1.

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. Eggs
B. Lettuce
C. Citrus fruits
D. Cheese

2. 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. Green leafy vegetables
C. Meats and dairy products
D. Broccoli and Brussels sprouts

3. 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. Total bilirubin, 0.3 mg/dL

B. Serum creatinine, 0.5 mg/dL
C. Hemoglobin, 16 g/dL
D. Folate, 1.5 ng/mL

4. 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
5. 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

6. 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 drinking plenty of fluids.”

B. “I have been gargling with warm salt water for my sore tongue.”
C. “I have 3 to 4 loose stools per day.”
D. “I take a vitamin B12 tablet every day.”

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 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

8. 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 to 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?”

9. 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

10. 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

11. A client with pernicious anemia asks why she must take vitamin B12 injections for
the rest of her life. What is the nurse’s best response?

A. “The reason for your vitamin deficiency is an inability to absorb the vitamin because
the stomach is not producing sufficient acid.”
B. “The reason for your vitamin deficiency is an inability to absorb the vitamin because
the stomach is not producing sufficient intrinsic factor.”
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.”

12. The nurse is assessing a client’s activity intolerance by having the client walk on a
treadmill for 5 minutes. Which of the following indicates an abnormal response?

A. Pulse rate increased by 20 bpm immediately after the activity

B. Respiratory rate decreased by 5 breaths/minute
C. Diastolic blood pressure increased by 7 mm Hg
D. Pulse rate within 6 bpm of resting phase after 3 minutes of rest.

13. 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. Check the dressing and drains for frank bleeding

B. Call the physician
C. Continue to monitor vital signs
D. Start oxygen at 2L/min per NC

14. A client is to receive epoetin (Epogen) injections. What laboratory value should the
nurse assess before giving the injection?

A. Hematocrit
B. Partial thromboplastin time
C. Hemoglobin concentration
D. Prothrombin time

15. A client states that she is afraid of receiving vitamin B12 injections because of the
potential toxic reactions. What is the nurse’s best response to relieve these fears?

A. “Vitamin B12 will cause ringing in the eats before a toxic level is reached.”
B. “Vitamin B12 may cause a very mild skin rash initially.”
C. “Vitamin B12 may cause mild nausea but nothing toxic.”
D. “Vitamin B12 is generally free of toxicity because it is water soluble.”

16. A 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 client’s
nutritional needs and personal preferences?

A. Egg yolks
B. Brown rice
C. Vegetables
D. Tea

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 nurse’s first
response?

A. Assess for potential abuse

B. Check for diminished sensations
C. Document the findings
D. Clean and dress the area

18. Which of the following nursing assessments is a late symptom of polycythemia

vera?
A. Headache
B. Dizziness
C. Pruritus
D. Shortness of breath

19. The nurse is teaching a client with polycythemia vera about potential
complications from this disease. Which manifestations would the nurse include in the
client’s teaching plan? Select all that apply.

A. Hearing loss
B. Visual disturbance
C. Headache
D. Orthopnea
E. Gout
F. Weight loss

20. 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

21. Which of the following blood components is decreased in anemia?

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

22. A client with anemia may be tired due to a tissue deficiency of which of the
following substances?

A. Carbon dioxide
B. Factor VIII
C. Oxygen
D. T-cell antibodies
23. Which of the following cells is the precursor to the red blood cell (RBC)?

A. B cell
B. Macrophage
C. Stem cell
D. T cell

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

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

25. Which of the following diagnostic findings are most likely for a client with aplastic
anemia?

A. Decreased production of T-helper cells

B. Decreased levels of white blood cells, red blood cells, and platelets
C. Increased levels of WBCs, RBCs, and platelets
D. Reed-Sternberg cells and lymph node enlargement

26. 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 a glass of milk.”
C. “Take the medication with cereal.”
D. “Take the medication on an empty stomach.”

27. Which of the following disorders results from a deficiency of factor VIII?

A. Sickle cell disease

B. Christmas disease
C. Hemophilia A
D. Hemophilia B
28. 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. Lack of oxygen in the red blood cells
C. Obstruction to circulation
D. Elevated serum bilirubin concentration.

29. The mothers asks the nurse why her child’s 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 placenta bars passage of the hemoglobin S from the mother to the fetus.”
B. “The red bone marrow does not begin to produce hemoglobin S until several months after
birth.”
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.”

30. Which of the following would the nurse identify as the priority nursing
diagnosis during a toddler’s vaso-occlusive sickle cell crisis?

A. Ineffective coping related to the presence of a life-threatening disease

B. Decreased cardiac output related to abnormal hemoglobin formation
C. Pain related to tissue anoxia
D. Excess fluid volume related to infection

31. 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.
32. Which statements by the mother of a toddler would lead the nurse to suspect that
the child has iron-deficiency anemia? Select all that apply.

A. “He drinks over 3 cups of milk per day.”

B. “I can’t keep enough apple juice in the house; he must drink over 10 ounces per day.”
C. “He refuses to eat more than 2 different kinds of vegetables.”
D. “He doesn’t like meat, but he will eat small amounts of it.”
5. “He sleeps 12 hours every night and take a 2-hour nap.”

33. Which of the following foods would the nurse encourage the mother to offer to her
child with iron deficiency anemia?

A. Rice cereal, whole milk, and yellow vegetables

B. Potato, peas, and chicken
C. Macaroni, cheese, and ham
D. Pudding, green vegetables, and rice

34. The physician has ordered several laboratory tests to help diagnose an infant’s
bleeding disorder. Which of the following tests, if abnormal, would the nurse interpret
as most likely to indicate hemophilia?

A. Bleeding time
B. Tourniquet test
C. Clot retraction test
D. Partial thromboplastin time (PTT)

35. Which of the following assessments in a child with hemophilia would lead the
nurse to suspect early hemarthrosis?

A. Child’s reluctance to move a body part

B. Cool, pale, clammy extremity
C. Ecchymosis formation around a joint
D. Instability of a long bone in passive movement

36. Because of the risks associated with administration of factor VIII concentrate, the
nurse would teach the client’s family to recognize and report which of the following?

