You are on page 1of 9



1. The nurse is preparing to teach a client
with microcytic hypochromic anemia about
the diet to follow after discharge. Which of
the following foods should be included in
the diet?
1. Eggs
2. Lettuce
3. Citrus fruits
4. Cheese
2. The nurse would instruct the client to
eat which of the following foods to obtain
the best supply of vitamin B12?

terminal ileum complaining of weakness,

shortness of breath, and a sore tongue.
Which client statement indicates a need
for intervention and client teaching?
1. I have been drinking plenty of fluids.
2. I have been gargling with warm salt
water for my sore tongue.
3. I have 3 to 4 loose stools per day.
4. I take a vitamin B12 tablet every day.
7. A vegetarian client was referred to a
dietitian for nutritional counseling for
anemia. Which client outcome indicates
that the client does not understand
nutritional counseling? The client:

1. Whole grains
2. Green leafy vegetables
3. Meats and dairy products
4. Broccoli and Brussels sprouts

1. Adds dried fruit to cereal and baked

2. Cooks tomato-based foods in iron pots
3. Drinks coffee or tea with meals
4. Adds vitamin C to all meals

3. The nurse has just admitted a 35-yearold female client who has a serum B12
concentration of 800 pg/ml. Which of the
following laboratory findings would cue the
nurse to focus the client history on specific
drug or alcohol abuse?

8. A client was admitted with iron

deficiency anemia and blood-streaked
emesis. Which question is most
appropriate for the nurse to ask in
determining the extent of the clients
activity intolerance?

1. Total bilirubin, 0.3 mg/dL

2. Serum creatinine, 0.5 mg/dL
3. Hemoglobin, 16 g/dL
4. Folate, 1.5 ng/mL

1. What activities were you able to do 6

months ago compared with the present?
2. How long have you had this problem?
3. Have you been able to keep up with all
your usual activities?
4. Are you more tired now than you used
to be?

4. The nurse understands that the client

with pernicious anemia will have which
distinguishing laboratory findings?
1. Schillings test, elevated
2. Intrinsic factor, absent.
3. Sedimentation rate, 16 mm/hour
4. RBCs 5.0 million
5. The nurse devises a teaching plan for
the patient with aplastic anemia. Which of
the following is the most important
concept to teach for health maintenance?
1. Eat animal protein and dark leafy
vegetables each day
2. Avoid exposure to others with acute
3. Practice yoga and meditation to
decrease stress and anxiety
4. Get 8 hours of sleep at night and take
naps during the day
6. A client comes into the health clinic 3
years after undergoing a resection of the

9. The primary purpose of the Schilling

test is to measure the clients ability to:
1. Store vitamin B12
2. Digest vitamin B12
3. Absorb vitamin B12
4. Produce vitamin B12
10. The nurse implements which of the
following for the client who is starting a
Schilling test?
1. Administering methylcellulose (Citrucel)
2. Starting a 24- to 48 hour urine
specimen collection
3. Maintaining NPO status
4. Starting a 72 hour stool specimen
11. A client with pernicious anemia asks
why she must take vitamin B12 injections

for the rest of her life. What is the nurses

best response?
1. The reason for your vitamin deficiency
is an inability to absorb the vitamin
because the stomach is not producing
sufficient acid.
2. The reason for your vitamin deficiency
is an inability to absorb the vitamin
because the stomach is not producing
sufficient intrinsic factor.
3. The reason for your vitamin deficiency
is an excessive excretion of the vitamin
because of kidney dysfunction.
4. The reason for your vitamin deficiency
is an increased requirement for the
vitamin because of rapid red blood cell
12. The nurse is assessing a clients
activity intolerance by having the client
walk on a treadmill for 5 minutes. Which of
the following indicates an abnormal
1. Pulse rate increased by 20 bpm
immediately after the activity
2. Respiratory rate decreased by 5
3. Diastolic blood pressure increased by 7
mm Hg
4. Pulse rate within 6 bpm of resting
phase after 3 minutes of rest.
13. When comparing the hematocrit
levels of a post-op client, the nurse notes
that the hematocrit decreased from 36%
to 34% on the third day even though the
RBC and hemoglobin values remained
stable at 4.5 million and 11.9 g/dL,
respectively. Which nursing intervention is
most appropriate?
1. Check the dressing and drains for frank
2. Call the physician
3. Continue to monitor vital signs
4. Start oxygen at 2L/min per NC
14. A client is to receive epoetin (Epogen)
injections. What laboratory value should
the nurse assess before giving the
1. Hematocrit
2. Partial thromboplastin time
3. Hemoglobin concentration
4. Prothrombin time

