Uploaded by Jannel Osilla Galiste

Nsg Sem 16-23 Rationale

Nursing Seminar 1
Session 16:
1. In the diagnosis of HIV, which of the following tests would confirm that Freddie is positive for the
a. Enzyme-linked immunosorbent assay (ELISA) test
b. Western-blot test
c. Viral load test
d. Home access express test
RATIONALE: The primary tests for diagnosing HIV and AIDs include: ELISA Test ELISA, which stands for
enzyme-linked immunosorbent assay, is used to detect HIV infection. If an ELISA test is positive, the
Western blot test is usually administered to confirm the diagnosis.
2. Freddie is asking Nurse Freda on how the virus is transmitted. The nurse must know that Freddie
must have gotten the virus through unprotected sexual intercourse. Which of the following sexual
acts would least likely transmit HIV?
a. Anal sex
b. Vaginal sex
c. Oral sex
d. None of the above
RATIONALE: According to the CDC, unless the person has open lesions in the oral mucosa, the person at
the receiving end of oral sex is least likely to have the disease.
3. Nurse Freda is planning for the confinement of Freddie at the infectious disease ward. Which of
the following types of isolation precautions will Nurse Freda implement with regard to Freddie’s
Contact precautions
Airborne precautions
Reverse isolation precautions
Droplet precautions
RATIONALE: Since the patient is immunocompromised, reverse isolation is a procedure designed to
protect a patient from infectious organisms carried by staff, patients or other patients. The organisms are
typically spread by droplets in the air or on equipment. All staff should wash their hands prior to entering
the room.
4. Freddie has stated to the nurse, “I think my friends have abandoned me when they learned about
my condition. I feel so hopeless.” The nurse’s most appropriate nursing intervention for his
statement would be
a. Powerlessness
b. Deficient knowledge
c. Social isolation
d. Disturbed thought processes
RATIONALE: Since the patient feels that his friends may have abandoned him, the most appropriate
nursing diagnosis for him would be social isolation.
5. When doing the discharge planning for Freddie, the nurse must advise the patient to avoid which
of the following types of food?
a. Lean meats such as beef sirloin and chicken breast
b. Raw fresh food such as sushi
c. Soft fruits such as bananas or pears
d. Peanut butter on toast and crackers
RATIONALE: Avoid foods that are raw since they can cause GI infection brought about by the patient’s
SITUATION: A 10-year old child named Rolando was brought to the hospital with signs and symptoms of
fever with a temperature of 38.9 degrees Celsius; complaints of headache; and nausea. Serum laboratory
tests show that Roland has lower than the usual platelet count. His doctor diagnosed him to have dengue
6. Nurse Kim is currently attending to the needs of Rolando. Nurse Kim must know that the prevalence
of dengue fever in the Philippines is
a. Epidemic
b. Pandemic
c. Endemic
d. Sporadic
RATIONALE: Dengue occurs nationally and year-round in the Philippines. Peak transmission occurs
during the rainy season, May through November. Endemic refers to the constant presence and/or usual
prevalence of a disease or infectious agent in a population within a geographic area. Hyperendemic refers
to persistent, high levels of disease occurrence. Occasionally, the amount of disease in a community rises
above the expected level.
7. Based from the laboratory results of Rolando, Nurse Kim must formulate which of the following
appropriate nursing diagnosis for this patient?
Risk for bleeding
Deficient fluid volume
Ineffective tissue perfusion
Risk for shock
RATIONALE: The patient is at high risk for bleeding since the platelet count is low. The nurse must watch
out for signs of bleeding such as epistaxis, gum bleeding, petechiae, etc.
8. Since Rolando has a low platelet count, the attending physician has ordered to infuse platelet
concentrate to the patient. After blood typing and cross-matching, Nurse Kim together with her
colleague Nurse Joyce has started the transfusion of the blood product. How many minutes will the
nurse stay with the patient after starting the transfusion?
a. 30 minutes
b. 5 minutes
c. 15 minutes
d. 45 minutes
RATIONALE: A nurse will remain with you for at least the first 15 minutes of the transfusion. This is because
most reactions with blood transfusions, if they happen, occur immediately.
9. Nurse Kim plans to give antipyretics to Rolando to help control the fever. Which of the following
antipyretics would Nurse Kim question from the doctor’s order?
a. Paracetamol
b. Acetaminophen
c. Ibuprofen
d. Aspirin
RATIONALE: Aspirin, an NSAID, affects clotting factors and places the patient at risk for bleeding.
10. Signs of plasma leakage in dengue fever appears after how many days after the fever breaks out?
a. 1 day
b. 2 days
c. 3 days
d. 7 days
RATIONALE: Shortly after the fever breaks or sometimes within 24 hours before, signs of plasma leakage
appear along with the development of hemorrhagic symptoms.
SITUATION: A 45-year-old male banker named Arturito presents to the health department with complaints
of a sore on his penis. The patient says that it is painless and started out as a “small red bump” and “turned
into this”. You note the area is ulcerated, red, has sharp borders and is approximately 2.5 cm. The patient
reports to having multiple sexual partners the past 3 months. A blood sample was collected from and results
show that he is positive for syphilis.
11. Nurse Monica, who is currently assigned to Arturito, must know that syphilis is caused by which of
the of following microorganisms?
a. Clostridium perfringens
b. Treponema pallidum
c. Chlamydia trachomatis
d. Serratia marcescens
RATIONALE: The causative agent for syphilis is treponema pallidum.
12. Rapid point-of-care test has determined his diagnosis of syphilis. Along with syphilis, this method
of testing also detects the presence of
a. Hepatitis A
b. Neisseria gonorheae
c. Human immunodeficiency virus (HIV)
d. Human papilloma virus (HPV)
RATIONALE: The introduction of rapid point-of-care tests (RDTs) that can detect both HIV and syphilis,
using one single blood specimen, would be a promising tool to integrate the detection
of syphilis into HIV programs and so improve the accessibility of syphilis testing and treatment.
13. Arturito asks Nurse Monica about the complications of syphilis if it is left untreated. Nurse Monica
must state that its complication is
a. Epididymitis
b. Epididymo-orchitis
c. Meningitis
d. Immunosuppression
RATIONALE: Meningitis is the late stage complication of syphilis. Epididymitis and orchitis is present in
chlamydial and gonorrheal infections. Immunosuppression is seen in the late stages of HIV infection.
14. Nurse Monica must expect the physician to prescribe which of the following drugs for the treatment
of syphilis?
a. Penicillin-G
b. Cotrimoxazole
c. Ceftriaxone
d. Amikacin
RATIONALE: Key principles for the treatment of syphilis include the following: Penicillin is the drug of
choice to treat syphilis. Doxycycline is the best alternative for treating early and late latent syphilis.
15. Nurse Monica is doing patient education prior to patient discharge. Which of the following
statements from Arturito would require further education?
a. “I must abstain from sexual contact with anyone until the skin lesion is healed.”
b. “I will be immune from the disease once I am cured from it.”
c. “When I resume sexual activities, I must wear condoms at all times.”
d. “It is better if I limit my sexual partners to one.”
RATIONALE: The treatment of choice for measles with eye complications would be the application of
tetracycline ointment on the eyes of the child. Advise the mother to apply it 4 times a day by applying it on
the inside of the lower lid of the child.
SITUATION: A 3-year-old boy named Denver was sent to the hospital for the presence of fever (38.5
degrees Celsius), rashes all over the body, and presence of the white spots on the patient’s oral mucosa.
Upon assessment, Denver is diagnosed to have measles.
16. Nurse Raquel is assessing the patient’s oral mucosa and saw spots that look like tiny grains of
white sand surrounded by a red ring. The nurse must note this on her chart as
a. Rose spots
b. Cullen sign
c. Koplik spots
d. Forscheimer’s spots
RATIONALE: Koplik's spots: Little spots inside the mouth that are highly characteristic of the early phase
of measles (rubeola). The spots look like a tiny grain of white sand, each surrounded by a red ring. They
are found especially on the inside of the cheek (the buccal mucosa) opposite the 1st and 2nd upper molars.
17. Nurse Raquel must know that measles is transmitted through which of the following methods?
a. Airborne respiratory droplets
b. Mosquito bite
c. Direct skin-to-skin contact
d. Fecal-oral
RATIONALE: Transmission, which is primarily by airborne respiratory droplets, increases during the late
winter and early spring in temperate climates and after the rainy season.
18. The average incubation period of measles is around
a. 7-21 days
b. 10-14 days
c. 17-23 days
d. 12-25 days
RATIONALE: The incubation period of measles, from exposure to prodrome, averages 10–14 days. Letter
A is for chickenpox, letter C for rubella, and letter D for mumps.
19. The causative agent for measles is
a. Rubella virus
b. Paramyxovirus
c. Varicella zoster virus
d. Rubeola virus
RATIONALE: Causative agent is rubeola virus. Rubella is for German measles, paramyxovirus is for
mumps and, the varicella zoster is for chickenpox.
20. The mother of Denver is asking Nurse Raquel if there is a cure for measles. Which of the following
statements by Nurse Raquel would be correct?
A. “Yes, there is a cure. The doctor can provide an antiviral for this disease.”
B. “Yes, we can give your son a vaccine in order for him to be free from this disease.”
C. “There is no cure. However, your son’s immune system will be fighting off this disease with
proper treatment of his signs and symptoms.”
D. “Sadly, there is no cure for this disease. Doctors are still trying to find the cure for measles.”
RATIONALE: This is the most appropriate answer for the mother since measles is a self-limiting disease.
With proper palliative treatment the child will be free from the disease and be immune from it.
Session 17
SITUATION: Harriet Roque a 47-year-old female patient came to the rural health unit complaining the
appearance of lesions on her skin which are multiple, symmetrical and erythematous. Some of the lesions
are already raised, large erythematous plaques which appear rough. A skin smear was obtained and
came back to be positive for mycobacterium leprae. She has multibacillary leprosy.
21. Patient Harriet asked the nurse on duty, Nurse Justine, on how she has contracted the disease.
Nurse Justine must state which of the following?
a. “Leprosy is transmitted via direct skin-to-skin contact.”
b. “Leprosy is acquired by eating foods contaminated with the bacteria.”
c. “Leprosy is a bacterial infection that is cause by tick bites.”
d. “Leprosy spreads from person-to-person by nasal secretions or droplets from the upper
respiratory tract.”
RATIONALE: Researchers suggest that M. leprae spreads person to person by nasal secretions or droplets
from the upper respiratory tract and nasal mucosa. However, the disease is not highly contagious like the flu.
They speculate that infected droplets reach other peoples' nasal passages and begin the infection there.
Some investigators suggest the infected droplets can infect others by entering breaks in the skin. M.
leprae apparently cannot infect intact skin.