A. Yellowing of the skin

B. Constipation
C. Abdominal distention
D. Puffiness around the eyes

37. 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. Platelet count
B. Hematocrit level
C. Reticulocyte count
D. Hemoglobin level

38. 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. Infection
B. Trauma
C. Fluid overload
D. Stress

39. 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. A decreased reticulocyte count
C. An elevated RBC count
D. Red blood cells that are microcytic and hypochromic

40. A pediatric nurse health educator provides a teaching session to the nursing staff
regarding hemophilia. Which of the following information regarding this disorder would
the nurse plan to include in the discussion?

A. Hemophilia is a Y linked hereditary disorder

B. Males inherit hemophilia from their fathers
C. Females inherit hemophilia from their mothers
D. Hemophilia A results from a deficiency of factor VIII
41. Which statement about how sickle cell anemia is passed to offspring is CORRECT?
A. This disease is an x-linked recessive disease.
B. Sickle cell anemia is an autosomal dominant disease.
C. This condition is an autosomal recessive disease.
D. Sickle cell anemia is rarely passed to offspring and is an autosomal x-linked dominant
disease.

42. Which type of hemoglobin is present in a patient who has sickle cell anemia?
A. Hemoglobin AA
B. Hemoglobin AS
C. Hemoglobin SS
C. Hemoglobin AC

43. Which type of hemoglobin is present in a patient who has sickle cell TRAIT?
A. Hemoglobin AA
B. Hemoglobin AS
C. Hemoglobin SS
D. Hemoglobin AC

44. A 25 year-old pregnant female and her partner both have sickle cell trait. What is the
percentage that their offspring will develop sickle cell anemia?
A. 50%
B. 25%
C. 75%
D. 100%

45. You're assisting a physician with sickle cell anemia screening. As the nurse you
know that which patient population listed below is at risk for sickle cell disease?
A. Native Americans
B. African-Americans
C. Pacific Islanders
D. Latino

46. A 14 year-old female has sickle cell anemia. Which factors below can increase the
patient’s risk for developing sickle cell crisis? Select all that apply:
A. Shellfish
B. Infection
C. Dehydration
D. Hypoxia
E. Low altitudes
F. Hemorrhage
G. Strenuous exercise

47. A 6 year-old is admitted with sickle cell crisis. The patient has a FACE scale rating of
10 and the following vital signs: HR 115, BP 120/82, RR 18, oxygen saturation 91%,
temperature 101.4'F. Select all the appropriate nursing interventions for this patient at
this time?
A. Administer IV Morphine per MD order
B. Administer oxygen per MD order
C. Keep NPO
D. Apply cold compresses
E. Start intravenous fluids per MD order
F. Administer iron supplement per MD order
G. Keep patient on bed rest
H. Remove restrictive clothing or objects from the patient

48. A patient is being tested for sickle cell disease. As the nurse, you know the
________ will assess for abnormal hemoglobin on the red blood cell, but will not
differentiate between sickle cell disease and sickle cell trait. Therefore, the patient will
need to have what other test to determine this?
A. dithionite test; hemoglobin electrophoresis
B. hemoglobin electrophoresis; sickledex
C. edrophonium test, dithionite test
D. sickledex; edrophonium test

49. During an outpatient well visit with a patient who has sickle cell anemia, you make it
PRIORITY to assess the patient's?
A. hemoglobin A1C level
B. heart rate
C. reflexes
D. vaccination history

50. An 18 year-old male is taking Hydroxyurea for treatment of sickle cell anemia. Which
options below indicate this medication is working successfully? Select all that apply:
A. The patient needs fewer blood transfusions.
B. The patient experiences diuresis.
C. The patient experiences an increase in fetal hemoglobin (Hbg F).
D. The patient experiences a decrease in hemoglobin S.
51. You're providing education to a patient with sickle cell anemia who is taking
Hydroxyurea. You will make it priority to tell the patient to?
A. Consume foods high in calcium and potassium
B. Avoid sick people and maintain strict hand hygiene
C. Take this medication with at least 8 oz of water
D. Monitor your blood glucose level daily

42. A mother brings in her 8 month-old child to the ER. The mother reports the baby has
recently started being extremely fussy, has a fever, and swelling in the hands and feet.
The child is diagnosed with sickle cell disease. As the nurse you know that the swelling
in the hands and feet in the infant is termed?
A. Dactylitis
B. Erythromelaglia
C. Dyshidrotia
D. Phalitis

43. You’re providing seminar teaching to a group of nurses about sickle cell anemia.
Which of the following is NOT a treatment for this condition?
A. Blood transfusion
B. Stem cell transplant
C. Intravenous fluids
D. Iron supplements
E. Antibiotics
F. Morphine

44. You're educating the parents of a 12 year-old, who was recently treated for sickle
cell crisis, on ways to prevent further sickle cell crises in the further. Which statement
by the parents demonstrates they understood your instructions?
A. "We will limit fluid intake during the day to 1-2 L a day."
B. "Cold showers are best to help with pain associated with sickling."
C. "We will avoid traveling to high altitude locations."
D. "It is important we refuse all future vaccinations unless absolutely necessary."

45. You're providing discharge teaching to a patient about pernicious anemia. Which
statement by the patient indicates they did NOT understand the discharge teaching?
A. "Pernicious anemia is caused by not consuming enough Vitamin B12."
B. "Pernicious anemia causes the red blood cells to appear very large and oval."
C. "Treatment for pernicious anemia includes a series of intramuscular injections of Vitamin
B12."
D. "A red, smooth tongue can be a sign of pernicious anemia."
46. In pernicious anemia, intrinsic factor is not being secreted by the _______ cells
which are found in the gastric mucosa.
A. Visceral
B. Langerhan
C. Parietal
D. Chief

47. Select the patient below who is at MOST risk for pernicious anemia:
A. A 75 year old male who recently had surgery on the ileum.
B. A 25 year old female who reports craving ice and clay.
C. A 66 year old male whose peripheral blood smear showed hypochromic red blood cells.
D. All the patients above are at risk for pernicious anemia.

