Med Surg Exam 3 - Practice Questions
and answers
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. - verified answer 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. - verified answer 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. - verified answer 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. - verified answer 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). - verified answer 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. - verified answer
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. - verified answer d
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