CLIENT WITH ANEMIA

1.

Which of the following blood components is decreased in anemia?

A. Erythrocytes
B. Granulocytes
C. Leukocytes
D. Platelets

2.

Which of the following symptoms is expected with hemoglobin of 10 g/dl?

A. Shortness of breath
B. Palpitations
C. Pallor
D. None

3.

A client with anemia may be tired due to a tissue deficiency of which of the following substances?
A. Factor VIII
B. Oxygen
C. Carbon dioxide
D. T-cell antibodies

4.

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 clients activity intolerance?
A. Have you been able to keep up with all your usual activities?
B. What activities were you able to do 6 months ago compared with the present?
C. Are you more tired now than you used to be?
D. How long have you had this problem?

5.

The nurse is assessing a clients activity intolerance by having the client walk on a treadmill for 5 minutes. Which of the following
indicates an abnormal response?
A. Pulse rate within 6 bpm of resting phase after 3 minutes of rest.
B. Respiratory rate decreased by 5 breaths/minute
C. Diastolic blood pressure increased by 7 mm Hg
D. Pulse rate increased by 20 bpm immediately after the activity

6.

A client is to receive epoetin (Epogen) injections. What laboratory value should the nurse assess before giving the injection?
A. Hemoglobin concentration
B. Partial thromboplastin time
C. Prothrombin time
D. Hematocrit

7.

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 vitamin C to all meals
B. Adds dried fruit to cereal and baked goods
C. Cooks tomato-based foods in iron pots
D. Drinks coffee or tea with meals

CLIENT WITH IRON DEFICIENCY ANEMIA

8.

Laboratory studies are performed for a child suspected of having iron deficiency anemia. The nurse reviews the laboratory results,
knowing that which of the following results would indicate this type of anemia?
A. An elevated hemoglobin level
B. An elevated RBC count
C. Abnormally high reticulocyte count
D. Red blood cells that are microcytic and hypochromic

9.

A mother asks the nurse if her childs iron deficiency anemia is related to the childs 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-deficient anemia are equally as susceptible to infection as are other children.
C. Children with iron-deficiency anemia are less susceptible to infection than are other children
D. Children with iron deficiency anemia are more susceptible to infection than are other children

10. A client with iron deficiency anemia is scheduled for discharge. Which instruction about prescribed ferrous gluconate therapy
should the nurse include in the teaching plan?
A. Take the medication with an antacid.
B. Take the medication with cereal.
C. Take the medication on an empty stomach.
D. Take the medication with a glass of milk.
11. client with microcytic anemia is having trouble selecting food items from the hospital menu. Which food is best for the nurse to
suggest for satisfying the clients nutritional needs and personal preferences?
A. Vegetables
B. Egg yolks
C. Tea
D. Brown rice
12. The nurse is preparing to teach a client with microcytic hypochromic anemia about the diet to follow after discharge. Which of the
following foods should be included in the diet?
A. Lettuce
B. Citrus fruits
C. Cheese
D. Eggs

CLIENT WITH MEGALOBLASTIC ANEMIA

13. The nurse would instruct the client to eat which of the following foods to obtain the best supply of vitamin B12?
A. Whole grains
B. Broccoli and Brussels sprouts
C. Green leafy vegetables
D. Meats and dairy products
14. The primary purpose of the Schilling test is to measure the clients ability to:
A. Produce vitamin B12
B. Digest vitamin B12
C. Absorb vitamin B12
D. Store vitamin B12
15. The nurse implements which of the following for the client who is starting a Schilling test?
A. Starting a 72 hour stool specimen collection
B. Maintaining NPO status
C. Administering methylcellulose (Citrucel)
D. Starting a 24- to 48 hour urine specimen collection
16. The nurse understands that the client with pernicious anemia will have which distinguishing laboratory findings?
A. RBCs 5.0 million
B. Intrinsic factor, absent
C. Sedimentation rate, 16 mm/hour
D. Schillings test, elevated
17. A client with macrocytic anemia has a burn on her foot and states that she had been watching television while lying on a heating
pad. What is the nurses first response?
A. Assess for potential abuse
B. Clean and dress the area
C. Document the findings
D. Check for diminished sensations
18. The nurse has just admitted a 35-year-old female client who has a serum B12 concentration of 800 pg/ml. Which of the following
laboratory findings would cue the nurse to focus the client history on specific drug or alcohol abuse?
A. Hemoglobin, 16 g/dL
B. Serum creatinine, 0.5 mg/dL
C. Total bilirubin, 0.3 mg/dL
D. Folate, 1.5 ng/mL
19. A client comes into the health clinic 3 years after undergoing a resection of the terminal ileum complaining of weakness, shortness
of breath, and a sore tongue. Which client statement indicates a need for intervention and client teaching?
A. I have been gargling with warm salt water for my sore tongue.
B. I have been drinking plenty of fluids.
C. I have 3 to 4 loose stools per day.
D. I take a vitamin B12 tablet every day.
20. A client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. What is the nurses best
response?
A. The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient
intrinsic factor.
B. The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient
acid.
C. The reason for your vitamin deficiency is an excessive excretion of the vitamin because of kidney dysfunction.
D. The reason for your vitamin deficiency is an increased requirement for the vitamin because of rapid red blood cell
production.
21. A client states that she is afraid of receiving vitamin B12 injections because of the potential toxic reactions. What is the nurses best
response to relieve these fears?
A. Vitamin B12 may cause a very mild skin rash initially.
B. Vitamin B12 will cause ringing in the eats before a toxic level is reached.
C. Vitamin B12 may cause mild nausea but nothing toxic.
D. Vitamin B12 is generally free of toxicity because it is water soluble.