48. A doctor suspects pernicious anemia in a patient presenting with a beefy red tongue.
The patient reports feeling extremely fatigued and numbness and tingling in the hands.
The doctor orders a peripheral blood smear. From your nursing knowledge, how will the
red blood cells appear in the peripheral blood smear if pernicious anemia is present?
A. Round-shaped and hypochromic
B. Oval-shaped and hyperchromic
C. Large and oval-shaped
D. Small and hyperchromic

49. Select ALL the signs and symptoms that can present in pernicious anemia:
A. Erythema
B. Paresthesia of hands and feet
C. Racing thoughts
D. Extreme hunger
E. Depression
F. Unsteady gait
G. Shortness of breath with activity

50. A patient with pernicious anemia is ordered to receive supplementary Vitamin B12.
What is the best route to administer this medication for patients with this disorder?
A. Intravenous
B. Orally
C. Through a central line
D. Intramuscular
51. True or False: Intrinsic factor is a protein that plays a role in how the body absorbs
Vitamin B12.
True
False

52. A patient with severe pernicious anemia is being discharged home and requires
routine injections of Vitamin B12. Which statement by the patient demonstrates they
understood your instructions about their treatment regime?
A. "I will require one injection every 6 months until my Vitamin B12 levels are therapeutic and
then I'm done."
B. "Initially, I will need weekly injections of Vitamin B12 and then monthly injections for
maintenance, which will be a lifelong regime."
C. "I will only need vitamin B12 injections for a month and then I can take a low dose of oral
vitamin B12."
D. "When I start to feel weak and short of breath I need to call the doctor so I can schedule an
appointment for a Vitamin B12 injection."

53. True or False: The least common type of anemia is iron-deficiency anemia.
True
False

54. Select all the patients who are at MOST risk for iron-deficiency anemia:
A. A 55 year old male who reports taking Ferrous Sulfate regularly.
B. A 25 year old female who was recently diagnosed with Celiac Disease.
C. A 35 year old female who is 36 weeks pregnant that reports craving ice.
D. A 67 year old female with a Hemoglobin level of 14.

55. A patient, with a history of gastric bypass surgery 6 months ago, reports feeling
very fatigued and is having food cravings for clay and dirt. On assessment, you note
the patient has nail changes that look "spoon-shaped". This spoon-shaped appearance
of the nails is called?
A. Terry's Nails
B. Onychoschizia
C. Koilonychias
D. Leukonychia

56. The physician orders a patient with suspected iron-deficiency anemia a blood smear
test to assess the quality of the red blood cells. How would the red blood cells appear if
the patient had iron- deficiency anemia?
A. Hyperchromic and macrocytic
B. Hypochromic and microcytic
C. Hyperchromic and macrocytic
D. Hypochromic and macrocytic

57. You're providing education to a patient about how to take their prescribed iron
supplement. Which statement by the patient requires you to re-educate the patient on
how to take this supplement?
A. "I will take this medication on an empty stomach."
B. "I will avoid taking this medication with orange juice."
C. "I will wait and take my calcium supplements 2 hours after I take my iron supplement."
D. "This medication can cause constipation. So, I will drink plenty of fluids and take a stool
softer as needed."

58. A patient is admitted with iron- deficiency anemia and has been receiving iron
supplementation. The patient voices concern about how their stool is dark black. As the
nurse, you would?
A. Notify the doctor
B. Hold the next dose of iron
C. Reassure the patient this is a normal side effect of iron supplementation
D. None of the options are correct

59. You are providing diet teaching to a patient with low iron levels. Which foods would
you encourage the patient to eat regularly?
A. Herbal tea, apples, and watermelon
B. Sweet potatoes, artichokes, and packaged meat
C. Egg yolks, beef, and legumes
D. Chocolate, cornbread, and cabbage

60. True or False: The body uses hemoglobin to make iron.

True
False

61. True or False: High levels of iron lead to the body producing fewer red blood cells.
True
False

62. True or False: Early signs and symptoms of iron-deficiency anemia are vague.
True
False
In a severely anemic patient, you expect to find
A. dyspnea and tachycardia.
B. cyanosis and pulmonary edema.
C. cardiomegaly and pulmonary fibrosis.
D. ventricular dysrhythmias and wheezing.
A. dyspnea and tachycardia.

When obtaining assessment data from a patient with a microcytic, hypochromic anemia,
you 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.
B. dietary intake of iron.

When caring for a patient with metastatic cancer, you note a hemoglobin level of 8.7
g/dL and hematocrit of 26%. You place highest priority on initiating interventions that
can reduce
A. thirst.
B. fatigue.
C. headache.
D. abdominal pain.
B. fatigue.

You are caring for a patient with a diagnosis of iron-deficiency anemia. Which clinical
manifestations are you most likely to observe when assessing this patient?
A. Convex nails, bright red gums, and alopecia
B. Brittle nails; smooth, shiny tongue; and cheilosis
C. Tenting of the skin, sunken eyes, and complaints of diarrhea
D. Pale pink tongue; dull, brittle hair; and blue mucous membranes

When providing teaching for the patient with iron-deficiency anemia who has been
prescribed iron supplements, you should include taking the iron with which beverage?
A. Milk
B. Ginger ale
C. Orange juice
D. Water
The primary pathophysiology underlying thalassemia is
A. erythropoietin deficiency.
B. abnormal hemoglobin synthesis.
C. autoimmunity.
D. S-shaped hemoglobin.
B. abnormal hemoglobin synthesis.