15. A client states that she is afraid of

receiving vitamin B12 injections because
of the potential toxic reactions. What is the
nurses best response to relieve these
1. Vitamin B12 will cause ringing in the
eats before a toxic level is reached.
2. Vitamin B12 may cause a very mild
skin rash initially.
3. Vitamin B12 may cause mild nausea
but nothing toxic.
4. Vitamin B12 is generally free of toxicity
because it is water soluble.
16. A client with microcytic anemia is
having trouble selecting food items from
the hospital menu. Which food is best for
the nurse to suggest for satisfying the
clients nutritional needs and personal
1. Egg yolks
2. Brown rice
3. Vegetables
4. Tea
17. A client with macrocytic anemia has a
burn on her foot and states that she had
been watching television while lying on a
heating pad. What is the nurses first
1. Assess for potential abuse
2. Check for diminished sensations
3. Document the findings
4. Clean and dress the area
18. Which of the following nursing
assessments is a late symptom of
polycythemia vera?
1. Headache
2. Dizziness
3. Pruritus
4. Shortness of breath
19. The nurse is teaching a client with
polycythemia vera about potential
complications from this disease. Which
manifestations would the nurse include in
the clients teaching plan? Select all that
1. Hearing loss
2. Visual disturbance
3. Headache
4. Orthopnea
5. Gout
6. Weight loss

20. When a client is diagnosed with

aplastic anemia, the nurse monitors for
changes in which of the following
physiological functions?
1. Bleeding tendencies
2. Intake and output
3. Peripheral sensation
4. Bowel function
21. Which of the following blood
components is decreased in anemia?
1. Erythrocytes
2. Granulocytes
3. Leukocytes
4. Platelets
22. A client with anemia may be tired due
to a tissue deficiency of which of the
following substances?
1. Carbon dioxide
2. Factor VIII
3. Oxygen
4. T-cell antibodies
23. Which of the following cells is the
precursor to the red blood cell (RBC)?
1. B cell
2. Macrophage
3. Stem cell
4. T cell
24. Which of the following symptoms is
expected with hemoglobin of 10 g/dl?
1. None
2. Pallor
3. Palpitations
4. Shortness of breath
25. Which of the following diagnostic
findings are most likely for a client with
aplastic anemia?
1. Decreased production of T-helper cells
2. Decreased levels of white blood cells,
red blood cells, and platelets
3. Increased levels of WBCs, RBCs, and
4. Reed-Sternberg cells and lymph node
26. A client with iron deficiency anemia is
scheduled for discharge. Which instruction
about prescribed ferrous gluconate

