatic defects of cobalamin use.
17. You encourage the patient with cobalamin deficiency to seek treatment because untreated
pernicious anemia may result in
A. death.
B. liver failure.
, C. heart failure.
D. gastrectomy. (correct answers)A. death.
18. Without cobalamin administration, these individuals will die in 1 to 3 years.
19. The Schilling test for pernicious anemia involves
A. administration of radioactive cobalamin and measuring its excretion in the urine.
B. blood cultures for organism identification.
C. the measurement of serum iron.
D. the administration of iron and blood assessment of total iron binding in 24 hours.
(correct answers)A. administration of radioactive cobalamin and measuring its excretion
in the urine.
20. Parietal cell function can be assssed with a Schilling test. After radioactive cobalamin is
administered to the patient, the amount of cobalamin excreted in the urine is measured. An
individual who cannot absorb cobalamin excretes only a small amount of this radioactive form.
21. Which finding allows you to identify the patient's anemia as folic acid deficiency rather than
cobalamin deficiency?
A. Loss of appetite
B. Lack of neuromuscular symptoms
C. Red tongue
D. Change in nail shape (correct answers)B. Lack of neuromuscular symptoms
22. The absence of neurologic problems is an important diagnostic finding and differentiates folic
acid deficiency from cobalamin deficiency.
23. Which foods should you encourage patients with folic acid deficiency to include in their daily
food intake (select all that apply)?
A. Ready-to-eat cereal
B. Wheat tortillas
C. Lentils
D. Strawberries
E. Potatoes (correct answers)A. Ready-to-eat cereal
24. B. Wheat tortillas
25. C. Lentils
26. Whole-grain foods and beans are high in folic acid
27. Nursing interventions for a patient with severe anemia related to peptic ulcer disease include
(select all that apply)
A. monitoring stools for guaiac.
B. instructions about a high-iron diet.
C. taking vital signs every 8 hours.
D. teaching self-injection of erythropoietin. (correct answers)A. monitoring stools for
guaiac.
28. B. instructions about a high-iron diet.
29. The stool guaiac test is done to determine whetherthe cause of the iron-deficiency anemia is
related to gastrointestinal bleeding. Iron should be increased in the diet. Teach the patient
which foods are good sources of iron. If nutrition is already adequate, increasing iron intake by
UPDATE
1. In a severely anemic patient, you expect to find
A. dyspnea and tachycardia.
B. cyanosis and pulmonary edema.
C. cardiomegaly and pulmonary fibrosis.
D. ventricular dysrhythmias and wheezing. (correct answers)A. dyspnea and tachycardia.
2. Patients with severe anemia (hemoglobin <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,
dyspnea at rest.
3. When obtaining assessment data from a patient with a microcytic, hypochromic anemia, you
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. (correct answers)B. dietary intake of iron.
4. Iron deficiency anemia is a type of microcytic, hypochromic anemia.
5. When caring for a patient with metastatic cancer, you note a hemoglobin level of 8.7 g/dL and
hematocrit of 26%. You place highest priority on initiating interventions that can reduce
A. thirst.
B. fatigue.
C. headache.
D. abdominal pain. (correct answers)B. fatigue.
6. The patient with a low hemoglobin level and hematocrit is anemic and is most likely to
experience fatigue. Fatigue develops because of the lowered oxygen-carrying capacity that leads
to reduced tissue oxygenation with which to carry out cellular functions.
7. You are caring for a patient with a diagnosis of iron-deficiency anemia. Which clinical
manifestations are you most likely to observe when assessing this patient?
A. Convex nails, bright red gums, and alopecia
B. Brittle nails; smooth, shiny tongue; and cheilosis
C. Tenting of the skin, sunken eyes, and complaints of diarrhea
D. Pale pink tongue; dull, brittle hair; and blue mucous membranes (correct answers)B.
Brittle nails; smooth, shiny tongue; and cheilosis
8. Specific clinical manifestations may be related to iron-deficiency anemia. Pallor is the most
common finding, and glossitis (inflammation of the tongue) is the second most common;
another finding is cheilitis (inflammation of the lips). The patient may report headache,
, paresthesias, and a burning sensation of the tongue, all of which are caused by lack of iron in
the tissues.
9. When providing teaching for the patient with iron-deficiency anemia who has been prescribed
iron supplements, you should include taking the iron with which beverage?