You anticipate the onset of manifestations related to thalessemia to occur by

A. 6 months of age.
B. age 1 year.
C. age 2 year.
D. adolescence.

Which individual is at high risk for a cobalamin (vitamin B12) deficiency anemia?
A. A 47-year-old man who had a gastrectomy (removal of the stomach)
B. A 54-year-old man with a history of irritable bowel disease and ulcerative colitis
C. A 26-year-old woman who complains of heavy menstrual periods
D. A 15-year-old girl who is a vegetarian

You encourage the patient with cobalamin deficiency to seek treatment because
untreated pernicious anemia may result in
A. death.
B. liver failure.
C. heart failure.
D. gastrectomy.

The Schilling test for pernicious anemia involves

A. administration of radioactive cobalamin and measuring its excretion in the urine.
B. blood cultures for organism identification.
C. the measurement of serum iron.
D. the administration of iron and blood assessment of total iron binding in 24 hours.

Which finding allows you to identify the patient's anemia as folic acid deficiency rather
than cobalamin deficiency?
A. Loss of appetite
B. Lack of neuromuscular symptoms
C. Red tongue
D. Change in nail shape
B. Lack of neuromuscular symptoms
Which foods should you encourage patients with folic acid deficiency to include in their
daily food intake (select all that apply)?
A. Ready-to-eat cereal
B. Wheat tortillas
C. Lentils
D. Strawberries
E. Potatoes

Nursing interventions for a patient with severe anemia related to peptic ulcer disease
include (select all that apply)
A. monitoring stools for guaiac.
B. instructions about a high-iron diet.
C. taking vital signs every 8 hours.
D. teaching self-injection of erythropoietin.

You correctly identify which descriptions as characteristic of anemia of chronic disease

(select all that apply)
A. normocytic.
B. normochromic.
C. microcytic.
D. hypochromic.
E. proliferative.

You are evaluating the laboratory data of the patient with suspected aplastic anemia.
Which findings support this diagnosis?
A. Reduced RBCs, reduced white blood cells (WBCs), and reduced platelets
B. Reduced RBCs, normal WBCs, and normal platelets
C. Normal RBCs, reduced WBCs, and reduced platelets
D. Elevated RBCs, increased WBCs, and increased platelets

The care plan for a patient with aplastic anemia should include activities to minimize the
risk for which complications?
A. Dyspnea and pain
B. Diarrhea and fatigue
C. Nausea and malnutrition
D. Infection and hemorrhage

Which findings do you expect to find for a patient with acute loss of blood?
A. Weakness, lethargy, and warm, dry skin
B. Restlessness, hyperthermia, and bradycardia
C. Tachycardia, hypotension, and cool, clammy skin
D. Widened pulse pressure, anxiety, and hypoventilation

The nursing student asks the clinical instructor to explain why clinical symptoms are
more important than laboratory values when the patient has experienced blood loss.
The instructor correctly recognizes that
A. nurses should focus on clinical symptoms because those are the parameters of nursing
practice.
B. blood values are often normal or even high because fluid shifts have not occurred
and laboratory values are falsely high.
C. laboratory values are used to supplement nursing assessments.
D. laboratory findings are often falsely low in the early period of blood loss.

The nursing management of a patient in sickle cell crisis includes (select all that apply)
A. monitoring of the complete blood cell (CBC) count.
B. blood transfusions if required and iron chelation.
C. optimal pain management and oxygen therapy.
D. rest as needed and deep vein thrombosis prophylaxis.
All answers are correct!!!!

Which patient is most likely to experience anemia caused by increased destruction of

RBCs?
A. An African American man who has a diagnosis of sickle cell disease
B. A 59-year-old man whose alcoholism has precipitated folic acid deficiency
C. A 30-year-old woman with a history of "heavy periods" accompanied by anemia
D. A 3-year-old child whose impaired growth and development is attributable to thalassemia

Which points should be included in teaching the patient with sickle cell disease (select
all that apply)?
A. Avoid dehydration.
B. Avoid high altitudes.
C. Take cobalamin (vitamin B12) regularly.
D. Consume dairy products frequently.
E. Increase consumption of grapefruit juice.

In addition to altered red blood cells (RBCs), which laboratory finding does the nurse
expect for the patient with sickle cell disease?
A. Leukocytosis
B. Hypouricemia
C. Hyperbilirubinemia
D. Hypercholesteremia
C. Hyperbilirubinemia

Which sign or symptom would you recognize as a unique characteristic specific to

hemolytic anemia?
A. Tachycardia
B. Weakness
C. Decreased RBCs
D. Jaundice

Which organ is at greatest risk due to the effects of hemolytic anemia?

A. Heart
B. Spleen
C. Kidney
D. Liver
C. Kidney

You anticipate the patient with hemochromatosis to be from which ethnic group?
A. African American
B. Hispanic American
C. White European
D. Chinese

You expect which laboratory finding to be abnormal for a patient with

hemochromatosis?
A. RBCs
B. Platelets
C. Iron ( with hemochromatosis accumulate iron at a rate of 0.5 to 1.0 g each year and
may exceed total iron concentrations of 50 g.)
D. Folic acid

A complication of the hyperviscosity of polycythemia is

A. thrombosis.
B. cardiomyopathy.
C. pulmonary edema.
D. disseminated intravascular coagulation (DIC).

Caring for a patient with a diagnosis of polycythemia vera will likely require you to
A. encourage deep breathing and coughing.
B. assist with or perform phlebotomy at the bedside.
C. teach the patient how to maintain a low-activity lifestyle.
D. perform thorough and regularly scheduled neurologic assessments.

When providing care for a patient with thrombocytopenia, you instruct 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.

Which nursing intervention should you prioritize in the care of a 30-year-old woman
who has a diagnosis of immune thrombocytopenic purpura (ITP)?
A. Administration of packed red blood cells
B. Administration of clotting factors VIII and IX
C. Administration of oral or intravenous corticosteroids
D. Maintenance of reverse isolation and application of standard precautions

Which assessment findings are consistent with thrombocytopenia?

A. Petechiae, ecchymoses
B. Pallor, spider angiomas
C. Cyanosis, dullness
D. Jaundice, purpura

You anticipate that a patient with von Willebrand's disease undergoing surgery will be
treated with administration of von Willebrand factor (vWF) and:
A. thrombin.
B. factor VI.
C. factor VII.
D. factor VIII.
D. factor VIII.