therapy should the nurse include in the

teaching plan?
1. Take the medication with an antacid.
2. Take the medication with a glass of
3. Take the medication with cereal.
4. Take the medication on an empty
27. Which of the following disorders
results from a deficiency of factor VIII?
1. Sickle cell disease
2. Christmas disease
3. Hemophilia A
4. Hemophilia B
28. The nurse explains to the parents of a
1-year-old child admitted to the hospital in
a sickle cell crisis that the local tissue
damage the child has on admission is
caused by which of the following?
1. Autoimmune reaction complicated by
2. Lack of oxygen in the red blood cells
3. Obstruction to circulation
4. Elevated serum bilirubin concentration.
29. The mothers asks the nurse why her
childs hemoglobin was normal at birth but
now the child has S hemoglobin. Which of
the following responses by the nurse is
most appropriate?
1. The placenta bars passage of the
hemoglobin S from the mother to the
2. The red bone marrow does not begin
to produce hemoglobin S until several
months after birth.
3. Antibodies transmitted from you to the
fetus provide the newborn with temporary
4. The newborn has a high concentration
of fetal hemoglobin in the blood for some
time after birth.
30. Which of the following would the
nurse identify as the priority nursing
diagnosis during a toddlers vasoocclusive sickle cell crisis?
1. Ineffective coping related to the
presence of a life-threatening disease
2. Decreased cardiac output related to
abnormal hemoglobin formation
3. Pain related to tissue anoxia
4. Excess fluid volume related to infection

31. A mother asks the nurse if her childs

iron deficiency anemia is related to the
childs frequent infections. The nurse
responds based on the understanding of
which of the following?
1. Little is known about iron-deficiency
anemia and its relationship to infection in
2. Children with iron deficiency anemia
are more susceptible to infection than are
other children.
3. Children with iron-deficiency anemia
are less susceptible to infection than are
other children.
4. Children with iron-deficient anemia are
equally as susceptible to infection as are
other children.
32. Which statements by the mother of a
toddler would lead the nurse to suspect
that the child has iron-deficiency anemia?
Select all that apply.
1. He drinks over 3 cups of milk per day.
2. I cant keep enough apple juice in the
house; he must drink over 10 ounces per
3. He refuses to eat more than 2 different
kinds of vegetables.
4. He doesnt like meat, but he will eat
small amounts of it.
5. He sleeps 12 hours every night and
take a 2-hour nap.
33. Which of the following foods would
the nurse encourage the mother to offer to
her child with iron deficiency anemia?
1. Rice cereal, whole milk, and yellow
2. Potato, peas, and chicken
3. Macaroni, cheese, and ham
4. Pudding, green vegetables, and rice
34. The physician has ordered several
laboratory tests to help diagnose an
infants bleeding disorder. Which of the
following tests, if abnormal, would the
nurse interpret as most likely to indicate
1. Bleeding time
2. Tourniquet test
3. Clot retraction test
4. Partial thromboplastin time (PTT)

35. Which of the following assessments

in a child with hemophilia would lead the
nurse to suspect early hemarthrosis?
1. Childs reluctance to move a body part
2. Cool, pale, clammy extremity
3. Eccymosis formation around a joint
4. Instability of a long bone in passive
36. Because of the risks associated with
administration of factor VIII concentrate,
the nurse would teach the clients family to
recognize and report which of the
1. Yellowing of the skin
2. Constipation
3. Abdominal distention
4. Puffiness around the eyes
37. A child suspected of having sickle cell
disease is seen in a clinic, and laboratory
studies are performed. A nurse checks the
lab results, knowing that which of the
following would be increased in this
1. Platelet count
2. Hematocrit level
3. Reticulocyte count
4. Hemoglobin level
38. A clinic nurse instructs the mother of a
child with sickle cell disease about the
precipitating factors related to pain crisis.
Which of the following, if identified by the
mother as a precipitating factor, indicates
the need for further instructions?
1. Infection
2. Trauma
3. Fluid overload
4. Stress
39. Laboratory studies are performed for
a child suspected of having iron deficiency
anemia. The nurse reviews the laboratory
results, knowing that which of the
following results would indicate this type
of anemia?
1. An elevated hemoglobin level
2. A decreased reticulocyte count
3. An elevated RBC count
4. Red blood cells that are microcytic and
40. A pediatric nurse health educator
provides a teaching session to the nursing