CLIENT WITH APLASTIC ANEMIA

22. Which of the following diagnostic findings are most likely for a client with aplastic anemia?
A. Increased levels of WBCs, RBCs, and platelets
B. Reed-Sternberg cells and lymph node enlargement
C. Decreased levels of white blood cells, red blood cells, and platelets
D. Decreased production of T-helper cells
23. 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. Bowel function
D. Peripheral sensation
24. 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. Get 8 hours of sleep at night and take naps during the day
B. Eat animal protein and dark leafy vegetables each day

C.
D.

Practice yoga and meditation to decrease stress and anxiety

Avoid exposure to others with acute infection

CLIENT WITH POLYCYTHEMIA VERA

25. The nurse is teaching a client with polycythemia vera about potential complications from this disease. Which manifestations would
the nurse include in the clients teaching plan? Select all that apply.
I.
Weight loss
II.
Hearing loss
III.
Headache
IV.
Visual disturbance
V.
Orthopnea
VI.
Gout
A. All are correct
B. All except I and II
C. III, IV, and V
D. III and IV only
26. Which of the following nursing assessments is a late symptom of polycythemia vera?
A. Headache
B. Shortness of breath
C. Pruritus
D. Dizziness
27. When comparing the hematocrit levels of a post-op client, the nurse notes that the hematocrit decreased from 36% to 34% on the
third day even though the RBC and hemoglobin values remained stable at 4.5 million and 11.9 g/dL, respectively. Which nursing
intervention is most appropriate?
A. Call the physician
B. Start oxygen at 2L/min per NC
C. Check the dressing and drains for frank bleeding
D. Continue to monitor vital signs
28. Because of the risks associated with administration of factor VIII concentrate, the nurse would teach the clients family to recognize
and report which of the following?
A. Yellowing of the skin
B. Constipation
C. Puffiness around the eyes
D. Abdominal distention
29. Which of the following disorders results from a deficiency of factor VIII?
A. Christmas disease
B. Sickle cell disease
C. Hemophilia A
D. Hemophilia B

CLIENT WITH SICKLE CELL ANEMIA

30. The mother asks the nurse why her childs hemoglobin was normal at birth but now the child has S hemoglobin. Which of the
following responses by the nurse is most appropriate?
A. The red bone marrow does not begin to produce hemoglobin S until several months after birth.
B. The placenta bars passage of the hemoglobin S from the mother to the fetus.
C. Antibodies transmitted from you to the fetus provide the newborn with temporary immunity.
D. The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth.
31. A 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. Fluid overload
B. Trauma
C. Stress
D. Infection
32. The nurse explains to the parents of a 1-year-old child admitted to the hospital in a sickle cell crisis that the local tissue damage the
child has on admission is caused by which of the following?
A. Autoimmune reaction complicated by hypoxia
B. Obstruction to circulation
C. Lack of oxygen in the red blood cells
D. Elevated serum bilirubin concentration.
33. Which of the following would the nurse identify as the priority nursing diagnosis during a toddlers vaso-occlusive sickle cell crisis?
A. Ineffective coping related to the presence of a life-threatening disease
B. Excess fluid volume related to infection
C. Pain related to tissue anoxiaxx
D. Decreased cardiac output related to abnormal hemoglobin formation
34. A child suspected of having sickle cell disease is seen in a clinic, and laboratory studies are performed. A nurse checks the lab
results, knowing that which of the following would be increased in this disease?
A. Reticulocyte count
B. Platelet count
C. Hematocrit level
D. Hemoglobin level