22. What is the description of the mycobacterium leprae bacteria?
a. Acid-fast; gram positive bacterium
b. Non-acid fast; gram positive bacterium
c. Acid-fast; gram negative bacterium
d. Non-acid fast; gram negative bacterium
RATIONALE: Mycobacterium leprae is an obligate intracellular pathogen, first identified in the nodules of
lepromatous leprosy patients by Armauer Hansen in 1873. It is a rod-shaped, Gram-positive organism that
is acid-fast when stained by the Ziehl–Nielsen or the better Fite methods.
23. Nurse Justine is teaching Harriet about the home management of leprosy. Which of the following
statements by the patient would require further teaching?
e. “I should keep my skin moist to prevent dryness and fissuring and avoid ulceration or
infection of skin.”
f. “I should protect my hands and feet to avoid inadvertent injury and prevent chronic
g. “I should wear plastic footwear and gloves when going out or using my hands for work.”
h. “Ensure adequate intake of fluid to maintain optimal skin hydration.”
RATIONALE: The nurse must educate the patient to avoid plastic footwear or gloves which trap moisture
and cause ulceration.
24. One of the patient teachings that Nurse Justine is going to include when teaching the patient about
the side effects of Rifampicin would be
e. Tinnitus
f. Elevated liver enzymes
g. Nephrotoxicity
h. Yellow-orange tinged urine and secretions
RATIONALE: This medication may cause urine, sweat, saliva, or tears to change color (yellow, orange,
red, or brown). This effect is harmless and will go away when the medication is stopped. However, teeth and
contact lens staining may be permanent.
25. How many months should Harriet be taking the multiple drug treatment for her type of leprosy?
e. 6 months
f. 2 months
g. 9 months
h. 12 months
RATIONALE: Multibacillary patients should have a fixed-duration treatment, which means that after taking
12 monthly doses of multi drug therapy (MDT); the person is considered cured and should be removed from
the register.
SITUATION: A 7-year-old child named Berto is brought to the hospital with clinical manifestations of fever
38.5 degrees Celsius, neck and facial rigidity, board-like abdomen, and a grinning expression. The parents
of Berto has stated that their son has an infected foot injury. The patient was diagnosed to have tetanus.
26. Nurse Carol has noticed that Berto is constantly arching his back. Nurse Carol knows that this in
one of the characteristic signs of tetanus. She must place this on the chart as
a. Nuchal rigidity
b. Opisthotonos
c. Trismus
d. Risus sardonicus
RATIONALE: Opisthotonos is a specific abnormal posture associated with conditions and injuries that
impair brain and muscle function. The characteristic symptoms of opisthotonos are a severely arched or
curved spine and head and heels that tilt backward. Though relatively rare, the condition is usually a
symptom of severe neurological conditions that are life threatening and require medical care.
27. Which of the following tetanus toxins is responsible for muscle spasms?
RATIONALE: The toxin responsible for muscle spasms is tetanospasmin. Tetanolysin is responsible for the
destruction of the RBCs.
28. One of the equipment that Nurse Carol has to prepare at the patient’s bedside with regard to tetanus
e. Oxygen tank and mask
f. Tracheostomy set
g. Endotracheal tube and laryngoscope
h. Blood urea-nitrogen and
RATIONALE: The patient who is experiencing oliguria may be experiencing renal failure. In order to check
for the kidney functioning, the doctor will order for BUN and creatinine tests.
29. Which of the following status should Nurse Carol ask from the parents of Carlo?
e. Nutritional status
f. Vitamin A status
g. Deworming status
h. Immunization status
RATIONALE: Tetanus can be easily avoided if the parents are educated about the immunization against it.
That within 72 hours of a punctured wound, the patient should receive ATS, especially if the patient has no
previous immunization against it.
30. The parents told Nurse Carol that they are not aware of immunizations of any kind that is why they
have not availed it for their children since they were still infants. Which of the following nursing
diagnosis would be most applicable for them?
e. Anticipatory grieving
f. Knowledge deficit
g. High risk for infection
h. Social isolation
RATIONALE: The parents are not educated about the importance of immunization and the diseases that
they can prevent. It is a good opportunity for the nurse to educate them about vaccines.
SITUATION: A 25-year-old female patient named Karen came to the emergency room with complaints of
acute, profuse, watery diarrhea. She is also experiencing nausea and vomiting. Nurse Joy also has checked
that the patient has poor skin turgor brought about by dehydration from diarrhea. Rectal swab from the
patient has revealed that she has cholera.
31. Nurse Joy should know that the characteristic appearance of the stools of a patient with cholera
should be
e. Black-tarry stools
f. Stools that are blood streaked
g. Loose and watery
h. Rice-watery stools
RATIONALE: Initially the stools are brown and contains fecal material, but soon becomes pale gray and
“rice-watery” in appearance, with an inoffensive, fishy odor.
32. Which of the following questions is important for Nurse Joy to ask from Karen?
e. “When did you last eat your meals?”
f. “What were the foods or drinks that you may have taken prior to having the signs and
symptoms of cholera?”
g. “How many times have you eaten within the last 24 hours?”
h. “Have you been washing your hands regularly prior to eating?”
RATIONALE: Cholera is transmitted by fecal-to-oral route from contaminated water, milk, and other foods.
33. Karen told Nurse Joy that she has experienced 13 bowel movements within the last 24 hours Which
of the following pH imbalances would Karen be at risk with?
e. Metabolic alkalosis
f. Respiratory acidosis
g. Metabolic acidosis
h. Respiratory alkalosis
RATIONALE: Metabolic acidosis is due to the loss of a large volume of bicarbonate-rich stools.
34. Which of the following nursing diagnosis would be most appropriate for Karen based on the
situation above?
e. Altered tissue perfusion
f. Fluid volume deficit
g. Activity intolerance
h. Altered nutrition: less than body requirements
RATIONALE: Poor skin turgor brought about by dehydration means that the patient is deficient in fluids.
The nurse must increase the fluid intake of the patient and encourage to drink large amounts of water.
35. Enteric precaution is practiced around the patient with cholera. Which of the following is NOT true
with regard to enteric precautions?
e. Clean hands frequently with soap and water
f. Wear a gown and gloves when entering the patient’s room
g. Always wear a mask when entering the room
h. Place and “enteric precaution” sign outside the patient’s door
RATIONALE: There is no need to wear a mask for enteric precautions since the transmission is via the
fecal-oral route. It is best for health workers to practice hand hygiene and wear a gown and gloves whenever
entering the patient’s room.
SITUATION: A 35-year-old male patient named Juan went to the hospital with a chief complaint of cough
that has lasted for 4 weeks. He explained that he already is coughing out blood, is also experiencing night
sweats, and is often tired. He is suspected to have pulmonary tuberculosis.
36. Which of the following diagnostic procedures would be the most definitive for pulmonary
e. Mantoux test
f. Tuberculin test
g. Sputum culture
h. Chest x-ray
RATIONALE: The sputum culture for Mycobacterium tuberculosis is the only method of confirming the
diagnosis. Lesions in the lung may not be big enough to be seen on x-ray. Skin tests may be falsely positive
or falsely negative.
37. Since Juan is exhibiting the signs and symptoms of pulmonary tuberculosis. The nurse must expect
which of the following actions to be done by the attending physician?
e. Give prescription for isoniazid, 300 mg OD for 2 weeks, and send him home
f. Give a tuberculin test and ask him to come back after 2 days to have it read
g. Admit him to the hospital and place him in the isolation room
h. Prescribe isoniazid and tell him to go home and rest
RATIONALE: The client is showing s/s of active TB and because of a productive cough is highly contagious.
He should be admitted to the hospital, placed in respiratory isolation, and three sputum cultures should be
obtained to confirm the diagnosis. He would most likely be given isoniazid and two or three other
antitubercular antibiotics until the diagnosis is confirmed, then isolation and treatment would continue if the
cultures were positive for TB. After 7 to 10 days, three more consecutive sputum cultures will be obtained.
If they’re negative, he would be considered non-contagious and may be sent home, although he’ll continue
to take the antitubercular drugs for 9 to 12 months.
38. Isoniazid (INH) and rifampicin (Rifadin) have been prescribed for a client with TB. Nurse Lisa is
reviewing the medical record of Juan. Which of the following would require physician notification?
e. Rheumatic fever
f. Hepatitis B
g. Allergy to penicillin
h. Heart disease
RATIONALE: Isoniazid and rifampin are contraindicated in clients with acute liver disease or a history of
hepatic injury.
39. Nurse Lisa is teaching Juan about dietary elements that should be increased in the diet. The nurse
suggests that the Juan should increase which of the following in his diet?
e. Meats and citrus fruits
f. Grains and broccoli
g. Eggs and spinach
h. Potatoes and fish
RATIONALE: The nurse teaches the client with TB to increase intake of protein, iron, and vitamin C.
40. Which of the following among Juan’s family members exposed to him would be at highest risk for
contracting the disease?
E. 57-year-old mother
F. 10-year-old daughter
G. 7-year-old son
H. 76-year-old grandmother
RATIONALE: Elderly persons are believed to be at higher risk for contracting TB because of decreased
immunocompetence. Other high-risk populations in the US include the urban poor, AIDS, and minority
SITUATION: A 62-year-old female patient named Dolores is exhibiting the signs and symptoms of chills
with rising fever, stabbing pain whenever she coughs or breathes, has a sputum that is rusty in color, and
has body malaise. Sputum analysis shows that the patient is suffering from community acquired
41. Which the following bacterial microorganisms is most common in this type of pneumonia?
A. Streptococcus pneumoniae
B. Staphylococcus aureus
C. Haemophilus influenzae
D. Klebsiella pneumoniae
RATIONALE: The most common causative agent is Streptococcus pneumoniae, which is responsible for
almost 50% of cases, other common causes are respiratory viruses (mainly influenza A) and the atypical
bacteria Chlamydophila pneumoniae and Mycoplasma pneumoniae.
42. Nurse Mitzi is assigned to Dolores and has observed that she has developed dyspnea with a
respiratory rate of 32 breaths/minute and is having difficulty in expectorating her secretions. Nurse
Mitzi has heard bronchial sounds in the left lower lobe upon auscultation. The nurse determines
that the client requires which of the following initial treatments?
A. Antibiotics
B. Bed rest
C. Oxygen
D. Nutritional intake
RATIONALE: The client is having difficulty breathing and is probably becoming hypoxic. As an emergency
measure, the nurse can provide oxygen without waiting for a physician’s order. Antibiotics may be
warranted, but this isn’t a nursing decision. The client should be maintained on bedrest if he is dyspneic to
minimize his oxygen demands, but providing additional will deal more immediately with his problem. The
client will need nutritional support, but while dyspneic, he may be unable to spare the energy needed to eat
and at the same time maintain adequate oxygenation.
43. Currently Dolores has developed fever with a temperature of 39.4 degrees Celsius, has profuse
sweating, and a productive cough. Nurse Mitzi must include which of the following measures in the
plan of care for Dolores?