staff regarding hemophilia. Which of the

following information regarding this
disorder would the nurse plan to include in
the discussion?
1. Hemophilia is a Y linked hereditary
2. Males inherit hemophilia from their
3. Females inherit hemophilia from their
4. Hemophilia A results from a deficiency
of factor VIII
1. Which of the following arteries primarily
feeds the anterior wall of the heart?
a. Circumflex artery
b. Internal mammary artery
c. Left anterior descending artery
d. Right coronary artery
2. When do coronary arteries primarily
receive blood flow?
a. During inspiration
b. During diastole
c. During expiration
d. During systole
3. Which of the following illnesses is the
leading cause of death in the US?
a. Cancer
b. Coronary artery disease
c. Liver failure
d. Renal failure
4. Which of the following conditions most
commonly results in CAD?
a. Atherosclerosis
b. DM
c. MI
d. Renal failure
5. Atherosclerosis impedes coronary
blood flow by which of the following
a. Plaques obstruct the vein
b. Plaques obstruct the artery
c. Blood clots form outside the vessel wall
d. Hardened vessels dilate to allow the
blood to flow through
6. Which of the following risk factors for
coronary artery disease cannot be

a. Cigarette smoking
b. DM
c. Heredity
d. HPN
7. Exceeding which of the following serum
cholesterol levels significantly increases
the risk of coronary artery disease?
a. 100 mg/dl
b. 150 mg/dl
c. 175 mg/dl
d. 200 mg/dl
8. Which of the following actions is the
first priority care for a client exhibiting
signs and symptoms of coronary artery
a. Decrease anxiety
b. Enhance myocardial oxygenation
c. Administer sublingual nitroglycerin
d. Educate the client about his symptoms
9. Medical treatment of coronary artery
disease includes which of the following
a. Cardiac catheterization
b. Coronary artery bypass surgery
c. Oral medication administration
d. Percutaneous transluminal coronary
10. Prolonged occlusion of the right
coronary artery produces an infarction in
which of he following areas of the heart?
a. Anterior
b. Apical
c. Inferior
d. Lateral
11. Which of the following is the most
common symptom of myocardial
a. Chest pain
b. Dyspnea
c. Edema
d. Palpitations
12. Which of the following landmarks is
the correct one for obtaining an apical
a. Left intercostal space, midaxillary line
b. Left fifth intercostal space, midclavicular

c. Left second intercostal space,

midclavicular line
d. Left seventh intercostal space,
midclavicular line

19. After myocardial infarction, serum

glucose levels and free fatty acids are
both increase. What type of physiologic
changes are these?

13. Which of the following systems is the

most likely origin of pain the client
describes as knifelike chest pain that
increases in intensity with inspiration?

a. Electrophysiologic
b. Hematologic
c. Mechanical
d. Metabolic

a. Cardiac
b. Gastrointestinal
c. Musculoskeletal
d. Pulmonary

20. Which of the following complications is

indicated by a third heart sound (S3)?

14. A murmur is heard at the second left

intercostal space along the left sternal
border. Which valve area is this?
a. Aortic
b. Mitral
c. Pulmonic
d. Tricuspid
15. Which of the following blood tests is
most indicative of cardiac damage?
a. Lactate dehydrogenase
b. Complete blood count
c. Troponin I
d. Creatine kinase
16. What is the primary reason for
administering morphine to a client with
myocardial infarction?
a. To sedate the client
b. To decrease the clients pain
c. To decrease the clients anxiety
d. To decrease oxygen demand on the
clients heart
17. Which of the following conditions is
most commonly responsible for
myocardial infarction?
a. Aneurysm
b. Heart failure
c. Coronary artery thrombosis
d. Renal failure
18. What supplemental medication is most
frequently ordered in conjuction with
furosemide (Lasix)?
a. Chloride
b. Digoxin
c. Potassium
d. Sodium

