Comprehensive Master Review Guide: Nutrition &
Metabolic Deficiencies, Hematologic Disorders,
Oncology Pharmacology, Biologic Therapies, Immune
Responses, Clinical Management & High-Yield Exam
Questions With Correct Answers
A patient has a vitamin K deficiency. Which plasma protein should the nursemonitor for
deficiency?
A. Globulin
B. Albumin
C. Lipoprotein
D. Prothrombin D. Prothrombin
Because vitamin K is critical in the hepatic synthesis of clotting factors, the nurse monitors the
patient for a deficiency in prothrombin by analyzing the serum prothrombin level. Other plasma
proteins produced by the liver include globulin, albumin, and lipoprotein. Globulins are
antibodies; albumin is the primary plasma protein responsible for oncotic pressure; and
lipoproteins transport lipids in the blood.
A patient with a long history of alcoholism has a vitamin B6 deficiency. To which laboratory tests
should the nurse refer to evaluate the therapeutic effects of vitamin B6 supplementation?
A. Hematocrit
B. Reticulocytes
C. Mean corpuscular hemoglobin
D. Erythrocyte sedimentation rate C. Mean corpuscular hemoglobin
The nurse analyzes the hemoglobin concentration in the erythrocytes (mean corpuscular
hemoglobin, or MCH) to determine the therapeutic effect of vitamin B6 supplementation
because vitamin B6 is important in the synthesis of heme, the oxygen-carrying molecule found
in hemoglobin. The nurse reviews the MCH because it quantifies the concentration of
1|Page
,hemoglobin in erythrocytes. Vitamin B6 is not involved in erythrocyte production, so the
hematocrit and reticulocytes counts, as well as the sedimentation rate, are unrelated.
A patient with a history of GI bleeding as a result of peptic ulcer disease is started on famotidine
(Pepcid) upon admission. Which action is the nurse's priority in helping prevent anemia in the
patient?
A. Providing poultry, fish, and eggs
B. Administering parenteral iron
C. Providing lean meat and cheese
D. Administering vegetables and nuts A. Providing poultry, fish, and eggs
The patient is receiving an H2 blocker, which inhibits the secretion of hydrochloric acid by
gastric parietal cells; as a result, the patient is at risk for pernicious anemia because the lack of
hydrochloric acid in the stomach inhibits the absorption of vitamin B12, because of a lack of
intrinsic factor (secreted in gastric juices). To help prevent this anemia, the nurse provides rich
dietary sources of vitamin B12 including poultry, fish, and eggs. Iron is not indicated in the
prevention or treatment of pernicious anemia. Lean meat and cheese provide magnesium and
vegetables, and nuts provide B6.
A patient is recovering from extensive thoracic surgery. Which foods should the nurse include in
the patient's diet to promote healing?
A. Milk, cheese, yogurt, and bran
B. Green peppers and strawberries
C. Fortified cereals and orange juice
D. Orange-yellow vegetables and fruit B. Green peppers and strawberries
The nurse includes dietary sources of vitamin C to promote tissue repair and healing because it
is important for collagen synthesis and maintenance of connective tissue. Milk, cheese, yogurt,
and bran provide magnesium; fortified products provide vitamin D; and orange-yellow fruits and
vegetables provide vitamin A.
Which dietary supplement is critical in the proper function of nerve impulse transmission and
muscle contractions?
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,A. Zinc
B. Calcium
C. Pyridoxine
D. Cyanocobalamin B. Calcium
Calcium, in addition to helping strengthen bones, is important in the transmission of nerve
impulses and muscle contractions, among many other physiologic functions. Zinc is important in
enzymatic metabolic reactions, tissue growth, and repair. Pyridoxine is important in hemoglobin
synthesis, metabolic function, and the conversion of tryptophan to niacin and serotonin.
Cyanocobalamin is important in cell metabolism, growth, cell replication, hematopoiesis, and
nucleoprotein and myelin synthesis.
Which dietary supplement is needed in combination with calcium to promote the development
of strong bones and teeth?
A. Zinc
B. Vitamin C
C. Vitamin B complex
D. Phosphorus D. Phosphorus
Bone strength depends on the size and density of bone, and bone density depends on the bone
concentrations of calcium, phosphorus, and other minerals. Zinc is important in metabolic
processes and tissue repair, vitamin C in tissue repair, and vitamin B complex in multiple
physiologic processes.