A patient with a diagnosis of hemophilia fell down an escalator earlier in the day and is
now experiencing bleeding in her left knee joint. Your immediate response should
include:
A. immediate transfusion of platelets.
B. resting the patient's knee to prevent hemarthroses.
C. assistance with intracapsular injection of corticosteroids.
D. range-of-motion exercises to prevent thrombus formation.
The patient will receive desmopressin acetate (DDAVP) as a part of the treatment plan
for mild hemophilia A. The nurse knows the drug is used to stimulate blood clotting
factors and expects which outcome?
A. Increased red blood cell count
B. Decreased bleeding time
C. Increased reticulocytes
D. Increased platelets

Disseminated intravascular coagulation (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 and
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.

Your primary goal in the care of the patient with DIC is to

A. provide emotional support.
B. recognize early signs of occult or overt bleeding.
C. monitor nutritional intake.
D. report abnormal laboratory results.

Disseminated intravascular coagulation (DIC) is initiated by intravascular release of

which substance?
A. Platelets
B. Fibrin
C. Thrombin
D. Histamine
C. Thrombin

If the patient with DIC is actively bleeding, platelets are given to correct
thrombocytopenia if the count is less than
A. 150,000/μL.
B. 100,000/μL.
C. 50,000/μL.
D. 30,000/μL.
Priority nursing actions when caring for a hospitalized patient with new-onset
temperature of 102.2° F 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.
ALL answers are correct. !!!!
Early identification of an infective organism is a priority, and samples for cultures should be
obtained from various sites. In the febrile, neutropenic patient, antibiotics should be started
immediately (within 1 hour). Cultures of the nose, throat, sputum, urine, stool, obvious lesions,
and the blood may be indicated. Ongoing febrile episodes or a change in the patient's
assessment (or vital signs) requires a call to the physician to order additional cultures,
diagnostic tests, and antimicrobial therapies.

By definition, neutropenia occurs when the white blood cell (WBC) count drops below?
A. 4000/μL
B. 3000/μL
C. 2000/μL
D. 1000/μL

Because myelodysplastic syndrome (MDS) arises from the pluripotent hematopoietic

stem cells in the bone marrow, expected laboratory results include
A. an excess of T cells.
B. an excess of platelets.
C. an increase in lymphocytes.
D. a deficiency of all cellular blood components.

The most common type of leukemia in older adults is

A. acute myelocytic leukemia.
B. acute lymphocytic leukemia.
C. chronic myelocytic leukemia.
D. chronic lymphocytic leukemia.

Multiple drugs are often used in combinations to treat leukemia and lymphoma because
A. there are fewer toxic side effects.
B. the chance that one drug will be effective is increased.
C. the drugs are more effective without causing side effects.
D. the drugs work by different mechanisms to maximize killing of malignant cells.
A patient with acute myelogenous leukemia will soon start chemotherapy. When you
are teaching the patient about the induction stage of chemotherapy, what is the best
explanation?
A. The drugs are started slowly to minimize side effects.
B. You will develop even greater bone marrow depression with risk for bleeding and infection.
C. It will be necessary to have high-dose treatment every day for several months.
D. During this time you will regain energy and become more resistant to infection.

What would you expect to find in a bone marrow biopsy in the patient with acute
myelogenous leukemia?
A. Multiple myeloblasts
B. Abundant lymphocytes
C. Immature lymphoblasts
D. Insufficient numbers of erythrocytes

Which finding would you recognize as an indicator of chronic myelogenous leukemia

(CML)?
A. Presence of an abnormal LE cell
B. Numerous immature lymphoblasts
C. An elevated white blood cell count
D. Presence of the Philadelphia chromosome

A 25-year-old man who was recently diagnosed with Hodgkin's disease in the pelvic
area is about to begin radiation therapy and he expresses concern about becoming
infertile. What should the patient be told about sexual function?
A. Impotence may occur, but it will only be temporary.
B. Sperm cells will mature, resulting in deformed offspring.
C. Permanent sterility can occur; thus sperm banking should be considered.
D. Changes in secondary sex characteristics, including breast enlargement, may occur with
chemotherapy.

You are aware that a major difference between Hodgkin's lymphoma and non-Hodgkin's
lymphoma is that
A. Hodgkin's lymphoma occurs only in young adults.
B. Hodgkin's lymphoma is considered potentially curable.
C. non-Hodgkin's lymphoma can present in multiple organs.
D. non-Hodgkin's lymphoma is treated only with radiation therapy.

A factor unique to non-Hodgkin's lymphoma is that

A. relapses are unlikely.
B. treatment is limited to chemotherapy.
C. more aggressive tumors respond effectively to treatment.
D. tumors are present only in the lymph glands.

In non-Hodgkin's lymphoma, the involved cell in 90% of cases is the

A. B lymphocyte.
B. T lymphocyte.
C. Reed-Sternberg cell.
D. neutrophil.

A patient with multiple myeloma becomes confused and lethargic. You would expect
that these clinical manifestations may be explained by diagnostic results that indicate
A. hyperkalemia.
B. hyperuricemia.
C. hypercalcemia.
D. CNS myeloma.
C. hypercalcemia.

When reviewing the patient's hematologic laboratory values after a splenectomy, you
would expect to find
A. leukopenia.
B. RBC abnormalities.
C. decreased hemoglobin.
D. increased platelet count.

Complications of transfusions that can be decreased by the use of leukocyte depletion

or reduction for red blood cells are
A. chills and hemolysis.
B. leukostasis and neutrophilia.
C. fluid overload and pulmonary edema.
D. transmission of cytomegalovirus and fever.
D. transmission of cytomegalovirus and fever.

