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Quiz 10 Medical Surgical Nursing
Quiz 10 Medical Surgical Nursing
Multiple Choice.
1. The mother asks the nurse if her child's iron deficiency anemia is related to
the child's frequent infections. The nurse responds based on the
understanding of which of the following?
A. Little is known about iron-deficiency anemia and its relationship to
infection in children.
B. Children with iron deficiency anemia are more susceptible to infection
than are other children.
C. Children with iron-deficiency anemia are less susceptible to infection than
are other children.
D. Children with iron-deficient anemia are equally as susceptible to infection
as are other children.
2. You are preparing the client for a bone marrow aspiration and biopsy. Which
of the following statements, if made by the patient, indicates the need for
further teaching?
A. After the procedure I should avoid ambulating for 24-48 hours
B. Pain and discomfort is expected after the surgery. I can take some
Tylenol for the discomfort.
C. I should not take a bath for about 24 hours
D. The surgeon will collect the samples from my hip bone
3. The clinic nurse instructs the mother of a child with sickle cell disease about
the precipitating factors related to pain crisis. Which of the following, if
identified by the mother as a precipitating factor, indicates the need for
further instructions?
A. Infection
B. Trauma
C. Fluid overload
D. Stress
RATIONALE: C. Pain crisis may be precipitated by infection, dehydration,
hypoxia, trauma, or physical or emotional stress. The mother of a child
with sickle cell disease should encourage fluid intake of 1 1/2 to 2 times
the daily requirement to prevent dehydration.
4. The patient who underwent a bone biopsy yesterday calls the office thinking
something is wrong. Which of the following would be cause for concern by
the nurse? SATA:
A. Swelling and redness at the site
B. Red streaks spreading away from the area
C. T of 99.5
D. Pain in the area
5. When a client is diagnosed with aplastic anemia, the nurse monitors for
changes in which of the following physiological functions?
A. Bleeding tendencies
B. Intake and output
C. Peripheral sensation
D. Bowel function
Rationale: a. The level of the protein that carries oxygen in blood cells
(hemoglobin) and the percentage of red blood cells in the total blood
volume (the hematocrit) are normally high. B. Levels of erythropoietin
(a hormone that stimulated bone marrow to produce red blood cells)
are extremely low in polycythemia vera.
7. A client was admitted with iron deficiency anemia and blood-streaked emesis.
Which question is most appropriate for the nurse to ask in determining the
extent of the client's activity intolerance?
A. "What activities were you able to do 6 months ago compared with
present?"
B. "How long have you had this problem?"
C. "Have you been able to keep up with all your usual activities?"
D. "Are you more tired now than you used to be?"
10.The patient diagnosed with iron deficiency anemia tells you that she
constantly feels tired and exhausted. She tells you that she is concerned
about this problem. What is the nurse's best initial response?
A. Keep taking your supplements and report back to me in a couple to days
B. How has this affected your life?
C. You are going to need to take a break from those things for a period of
time to rest
D. Try to help get rid of the stress in your life. This will help with the tired
feeling
Rationale: B. Asking this client explain how the fatigue is affecting her life
will help open up the conversation and build rapport. Fatigue is a real
life-changing issue for patients with anemia and should not be dismissed.
Telling her that she must take a break from "things" is not an
understanding response and may not solve the underlying problem.
Clients should not be instructed to get rid of all the stress in life.
RATIONALE: A. Eggs are high in Iron. Other foods high in iron are organ
meats, muscle meats; shellfish, shrimp, and tuna; enriched, whole-grain,
and fortified cereals and breads; legumes, nuts, dried fruits, and beans;
oatmeal; and sweet potatoes.
12.Which medication might the nurse question if administered to the client with
anemia?
A. Cipro
B. Lisinopril
C. Acetaminophen
D. Ferrous sulfate
14.In which of the following diseases would bone marrow transplantation not be
indicated in a newly diagnosed client?
A. Severe aplastic anemia
B. Severe combined immunodeficiency
C. Acute lymphocytic leukemia
D. Chronic myeloid leukemia
15.A client has a bone marrow biopsy done. Which nursing intervention is the
priority post-procedure?
A. Applying pressure to the biopsy site
B. Inspecting the site for ecchymoses
C. Sending the biopsy specimens to the laboratory
D. Teaching the client about avoiding vigorous activity
18.A mother asks the nurse if her child's iron deficiency anemia is related to the
child's frequent infections. The nurse responds based on the understanding of
which of the following?
A. Little is known about iron-deficiency anemia and its relationship to
infection in children.
B. Children with iron deficiency anemia are more susceptible to infection
than are other children.
C. Children with iron-deficiency anemia are less susceptible to infection
than are other children.