The nurse needs to teach a patient who has vitamin and mineral deficiencies about food
sources of these substances. What is the most important information for the nurse to assess to
plan patient teaching for the patient's current nutritional deficits?
A. Times of day for meals at home
B. History of nutritional deficiencies
C. Presence of skeletal abnormalities
D. Person who plans meals at home D. Person who plans meals at home
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, The nurse knows that the patient has vitamin and mineral deficiencies and takes that data to
plan nursing care. The identity of the individual who plans meals is important information in the
planning of care because that person should be assessed and included in the implementation of
the nursing plan of care. Mealtimes are not important to determine and plan for because the
nurse will help the family plan three daily meals and the family can offer those meals at any
time. Historical data are not important in the planning of care for current nutritional deficits.
Skeletal abnormalities are important in the planning of nursing care related to movement and
activities of daily living.
A female patient tells the nurse that she takes calcium citrate 600 mg and vitamin D 200 mg
(Citracal-D) daily. Which action should the nurse implement to prevent toxicity?
A. Monitoring serum ionized calcium
B. Totaling the daily vitamin D intake
C. Monitoring the creatinine clearance
D. Assessing the patient for lethargy and constipation B. Totaling the daily vitamin D intake
To help prevent toxicity, the nurse totals the patient's daily vitamin D and calcium intakes and
compares the totals to the recommendation of the Dietary Reference Intakes. If the patient is
taking an excessive amount of either supplement, the nurse instructs the patient to adjust her
intake to meet current recommendations. Monitoring the patient's serum calcium level or
creatinine clearance and assessing the patient for lethargy and constipation are nursing
interventions designed for the early detection of adverse effects of therapy.
Which synthetic agent replaces a substance secreted by healthy kidneys that stimulates the
production of red blood cells (RBCs)?
A. Sargramostim (Leukine)
B. Darbepoetin alfa (Aranesp)
C. Oprelvekin (Neumega)
D. Epoetin alfa (Epogen) D. Epoetin alfa (Epogen)
Epoetin alfa replaces erythropoietin in patients with chronic renal failure to stimulate the
production of RBCs because dysfunctional kidneys secrete insufficient erythropoietin to
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Metabolic Deficiencies, Hematologic Disorders,
Oncology Pharmacology, Biologic Therapies, Immune
Responses, Clinical Management & High-Yield Exam
Questions With Correct Answers
A patient has a vitamin K deficiency. Which plasma protein should the nursemonitor for
deficiency?
A. Globulin
B. Albumin
C. Lipoprotein
D. Prothrombin D. Prothrombin
Because vitamin K is critical in the hepatic synthesis of clotting factors, the nurse monitors the
patient for a deficiency in prothrombin by analyzing the serum prothrombin level. Other plasma
proteins produced by the liver include globulin, albumin, and lipoprotein. Globulins are
antibodies; albumin is the primary plasma protein responsible for oncotic pressure; and
lipoproteins transport lipids in the blood.
A patient with a long history of alcoholism has a vitamin B6 deficiency. To which laboratory tests
should the nurse refer to evaluate the therapeutic effects of vitamin B6 supplementation?
A. Hematocrit
B. Reticulocytes
C. Mean corpuscular hemoglobin
D. Erythrocyte sedimentation rate C. Mean corpuscular hemoglobin
The nurse analyzes the hemoglobin concentration in the erythrocytes (mean corpuscular
hemoglobin, or MCH) to determine the therapeutic effect of vitamin B6 supplementation
because vitamin B6 is important in the synthesis of heme, the oxygen-carrying molecule found
in hemoglobin. The nurse reviews the MCH because it quantifies the concentration of
1|Page
,hemoglobin in erythrocytes. Vitamin B6 is not involved in erythrocyte production, so the
hematocrit and reticulocytes counts, as well as the sedimentation rate, are unrelated.
A patient with a history of GI bleeding as a result of peptic ulcer disease is started on famotidine
(Pepcid) upon admission. Which action is the nurse's priority in helping prevent anemia in the
patient?