A. Frequent offering of a bedpan
B. Frequent linen changes
C. Nasotracheal suctioning to clear secretions
D. Position changes every 4 hours
RATIONALE: Frequent linen changes are appropriate for this client because of diaphoresis. Diaphoresis
produces general discomfort. The client should be kept dry to promote comfort. Position changes need to
be done every 2 hours. Nasotracheal suctioning is not indicated with the client’s productive cough. Frequent
offering of a bedpan is not indicated by the data provided in this scenario.
44. Dolores then is observed to have cyanosis. The cyanosis that accompanies bacterial pneumonia
is mainly caused by which of the following
A. Decreased oxygenation of the blood
B. Inadequate peripheral circulation
C. Pleural effusion
D. Decreased cardiac output
RATIONALE: A client with pneumonia has less lung surface available for the diffusion of gases because of
the inflammatory pulmonary response that creates lung exudate and results in reduced oxygenation of the
blood. The client becomes cyanotic because blood is not adequately oxygenated in the lungs before it
enters the peripheral circulation.
45. Continuous positive airway pressure (CPAP) can be provided through an oxygen mask to improve
oxygenation in hypoxic patients by which of the following methods?
a. The mask provides pressurized at the end of expiration to open collapsed alveoli.
b. The mask provides pressurized oxygen so the client can breathe more easily.
c. The mask provides continuous air that the client can breathe.
d. The mask provides 100% oxygen to the client.
RATIONALE: The mask provides pressurized oxygen continuously through both inspiration and expiration.
The mask can be set to deliver any amount of oxygen needed. By providing the client with pressurized
oxygen, the client has less resistance to overcome in taking his next breath, making it easier to breathe.
Pressurized oxygen delivered at the end of expiration is positive end-expiratory pressure (PEEP), not
continuous positive airway pressure.
Session 18
1. A child is admitted to the pediatric unit with a diagnosis of suspected meningococcal meningitis.
Which of the following nursing measures should the nurse do FIRST?
Institute seizure precautions
Assess neurologic status
Place in respiratory isolation
Assess vital signs
RATIONALE: The initial therapeutic management of acute bacterial meningitis includes isolation
precautions, initiation of antimicrobial therapy and maintenance of optimum hydration. Nurses should take
necessary precautions to protect themselves and others from possible infection.
2. A client is diagnosed with methicillin resistant staphylococcus aureus pneumonia. What type of
isolation is MOST appropriate for this client?
Reverse isolation
Respiratory isolation
Standard precautions
Contact isolation
RATIONALE: Contact or Body Substance Isolation (BSI) involves the use of barrier protection (e.g.
gloves, mask, gown, or protective eyewear as appropriate) whenever direct contact with any body fluid is
expected. When determining the type of isolation to use, one must consider the mode of transmission.
The hands of personnel continues to be the principal mode of transmission for methicillin resistant
staphylococcus aureus (MRSA). Because the organism is limited to the sputum in this example,
precautions are taken if contact with the patient”s sputum is expected. A private room and BSI, along with
good hand washing techniques, are the best defense against the spread of MRSA pneumonia.
3. Several clients are admitted to an adult medical unit. The nurse would ensure airborne precautions
for a client with which of the following medical conditions?
A diagnosis of AIDS and cytomegalovirus
A positive PPD with an abnormal chest x-ray
A tentative diagnosis of viral pneumonia
Advanced carcinoma of the lung
RATIONALE: The client who must be placed in airborne precautions is the client with a positive PPD
(purified protein derivative) who has a positive x-ray for a suspicious tuberculin lesion.
4. Which of the following is the FIRST priority in preventing infections when providing care for a client?
Wearing gloves
Using a barrier between client’s furniture and nurse’s bag
Wearing gowns and goggles
RATIONALE: Handwashing remains the most effective way to avoid spreading infection. However, too
often nurses do not practice good handwashing techniques and do not teach families to do so. Nurses
need to wash their hands before and after touching the client and before entering the nursing bag.
5. An adult woman is admitted to an isolation unit in the hospital after tuberculosis was detected during
a pre-employment physical. Although frightened about her diagnosis, she is anxious to cooperate with
the therapeutic regimen. The teaching plan includes information regarding the most common means
of transmitting the tubercle bacillus from one individual to another. Which contamination is usually
Droplet nuclei.
Milk products.
Eating utensils.
RATIONALE: Hands are the primary method of transmission of the common cold. The most frequent
means of transmission of the tubercle bacillus is by droplet nuclei. The bacillus is present in the air as a
result of coughing, sneezing, and expectoration of sputum by an infected person. The tubercle bacillus is
not transmitted by means of contaminated food. Contact with contaminated food or water could cause
outbreaks of salmonella, infectious hepatitis, typhoid, or cholera. The tubercle bacillus is not transmitted
by eating utensils. Some exogenous microbes can be transmitted via reservoirs such as linens or eating
6. A 2-year-old is to be admitted in the pediatric unit. He is diagnosed with febrile seizures. In preparing
for his admission, which of the following is the most important nursing action?
Order a stat admission CBC.
Place a urine collection bag and specimen cup at the bedside.
Place a cooling mattress on his bed.
Pad the side rails of his bed.
RATIONALE: Preparing for routine laboratory studies is not as high a priority as preventing injury and
promoting safety. Preparing for routine laboratory studies is not as high a priority as preventing injury and
promoting safety. A cooling blanket must be ordered by the physician and is usually not used unless other
methods for the reduction of fever have not been successful. The child has a diagnosis of febrile seizures.
Precautions to prevent injury and promote safety should take precedence.
7. A young adult is being treated for second and third degree burns over 25% of his body and is now
ready for discharge. The nurse evaluates his understanding of discharge instructions relating to
wound care and is satisfied that he is prepared for home care when he makes which statement?
a. “I will need to take sponge baths at home to avoid exposing the wounds to unsterile bath
b. “If any healed areas break open I should first cover them with a sterile dressing and then
report it.”
c. “I must wear my Jobst elastic garment all day and can only remove it when I’m going to bed.”
d. “I can expect occasional periods of low-grade fever and can take Tylenol every 4 hours.”
RATIONALE: Bathing or showering in the usual manner is permitted, using a mild detergent soap such
as Ivory Snow. This cleanses the wounds, especially those that are still open, and removes dead tissue.
The client is taught to report changes in wound healing such as blister formation, signs of infection, and
opening of a previously healed area. Sterile dressings are applied until the wound is assessed and a plan
of care developed. The Jobs garment is designed to place constant pressure on the new healthy tissue
that is forming to promote adherence to the underlying structure in order to prevent hypertrophic scarring.
In order to be effective, the garment must be worn for 23 hours daily. It is removed for wound assessment
and wound care and to permit bathing. The client must be aware that infection of the wound may occur;
signs of infection, including fever, redness, pain, warmth in and around the wound and increased or foul
smelling drainage must be reported immediately.
8. An eighty-five-year-old man was admitted for surgery for benign prostatic hypertrophy. Preoperatively
he was alert, oriented, cooperative, and knowledgeable about his surgery. Several hours after
surgery, the evening nurse found him acutely confused, agitated, and trying to climb over the
protective side rails on his bed. The most appropriate nursing intervention that will calm an agitated
client is
limit visits by staff.
encourage family phone calls.
position in a bright, busy area.
speak soothingly and provide quiet music.
RATIONALE: The client needs frequent visits by the staff to orient him and to assess his safety. Phone
calls from his family will not help a client who is trying to climb over the side rails and may even add to his
danger. Putting the client in a bright, busy area would probably add to his confusion. The environment is
an important factor in the prevention of injuries. Talking softly and providing quiet music have a calming
effect on the agitated client.
9. Ms. Smith is admitted for internal radiation for cancer of the cervix. The nurse knows the client
understands the procedure when she makes which of the following remarks the night before the
a. She says to her husband, “Please bring me a hamburger and French fries tomorrow when
you come. I hate hospital food.”
b. “I told my daughter who is pregnant to either come to see me tonight or wait until I go home
from the hospital.”
c. “I understand it will be several weeks before all the radiation leaves my body.”
d. “I brought several craft projects to do while the radium is inserted.”
RATIONALE: The client will be on a clear liquid or very low residue diet. Hamburgers and french fries are
not allowed. People who are pregnant should not come in close contact with someone who has internal
radiation therapy. The radioactivity could possibly damage the fetus. This statement is not true. As soon
as the radiation source is removed (probably 36 to 72 hours after insertion), the client is no longer
contaminated with radioactivity. Craft projects usually require the client to sit. The client must remain flat
with very little head elevation during the time the rods are in place.
10. The nurse in charge is evaluating the infection control procedures on the unit. Which finding indicates
a break in technique and the need for education of staff?
a. The nurse aide is not wearing gloves when feeding an elderly client.
b. A client with active tuberculosis is asked to wear a mask when he leaves his room to go to
another department for testing.
c. A nurse with open, weeping lesions of the hands puts on gloves before giving direct client
d. The nurse puts on a mask, a gown, and gloves before entering the room of a client on strict
RATIONALE: There is no need to wear gloves when feeding a client. However, universal precautions
(treating all blood and body fluids as if they are infectious) should be observed in all situations. A client
with active tuberculosis should be on respiratory precautions. Having the client wear a mask when
leaving his private room is appropriate. Persons with exudative lesions or weeping dermatitis should not
give direct client care or handle client-care equipment until the condition resolves. Strict isolation requires
the use of mask, gown, and gloves.
11. The charge nurse observes a new staff nurse who is changing a dressing on a surgical wound. After
carefully washing her hands the nurse dons sterile gloves to remove the old dressing. After removing
the dirty dressing, the nurse removes the gloves and dons a new pair of sterile gloves in preparation
for cleaning and redressing the wound. The most appropriate action for the charge nurse is to:
a. interrupt the procedure to inform the staff nurse that sterile gloves are not needed to remove
the old dressing.
b. congratulate the nurse on the use of good technique.
c. discuss dressing change technique with the nurse at a later date.
d. interrupt the procedure to inform the nurse of the need to wash her hands after removal of
the dirty dressing and gloves.
RATIONALE: Nonsterile gloves are adequate to remove the old dressing. However, the use of sterile
gloves does not put the client in danger so discussion of this can wait until later. The staff nurse is doing
two things incorrectly. Nonsterile gloves are adequate to remove the old dressing. The nurse should wash
her hands after removing the soiled dressing and before donning sterile gloves to clean and dress the
wound. The nurse should wash her hands after removing the soiled dressing and before donning the
sterile gloves to clean and dress the wound. Not doing this compromises client safety and should be
brought to the immediate attention of the nurse. The staff nurse is doing two things incorrectly. Nonsterile
gloves are adequate to remove the old dressing. However, the use of sterile gloves does not put the client
in danger so discussion of this can wait until later. However, the nurse should wash her hands after
removing the soiled dressing and before donning sterile gloves to clean and dress the wound. Not doing
this compromises client safety and should be brought to the immediate attention of the nurse.
12. Nurse Jane is visiting a client at home and is assessing him for risk of a fall. The most important
factor to consider in this assessment is:
Correct illumination of the environment.
amount of regular exercise.
the resting pulse rate.
status of salt intake.
