Med Surg. Exam 3 __ Practice Questions
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
Rationale: von Willebrand disease involves deficiency of the von Willebrand coagulation protein,
variable factor VIII deficiencies, and platelet dysfunction. Treatment includes administration of
von Willebrand factor and factor VIII.
DIC is a disorder in which
a. the coagulation pathway is genetically altered, leading to thrombus formation in all major
blood vessels.
b. an underlying disease depletes hemolytic factors in the blood, leading to diffuse thrombotic
episodes and infarcts.
c. a disease process stimulates coagulation processes with resultant thrombosis, as well as
depletion of clotting factors, leading to diffuse clotting and hemorrhage.
d. an inherited predisposition causes a deficiency of clotting factors that leads to overstimulation
of coagulation processes in the vasculature. - ANS-c
Rationale: In disseminated intravascular coagulation (DIC), the coagulation process is
stimulated, with resultant thrombosis and depletion of clotting factors, which leads to diffuse
clotting and hemorrhage. The paradox of this condition is characterized by the profuse bleeding
that results from the depletion of platelets and clotting factors.
Priority nursing actions when caring for a hospitalized patient with a new-onset temperature of
102.2° F (39° C) and severe neutropenia include (select all that apply)
a. administering the prescribed antibiotic STAT.
b. drawing peripheral and central line blood cultures.
c. ongoing monitoring of the patient's vital signs for septic shock.
d. taking a full set of vital signs and notifying the physician immediately.
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
Rationale: von Willebrand disease involves deficiency of the von Willebrand coagulation protein,
variable factor VIII deficiencies, and platelet dysfunction. Treatment includes administration of
von Willebrand factor and factor VIII.
DIC is a disorder in which
a. the coagulation pathway is genetically altered, leading to thrombus formation in all major
blood vessels.
b. an underlying disease depletes hemolytic factors in the blood, leading to diffuse thrombotic
episodes and infarcts.
c. a disease process stimulates coagulation processes with resultant thrombosis, as well as
depletion of clotting factors, leading to diffuse clotting and hemorrhage.
d. an inherited predisposition causes a deficiency of clotting factors that leads to overstimulation
of coagulation processes in the vasculature. - ANS-c
Rationale: In disseminated intravascular coagulation (DIC), the coagulation process is
stimulated, with resultant thrombosis and depletion of clotting factors, which leads to diffuse
clotting and hemorrhage. The paradox of this condition is characterized by the profuse bleeding
that results from the depletion of platelets and clotting factors.
Priority nursing actions when caring for a hospitalized patient with a new-onset temperature of
102.2° F (39° C) and severe neutropenia include (select all that apply)
a. administering the prescribed antibiotic STAT.
b. drawing peripheral and central line blood cultures.
c. ongoing monitoring of the patient's vital signs for septic shock.
d. taking a full set of vital signs and notifying the physician immediately.
