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NURS 316 Unit 4 Exam Questions And Answers
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NURS 316 Unit 4 Exam Questions And AnswersMegaloblastic anemias caused by folic acid or vitamin B12 deficiencies have a greatly
impaired production of RBCs. Which of the following lab results would confirm this
condition?
A. Iron level of 70 g/dL (normal)
B. Mean corpuscular hemoglobin (MCV) 120 fL (high)
C. Platelet count 200,000 (normal)
D. Reticulocyte count 3.6% (high) - ANSWER B. Mean corpuscular hemoglobin (MCV)
120 fL (high) ---Megaloblastic anemias are due to deranged DNA synthesis leading to
large RBCs (MCV >100) because of failure of cell maturation and division. Folic acid
and/or vit B12 plays a critical role in normal iron and platelet level or a high reticulocyte
count.
Of the following, which of the clients is most likely to have megaloblastic anemia
A. A 69 y/o female who takes ASA four times a day for her arthritis
B. A 44 y/o who has lost about 500n mL blood from an injury at work
C. A 21 y/o college student who is a vegan
D. An infant who is only taking commercial baby formula. - ANSWER C. A 21 y/o college
student who is following a vegan lifestyle
Choose the client who is considered to be at high risk for anemia. Select all that apply.
A. A HIV+ client who is suffering from frequent infection and with rising CD4+ counts.
B. A client with breast cancer who is receiving both chemo and radiation.
C. A client who has colectomy 3 weeks ago to remove adhesions and fecal impaction.
D. A COPD client with acute exacerbation requiring 02 therapy via C-PAP.
E. A middle-aged renal failure client who has hemodialysis 3 times/week. - ANSWER A. A
HIV+ client who is experiencing frequent infection and elevated CD4+ counts.
B. A breast cancer client undergoing chemo and radiation.
,E. A middle-aged renal failure client who has hemodialysis 3 times/week.
Which of the following clients are at risk of developing folic acid deficiency anemia?
Select all that apply.
A. A vegetarian who consumes no meats but gets protein from nuts/legumes
B. A HIV+ client who consumes "green juice" at least 2/day made with organic fruits and
vegetables.
C. A male geriatric patient who has poor eating habits and consumes about five
alcoholic drinks/day .
D. A pregnant customer who has had prolonged morning sickness into most of the day
that includes nausea and vomiting frequently.
E. A toddler who insists on chicken nuggets and French fries but refuses to eat any
green food. - ANSWER C. A male geriatric patient who has poor eating habits and
consumes about five alcoholic drinks/day.
D. A pregnant client with prolonged morning sickness lasting most of the day with
nausea and frequent vomiting noted. --- Folic acid is readily absorbed from the intestine.
It is found in vegetables (particularly the green leafy types), fruits, cereals, and meats.
Much of the vitamin, however is lost in cooking. The most common causes of deficiency
are malnutrition or dietary lack, especially among the elderly or in association with
alcoholism. Because pregnancy increases the need for folic acid 5- to 10-fold, a
deficiency commonly occurs. Poor dietary habits, anorexia, and nausea are other
reasons for folic acid deficiency during pregnancy. Various studies have been
conducted indicating an association with neural tube defects.
For which of the following health problems is stem cell transplantation likely to be of
therapeutic benefit?
A. Aplastic anemia
B. Thalassemias
C. Chronic disease anemias
D. Secondary polycythemia - ANSWER A. Aplastic anemia --- The etiology of aplastic
anemia involves depression of the bone marrow, a problem that can sometimes be
treated by stem cell transplantation. Thalassemia, polycythemia, and anemias caused
by chronic diseases are not amenable to stem cell transplantation.
,A 48 y/o male client, who normally enjoys good health, has been admitted to the hospital
for the treatment of polycythemia vera. The nurse who is providing care of the client
should prioritize assessments aimed at the early identification of which of the following
health problems?
A. Orthostatic hypotension
B. Hyperventilation
C. Vasculitis
D. Thromboembolism - ANSWER D. Thromboembolism
Polycythemia develops in clients with lung disease as a result of:
A. Hyperventilation
B. Chronic hypoxia
C. Decreased blood viscosity
D. Excessive respiratory fluid loss. - ANSWER B. Chronic hypoxia
A 68 y/o client with an 80 pack/year history of smoking was diagnosed with emphysema
18 months ago. The client's most recent scheduled blood work showed excessive
increase in production of red blood cell (erythrocytes), a problem that suggests the
need for which of the following interventions?
A. Vitamin B12 supplements
B. Increased supplementary oxygen therapy
C. Hemodialysis or peritoneal dialysis
D. Scheduled erythropoietin injections - ANSWER B. Increased supplementary oxygen
therapy
Which of the following trends in the hematologic status of a 6 week infant (born at 32
weeks gestation) most clearly warrants medical intervention?
A. Decreasing red blood cell counts.
B. Increasing HgA levels
C. Decreasing mean corpuscular volume (MCV)
, D. Severe anemia. --- Apnoea, poor weight gain, pallor, diminished activity and
tachycardia are signs and symptoms. The clinical features become more obvious with
infants born prior to 33 weeks of gestation or with hematocrits less than 33%.
Decreasing RBC counts, hematocrit and MCV are normal findings after birth. Levels of
HgA increase gradually after birth.
Lab results for an infant (5 days old) indicate a high level of unconjugated bilirubin
resulting from hemolysis of RBCs. Based on this, which assessment findings would
relate to this abnormal laboratory value? Select all that apply.
A. Difficulty to arouse (lethargy)
B. Cyanosis in hands and feet
C. Click in the right hip area when adducted
D. Jaundice
E. Rigidity and tremors - ANSWER A. Difficulty to arouse (lethargy)
D. Jaundice
A 2 week old infant presents to the emerg with his mother, who is concerned because
the infant's jaundice has persisted and continues to worsen. Blood testing indicates an
unconjugated bilirubin level of 28 mg/dL, and no neurologic deficits are noted upon
assessment. The infant's weight is at a normal percentile, and the mother reports no
significant difficulty feeding the infant. The most likely treatment for this infant will be:
A. Phototherapy
B. Packed red blood cell transfusion
C. Phlebotomy
D. Intravenous antibiotics - ANSWER A. Phototherapy
If an Rh-negative mother has become sensitized and is carrying an Rhpositive fetus,
what will happen to the fetus?
A. Bilirubin deficiency
B. Nothing, this is normal
C. Plasma volume depletion
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