1)  The nurse is preparing to teach a client with microcytic hypochromic anemia about the diet to follow after discharge. Which of the following foods should be included in the diet?

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

2)  The nurse would instruct the client to eat which of the following foods to obtain the best supply of vitamin B12?

A. Whole grains
B. Green leafy vegetables
C. Meats and dairy products
D. Broccoli and Brussels sprouts

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

A. Total bilirubin, 0.3 mg/dL
B. Serum creatinine, 0.5 mg/dL
C. Hemoglobin, 16 g/dL
D. Folate, 1.5 ng/mL

4)  The nurse understands that the client with pernicious anemia will have which distinguishing laboratory findings?

A. Schilling’s test elevated
B. Intrinsic factor, absent.
C. Sedimentation rate, 16 mm/hour
D. RBCs 5.0 million

5)  The nurse devises a teaching plan for the patient with a plastic anemia. Which of the following is the most important concept to teach for health maintenance?

A. Eat animal protein and dark leafy vegetables each day
B. Avoid exposure to others with acute infection
C. Practice yoga and meditation to decrease stress and anxiety
D. Get 8 hours of sleep at night and take naps during the day

6)  A client comes into the health clinic 3 years after undergoing a resection of the terminal ileum complaining of weakness, shortness of breath, and a sore tongue. Which client statement indicates a need for intervention and client teaching?

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

7)  A vegetarian client was referred to a dietitian for nutritional counseling for anemia. Which client outcome indicates that the client does not understand nutritional counseling? The client:

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

8)  A client was admitted with iron deficiency anemia and blood-streaked emesis. Which question is most appropriate for the nurse to ask in determining the extent of the client’s activity intolerance?

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

9)  The primary purpose of the Schilling test is to measure the client’s ability to:

A. Store vitamin B12
B. Digest vitamin B12
C. Absorb vitamin B12
D. Produce vitamin B12

10)  The nurse implements which of the following for the client who is starting a Schilling test?

A. Administering methylcellulose (Citrucel)
B. Starting a 24- to 48 hour urinespecimen collection
C. Maintaining NPO status
D. Starting a 72 hour stool specimen collection

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

A. “The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient acid.”
B. “The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor.”
C. “The reason for your vitamin deficiency is an excessive excretion of the vitamin because of kidney dysfunction.”
D. “The reason for your vitamin deficiency is an increased requirement for the vitamin because of rapid red blood cell production.”

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

A. Pulse rate increased by 20 bpm immediately after the activity
B. Respiratory rate decreased by 5 breaths/minute
C. Diastolic blood pressure increased by 7 mm Hg
D. Pulse rate within 6 bpm of resting phase after 3 minutes of rest.

13)  When comparing the hematocrit levels of a post-op client, the nurse notes that the hematocrit decreased from 36% to 34% on the third day even though the RBC and hemoglobin values remained stable at 4.5 million and 11.9 g/dL, respectively. Which nursing intervention is most appropriate?

A. Check the dressing and drains for frank bleeding
B. Call the physician
C. Continue to monitor vital signs
D. Start oxygen at 2L/min per NC

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

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

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

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

16)  A client with microcytic anemia is having trouble selecting food items from the hospital menu. Which food is best for the nurse to suggest for satisfying the client’s nutritional needs and personal preferences?

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

17)  A client with macrocytic anemia has a burn on her foot and states that she had been watching television while lying on a heating pad. What is the nurse’s first response?

A. Assess for potential abuse
B. Check for diminished sensations
C. Document the findings
D. Clean and dress the area

18)  Which of the following nursing assessments is a late symptom of polycythemia vera?

A, Headache
B. Dizziness
C. Pruritus
D. Shortness of breath

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

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

20)  When a client is diagnosed with a plastic anemia, the nurse monitors for changes in which of the following physiological functions?

A. Bleeding tendencies
B. Intake and output
C. Peripheral sensation
D. Bowel function

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

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

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

A. Carbon dioxide
B. Factor VIII
C. Oxygen
D. T-cell antibodies

23)  Which of the following cells is the precursor to the red blood cell (RBC)?

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

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

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

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

A. Decreased production of T-helper cells
B. Decreased levels of white blood cells, red blood cells, and platelets
C. Increased levels of WBCs, RBCs, and platelets
D. Reed-Sternberg cells and lymphnode enlargement

26)  A client with iron deficiency anemia is scheduled for discharge. Which instruction about prescribed ferrous gluconate therapy should the nurse include in the teaching plan?

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

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

A. Sickle cell disease
B. Christmas disease
C. Hemophilia A
D. Hemophilia B

28)  The nurse explains to the parents of a 1-year-old child admitted to the hospital in a sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following?

A. Autoimmune reaction complicated by hypoxia
B. Lack of oxygen in the red blood cells
C. Obstruction to circulation
D. Elevated serum bilirubin concentration.

29)  The mothers asks the nurse why her child’s hemoglobin was normal at birth but now the child has S hemoglobin. Which of the following responses by the nurse is most appropriate?

A. “The placenta bars passage of the hemoglobin S from the mother to the fetus.”
B. “The red bone marrow does not begin to produce hemoglobin S until several months after birth.”
C. “Antibodies transmitted from you to the fetus provide the newborn with temporary immunity.”
D. “The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth.”

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

A. Ineffective coping related to the presence of a life-threatening disease
B. Decreased cardiac output related to abnormal hemoglobin formation
C. Pain related to tissue anoxia
D. Excess fluid volume related to infection

31)  A mother asks the nurse if her child’s iron deficiency anemia is related to the child’s frequent infections. The nurse responds based on the understanding of which of the following?

A. Little is known about iron-deficiency anemia and its relationship to infection in children.
B. Children with iron deficiency anemia are more susceptible to infection than are other children.
C. Children with iron-deficiency anemia are less susceptible to infection than are other children.
D. Children with iron-deficient anemia are equally as susceptible to infection as are other children.

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

A. “He drinks over 3 cups of milk per day.”
B. “I can’t keep enough apple juice in the house; he must drink over 10 ounces per day.”
C. “He refuses to eat more than 2 different kinds of vegetables.”
D. “He doesn’t like meat, but he will eat small amounts of it.”
5. “He sleeps 12 hours every night and take a 2-hour nap.”

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

A. Rice cereal, whole milk, and yellow vegetables
B. Potato, peas, and chicken
C. Macaroni, cheese, and ham
D. Pudding, green vegetables, and rice

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

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

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

A. Child’s reluctance to move a body part
B. Cool, pale, clammy extremity
C. Ecchymosis formation around a joint
D. Instability of a long bone in passive movement

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

A. Yellowing of the skin
B. Constipation
C. Abdominal distention
D. Puffiness around the eyes

37)  A child suspected of having sickle cell disease is seen in a clinic, and laboratory studies are performed. A nurse checks the lab results, knowing that which of the following would be increased in this disease?

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

38)  A clinic nurse instructs the mother of a child with sickle cell disease about the precipitating factors related to pain crisis. Which of the following, if identified by the mother as a precipitating factor, indicates the need for further instructions?

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

39)  Laboratory studies are performed for a child suspected of having iron deficiency anemia. The nurse reviews the laboratory results, knowing that which of the following results would indicate this type of anemia?

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

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

A. Hemophilia is a Y linked hereditary disorder
B. Males inherit hemophilia from their fathers
C. Females inherit hemophilia from their mothers
D. Hemophilia A results from a deficiency of factor VIIID