a. Ventricular dilation
b. Systemic hypertension
c. Aortic valve malfunction
d. Increased atrial contractions
21. After an anterior wall myocardial
infarction, which of the following problems
is indicated by auscultation of crackles in
the lungs?
a. Left-sided heart failure
b. Pulmonic valve malfunction
c. Right-sided heart failure
d. Tricuspid valve malfunction
22. Which of the following diagnostic tools
is most commonly used to determine the
location of myocardial damage?
a. Cardiac catheterization
b. Cardiac enzymes
c. Echocardiogram
d. Electrocardiogram
23. What is the first intervention for a
client experiencing myocardial infarction?
a. Administer morphine
b. Administer oxygen
c. Administer sublingual nitroglycerin
d. Obtain an electrocardiogram
24. What is the most appropriate nursing
response to a myocardial infarction client
who is fearful of dying?
a. Tell me about your feeling right now.
b. When the doctor arrives, everything
will be fine.
c. This is a bad situation, but youll feel
better soon.
d. Please be assured were doing
everything we can to make you feel
25. Which of the following classes of
medications protects the ischemic

myocardium by blocking catecholamines

and sympathetic nerve stimulation?
a. Beta-adrenergic blockers
b. Calcium channel blockers
c. Narcotics
d. Nitrates
26. What is the most common
complication of a myocardial infarction?
a. Cardiogenic shock
b. Heart failure
c. Arrhythmias
d. Pericarditis

32. In which of the following disorders

would the nurse expect to assess sacral
edema in bedridden client?
a. DM
b. Pulmonary emboli
c. Renal failure
d. Right-sided heart failure
33. Which of the following symptoms
might a client with right-sided heart failure

27. With which of the following disorders

is jugular vein distention most prominent?

a. Adequate urine output

b. Polyuria
c. Oliguria
d. Polydipsia

a. Abdominal aortic aneurysm

b. Heart failure
c. Myocardial infarction
d. Pneumothorax

34. Which of the following classes of

medications maximizes cardiac
performance in clients with heat failure by
increasing ventricular contractility?

28. What position should the nurse place

the head of the bed in to obtain the most
accurate reading of jugular vein

a. Beta-adrenergic blockers
b. Calcium channel blockers
c. Diuretics
d. Inotropic agents

a. High-fowlers
b. Raised 10 degrees
c. Raised 30 degrees
d. Supine position

35. Stimulation of the sympathetic

nervous system produces which of the
following responses?

29. Which of the following parameters

should be checked before administering
a. Apical pulse
b. Blood pressure
c. Radial pulse
d. Respiratory rate
30. Toxicity from which of the following
medications may cause a client to see a
green halo around lights?
a. Digoxin
b. Furosemide
c. Metoprolol
d. Enalapril
31. Which ofthe following symptoms is
most commonly associated with left-sided
heart failure?
a. Crackles
b. Arrhythmias
c. Hepatic engorgement
d. Hypotension

a. Bradycardia
b. Tachycardia
c. Hypotension
d. Decreased myocardial contractility
36. Which of the following conditions is
most closely associated with weight gain,
nausea, and a decrease in urine output?
a. Angina pectoris
b. Cardiomyopathy
c. Left-sided heart failure
d. Right-sided heart failure
37. What is the most common cause of
abdominal aortic aneurysm?
a. Atherosclerosis
b. DM
c. HPN
d. Syphilis
38. In which of the following areas is an
abdominal aortic aneurysm most
commonly located?
a. Distal to the iliac arteries