RATIONALE: To prevent falls, the environment should be well lighted. Night lights should be used if
necessary. Other factors to assess include removing loose scatter rugs, removing spills, and installing
handrails and grab bars as appropriate. The amount of regular exercise is not the most important factor to
assess. It is only indirectly related. The resting pulse rate is not related to preventing falls. The salt intake
is not directly related to preventing falls.
13. Mrs. Jones will have to change the dressing on her injured right leg twice a day. The dressing will be
a sterile dressing, using 4 X 4s, normal saline irrigant, and abdominal pads. Which statement best
indicates that Mrs. Jones understands the importance of maintaining asepsis?
“If I drop the 4 X 4s on the floor, I can use them as long as they are not soiled.”
“If I drop the 4 X 4s on the floor, I can use them if I rinse them with sterile normal saline.”
“If I question the sterility of any dressing material, I should not use it.”
“I should put on my sterile gloves, then open the bottle of saline to soak the 4 X 4s.”
RATIONALE: Anything dropped on the floor is no longer sterile and should not be used. The statement
indicates lack of understanding. Anything dropped on the floor is no longer sterile and should not be used.
The statement indicates lack of understanding. If there is ever any doubt about the sterility of an
instrument or dressing, it should not be used. The 4 X 4s should be soaked prior to donning the sterile
gloves. Once the sterile gloves touch the bottle of normal saline they are no longer sterile. This statement
indicates a need for further instruction.
14. A client has been placed in blood and body fluid isolation. The nurse is instructing auxiliary personnel
in the correct procedures. Which statement by the nursing assistant indicates the best understanding
of the correct protocol for blood and body fluid isolation?
Masks should be worn with all client contact.
Gloves should be worn for contact with nonintact skin, mucous membranes, or soiled items.
Isolation gowns are not needed.
A private room is always indicated.
RATIONALE: Masks should only be worn during procedures that are likely to cause splashes of blood or
body fluid. Gloves should be worn for all contact with blood and body fluids, nonintact skin and mucous
membranes; for handling soiled items; and for performing venipuncture. Gowns should be worn during
procedures that are likely to cause splashes of blood or body fluids. A private room is only indicated if the
client’s hygiene is poor.
15. A client has been placed in blood and body fluid isolation. The nurse is instructing auxiliary personnel
in the correct procedures. Which statement by the nursing assistant indicates the best understanding
of the correct protocol for blood and body fluid isolation?
Masks should be worn with all client contact.
Gloves should be worn for contact with nonintact skin, mucous membranes, or soiled items.
Isolation gowns are not needed.
A private room is always indicated.
RATIONALE: Masks should only be worn during procedures that are likely to cause splashes of blood or
body fluid. Gloves should be worn for all contact with blood and body fluids, nonintact skin and mucous
membranes; for handling soiled items; and for performing venipuncture. Gowns should be worn during
procedures that are likely to cause splashes of blood or body fluids. A private room is only indicated if the
client’s hygiene is poor.
16. The nurse is evaluating whether nonprofessional staff understand how to prevent transmission of
HIV. Which of the following behaviors indicates correct application of universal precautions?
a. A lab technician rests his hand on the desk to steady it while recapping the needle after
drawing blood.
b. An aide wears gloves to feed a helpless client.
c. An assistant puts on a mask and protective eye wear before assisting the nurse to suction a
d. A pregnant worker refuses to care for a client known to have AIDS.
RATIONALE: Needles that have been used to draw blood should not be recapped. If it is necessary to
recap them, an instrument such as a hemostat should be used to recap. The hand should never be used.
Gloves are not necessary when feeding, since there is no contact with mucus membranes. Although
saliva may have small amounts of HIV in it, the virus does not invade through unbroken skin. There is no
evidence in the question to indicate broken skin. Masks and protective eye wear are indicated anytime
there is great potential for splashing of body fluids that may be contaminated with blood. Suctioning of a
tracheostomy almost always stimulates coughing, which is likely to generate droplets that may splash the
health care worker. Clients who are suctioned frequently or have had an invasive procedure like a
tracheostomy are likely to have blood in the sputum. There is no reason to restrict pregnant workers from
caring for persons with AIDS as long as they utilize universal precautions.
17. Jermaine, 1-year old child has a staph skin infection. His brother has also developed the same
infection. Which behavior by the children is most likely to have caused the transmission of the
Bathing together.
Coughing on each other.
Sharing pacifiers.
Eating off the same plate.
RATIONALE: Direct contact is the mode of transmission for staphylococcus. Staph is not spread by
coughing. Staph is not spread through oral secretions. Direct contact is required. Staph is not spread
through oral secretions.
18. Jessie, a young man with newly diagnosed acquired immune deficiency syndrome (AIDS) is being
discharged from the hospital. The nurse knows that teaching regarding prevention of AIDS
transmission has been effective when the client:
verbalizes the role of sexual activity in spread of the disorder.
states he will make arrangements to drop his college classes.
acknowledges the need to avoid all contact sports.
says he will avoid close contact with his three-year-old niece.
RATIONALE: The AIDS virus is spread through direct contact with body fluids such as blood and through
sexual intercourse. Casual contact with other people does not pose a risk of transmission of AIDS. Unless
the client is feeling very ill, there is no need for him to drop his college classes. Contact sports are not
contraindicated unless there is a significant chance of bleeding and direct contact with others. Casual
contact with other people does not pose a risk of transmission of AIDS. There is no need to limit casual
contact with children.
19. Which question is least useful in the assessment of a client with AIDS?
Are you a drug user?
Do you have many sex partners?
What is your method of birth control?
How old were you when you became sexually active?
RATIONALE: Drug use is a risk factor for AIDS. Multiple sex partners is a risk factor for AIDS. Birth
control methods are important to prevent a baby from being born with the AIDS virus. The age at which
sexual activity began it not relevant as it does not usually provide information that identifies the presence
of risk factors for AIDS.
20. Mrs. Parker, a 70-year-old woman with severe macular degeneration, is admitted to the hospital the
day before scheduled surgery. The nurse’s preoperative goals for Mrs. M. would include:
independently ambulating around the unit.
reading the routine preoperative education materials.
maneuvering safely after orientation to the room.
using a bedpan for elimination needs.
RATIONALE: Independently ambulating around the unit is not appropriate because the unit environment
can change and injury could result. Assistance is necessary because of the client’s visual deficit. It is
unlikely the client can see well enough to read the materials. Maneuvering safely after orientation to the
room is a realistic goal for a person with impaired vision. Orienting the client to the room should help the
client to move safely. Using the bedpan is an unnecessary restriction on the client as she can be oriented
to the bathroom or to call for assistance.
Session 19
Situation: A 65-year old male named Tony Stark was recently admitted to the hospital with the presence
of cough together with back and joint pains. He was diagnosed to have infective endocarditis.
Which of the following would be a risk factor in the development of Tony’s disease?
a. Old age
b. Having arthritis
c. Living in the city
d. His job as a farmer
RATIONALE: Risk factors of having infective endocarditis are the following: patients with cardiac
structural defects; older people; IV injection drug users; patients who undergo invasive procedure;
patients who have implants or invasive equipment; and patients who are receiving immunosuppressive
drugs or corticosteroids.
Upon assessment the nurse noticed small erythematous nodular lesions on the palms of the
patient. Tony has stated that these lesions are not painful. The nurse must document this as
a. Osler’s nodes
b. Splinter hemorrhages
c. Janeway lesions
d. Roth’s spots
RATIONALE: Classically, Osler's nodes are on the tip of the finger or toes and painful. Janeway
lesions occur on palm and soles and are non-painful. Osler's nodes are thought to be caused by localised
immunological-mediated response while Janeway lesions are thought to be caused by septic
The nurse must know that the infection of Tony is found on the
a. Valves and endothelium
b. Myocardium
c. Pericardium
d. Epicardium
RATIONALE: There is a deformity of the valve and inflammation of the endothelium in this disease,
hence the term endocarditis.
Parenteral antibiotic therapy is done for Tony, the nurse must assess which of the following first
prior to administration of the drug?
Patient’s vital signs
Allergies to the antibiotic prescribed
Body temperature
Level of pain
RATIONALE: It is the task of the nurse to identify any allergies to any antibiotic drug prescribed in order
for the physician to order an alternative antibiotic.
Antibiotic therapy for patients with infective endocarditis usually takes how many weeks?
a. 2 weeks
b. 1 week
c. 4-6 weeks
d. 8-10 weeks
RATIONALE: Antibiotic therapy for infective endocarditis is done around 4-6 weeks via the parenteral
Situation: A 33-year old patient named Steve Rogers was admitted to the emergency room experiencing
chest pain and a temperature of 38.1 o Celsius. The nurse has assessed that the patient has increased
respiratory rate and heart rate. The patient was diagnosed to have acute pericarditis.
During assessment nurse Natasha has noticed hypotension, elevated jugular pressure, and
muffled heart sounds. These signs are known as
a. Pulsus paradoxus
b. Cardiac tamponade
c. Pericardial friction rub
d. Beck triad
RATIONALE: Beck triad is a collection of three clinical signs associated with pericardial tamponade
which is due to an excessive accumulation of fluid within the pericardial sac. The three signs are: low
blood pressure (weak pulse or narrow pulse pressure) muffled heart sounds. raised jugular venous
During the patient’s CT scan the physician has observed an accumulation of excessive fluid in the
pericardial space. The nurse must observe for signs of
a. Cardiac tamponade
b. Pericardial friction rub
c. Beck triad
d. Pleuritic pain
RATIONALE: Once there is an accumulation of excessive fluid in the pericardial sac, consequently, there
will be a rise in the intrapericardial pressure which is known as cardiac tamponade.
Prior to the patient’s CT scan, one of the responsibilities of nurse Natasha is to
a. Check for the patient’s anxiety level
b. Obtain any history of allergies in iodine
c. Assess for chest pain in the patient
d. Advise the patient to increase his fluid intake
RATIONALE: For the type of CT scan that is going to be done in the patient, the doctor will usually
require a contrast agent. Before the diagnostic procedure is done, the nurse must identify if the patient
has allergies to iodine.
Steve has complained of chest pain. The most appropriate nursing diagnosis for this would be
a. Risk for ineffective breathing pattern
b. Activity intolerance
c. Altered tissue perfusion
d. Pain
RATIONALE: The nurse should address the patient’s complaint of pain and should have a nursing
diagnosis related to pain.
10 The type of surgery that would treat Steve’s pericarditis would be
a. Pericardiocentesis
b. Cardiac catheterization
c. Balloon angioplasty
d. Fontan procedure
RATIONALE: Pericardiocentesis is a procedure done to remove fluid that has built up in the sac around
the heart (pericardium). It's done using a needle and small catheter to drain excess fluid.
Situation: A 45-year old male patient named Jim Hopper is admitted to the hospital with a chief complaint
of chest pain together with nausea and vomiting. He is diagnosed to have atherosclerosis. Nurse Joyce is
assigned to the patient.