You receive a physician's order to transfuse fresh frozen plasma to a patient suffering
from an acute blood loss. Which procedure is most appropriate for infusing this blood
product?
A. Infuse the fresh frozen plasma as rapidly as the patient will tolerate.
B. Hang the fresh frozen plasma as a piggyback to the primary IV solution.
C. Infuse the fresh frozen plasma as a piggyback to a primary solution of normal saline.
D. Hand the fresh frozen plasma as a piggyback to a new bag of primary IV solution without
KCl.

The nurse is performing an assessment on a client with a diagnosis of pernicious

anemia. Which finding would the nurse expect to note in this client?
a. Dyspnea
b. Dusky mucous membranes
c. Shortness of breath on exertion
d. Red tongue that is smooth and sore
d. Red tongue that is smooth and sore
Classic signs of pernicious anemia include weakness, mild diarrhea, and smooth, sore, red
tongue. The client also may have nervous system signs and symptoms such as paresthesias,
difficulty with balance, and occasional confusion.

The nurse is preparing to perform an assessment on a client being admitted to the

hospital with a diagnosis of sickle cell crisis, vaso-occlusive crisis. Which findings
should the nurse expect to note on assessment of the client? Select all that apply.
a. Pallor
b. Fever
c. Joint swelling
d. Blurred vision
e. Abdominal pain

The nurse is performing an assessment on a client with a diagnosis of anemia that

developed as a result of blood loss after a traumatic injury. The nurse should expect to
note which sign or symptom in the client as a result of the anemia?
a. Bradycardia
b. Muscle cramps
c. Increased respiratory rate
d. Shortness of breath with activity
The nurse is admitting a 24-year-old African American female client with a diagnosis
of rule-out anemia. The client has a history of gastric bypass surgery for obesity four
(4) years ago. Current assessment findings include height 5′5′′; weight 75 kg; P 110,
R 27, and BP 104/66; pale mucous membranes and dyspnea on exertion. Which type
of anemia would the nurse suspect the client has developed?
1. Vitamin B12 deficiency.
2. Folic acid deficiency.
3. Iron deficiency.
4. Sickle cell anemia.

The client diagnosed with menorrhagia complains to the nurse of feeling listless and
tired all the time. Which scientific rationale would explain why these symptoms
occur?
1. The pain associated with the menorrhagia does not allow the client to rest.
2. The client's symptoms are unrelated to the diagnosis of menorrhagia.
3. The client probably has been exposed to a virus that causes chronic fatigue.
4. Menorrhagia has caused the client to have decreased levels of hemoglobin.

The nurse writes a diagnosis of altered tissue perfusion for a client diagnosed with
anemia. Which interventions should be included in the plan of care? Select all that
apply.
1. Monitor the client's hemoglobin and hematocrit.
2. Move the client to a room near the nurse's desk.
3. Limit the client's dietary intake of green vegetables.
4. Assess the client for numbness and tingling.
5. Allow for rest periods during the day for the client.

The client diagnosed with iron-deficiency anemia is prescribed ferrous gluconate

orally. Which should the nurse teach the client?
1. Take Imodium, an antidiarrheal, OTC for diarrhea.
2. Limit exercise for several weeks until a tolerance is achieved.
3. The stools may be very dark, and this can mask blood.
4. Eat only red meats and organ meats for protein.

The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a
medical unit. Which task should the nurse delegate to the UAP?
1. Check on the bowel movements of a client diagnosed with melena.
2. Take the vital signs of a client who received blood the day before.
3. Evaluate the dietary intake of a client who has been noncompliant with eating.
4. Shave the client diagnosed with severe hemolytic anemia.

The client is diagnosed with congestive heart failure and anemia. The HCP ordered
a transfusion of two (2) units of packed red blood cells. The unit has 250 mL of red
blood cells plus 45 mL of additive. At what rate should the nurse set the IV pump to
infuse each unit of packed red blood cells? ____________
74ml/hr

The client is being admitted with folic acid deficiency anemia. Which would be the
most appropriate referral?
1. Alcoholics Anonymous.
2. Leukemia Society of America.
3. A hematologist.
4. A social worker.

The charge nurse is making assignments on a medical floor. Which client should be
assigned to the most experienced nurse?
1. The client diagnosed with iron-deficiency anemia who is prescribed iron
supplements.
2. The client diagnosed with pernicious anemia who is receiving vitamin B12
intramuscularly.
3. The client diagnosed with aplastic anemia who has developed pancytopenia.
4. The client diagnosed with renal disease who has a deficiency of erythropoietin

The client diagnosed with anemia begins to complain of dyspnea when ambulating in
the hall. Which intervention should the nurse implement first?
1. Apply oxygen via nasal cannula.
2. Get a wheelchair for the client.
3. Assess the client's lung fields.
4. Assist the client when ambulating in the hall.

The nurse is transcribing the HCP's order for an iron supplement on the MAR. At which
time should the nurse schedule the daily dose?
1. 0900.
2. 1000.
3. 1200.
4. 1630.
The nurse is discharging a client diagnosed with anemia. Which discharge instruction
should the nurse teach?
1. Take the prescribed iron until it is completely gone.
2. Monitor pulse and blood pressure at a local pharmacy weekly.
3. Have a complete blood count checked at the HCP's office.
4. Perform isometric exercise three (3) times a week.

The nurse writes a client problem of "activity intolerance" for a client diagnosed with
anemia. Which intervention should the nurse implement?
1. Pace activities according to tolerance.
2. Provide supplements high in iron and vitamins.
3. Administer packed red blood cells.
4. Monitor vital signs every four (4) hours.

The charge nurse in the intensive care unit is making client assignments. Which client
should the charge nurse assign to the graduate nurse who has just finished the three
(3)-month orientation?
1. The client with an abdominal peritoneal resection who has a colostomy.
2. The client diagnosed with pneumonia who has acute respiratory distress
syndrome.
3. The client with a head injury developing disseminated intravascular coagulation.
4. The client admitted with a gunshot wound who has an H&H of 7 and 22.

Which client would be most at risk for developing disseminated intravascular

coagulation (DIC)?
1. A 35-year-old pregnant client with placenta previa.
2. A 42-year-old client with a pulmonary embolus.
3. A 60-year-old client receiving hemodialysis 3 days a week.
4. A 78-year-old client diagnosed with septicemia.