b. Distal to the renal arteries

c. Adjacent to the aortic branch
d. Proximal to the renal arteries
39. A pulsating abdominal mass usually
indicates which of the following
a. Abdominal aortic aneurysm
b. Enlarged spleen
c. Gastic distention
d. Gastritis
40. What is the most common symptom in
a client with abdominal aortic aneurysm?
a. Abdominal pain
b. Diaphoresis
c. Headache
d. Upper back pain
41. Which of the following symptoms
usually signifies rapid expansion and
impending rupture of an abdominal aortic
a. Abdominal pain
b. Absent pedal pulses
c. Angina
d. Lower back pain
42. What is the definitive test used to
diagnose an abdominal aortic aneurysm?
a. Abdominal X-ray
b. Arteriogram
c. CT scan
d. Ultrasound
43. Which of the following complications is
of greatest concern when caring for a
preoperative abdominal aneurysm client?
a. HPN
b. Aneurysm rupture
c. Cardiac arrhythmias
d. Diminished pedal pulses
44. Which of the following blood vessel
layers may be damaged in a client with an
a. Externa
b. Interna
c. Media
d. Interna and Media
45. When assessing a client for an
abdominal aortic aneurysm, which area of
the abdomen is most commonly palpated?

a. Right upper quadrant

b. Directly over the umbilicus
c. Middle lower abdomen to the left of the
d. Midline lower abdomen to the right of
the midline
46. Which of the following conditions is
linked to more than 50% of clients with
abdominal aortic aneurysms?
a. DM
b. HPN
c. PVD
d. Syphilis
47. Which of the following sounds is
distinctly heard on auscultation over the
abdominal region of an abdominal aortic
aneurysm client?
a. Bruit
b. Crackles
c. Dullness
d. Friction rubs
48. Which of the following groups of
symptoms indicated a ruptured abdominal
a. Lower back pain, increased BP,
decreased RBC, increased WBC
b. Severe lower back pain, decreased BP,
decreased RBC, increased WBC
c. Severe lower back pain, decreased BP,
decreased RBC, decreased WBC
d. Intermittent lower back pain, decreased
BP, decreased RBC, increased WBC
49. Which of the following complications
of an abdominal aortic repair is indicated
by detection of a hematoma in the
perineal area?
a. Hernia
b. Stage 1 pressure ulcer
c. Retroperitoneal rupture at the repair site
d. Rapid expansion of the aneurysm
50. Which hereditary disease is most
closely linked to aneurysm?
a. Cystic fibrosis
b. Lupus erythematosus
c. Marfans syndrome
d. Myocardial infarction

51. Which of the following treatments is

the definitive one for a ruptured
a. Antihypertensive medication
b. Aortogram
c. Beta-adrenergic blocker administration
d. Surgical intervention
52. Which of the following heart muscle
diseases is unrelated to other
cardiovascular disease?
a. Cardiomyopathy
b. Coronary artery disease
c. Myocardial infarction
d. Pericardial Effusion
53. Which of the following types of
cardiomyopathy can be associated with
a. Dilated
b. Hypertrophic
c. Myocarditis
d. Restrictive
54. Septal involvement occurs in which
type of cardiomyopathy?
a. Congestive
b. Dilated
c. Hypertrophic
d. Restrictive
55. Which of the following recurring
conditions most commonly occurs in
clients with cardiomyopathy?
a. Heart failure
b. DM
c. MI
d. Pericardial effusion

56. What is the term used to describe an

enlargement of the heart muscle?
a. Cardiomegaly
b. Cardiomyopathy
c. Myocarditis
d. Pericarditis
57. Dyspnea, cough, expectoration,
weakness, and edema are classic signs
and symptoms of which of the following
a. Pericarditis
b. Hypertension
c. Obliterative
d. Restrictive
58. Which of the following types of
cardiomyopathy does not affect cardiac
a. Dilated
b. Hypertrophic
c. Restrictive
d. Obliterative
59. Which of the following cardiac
conditions does a fourth heart sound (S4)
a. Dilated aorta
b. Normally functioning heart
c. Decreased myocardial contractility
d. Failure of the ventricle to eject all the
blood during systole
60. Which of the following classes of
drugs is most widely used in the treatment
of cardiomyopathy?
a. Antihypertensive
b. Beta-adrenergic blockers
c. Calcium channel blockers
d. Nitrates