11 Nurse Joyce is taking the patient’s health history. Which of the following statements of the patient
may have led to the development of atherosclerosis?
a. “I rarely cook food. I always order food from fast food restaurants.”
b. “I have been a smoker for more than 20 years now.”
c. “I have been taking medications for hypertension.”
d. All of the above statements
RATIONALE: Eating fatty foods have a high risk in the development of atherosclerosis. Smoking may
lead to arteriosclerosis.
12 Which of the following diagnostic procedures would show the location and the extent of the
narrowing of Jim’s CAD?
a. Coronary angiography
b. ECG
c. Stress test
d. Chest X-ray
RATIONALE: Coronary angiography is a procedure that uses contrast dye, usually containing iodine, and
x ray pictures to detect blockages in the coronary arteries that are caused by plaque buildup.
13 The most important goal in patients who have a coronary artery disease would be
a. Decreasing the weight of obese patients
b. Increase oxygen supply to the myocardium
c. Taking anticoagulants
d. Offering exercise classes
RATIONALE: Goals in the medical management of atherosclerosis are the following: decrease
myocardial oxygen demand/cardiac workload; increase oxygen supply to the myocardium; alleviate chest
14 One of the medications prescribed to Jim would be Cholestyramine (Questran). The nurse must
advise the patient to take this medication
a. Before meals
b. After meals
c. At bedtime
d. At noon
RATIONALE: Take this medication before a meal and/or at bedtime, and try to take any other
medications at least 1 hour before or 4 hours after you take cholestyramine because cholestyramine can
interfere with their absorption.
15 During the diagnosis of the patient’s disease, the doctor has observed for the development of a
fibrous plaque in his coronary artery, this is also known as
a. Thrombosis
b. Embolus
c. Atheroma
d. Cardiomyopathy
RATIONALE: An atheroma, or atheromatous plaque ("plaque"), is an abnormal accumulation of material
in the inner layer of the wall of an artery. The material consists of mostly macrophage cells, or debris,
containing lipids, calcium and a variable amount of fibrous connective tissue.
16 If Jim’s atherosclerosis is left untreated, he may have which of the following complications?
Liver failure
Severe hypertension
Myocardial infarction
Acute renal failure
RATIONALE: The complications of atherosclerosis depend on which arteries are blocked. For example:
Coronary artery disease. When atherosclerosis narrows the arteries close to your heart, you may develop
coronary artery disease, which can cause chest pain (angina), a heart attack or heart failure.
17 Jim has been started on anticoagulant therapy. His doctor has prescribed Warfarin (Coumadin).
Which of the following must Nurse Joyce place at the patient’s bedside?
a. Alteplase
b. Calcium gluconate
c. Protamine sulfate
d. Vitamin K
RATIONALE: If overdose occurs or anticoagulation needs to be immediately reversed, the antidote
is vitamin K (phytonadione, Aquamephyton).
18 Which of the following will Nurse Joyce immediately report to the doctor during Jim’s warfarin
(Coumadin) therapy?
Increased urine output
RATIONALE: Adverse effects of warfarin are the following: Severe bleeding, including heavier than
normal menstrual bleeding; red or brown urine; black or bloody stool; severe headache or stomach pain;
joint pain, discomfort or swelling, especially after an injury; vomiting of blood or material that looks like
coffee grounds; coughing up blood.
19 Jim is also prescribed to take propranolol (Inderal). When administering this the nurse must first
check which of the following?
a. Body temperature
b. Urine output
c. Respiratory rate
d. Pulse rate
RATIONALE: Take apical pulse before administering. If <50 bpm or if arrhythmia occurs, withhold
medication and notify health care professional. Administer metoprolol with meals or directly after eating.
Extended-release tablets should be swallowed whole; do not break, crush, or chew.
20 Nurse Joyce must also teach about dietary changes in Jim’s diet. She should teach Jim to take
how may grams of fiber per day?
a. 10 grams
b. 15-18 grams
c. 2-3 grams
d. 20-30 grams
RATIONALE: The nutrient content of the therapeutic lifestyle changes in the diet of the patient for fiber is
usually at 20-30 grams per day.
21 Nurse Joyce must also emphasize about the intake of saturated fats. She should tell Jim to take
how much saturated fats per day?
a. >7% of calories
b. >10% of calories
c. <7% of calories
d. <20% of calories
RATIONALE: Saturated fats should be very minimal in patients with atherosclerosis. It should be less
than 7% per day.
22 Jim is also started on antilipidemics. He has been prescribed to take Simvastatin (Zocor). The
nurse must watch out for
a. Bleeding
b. Hypertension
c. Dizziness
d. Myalgia and arthralgia
RATIONALE: The common side effects of statins are the following: headache; nausea; stomach pain;
constipation; muscle pain (myalgia) or weakness; joint pain (arthralgia); and upper respiratory infections.
23 After several months, Jim was sent back to the hospital and has suffered a myocardial infarction.
The physician has referred him to a cardiac surgeon and he will be undergoing coronary artery
bypass graft. In doing this procedure, a vein graft is used. This is commonly obtained from the
a. Brachial vein
b. Pedal vein
c. Femoral vein
d. Saphenous vein
RATIONALE: The saphenous vein (SPV) is a commonly used conduit for bypass due to the ease of
harvest, which can generally be done through minimally invasive procedures, with less scarring and faster
recovery. But the failure of vein grafts over the long term remains a significant problem.
24 To change Jim’s lifestyle and prevent his CAD from further complicating, the nurse must
emphasize which of the following?
a. Changes in his diet
b. Avoid eating in fast food restaurants
c. Cessation of smoking
d. All of the above
RATIONALE: All factors must be done by the patient in order to improve his condition most especially in
the avoidance of foods that are high in fat. The nurse must teach the patient about choosing the proper
diet for his condition.
25 Which of the following would help Jim reduce his stress from work?
a. Practicing yoga
b. Taking benzodiazepines
c. Maintaining a balanced diet
d. Resigning from his job and seek better job opportunities
RATIONALE: This is the one of the best options in stress reduction techniques. Other stress reduction
techniques would be mindfulness meditation, guided imagery, body scan, breath focus, etc.
Session 20
Situation 5: A 47-year old patient named Scott Lang was brought to the ER with complaints of chest pain
and dyspnea. Upon echocardiography the doctor has diagnosed myocarditis. Nurse Hope is tasked to
obtain the patient’s health history.
26 Which of the following statements from the patient would probably have led him to have
a. “I have been taking corticosteroid therapy for several months now to treat my arthritis.”
b. “I have been experiencing hypertension every now and then.”
c. “I have been stressed a lot lately because of my work.”
d. “I am fond of eating salty foods.”
RATIONALE: Risk factors of myocarditis are the following: patients who have viral, bacterial, protozoan,
or parasitic infections; patients who are receiving immunosuppressive drugs or corticosteroids; and
patients who may develop sensitivity reaction to long-term drug therapy.
27 Which of the following drugs prescribed by the doctor is Nurse Hope going to question?
a. Penicillin-G
b. Ceftriaxone
c. Aspirin
d. Ampicillin
RATIONALE: Do not give NSAIDs to patients with cardiovascular diseases especially heart failure
because they may cause further myocardial damage.
28 One of the goals in the treatment of myocarditis is to prevent embolization. The nurse must
emphasize which of the following?
a. Application of elastic pressure stockings
b. ROM exercises
c. Taking anticoagulants
d. All of these
RATIONALE: All of these choices prevent embolization and the nurse must teach the patients properly
about doing these precautions.
29 Scott has suddenly developed shortness of breath, dyspnea, crackles, and a pink-frothy sputum.
The nurse must suspect for?
a. Right-sided heart failure
b. Left-sided heart failure
c. Cardiac tamponade
d. Pericardial friction rub
RATIONALE: Clinical manifestations of left-sided heart failure always has respiratory signs and
30 The goal in the treatment of Scott’s myocarditis would be
a. Eliminating pain
b. Prevention of thrombus formation
c. Treatment of the underlying infection
d. Cardiac monitoring
RATIONALE: Since infection is the root of myocarditis, the best treatment of this is by giving the
appropriate drugs (e.g. bacterial myocarditis – antibiotics).
Situation: A 27-year old patient named Ethan del Rosario has been diagnosed to have angina pectoris
due to having atherosclerosis during a routine check-up. He has frequently complained of chest pains. He
currently works as a bartender and states about his stress in the nature of his work. Nurse Joy is
assigned to this patient.
31 Upon assessment of nurse Joy, Ethan has stated that he has been experiencing chest pain
whenever he is tired from work. It happens every time his shift ends. The nurse must note that
this type of angina could be?
a. Silent angina
b. Stable angina
c. Unstable angina
d. Variant angina
RATIONALE: Stable angina is caused by predictable degree of exertion. Stable pattern of onset,
duration, severity, and relieving factor.
32 Nurse Joy must also note that the location of Ethan’s chest pain in angina pectoris would be at
a. Lateral portion of the chest
b. Slightly to the left of the sternum
c. Center of the chest
d. Slightly to the right of the sternum
RATIONALE: The location of angina pectoris is retrosternal or slightly to the left of the sternum.
33 The pain felt by Ethan may radiate to the
a. Left shoulder
b. Right shoulder
c. Right arm
d. Abdomen
RATIONALE: The radiation of pain for patients with angina pectoris would be at the left shoulder, arms,
neck, and jaw.
34 In angina pectoris, the nurse is going to anticipate for the doctor to prescribe which of the
following to Ethan?
b. Nitroglycerine
c. Reteplase
d. Digoxin
RATIONALE: Sublingual nitroglycerin has been the mainstay of treatment for angina pectoris. Sublingual
nitroglycerin can be used for acute relief of angina and prophylactically before activities that may
precipitate angina.
35 In the discharge teaching of Ethan, Nurse Joy must instruct the patient about the handling of
nitroglycerine. She should advise Ethan to
a. Always carry it wherever he goes and place it in a dark glass bottle
b. Place the medication in a well-lit room
c. Store the medication in his medicine cabinet
d. Learn the basics of IM drug administration
RATIONALE: Always tell the patient to bring the medication with him at all times and place it in a dark
glass bottle since this drug is photosensitive. Protect nitroglycerine from light at all times.
36 Nurse Joy must also teach Ethan on how to take nitroglycerine, that if pain is not relieved, Ethan
must take it after how many minutes?
a. 10 minutes
b. 15 minutes
c. 1 minute
d. 5 minutes
RATIONALE: Adults—1 tablet placed under the tongue or between the cheek and gum at the first sign of
an angina attack. 1 tablet may be used every 5 minutes as needed, for up to 15 minutes. Do not take
more than 3 tablets in 15 minutes.
37 Nurse Joy will also advise Ethan that when all three doses of nitroglycerine have been exhausted,
Ethan must
a. Take a fourth dose
b. Take morphine sulfate next
c. Call for the hospital immediately
d. Wait for the pain to subside
RATIONALE: If the patient still has chest pain after a total of 3 nitroglycerine tablets, the patient must
contact the doctor or go to the hospital immediately.
