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QUESTION #1
Medical-Surgical Exam 1 Med-Surg
When planning discharge teaching for the patient who was admitted with a sickle cell crisis, which information will the nurse include?
A Drink only one or two caffeinated beverages daily.
B Take a daily multivitamin with iron.
C Limit fluids to 2 to 3 quarts a day.
D Avoid exposure to crowds as much as possible.

Explanations

A
Caffeine can contribute to dehydration, which increases sickling risk. Patients are usually advised to limit or avoid caffeine.
B
Iron supplements are not routinely recommended because many sickle cell patients already have adequate or elevated iron levels. Unnecessary iron can be harmful.
C
Fluids should be encouraged, not restricted, to prevent dehydration and sickling. Limiting fluids is inappropriate.
D
Infection is a major trigger for sickle cell crises. Avoiding crowds helps reduce exposure to illness.
Infection prevention is critical for patients with sickle cell disease. On exams, avoid crowds and sick contacts is a key discharge teaching point.
QUESTION #2
Medical-Surgical Exam 1 Med-Surg
Which of the following would the nurse identify as the priority nursing diagnosis during a 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

Explanations

A
Coping is important but not the immediate priority during an acute crisis. Physiologic needs take precedence.
B
Cardiac output is not the primary problem in a vaso-occlusive crisis. The main issue is blocked blood flow causing ischemia.
C
Vaso-occlusion leads to tissue ischemia and hypoxia, resulting in severe pain. Pain management is the top priority during crisis.
D
Fluid overload is not typical in sickle cell crisis; hydration is usually needed, not restricted. Infection is not implied here.
Vaso-occlusive crisis causes ischemia and severe pain due to blocked blood vessels. On exams, pain related to tissue hypoxia/anoxia is always the priority diagnosis.
QUESTION #3
Medical-Surgical Exam 1 Med-Surg
Which of the following foods would the nurse encourage the client in sickle cell crisis to eat?
A Peaches
B Cottage cheese
C Popsicle
D Lima beans

Explanations

A
Peaches provide vitamins but do not significantly help with hydration during an acute crisis. Hydration is the priority.
B
Dairy does not contribute to hydration and may be poorly tolerated during acute illness. It is not the best choice during crisis.
C
Popsicles promote oral fluid intake and hydration, which helps reduce blood viscosity and sickling. Hydration is a key priority in sickle cell crisis.
D
Lima beans are nutritious but are not appropriate during an acute crisis when hydration is more important than solid food intake.
During a sickle cell crisis, hydration is a top priority to reduce sickling. On exams, choose foods that increase fluid intake, such as popsicles or clear liquids.
QUESTION #4
Medical-Surgical Exam 1 Med-Surg
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

Explanations

A
Sickle cell disease is not an autoimmune disorder. Tissue injury is not caused by immune attack.
B
The primary problem is not oxygen inside the RBCs but blocked blood flow. Reduced delivery occurs because vessels are obstructed.
C
Sickled red blood cells occlude small blood vessels, leading to ischemia and local tissue damage. This vaso-occlusion causes pain and injury.
D
Elevated bilirubin results from hemolysis and causes jaundice, not localized tissue damage.
Characteristic sickle cells tend to cause "log jams" in capillaries. This results in poor circulation to local tissues, leading to ischemia and necrosis. The basic defect in sickle cell disease is an abnormality in the structure of RBCs. The erythrocytes are sickle-shaped, rough in texture, and rigid. Sickle cell disease is an inherited disease, not an autoimmune reaction. Elevated serum bilirubin concentrations are associated with jaundice, not sickle cell disease.
QUESTION #5
Medical-Surgical Exam 1 Med-Surg
A patient with sickle cell anemia is admitted to the hospital with a sickle cell crisis. While caring for the patient during the crisis, it is important for the nurse to
A limit the patient's intake of oral and IV fluids.
B evaluate the effectiveness of opioid analgesics.
C encourage the patient to ambulate as much as tolerated.
D teach the patient about high-protein, high-calorie foods.