The client admitted with full-thickness burns may be developing DIC. Which
signs/symptoms would support the diagnosis of DIC?
1. Oozing blood from the IV catheter site.
2. Sudden onset of chest pain and frothy sputum.
3. Foul-smelling, concentrated urine.
4. A reddened, inflamed central line catheter site.
Which laboratory result would the nurse expect in the client diagnosed with DIC?
1. A decreased prothrombin time (PT).
2. A low fibrinogen level.
3. An increased platelet count.
4. An increased white blood cell count
2. A low fibrinogen level.

Which collaborative treatment would the nurse anticipate for the client diagnosed
with DIC?
1. Administer oral anticoagulants.
2. Prepare for plasmapheresis.
3. Administer frozen plasma.
4. Calculate the intake and output.
3. Administer frozen plasma.

The unlicensed assistive personnel (UAP) asks the primary nurse, "How does
someone get hemophilia A?" Which statement would be the primary nurse's best
response?
1. "It is an inherited X-linked recessive disorder."
2. "There is a deficiency of the clotting factor VIII."
3. "The person is born with hemophilia A."
4. "The mother carries the gene and gives it to the son."

Which sign/symptom should the nurse expect to assess in the client diagnosed with
hemophilia A?
1. Epistaxis.
2. Petechiae.
3. Subcutaneous emphysema.
4. Intermittent claudication.

Which situation might cause the nurse to think that the client has von Willebrand's
disease?
1. The client has had unexplained episodes of hematemesis.
2. The client has microscopic blood in the urine.
3. The client has prolonged bleeding following surgery.
4. The female client developed abruptio placentae

The client with hemophilia A is experiencing hemarthrosis. Which intervention should

the nurse recommend to the client?
1. Alternate aspirin and acetaminophen to help with the pain.
2. Apply cold packs for 24 to 48 hours to the affected area.
3. Perform active range-of-motion exercise on the extremity.
4. Put the affected extremity in the dependent position.
Which sign would the nurse expect to assess in the client diagnosed with idiopathic
thrombocytopenic purpura (ITP)?
1. Petechiae on the anterior chest, arms, and neck.
2. Capillary refill of less than three (3) seconds.
3. An enlarged spleen.
4. Pulse oximeter reading of 95%.

The nurse is caring for the following clients. Which client should the nurse assess first?
1. The client whose partial thromboplastin time (PTT) is 38 seconds.
2. The client whose hemoglobin is 14 g/dL and hematocrit is 45%.
3. The client whose platelet count is 75,000 per cubic millimeter of blood.
4. The client whose red blood cell count is 4.8 × 106/mm3.

Which nursing interventions should the nurse implement when caring for a client
diagnosed with hemophilia A? Select all that apply.
1. Instruct the client to use a razor blade to shave.
2. Avoid administering enemas to the client.
3. Encourage participation in noncontact sports.
4. Teach the client how to apply direct pressure if bleeding occurs.
5. Explain the importance of not flossing the gums

The client has a hematocrit of 22.3% and a hemoglobin of 7.7 g/dL. The HCP has
ordered two (2) units of packed red blood cells to be transfused. Which interventions
should the nurse implement? Select all that apply.
1. Obtain a signed consent.
2. Initiate a 22-gauge IV.
3. Assess the client's lungs.
4. Check for allergies.
5. Hang a keep-open IV of D5W

The client is admitted to the emergency department after a motor-vehicle accident.

The nurse notes profuse bleeding from a right-sided abdominal injury. Which
intervention should the nurse implement first?
1. Type and crossmatch for red blood cells immediately (STAT).
2. Initiate an IV with an 18-gauge needle and hang normal saline.
3. Have the client sign a consent for an exploratory laparotomy.
4. Notify the significant other of the client's admission.
The nurse is working in a blood bank facility procuring units of blood from donors.
Which client would not be a candidate to donate blood?
1. The client who had wisdom teeth removed a week ago.
2. The nursing student who received a measles immunization two (2) months ago.
3. The mother with a six (6)-week-old newborn.
4. The client who developed an allergy to aspirin in childhood.

The client with O+ blood is in need of an emergency transfusion but the laboratory does
not have any O+ blood available. Which potential unit of blood could be given
to the client?
1. The O- unit.
2. The A+ unit.
3. The B+ unit.
4. Any Rh+ unit.

The client is scheduled to have a total hip replacement in two (2) months and has
chosen to prepare for autologous transfusions. Which medication would the nurse
administer to prepare the client?
1. Prednisone, a glucocorticoid.
2. Zithromax, an antibiotic.
3. Ativan, a tranquilizer.
4. Epogen, a biologic response modifier

The client undergoing knee replacement surgery has a "cell saver" apparatus attached
to the knee when he arrives in the post-anesthesia care unit (PACU). Which intervention
should the nurse implement to care for this drainage system?
1. Infuse the drainage into the client when a prescribed amount fills the chamber.
2. Attach an hourly drainage collection bag to the unit and discard the drainage.
3. Replace the unit with a continuous passive motion unit and start it on low.
4. Have another nurse verify the unit number prior to reinfusing the blood.

Which statement is the scientific rationale for infusing a unit of blood in less than
four (4) hours?
1. The blood will coagulate if left out of the refrigerator for >four (4) hours.
2. The blood has the potential for bacterial growth if allowed to infuse longer.
3. The blood components begin to break down after four (4) hours.
4. The blood will not be affected; this is a laboratory procedure.

The HCP orders two (2) units of blood to be administered over eight (8) hours each
for a client diagnosed with heart failure. Which intervention(s) should the nurse take?
1. Call the HCP to question the order because blood must infuse within four
(4) hours.
2. Retrieve the blood from the laboratory and run each unit at an eight (8)-hour rate.
3. Notify the lab to split each unit into half-units and infuse each half for four
(4) hours.
4. Infuse each unit for four (4) hours, the maximum rate for a unit of blood

The client receiving a unit of PRBCs begins to chill and develops hives. Which
action should be the nurse's first response?
1. Notify the laboratory and health-care provider.
2. Administer the histamine-1 blocker, Benadryl, IV.
3. Assess the client for further complications.
4. Stop the transfusion and change the tubing at the hub.