38 In nitroglycerine therapy, Nurse Joy must teach Ethan to take the tablets
a. Orally
b. Sublingually
c. Via the buccal route
d. With food
RATIONALE: Nitroglycerin sublingual tablets should not be chewed, crushed, or swallowed. They work
much faster when absorbed through the lining of the mouth. Place the tablet under the tongue or between
the cheek and gum, and let it dissolve.
39 When giving Atenolol (Tenormin) to Ethan, Nurse Joy has observed for bradycardia. She should
a. Continue giving the medication
b. Withhold the medication
c. Double the dose of the medication
d. Lower the dosage of the medication
RATIONALE: Beta blockers can further lower the heart rate of patient who is already experiencing
40 Ethan is also started on acetylsalicylic acid (Aspirin) therapy. Nurse Joy must instruct the patient
a. Take it with food
b. Take it on an empty stomach
c. Drink it with coffee
d. Take it before meals
RATIONALE: Aspirin is a gastric irritant, it is important to teach the patient to take it with meals to avoid
stomachaches from occurring.
41 Ethan also is prescribed to take heparin sodium. Nurse Joy must keep what available?
Vitamin K
Protamine sulfate
RATIONALE: When clinical circumstances (bleeding) require reversal of heparinization, protamine sulfate
(1% solution) by slow infusion will neutralize heparin sodium. No more than 50 mg should be
administered, very slowly in any 10 minute period. Each mg of protamine sulfate neutralizes
approximately 100 USP heparin units.
42 Which of the following would Nurse Joy advise Ethan to increase in his diet to help decrease his
low-density lipoproteins?
a. Sodium intake
b. Fiber intake
c. Fluid intake
d. All of the above
RATIONALE: A greater intake of dietary fiber may reduce the risk of developing cardiovascular
disease through a variety of mechanisms, such as improving serum lipid concentrations, lowering blood
pressure, and reducing inflammation.
43 Percutaneous transluminal coronary angioplasty (PTCA) is about to be done on Ethan to treat his
CAD. The nurse must know that this is done through
a. Open heart surgery
b. A cardiac window
c. Cardiac catheterization
d. Coronary artery stripping
RATIONALE: In PTCA, patients are taken to cardiac catherization lab within 24 to 48 hours.
44 Ethan asks the nurse why he should take anticoagulants. The nurse’s reply must be
a. “To prevent the occurrence of blood clots which can lead to myocardial infarction.”
b. “This is done to decrease your blood pressure.”
c. “It helps your heart properly pump out blood.”
d. “They prevent you from having an infection.”
RATIONALE: Anticoagulants are medicines that help prevent blood clots. They're given to people at a
high risk of getting clots, to reduce their chances of developing serious conditions such as strokes and
heart attacks.
45 Which of the following lab values must the nurse monitor if Ethan is placed on heparin sodium?
a. Prothrombin time
b. Partial thromboplastin time
c. Creatine-kinase
d. Troponin I
RATIONALE: Heparin—is an anticoagulant and will prolong a PTT, either as a contaminant of the sample
or as part of anticoagulation therapy.
Situation: A 45-year old patient named Bruce Banner went for a routine check-up. The nurse on duty has
assessed that he has a blood pressure of 140/90 mmHg. Upon obtaining the patient’s health history and
doing further tests on the patient his doctor has diagnosed him to have essential hypertension.
46 Which of the following is the cause of having essential hypertension?
a. Chronic renal failure
b. Diabetes mellitus
c. Idiopathic
d. Coronary artery disease
RATIONALE: The cause of essential hypertension is unknown.
47 Which of the following can further worsen the Bruce’s hypertension?
a. The patient’s vegetarian diet
b. His weekly football game with his friends
c. Stress from work
d. His daily intake of rice
RATIONALE: Your body produces a surge of hormones when you're in a stressful situation. These
hormones temporarily increase your blood pressure by causing your heart to beat faster and
your blood vessels to narrow.
48 Bruce has been prescribed to take metoprolol (Lopressor) for the control of hypertension. The
nurse must know that this drug inhibits the release of
a. Renin
b. Angiotensin I
c. Angiotensin-converting enzyme
d. Aldosterone
RATIONALE: Beta-blockers have an additional benefit as a treatment for hypertension in that they inhibit
the release of renin by the kidneys (the release of which is partly regulated by β1-adrenoceptors in the
49 When giving vasodilators such as hydralazine (Apresoline) to Bruce for the treatment of
hypertension, the nurse must advise the patient to watch for
a. Increased urine output
b. Blurred vision
c. Peripheral edema
d. Rashes
RATIONALE: The nursing considerations when giving vasodilators such as hydralazine are: assess for
peripheral edema; take it with food; and assess BP before administering the drug.
50 The nurse is about to give Nifedipine (Adalat) to Bruce. Before giving the drug, the nurse has
assessed for hypotension 88/60 mmHg. The nurse must do which of the following?
a. Come back after 5 minutes and give the drug
b. Double the dosage of the drug
c. Decrease the drug dosage
d. Withhold the drug
RATIONALE: Nifedipine decreases peripheral resistance and can worsen hypotension. Nifedipine should
not be used in patients with systolic blood pressures of less than 90 mm Hg (i.e.,
severe hypotension). Nifedipine should be used with caution in patients with mild to
moderate hypotension.
Session 21
Situation 7: A 56-year old male client named Happy Hogan is brought to the emergency department
because of severe chest pain not relieved by nitroglycerine. He has a history of angina pectoris. The
attending physician diagnosed him to have myocardial infarction. He is attended to by Nurse May.
The immediate nursing intervention in the diagnosis of myocardial infarction would be
a. Oxygen administration as ordered by the physician
b. Administration of morphine sulfate
c. Preparing for the immediate surgery of the patient
d. Administration of nitroglycerine
RATIONALE: The rationale behind oxygen therapy is to increase oxygen delivery to the ischemic
myocardium and thereby limit infarct size and subsequent complications.
During the diagnosis of myocardial infarction the doctor has noted that the endocardial muscles
are affected. The nurse must know that this classification of MI is
a. Transmural infarct
b. Subendocardial infarct
c. Intramural infarct
d. Intermural infarct
RATIONALE: A subendocardial infarct results in necrosis exclusively inolving the innermost aspect of the
The client’s creatine-phosphokinase MB (CPK-MB) is monitored. The nurse must know that the
peak usually is achieved within how many hours after a myocardial infarction?
a. 3-6 hours
b. 12-18 hours
c. 3-4 days
d. 5-7 days
RATIONALE: CK-MB first appears 3-6 hours after symptom onset, peaks at 12-18 hours, and returns to
normal in 48-72 hours. Its value in the early and late (>72 h) diagnosis of acute MI is limited. However, its
release kinetics can assist in diagnosing reinfarction if levels rise after initially declining following acute
In the ECG reading interpretation, the nurse has noted a T-wave depression. Nurse May must
this as
a. Zone of ischemia
b. Zone of injury
c. Zone of infarction
d. Zone of occlusion
RATIONALE: T wave depression – ischemia, ST segment elevation – injury, pathologic Q wave –
Aside from relieving pain from MI, morphine sulfate is administered since it causes what to the
coronary arteries?
a. Vasodilation
b. Vasoconstriction
c. Vasospasms
d. Thrombolytic
RATIONALE: Morphine sulfate is also a vasodilator and decreases the workload of the heart by reducing
preload and afterload.
One of the discharge teachings to Happy is to prevent constipation from occurring since straining
during a bowel movement can cause
a. Heart failure
b. Arteriosclerosis
c. Cardiac arrhythmias
d. Hypertension
RATIONALE: Straining during defecation can cause cardiac arrythmias due to vagal nerve stimulation.
In order to prevent constipation, nurse May must instruct Happy to
a. Increase fiber in the diet
b. Increase sodium in the diet
c. Increase vitamin K in the diet
d. Increase fluid intake
RATIONALE: Increased fiber intake will help the patient pass out stools with ease in order to avoid
straining during defecation.
Great sources of vitamin K would be found in
a. Citrus fruits
b. Meats
c. Cereals
d. Green, leafy vegetables
RATIONALE: Vitamin K is found in the following foods: Green leafy vegetables, such as kale, spinach,
turnip greens, collards, Swiss chard, mustard greens, parsley, romaine, and green leaf lettuce.
Vegetables such as Brussels sprouts, broccoli, cauliflower, and cabbage.
Which of the following drugs would be beneficial in dissolving the thrombus that has caused a
blockage in Happy’s coronary artery?
a. Aspirin
b. Heparin sodium
c. Warfarin
d. Alteplase
RATIONALE: Alteplase (t-PA) is a thrombolytic medication, used to treat acute ST elevation myocardial
infarction (a type of heart attacks), pulmonary embolism associated with low blood pressure, acute
ischemic stroke, and blocked central venous access devices (CVAD). It is given by injection into a vein or
artery within the first 12 hours of myocardial infarction.
10 If Happy is not relieved by drug and oxygen therapy for myocardial infarction the Nurse May must
a. Prepare the patient for emergency surgery
b. Increase the delivery of oxygen
c. Suggest to the physician to increase the dose of the drugs
d. Reassess the patient’s ECG readings
RATIONALE: If the client is not relived by the following: morphine, oxygen, nitroglycerine, and aspirin, the
patient will most likely undergo emergency surgery.
11 One of the drugs prescribed by the physician is furosemide (Lasix). When giving this drug to
Happy, nurse May should monitor the patient’s
a. Intake and output
b. Body temperature
c. Level of pain
d. Respiratory rate
RATIONALE: Since furosemide is a diuretic, one of the things that the nurse must take into consideration
with this drug is to monitor the intake and output of the patient.
12 In the administration of morphine sulfate, the nurse must monitor for the adverse effect of the
drug which is
a. Respiratory depression
b. Hypotension
c. Oliguria
d. Increased temperature
RATIONALE: The fatal adverse effect of morphine sulfate is respiratory depression. The nurse
administering this must monitor the patient’s respiratory rate.
13 Upon discharge which of the following patient response would require further teaching by the
a. “I will increase my fiber intake to prevent constipation.”
b. “I will minimize my intake of sodium.”
c. “I will report signs of bleeding in my anticoagulant therapy.”
d. “I will take aspirin on an empty stomach.”
RATIONALE: Aspirin should be taken with food since it can irritate the gastric mucosa.
14 Which of the following phases of cardiac rehabilitation would include long-term maintenance of
what was performed in the first 3 phases?
a. Phase I
b. Phase II
c. Phase III
d. Phase IV
RATIONALE: Phase 4 is the long-term future of the individual, continuing with the healthy living habits
which have been encouraged by phases 1 to 3, with regular monitoring of clinical condition, risk factors,
and medication — usually by the primary care team.