A. Providing poultry, fish, and eggs
B. Administering parenteral iron
C. Providing lean meat and cheese
D. Administering vegetables and nuts A. Providing poultry, fish, and eggs
The patient is receiving an H2 blocker, which inhibits the secretion of hydrochloric acid by
gastric parietal cells; as a result, the patient is at risk for pernicious anemia because the lack of
hydrochloric acid in the stomach inhibits the absorption of vitamin B12, because of a lack of
intrinsic factor (secreted in gastric juices). To help prevent this anemia, the nurse provides rich
dietary sources of vitamin B12 including poultry, fish, and eggs. Iron is not indicated in the
prevention or treatment of pernicious anemia. Lean meat and cheese provide magnesium and
vegetables, and nuts provide B6.
A patient is recovering from extensive thoracic surgery. Which foods should the nurse include in
the patient's diet to promote healing?
A. Milk, cheese, yogurt, and bran
B. Green peppers and strawberries
C. Fortified cereals and orange juice
D. Orange-yellow vegetables and fruit B. Green peppers and strawberries
The nurse includes dietary sources of vitamin C to promote tissue repair and healing because it
is important for collagen synthesis and maintenance of connective tissue. Milk, cheese, yogurt,
and bran provide magnesium; fortified products provide vitamin D; and orange-yellow fruits and
vegetables provide vitamin A.
Which dietary supplement is critical in the proper function of nerve impulse transmission and
muscle contractions?
2|Page
,A. Zinc
B. Calcium
C. Pyridoxine
D. Cyanocobalamin B. Calcium
Calcium, in addition to helping strengthen bones, is important in the transmission of nerve
impulses and muscle contractions, among many other physiologic functions. Zinc is important in
enzymatic metabolic reactions, tissue growth, and repair. Pyridoxine is important in hemoglobin
synthesis, metabolic function, and the conversion of tryptophan to niacin and serotonin.
Cyanocobalamin is important in cell metabolism, growth, cell replication, hematopoiesis, and
nucleoprotein and myelin synthesis.
Which dietary supplement is needed in combination with calcium to promote the development
of strong bones and teeth?
A. Zinc
B. Vitamin C
C. Vitamin B complex
D. Phosphorus D. Phosphorus
Bone strength depends on the size and density of bone, and bone density depends on the bone
concentrations of calcium, phosphorus, and other minerals. Zinc is important in metabolic
processes and tissue repair, vitamin C in tissue repair, and vitamin B complex in multiple
physiologic processes.
The nurse needs to teach a patient who has vitamin and mineral deficiencies about food
sources of these substances. What is the most important information for the nurse to assess to
plan patient teaching for the patient's current nutritional deficits?
A. Times of day for meals at home
B. History of nutritional deficiencies
C. Presence of skeletal abnormalities
D. Person who plans meals at home D. Person who plans meals at home
3|Page
, The nurse knows that the patient has vitamin and mineral deficiencies and takes that data to
plan nursing care. The identity of the individual who plans meals is important information in the
planning of care because that person should be assessed and included in the implementation of
the nursing plan of care. Mealtimes are not important to determine and plan for because the
nurse will help the family plan three daily meals and the family can offer those meals at any
time. Historical data are not important in the planning of care for current nutritional deficits.
Skeletal abnormalities are important in the planning of nursing care related to movement and
activities of daily living.
A female patient tells the nurse that she takes calcium citrate 600 mg and vitamin D 200 mg
(Citracal-D) daily. Which action should the nurse implement to prevent toxicity?
A. Monitoring serum ionized calcium
B. Totaling the daily vitamin D intake
C. Monitoring the creatinine clearance
D. Assessing the patient for lethargy and constipation B. Totaling the daily vitamin D intake
To help prevent toxicity, the nurse totals the patient's daily vitamin D and calcium intakes and
compares the totals to the recommendation of the Dietary Reference Intakes. If the patient is
taking an excessive amount of either supplement, the nurse instructs the patient to adjust her
intake to meet current recommendations. Monitoring the patient's serum calcium level or
creatinine clearance and assessing the patient for lethargy and constipation are nursing
interventions designed for the early detection of adverse effects of therapy.
Which synthetic agent replaces a substance secreted by healthy kidneys that stimulates the
production of red blood cells (RBCs)?
A. Sargramostim (Leukine)
B. Darbepoetin alfa (Aranesp)
C. Oprelvekin (Neumega)
D. Epoetin alfa (Epogen) D. Epoetin alfa (Epogen)
Epoetin alfa replaces erythropoietin in patients with chronic renal failure to stimulate the
production of RBCs because dysfunctional kidneys secrete insufficient erythropoietin to
4|Page