D. Children with iron-deficient anemia are equally as susceptible to
infection as are other children.
20.Which blood test result for a client being assessed for a hematologic problem
indicates to the nurse that chronic anemia is likely?
A. International normalized ratio (INR) is 0.9
B. Platelet count of 180,000/mm3
C. Reticulocyte value of 14%
D. Hematocrit of 27%
21.Which of the following is usually the first treatment given to patients with
autoimmune hemolytic anemia?
A. Corticosteroid
B. Blood transfusions
C. Immunosuppressant drugs
D. Removal of the spleen
23.The nurse understands that the client with pernicious anemia will have which
distinguishing laboratory findings?
A. Schilling's test, elevated
B. Intrinsic factor, absent
C. Sedimentation rate, 16 mm/hour
D. RBCs 5.0 million
24.Imagine this. You enter the unit as an RN on your first day on the job. You
breathe in the smell of awesomeness and drink your Starbucks coffee. You
see that you are taking care of a Mr. Smith who has been diagnosed
Polycythemia Vera. Because you are so freakin' awesome, you know that Mr.
Smith is at risk for which of the following complications?
A. Excessive Bleeding
B. Pruritus
C. Hepatomegaly
D. Pancreatitis
26. A patient is about to undergo bone marrow aspiration and biopsy and
expresses fear and anxiety about the procedure. Which of the following is the
most effective nursing response?
A. Warn the patient to stay very still because the smallest movement will
increase her pain.
B. Encourage the family to stay in the room for the procedure.
C. Stay with the patient and focus on slow deep breathing for relaxation.
D. Delay the procedure to allow the patient to deal with her feelings.
27.Which of the following is both the standard treatment and also a potential
cure for aplastic anemia?
A. Antithymocyte globulin
B. Cyclosporine
C. Stem cell transplantation
D. Transfusions
29.A newly admitted client has an elevated reticulocyte count. Which disorder
does the nurse suspect in this client?
A. Aplastic anemia
B. Hemolytic anemia
C. Infectious process
D. Leukemia
30.The nurse devises a teaching plan for the patient with aplastic anemia. Which
of the following is the most important concept to teach for health
maintenance?
A. Eat animal protein and dark leafy vegetables each day
B. Avoid exposure to others with acute infection
C. Practice yoga and meditation to decrease stress and anxiety
D. Get 8 hours of sleep at night and take naps during the day
31.A client was admitted with iron deficiency anemia and blood-streaked emesis.
Which question is most appropriate for the nurse to ask in determining the
extent of the client's activity intolerance?
A. "What activities were you able to do 6 months ago compared with
present?"
B. "How long have you had this problem?"
C. "Have you been able to keep up with all your usual activities?"
D. "Are you more tired now than you used to be?"
32.A client is scheduled for a bone marrow aspiration. What does the client's
nurse do before taking the client to the treatment room for the biopsy?
A. Cleans the biopsy site with an antiseptic or povidone-iodine (Betadine)
B. Holds the client's hand and asks about concerns
C. Reviews the client's platelet (thrombocyte) count
D. Verifies that the client has given informed consent
34. A vegetarian client was referred to a dietitian for nutritional counseling for
anemia. Which client outcome indicates that the client does not understand
nutritional counseling? The client:
A. Adds dried fruit to cereal and baked goods
B. Cooks tomato-based foods in iron pots
C. Drinks coffee or tea with meals
D. Adds vitamin C to all meals
35.The term “leukopenia” is the medical term for which of the following?
A. Easy bleeding and bruising
B. Too few platelets
C. Too few red blood cells
D. Too few white blood cells
Rationale: D. The term “leukopenia” is the medical term for too few
white blood cells. Choice A is incorrect. Choice B: Easy bleeding and
bruising are caused by “thrombocytopenia,” the medical term for too
few platelets. Choice C: The medical term for too few red blood cells is
“anemia.”
36.A client was admitted with iron deficiency anemia and blood-streaked emesis.
Which question is most appropriate for the nurse to ask in determining the
extent of the client's activity intolerance?
A. "What activities were you able to do 6 months ago compared with the
present?"
B. "How long have you had this problem?"
C. "Have you been able to keep up with all your usual activities?"
D. "Are you more tired now than you used to be?"
RATIONALE: A. It is difficult to determine activity intolerance without
objectively comparing activities from one time frame to another. Because
iron deficiency anemia can occur gradually and individual endurance
varies, the nurse can best assess the client's activity tolerance by asking
the client to compare activities 6 months ago and at the present. Asking a
client how long a problem has existed is a very open-ended question that
allows for too much subjectivity for any definition of the client's activity
tolerance. Also, the client may not even identify that a "problem" exists.