15 In the phase III of cardiac rehabilitation, the patient is undergoing
a. In-patient treatment
b. Exercise and education program
c. Immediate post-discharge period
d. Long term maintenance
RATIONALE: Phase I: Inpatient Stay. Phase II: immediate post-discharge period. Phase III: Exercise and
education program. Phase IV: Long term maintenance
Situation: A 22-year old female patient named Sasha Braus has been rushed to the hospital with a chief
complaint of dyspnea. Nurse Armin assigned at the ER assessed Sasha and has observed for crackles
upon auscultation, pink-frothy sputum, and has a pre-existing disease of ventricular septal defect. The
attending physician has diagnosed the patient to have heart failure.
16 Based on Nurse Armin’s assessment findings, the patient is experiencing which type of heart
a. Right-sided heart failure
b. Left-sided heart failure
c. Bilateral heart failure
d. End-stage heart failure
RATIONALE: Signs and symptoms of left-sided heart failure is pulmonary in origin.
17 The doctor has prescribed a cardiac glycoside known as digoxin (Lanoxin). What is NOT an
action of this drug?
a. Increases force of contraction of the heart
b. Rate of heart is decreased
c. Negative dromotropic effect
d. Heart rate is increased
RATIONALE: Heart rate is rather decreased in the administration of digoxion. Digoxin is known to have a
negative chronotropic effect.
18 Sasha asks the nurse why she should be in sodium restriction. Nurse Armin must reply which of
the following statements?
a. “You salt intake is limited since sodium will cause water to be retained in your blood
which can increase the workload of your heart.”
b. “Sodium is restricted because it causes your heart to pump ineffectively.”
c. “Sodium is taken in limited amounts since it can excite the nerves of the heart.”
d. “Salt is reduced to increase the potassium levels of your blood.”
RATIONALE: Sodium will always attract water causing blood volume to increase. Increase in blood
volume will increase the cardiac workload. Bland diet is instead offered to patients with heart failure.
19 When administering furosemide (Lasix) to Sasha, nurse Armin must watch out for which of the
a. Hypokalemia
b. Hyperkalemia
c. Hypernatremia
d. Hypocalcemia
RATIONALE: Furosemide is a potassium-wasting loop diuretic. Increase excretion of potassium will lead
to hypokalemia.
20 Nurse Armin must also determine the difference between right-sided and left-sided heart failure.
The signs and symptoms of right-sided heart failure would NOT include which of the following?
a. Distended jugular veins
b. Hepatomegaly
c. Pulmonary edema
d. Ascites
RATIONALE: Pulmonary edema is seen usually in left-sided heart failure.
21 After the administration of digoxin (Lanoxin) to Sasha, the nurse must watch out for
a. Blurred vision
b. Yellow halos around lights
c. Photophobia
d. Nausea and vomiting
RATIONALE: Xanthopsia is a color vision deficiency in which there is a predominance
of yellow in vision due to a yellowing of the optical media of the eye. The most common cause is digoxin's
inhibitory action on the sodium pump, and the development of cataracts which can cause a yellow filtering
22 Nurse Armin must advise Sasha to avoid which of the following substances?
a. Nicotine
b. Alcohol
c. Caffeine
d. All of these
RATIONALE: All of these substances are contraindicated to patients who have heart failure since they
can increase heart rate and therefore increasing the workload of the heart.
23 When administering furosemide (Lasix) to a patient with heart failure nurse Armin must advise
Sasha to eat fruits that are high in
a. Chloride
b. Potassium
c. Calcium
d. Sodium
RATIONALE: Refer to no. 19
24 Sasha tells that nurse that she always feels exhausted whenever she walks to and from the toilet
whenever she has the urge to urinate. The appropriate nursing diagnosis for her would be
a. Risk for decreased cardiac output
b. Activity intolerance
c. Acute pain
d. Ineffective tissue perfusion
RATIONALE: This is the most appropriate nursing diagnosis since the patient is always experiencing
fatigue brought about by any normal day-to-day activities.
25 In order to truly eradicate Sasha’s heart failure, the doctor must
a. Advise the patient to be on cardiac glycosides and diuretics for life
b. Refer the patient to a surgeon who can correct her ventricular septal defect
c. Totally restrict sodium from her diet until she gets better
d. Modify her lifestyle
RATIONALE: Treating the underlying disorder of the patient can help treat heart failure as well.
Session 22
1. A nursing student is asking her clinical instructor about the lifespan of red blood cells. The
instructor should know that the life of the erythrocytes is usually at around
a. 60 days
b. 100 days
c. 120 days
d. 180 days
RATIONALE: When matured, in a healthy individual these cells live in blood circulation for about 100 to
120 days (and 80 to 90 days in a full-term infant). At the end of their lifespan, they are removed from
circulation. In many chronic diseases, the lifespan of the red blood cells is reduced.
2. When the patient has low hemoglobin and hematocrit, the nurse must suspect the patient to have
a. Anemia
b. Leukemia
c. Thrombocytopenia
d. Polycythemia
RATIONALE: Low Hgb/Hct leads to anemia. Anemia can be caused by blood loss, decreased blood cell
production, increased blood cell destruction, and hemodilution.
3. The blood cells that are high in the event that the patient is suffering from an allergic reaction
would be
a. Basophils
b. Eosinophils
c. Neutrophils
d. Both a and b
RATIONALE: It can be caused by infections, severe allergies, or an overactive thyroid gland.
4. A 7-year-old patient was admitted to the hospital for suspected dengue fever. The complete blood
count shows that the patient has a platelet count of 20,000 cells per mm3. The nurse interprets
this as
a. Neutropenia
b. Thrombocytopenia
c. Leukopenia
d. Anemia
RATIONALE: Thrombocytopenia is a condition in which you have a low blood platelet count. Platelets
(thrombocytes) are colorless blood cells that help blood clot. Platelets stop bleeding by clumping and
forming plugs in blood vessel injuries. Normal value of thrombocytes is at 150,000-450,000 cells per mm3
5. The nurse has observed that in the patient’s CBC, the white blood cells of the patient is at 13000
cells per mm3. The patient might be having a/an
a. Anemia
b. Infection
c. Dengue hemorrhagic fever
d. Blood dyscrasia
RATIONALE: A high white blood cell count may indicate that the immune system is working to destroy an
infection. It may also be a sign of physical or emotional stress.
6. Which of the following cells are considered to be phagocytes?
a. Monocytes
b. Basophils
c. Neutrophils
d. Both a and c
RATIONALE: There are three types of phagocytic cells in the body namely, monocytes, macrophages,
and neutrophils.
7. Iron-deficiency anemia is common in men and women who have which of the following coexisting disorders?
a. Ulcers
b. Inflammatory bowel disease
c. GI tumors
d. All of the above
RATIONALE: The most common cause of IDA in men and postmenopausal women is bleeding from
ulcers, gastritis, inflammatory bowel disease, or GI tumors.
8. Which of the following group of drugs can cause chronic blood loss from the GI tract further
contributing to the development of iron-deficiency anemia?
a. Antibiotics
c. Anti-ulcer drugs
d. Antacids
RATIONALE: patients with chronic alcoholism or who take aspirin, steroids, or NSAIDs often have
chronic blood loss from the GI tract, which causes iron loss and eventual anemia.
9. Which of the following is NOT a sign or symptom of having iron-deficiency anemia?
a. Smooth, red tongue
b. Angular cheilosis
c. Stomachache
d. Brittle and rigid nails
RATIONALE: Signs and symptoms of IDA are the following: weakness, pallor of the skin and mucous
membranes, smooth-red tongue, brittle and ridged nails, and angular cheilosis.
10. In the event of a dark-skinned patient, the best site to assess the pallor of the patient with irondeficiency anemia would be at the
a. Conjunctiva
b. Palms
c. Soles
d. Abdomen
RATIONALE: It is hard to check for pallor on the skin of patients who are dark-skinned. The best site is to
check the conjunctiva.
11. The definitive method of establishing the diagnosis of iron-deficiency anemia would be
a. Complete blood count
b. Cardiac catheterization
c. Angiography
d. Bone marrow aspiration
RATIONALE: The absence of stainable iron in a bone marrow aspirate that contains spicules and a
simultaneous control specimen containing stainable iron permit establishment of a diagnosis of iron
deficiency without other laboratory tests.
12. The nurse is about to give iron supplements to a patient with iron-deficiency anemia. Which of the
following beverages can be given together with iron supplementation?
a. Orange juice
b. Milk tea
c. Cappuccino
d. Yogurt drink
RATIONALE: Taking iron supplement pills and getting enough iron in your food will correct most cases
of iron deficiency anemia. You usually take iron pills 1 to 3 times a day. To get the most benefit from
the pills, take them with vitamin C (ascorbic acid) pills or orange juice. Vitamin C helps your body absorb
more iron.
13. Which of the following routine tests should people above 50 years of age have to detect
ulcerations, polyps or cancer of the GI tract?
a. Colonoscopy
b. Endoscopy
c. Upper GI and Lower GI series
d. All of the above
RATIONALE: People 50 years of age or older should have a colonoscopy, endoscopy, or other
examination of the gastrointestinal tract to detect ulcerations, gastritis, polyps, or cancer.
14. Which of the following food items would be beneficial for patients who have iron-deficiency
a. Chicken breast
b. Chicken liver
c. Red fruits
d. Carrots
RATIONALE: Organ meats such as liver is high in iron. The nurse must also teach the patient to eat
green-leafy vegetables since they are also high in iron.
15. A person taking fluid preparation of ferrous sulfate might have which of the following is he did not
use a straw?
a. Tooth decay
b. Teeth staining
c. Tartar
d. Halitosis
RATIONALE: Liquid forms of iron supplement tend to stain the teeth. To prevent, reduce, or remove
these stains: Mix each dose in water, fruit juice, or tomato juice. You may use a drinking tube or straw to
help keep the iron supplement from getting on the teeth.
16. Which of the following vitamins enhances the absorption of iron in the body?
a. Vitamin A
b. Vitamin K
c. Vitamin C
d. Vitamin D
RATIONALE: refer to no. 12
17. The pathology of aplastic anemia is brought about by
a. Deficiency in vitamin B12
b. Deficiency in folic acid
c. Destruction of red bone marrow stem cells
d. Absence of intrinsic factor from the GI
RATIONALE: Aplastic anemia is a rather rare disease caused by a decrease in or damage to marrow
stem cells, damage to the microenvironment within the marrow, and replacement of the marrow with fat.
18. Which of the following substances is NOT associated with aplastic anemia?
a. Sulfonamides
b. Phenothiazines
c. Antineoplastic agents
d. Vitamin and mineral supplements
RATIONALE: Causes of aplastic anemia are the following: benzene and benzene derivatives; inorganic
arsenic; pesticides such as DDT; medications such as phenothiazines, sulfonamides, sedatives, and
antioneoplastic agents.
19. Management of aplastic anemia is best done through
a. Transfusion of platelet concentrate
b. Transfusion of fresh frozen plasma
c. Bone marrow transplantation
d. Iron supplementation
RATIONALE: Bone marrow transplantation or peripheral stem cell transplantation together with
immunosuppressant therapy by giving antihymocyte globulin and cyclophosphamide.