The nurse and an unlicensed assistive personnel (UAP) are caring for clients on an
oncology floor. Which nursing task would be delegated to the UAP?
1. Assess the urine output on a client who has had a blood transfusion reaction.
2. Take the first 15 minutes of vital signs on a client receiving a unit of PRBCs.
3. Auscultate the lung sounds of a client prior to a transfusion.
4. Assist a client who received 10 units of platelets in brushing the teeth.

The nurse is caring for clients on a medical floor. After the shift report, which client
should be assessed first?
1. The client who is two thirds of the way through a blood transfusion and has had
no complaints of dyspnea or hives.
2. The client diagnosed with leukemia who has a hematocrit of 18% and petechiae
covering the body.
3. The client with peptic ulcer disease who called over the intercom to say that he is
vomiting blood.
4. The client diagnosed with Crohn's disease who is complaining of perineal
discomfort.

The client received two (2) units of packed red blood cells of 250 mL with 63 mL of
preservative each during the shift. There was 240 mL of saline remaining in the
500-mL bag when the nurse discarded the blood tubing. How many milliliters of fluid
should be documented on the intake and output record? _____________ 886ml/hr

The student nurse asks the nurse, "What is sickle cell anemia?" Which statement by
the nurse would be the best answer to the student's question?
1. "There is some written material at the desk that will explain the disease."
2. "It is a congenital disease of the blood in which the blood does not clot."
3. "The client has decreased synovial fluid that causes joint pain."
4. "The blood becomes thick when the client is deprived of oxygen."

The client's nephew has just been diagnosed with sickle cell anemia. The client asks
the nurse, "How did my nephew get this disease?" Which statement would be the
best response by the nurse?
1. "Sickle cell anemia is an inherited autosomal recessive disease."
2. "He was born with it and both his parents were carriers of the disease."
3. "At this time, the cause of sickle cell anemia is unknown."
4. "Your sister was exposed to a virus while she was pregnant."

The client diagnosed with sickle cell anemia comes to the emergency department
complaining of joint pain throughout the body. The oral temperature is 102.4˚F and
the pulse oximeter reading is 91%. Which action should the emergency room nurse
implement first?
1. Request arterial blood gases STAT.
2. Administer oxygen via nasal cannula.
3. Start an IV with an 18-gauge angiocath.
4. Prepare to administer analgesics as ordered.

The client diagnosed with sickle cell anemia is experiencing a vaso-occlusive sickle cell
crisis secondary to an infection. Which medical treatment should the nurse anticipate
the HCP ordering for the client?
1. Administer meperidine (Demerol) intravenously.
2. Admit the client to a private room and keep in reverse isolation.
3. Infuse D5W 0.33% NS at 150 mL/hr via pump.
4. Insert a 22-French Foley catheter with a urimeter.

The nurse is assessing an African American client diagnosed with sickle cell crisis.
Which assessment datum is most pertinent when assessing for cyanosis in clients with
dark skin?
1. Assess the client's oral mucosa.
2. Assess the client's metatarsals.
3. Assess the client's capillary refill time.
4. Assess the sclera of the client's eyes.

The client is diagnosed with sickle cell crisis. The nurse is calculating the client's intake
and output (I & O) for the shift. The client had 20 ounces of water, eight (8)
ounces of apple juice, three (3) cartons of milk with four (4) ounces each, 1,800 mL of IV
fluids for the last 12 hours, and a urinary output of 1,200. What is the client's
total intake for this shift? _____________
3,000 mL.

The nurse is caring for the female client recovering from a sickle cell crisis. The client
tells the nurse her family is planning a trip this summer to Yellowstone National Park.
Which response would be best for the nurse?
1. "That sounds like a wonderful trip to take this summer."
2. "Have you talked to your doctor about taking the trip?"
3. "You really should not take a trip to areas with high altitudes."
4. "Why do you want to go to Yellowstone National Park?"

Which is a potential complication that occurs specifically to a male client diagnosed

with sickle cell anemia during a sickle cell crisis?
1. Chest syndrome.
2. Compartment syndrome.
3. Priapism.
4. Hypertensive crisis.
3. Priapism.

The nurse is completing discharge teaching for the client diagnosed with a sickle cell
crisis. The nurse recommends the client getting the flu and pneumonia vaccines. The
client asks, "Why should I take those shots? I hate shots." Which statement by the
nurse is the best response?
1. "These vaccines promote health in clients with chronic illnesses."
2. "You are susceptible to infections. These shots may help prevent a crisis."
3. "The vaccines will help your blood from sickling secondary to viruses."
4. "The doctor wanted to make sure that I discussed the vaccines with you."

The client diagnosed with sickle cell anemia asks the nurse, "Should I join the Sickle
Cell Foundation? I received some information from the Sickle Cell Foundation. What
kind of group is it?" Which statement is the best response by the nurse?
1. "It is a foundation that deals primarily with research for a cure for SCA."
2. "It provides information on the disease and on support groups in this area."
3. "I recommend joining any organization that will help deal with your disease."
4. "The foundation arranges for families that have children with sickle cell to meet."

Which sign/symptom will the nurse expect to assess in the client diagnosed with a
vaso-occlusive sickle cell crisis?
1. Lordosis.
2. Epistaxis.
3. Hematuria.
4. Petechiae.

The male client with sickle cell anemia comes to the emergency room with a
temperature of 101.4˚F and tells the nurse that he is having a sickle cell crisis. Which
diagnostic test should the nurse anticipate the emergency room doctor ordering for
the client?
1. Spinal tap.
2. Hemoglobin electrophoresis.
3. Sickle-turbidity test (Sickledex).
4. Blood cultures.