A. Milk
B. Ginger ale
C. Orange juice
D. Water (correct answers)C. Orange juice
10. Taking iron with vitamin C (ascorbic acid) or orange juice, which contains ascorbic acid, also
enhances iron absorption. Milk may interfere with iron absorption. Ginger ale and water do not
facilitate iron absorption.
11. The primary pathophysiology underlying thalassemia is
A. erythropoietin deficiency.
B. abnormal hemoglobin synthesis.
C. autoimmunity.
D. S-shaped hemoglobin. (correct answers)B. abnormal hemoglobin synthesis.
12. Thalassemia is a group of autosomal recessive diseases that involve inadequate production of
normal hemoglobin. Hemolysis also occurs in thalassemia, but insufficient production of normal
hemoglobin is the predominant problem. Erythropoietin deficiency is associated with a renal
disorder, and S-shaped hemoglobin is associated with sickle cell disease.
13. You anticipate the onset of manifestations related to thalessemia to occur by
A. 6 months of age.
B. age 1 year.
C. age 2 year.
D. adolescence. (correct answers)C. age 2 year.
14. The manifestations, including growth and developmental deficits, develop in childhood by 2
years of age.
15. Which individual is at high risk for a cobalamin (vitamin B12) deficiency anemia?
A. A 47-year-old man who had a gastrectomy (removal of the stomach)
B. A 54-year-old man with a history of irritable bowel disease and ulcerative colitis
C. A 26-year-old woman who complains of heavy menstrual periods
D. A 15-year-old girl who is a vegetarian (correct answers)A. A 47-year-old man who had a
gastrectomy (removal of the stomach)
16. There are many causes of cobalamin deficiency. The most common cause is pernicious anemia,
a disease in which the gastric mucosa is not secreting intrinsic factor (IF) because of antibodies
being directed against the gastric parietal cells or IF itself. Other causes of cobalamin deficiency
include gastrectomy, gastritis, nutritional deficiency, chronic alcoholism, and hereditary
enzymatic defects of cobalamin use.
17. You encourage the patient with cobalamin deficiency to seek treatment because untreated
pernicious anemia may result in
A. death.
B. liver failure.
, C. heart failure.
D. gastrectomy. (correct answers)A. death.
18. Without cobalamin administration, these individuals will die in 1 to 3 years.
19. The Schilling test for pernicious anemia involves
A. administration of radioactive cobalamin and measuring its excretion in the urine.
B. blood cultures for organism identification.
C. the measurement of serum iron.
D. the administration of iron and blood assessment of total iron binding in 24 hours.
(correct answers)A. administration of radioactive cobalamin and measuring its excretion
in the urine.
20. Parietal cell function can be assssed with a Schilling test. After radioactive cobalamin is
administered to the patient, the amount of cobalamin excreted in the urine is measured. An
individual who cannot absorb cobalamin excretes only a small amount of this radioactive form.
21. Which finding allows you to identify the patient's anemia as folic acid deficiency rather than
cobalamin deficiency?
A. Loss of appetite
B. Lack of neuromuscular symptoms
C. Red tongue
D. Change in nail shape (correct answers)B. Lack of neuromuscular symptoms
22. The absence of neurologic problems is an important diagnostic finding and differentiates folic
acid deficiency from cobalamin deficiency.
23. Which foods should you encourage patients with folic acid deficiency to include in their daily
food intake (select all that apply)?
A. Ready-to-eat cereal
B. Wheat tortillas
C. Lentils
D. Strawberries
E. Potatoes (correct answers)A. Ready-to-eat cereal
24. B. Wheat tortillas
25. C. Lentils
26. Whole-grain foods and beans are high in folic acid
27. Nursing interventions for a patient with severe anemia related to peptic ulcer disease include
(select all that apply)
A. monitoring stools for guaiac.
B. instructions about a high-iron diet.
C. taking vital signs every 8 hours.
D. teaching self-injection of erythropoietin. (correct answers)A. monitoring stools for
guaiac.
28. B. instructions about a high-iron diet.
29. The stool guaiac test is done to determine whetherthe cause of the iron-deficiency anemia is
related to gastrointestinal bleeding. Iron should be increased in the diet. Teach the patient
which foods are good sources of iron. If nutrition is already adequate, increasing iron intake by