20. What is the primary cause of aplastic anemia?
a. Infections
b. Toxic substances
c. Antineoplastic therapy
d. Idiopathic
RATIONALE: In many cases, doctors aren't able to identify the cause of aplastic
anemia (idiopathic aplastic anemia).
21. In megaloblastic anemia, the patient may have a deficiency in which of the following?
a. Folic acid
b. Iron
c. Vitamin B12
d. Both a and c
RATIONALE: Megaloblastic anemia: Folic acid and vitamin B12 metabolism. Folic acid and cobalamin
are B-group vitamins that play an essential role in many cellular processes. Deficiency in one or both of
these vitamins causes megaloblastic anemia, a disease characterized by the presence of megaloblasts.
22. Which of the following best describes the appearance of the blood cells in megaloblastic anemia?
a. Sickle-shaped
b. Irregularly-shaped
c. Microcytic
d. Large and bizarre
RATIONALE: Megaloblastic anemia is a condition in which the bone marrow produces unusually large,
structurally abnormal, immature red blood cells (megaloblasts).
23. This is known as a decrease in all myeloid-derived cells
a. Pancytopenia
b. Thrombocytopenia
c. Anemia
d. Polycythemia
RATIONALE: Pancytopenia is a condition that occurs when a person has low counts for all three types of
blood cells: red blood cells, white blood cells, and platelets. Pancytopenia is usually due to a problem with
the bone marrow that produces the blood cells. However, there can be several different underlying
24. The mean corpuscular volume of a patient with megaloblastic anemia would be
a. 81-96 µm3
b. 75 µm3
c. > 110 µm3
d. < 80 µm3
RATIONALE: Because the RBCs are very large, the MCV is very high, usually exceeding 110 μm3.
25. Folic acid deficiency may be brought about by
a. Decreased consumption of vegetables
b. Increased consumption of meats
c. Increased consumption of vegetables
d. Decreased consumption of seafood
RATIONALE: Since folic acid is highly present in vegetables such as the leafy ones. Decreased
consumption can lead to folic acid deficiency.
Session 23
1. In Schilling test, this is done by
a. Letting the patient take radioactive iodine
b. Letting the patient take radioactive vitamin B12
c. Letting the patient take radioactive folic acid
d. Letting the patient take radioactive intrinsic factor
RATIONALE: This test is divided into 2 main stages. The patient is given radiolabeled vitamin B12 orally,
following an intramuscular (IM) dose of unlabeled vitamin B12 one hour later. The injection is given to
ensure that none of the radioactive B12 binds to any vitamin B12 depleted tissues, for example, the liver.
2. Under production of the intrinsic factor can cause malabsorption of which of the following?
a. Vitamin B6
b. Vitamin B1
c. Vitamin B12
d. Vitamin B2
RATIONALE: Intrinsic factor is a glycoprotein secreted by parietal (humans) or chief (rodents) cells of the
gastric mucosa. In humans, it has an important role in the absorption of vitamin B12 (cobalamin) in the
intestine, and failure to produce or utilize intrinsic factor results in the condition pernicious anemia.
3. The administration of folic acid for megaloblastic anemia would be
a. 1 gram daily
b. 10 mg daily
c. 100 mg daily
d. 1 mg daily
RATIONALE: Folate deficiency is treated by increasing the amount of folic acid in the diet and
administering 1 mg of folic acid daily.
4. For vegetarians suffering from megaloblastic anemia the nurse must teach the patient to take
a. Vitamin B12 supplements
b. Iron supplements
c. Vitamin C supplements
d. Taking intrinsic factor through IV
RATIONALE: Vegetarians can prevent or treat deficiency with oral supplements through vitamins or
fortified soy milk.
5. Patients with megaloblastic anemia may have difficulty maintaining which of the following
a. Speech
b. Hearing
c. Balance
d. Erection
RATIONALE: The nurse needs to pay particular attention to ambulation and should assess the patient’s
gait and stability as well as the need for assistive devices (eg, canes, walkers) and for assistance in
managing daily activities.
6. Which of the following races are prone to develop sickle-cell anemia?
a. Europeans
b. Austronesians
c. Africans
d. East Asians
RATIONALE: The HbS gene is inherited in people of African descent and to a lesser extent in people
from the Middle East, the Mediterranean area, and aboriginal tribes in India.
7. This is known as the prolonged erection of the penis in patients with sickle-cell anemia which is
often painful
a. Sickling
b. Priapism
c. Auto-erection
d. Phimosis
RATIONALE: Priapism is a prolonged erection of the penis. The persistent erection continues hours
beyond or isn't caused by sexual stimulation. Priapism is usually painful. Although priapism is an
uncommon condition overall, it occurs commonly in certain groups, such as people who have sickle cell
8. Which of the following organs is most responsible for sequestration in sickle-cell anemia in
a. Liver
b. Pancreas
c. Spleen
d. Stomach
RATIONALE: Splenic sequestration is a problem with the spleen that can happen in people who
have sickle cell disease. Splenic sequestration happens when a lot of sickled red blood cells become
trapped in the spleen. The spleen can enlarge, get damaged, and not work as it should.
9. With current management strategies, the average life expectancy of patients with sickle-cell
anemia is at
a. 28 years
b. 42 years
c. 34 years
d. 12 years
RATIONALE: Some children die in the first years of life, typically from infection, but the use of antibiotics
and parent teaching have greatly improved the outcomes for these children. However, with current
management strategies, the average life expectancy is still suboptimal, at 42 years.
10. This is a blood test used to measure and identify the different type of hemoglobin in the
a. Bone marrow aspiration
b. Hemoglobin electrophoresis
c. Schilling test
d. Complete blood count
RATIONALE: Hemoglobin electrophoresis is a blood test that measures different types of a protein
called hemoglobin in your red blood cells. It's sometimes called “hemoglobin evaluation” or “sickle cell
11. The drug of choice for patients with sickle cell anemia would be
a. Aspirin
b. Iron supplements
c. Folic acid supplements
d. Hydroxyurea (Hydrea)
RATIONALE: Hydroxyurea (Hydrea), a chemotherapy agent, has been shown to be effective in
increasing hemoglobin F levels in patients with sickle cell anemia, thereby decreasing the permanent
formation of sickled cells.
12. Prolonged occurrence of priapism in males can lead to
a. Impotence
b. Premature ejaculation
c. Anorgasmia
d. Low sperm cell count
RATIONALE: Ischemic priapism can cause serious complications. The blood trapped in the penis is
deprived of oxygen. When an erection lasts for too long, this oxygen-poor blood can begin to damage or
destroy tissues in the penis. As a result, untreated priapism can cause erectile dysfunction.
13. Beta thalassemia are common in
a. Northern Europe
b. Mediterranean population
c. Caribbean people
d. Pacific islanders
RATIONALE: These anemias occur worldwide, but the highest prevalence is found in people of
Mediterranean, African, and Southeast Asian ancestry.
14. Regular transfusion of which of the following blood products is beneficial in patients with beta
a. Platelet concentrate
b. Fresh frozen plasma
c. Packed RBCs
d. Fresh whole blood
RATIONALE: Deformed RBCs are found in patients who have beta thalassemia; therefore they need
transfusion of RBCs that are regular in appearance.
15. Which of the following is NOT a characteristic of thalassemia?
a. Hypochromia
b. Extreme macrocytosis
c. Decreased clotting factors
d. Destruction of blood elements
RATIONALE: Red blood cells in thalassemia are microcytic instead of macrocytic.
16. G6PD is a type of
a. X-linked disease
b. Autosomal dominant
c. Autosomal recessive
d. Y-linked disease
RATIONALE: All types of G-6-PD deficiency are inherited as X-linked defects; therefore, many more men
are at risk than women.
17. The diagnosis of G6PD is done through
a. Newborn screening
b. Complete blood count
c. Bone marrow aspiration
d. Hemoglobin electrophoresis
RATIONALE: Newborn screening is essential to be done on neonate for the detection of G6PD, maple
syrup urine disease, congenital hypothyroidism, PKU, and congenital adrenal hyperplasia.
18. One of the most important patient teaching in patients with G6PD is to
a. Advise patients to avoid foods that are high in iodine
b. Teach the patient about avoiding crowded places
c. Telling the patient to minimize intake of eggs
d. Educating the patient about a list of medications to avoid
RATIONALE: The patient should be educated about the disease and given a list of medications to avoid.
19. If polycythemia vera is left untreated this might lead to which of the following diseases?
a. Osteosarcoma
b. Myeloid metaplasia
c. Aplastic anemia
d. Acute lymphocytic leukemia
RATIONALE: The disease evolves into myeloid metaplasia with myelofibrosis or AML in a significant
proportion of patients; this form of AML is usually refractory to standard treatments.
20. The description of erythromelalgia in polycythemia vera is best described as
a. Numbness of the fingers and toes
b. Chest pain from enlarged spleen
c. Burning sensation in the fingers and toes
d. Clubbing of the fingers and toes
RATIONALE: Erythromelalgia, a burning sensation in the fingers and toes, may be reported and is only
partially relieved by cooling.
21. This is one of the treatment options in polycythemia vera where the doctor removes enough blood
to deplete the patient’s iron stores
a. Cardiac catheterization
b. Hemoglobin electrophoresis
c. Bone marrow aspiration
d. Phlebotomy
RATIONALE: Phlebotomy is an important part of therapy and can be performed repeatedly to keep the
hematocrit within normal range. This is achieved by removing enough blood (initially 500 mL once or
twice weekly) to deplete the patient’s iron stores, thereby rendering the patient iron deficient and
consequently unable to continue to manufacture RBCs excessively.
22. For the prevention of gouty attacks in patients with polycythemia vera the nurse must anticipate
the prescription of which of the following drugs?
a. Dypyridamole (Persantine)
b. Hydroxyurea (Hydrea)
c. Allopurinol (Zyloprim)
d. Acetylsalicylic acid (Aspirin)
RATIONALE: If the patient has an elevated uric acid concentration, allopurinol (Zyloprim) is used to
prevent gouty attacks.
23. Which of the following beverages should the nurse teach the patient with polycythemia vera to
a. Coffee
b. Alcohol
c. Tea
d. Milk
RATIONALE: Minimizing alcohol intake should also be emphasized to further diminish any risk for
24. Factor VIII activity of around 1-5% and bleeding with trauma in hemophilic patients would fall
under which severity of bleeding?
a. Mild
b. Moderate
c. Severe
d. Profound
RATIONALE: Mild has Factor VIII activity of 5-50%; Moderate has a Factor VII activity of 1-5%; Severe
has a Factor VIII activity of 1%.
25. One of the patient teachings that the nurse must NOT advise to patients with hemophilia would
a. Advise the patient to use an electric razor
b. Tell the patient to participate in contact sports
c. Teach the patient to cut nails across
d. Advise the patient not to go barefooted
RATIONALE: Contact sports are avoid as well since they are prone to develop bruises even with the
mildest trauma on their body