Asking the client whether he is staying abreast of usual activities
addresses whether the tasks were completed, not the tolerance of the
client while the tasks were being completed or the resulting condition of
the client after the tasks were completed. Asking the client if he is more
tired now than usual does not address his activity tolerance. Tiredness is
a subjective evaluation and again can be distorted by factors such as the
gradual onset of the anemia or the endurance of the individual.
37.Anemia is a condition in which the number of red blood cells or the amount of
hemoglobin (the protein that carries oxygen in red blood cells) is low. Which
of the following is NOT one of the mechanisms that can lead to anemia?
A. Blood loss (excessive bleeding)
B. Excessive destruction of red blood cells
C. Inadequate production of red blood cells
D. Inadequate production of white blood cells
38.A nurse is reviewing complete blood count (CBC) data for a 76-year-old
client. Which decreased value causes concern because it is not age related?
A. Hemoglobin (Hgb) level
B. Platelet (thrombocyte) count
C. Red blood cell (RBC) count
D. White blood cell (WBC) response
Rationale: A. Even when anemia is mild, older people are more likely
than younger people to develop confusion, agitation, depression,
and/or listlessness. B, C, and D: These symptoms occur with similar
frequency in younger and older people with anemia.
40.Which of the following causes of long-term blood loss may NOT cause
noticeable symptoms?
A. Bleeding from the kidneys.
B. Heavy menstrual bleeding.
C. Intestinal polyps.
D. Ruptured blood vessel.
41.Bone marrow samples are usually taken from which part of the body?
A. Arm bone
B. Breastbone
C. Hipbone
D. Leg bone
Rationale: c. Bone marrow samples are usually taken from the hipbone
(iliac crest), although aspirates are rarely taken from the breastbone
(sternum—choice B). D: In very young children, bone marrow samples
are occasionally taken from one of the bones in the lower leg (tibia).
42.A nurse is teaching a client about what to expect during a bone marrow
biopsy. Which statement by the nurse accurately describes the procedure?
A. "The doctor will place a small needle in your back and will withdraw
some fluid."
B. "You may experience a crunching sound or a scraping sensation as the
needle punctures your bone."
C. "You will be alone because the procedure is a sterile one; we cannot
allow additional people to contaminate the area."
D. "You will be sedated, so you will not be aware of anything."
Rationale: B. This description is accurate. Proper expectations
minimize the client's fear during the procedure. A very large-bore
needle is used for a bone marrow biopsy, not a small needle. The
puncture is made in the hip or in the sternum, not the back. The
nurse, or sometimes a family member, is available to the client for
support during a bone marrow biopsy. The procedure is sterile at the
site of the biopsy, but others can be present without contamination at
the site. A local anesthetic agent is injected into the skin around the
site. The client may also receive a mild tranquilizer or a rapid-acting
sedative (such as lorazepam [Ativan]) but will not be completely
sedated. Clients are aware of what is happening during the procedure.
43.Aplastic anemia is a disorder in which the bone marrow cells that develop
into mature blood cells become damaged. The damaged bone marrow cells
can lead to low numbers of red blood cells, white blood cells, and/or
platelets. When the cause of aplastic anemia cannot be diagnosed, the cause
is likely which of the following?
A. An autoimmune disorder
B. Chemotherapy drugs
C. Radiation exposure
D. Toxins
44.When a client is diagnosed with aplastic anemia, the nurse monitors for
changes in which of the following physiological functions?
A. Bleeding tendencies
B. Intake and output
C. Peripheral sensation
D. Bowel function
45.The primary purpose of the Schilling test is to measure the client's ability to:
A. Store vitamin B12
B. Digest vitamin B12
C. Absorb vitamin B12
D. Produce vitamin B12
46.The nurse implements which of the following for the client who is starting a
Schilling test?
A. Administering methylcellulose (Citrucel)
B. Starting a 24- to 48 hour urine specimen collection
C. Maintaining NPO status
D. Starting a 72 hour stool specimen collection
47.A client with anemia asks, "Why am I feeling tired all the time?" How does
the nurse respond?
A. "How many hours are you sleeping at night?"
B. "You are not getting enough iron."
C. "You need to rest more when you are sick."
D. "Your cells are delivering less oxygen than you need."
48.A client has a bone marrow biopsy done. Which nursing intervention is the
priority post procedure?
A. Applying pressure to the biopsy site
B. Inspecting the site for ecchymoses
C. Sending the biopsy specimens to the laboratory
D. Teaching the client about avoiding vigorous activity
50.A client with anemia asks the nurse, "Do most people have the same number
of red blood cells?" How does the nurse respond?
A. "No, they don't."
B. "The number varies with gender, age, and general health."
C. "Yes, they do."
D. "You have fewer red blood cells because you have anemia."'