Explanations

A
Fluids should be encouraged to reduce blood viscosity and prevent further sickling. Limiting fluids would worsen the crisis.
B
Severe pain is the hallmark of sickle cell crisis, and opioids are the mainstay of treatment. Ongoing evaluation ensures adequate pain control.
C
During an acute crisis, rest is preferred to reduce oxygen demand. Excess activity can worsen hypoxia and pain.
D
Nutrition teaching is important but is not the priority during an acute pain crisis. Pain control and stabilization come first.
Sickle cell crisis management prioritizes aggressive pain control and hydration. On exams, focus on pain assessment and opioid effectiveness during the acute phase.
QUESTION #6
Medical-Surgical Exam 1 Med-Surg
A patient who is having a sickle cell crisis asks the nurse why the sickling causes such pain. The nurse explains that the pain of sickling is caused by
A Spasms of the blood cells as they change shape
B Deposition of sickled red cells in the bone marrow
C Tissue hypoxia caused by small blood vessel occlusion
D Infectious processes in organs affected by the sickling

Explanations

A
Red blood cells do not spasm; shape change alone does not cause pain. The problem is impaired blood flow.
B
Sickled cells obstruct vessels throughout the body, not just the bone marrow. Pain is not caused by deposition itself.
C
Sickled cells block capillaries, reducing oxygen delivery to tissues. Ischemia and hypoxia cause severe pain.
D
Infections are a complication of sickle cell disease, not the direct cause of acute pain during a crisis.
Sickle cell pain results from vaso-occlusion, which leads to tissue ischemia and hypoxia. On exams, think blocked vessels = pain.
QUESTION #7
Medical-Surgical Exam 1 Med-Surg
A 43-year-old African American male is admitted with sickle cell anemia. The nurse plans to assess circulation in the lower extremities every 2 hours. Which of the following outcome criteria would the nurse use?
A Body temperature of 99°F or less
B Toes moved in active range of motion
C Sensation reported when soles of feet are touched
D Capillary refill of < 3 seconds

Explanations

A
Temperature reflects infection or inflammation, not peripheral circulation. It does not directly measure blood flow to the extremities.
B
Movement assesses motor function, not circulation. Adequate motion can occur despite impaired blood flow.
C
Sensation reflects neurologic status rather than circulatory adequacy. It does not directly evaluate perfusion.
D
Capillary refill is a direct, quick indicator of peripheral perfusion. Normal refill suggests adequate circulation.
It is important to assess the extremities for blood vessel occlusion in the client with sickle cell anemia because a change in capillary refill would indicate a change in circulation.
QUESTION #8
Medical-Surgical Exam 1 Med-Surg
You're providing discharge teaching to a patient about pernicious anemia. Which statement by the patient indicates they did NOT understand the discharge teaching?
A "Pernicious anemia is caused by not consuming enough Vitamin B12."
B "Pernicious anemia causes the red blood cells to appear very large and oval."
C "Treatment for pernicious anemia includes a series of intramuscular injections of Vitamin B12."
D "A red, smooth tongue can be a sign of pernicious anemia."

Explanations

A
Pernicious anemia is caused by lack of intrinsic factor and impaired B12 absorption, not inadequate dietary intake. This statement reflects misunderstanding.
B
Pernicious anemia is a macrocytic anemia with large, oval RBCs. This statement is accurate.
C
Lifelong intramuscular B12 injections are standard treatment due to malabsorption. This shows correct understanding.
D
A red, smooth tongue (glossitis) is a known sign of B12 deficiency. This statement is correct.
Pernicious anemia results from intrinsic factor deficiency, not poor diet. On exams, dietary B12 fixes deficiency—injections fix pernicious anemia.
QUESTION #9
Medical-Surgical Exam 1 Med-Surg
The nurse is admitting a 24 year old female with a diagnosis of rule-out anemia. The client has a history of gastric bypass surgery for obesity 4 years ago. Current assessment findings include height 5'5, wt. 75 kg, P 110, R 27, and BP 104/66; pale mucous membranes and dyspnea on exertion. Which type of anemia would the nurse suspect the client has developed?
A Vitamin B12 deficiency
B Folic acid deficiency
C Iron deficiency
D Sickle cell anemia

Explanations

A
Gastric bypass surgery reduces intrinsic factor and stomach surface area, impairing vitamin B12 absorption. This commonly leads to B12 deficiency anemia years after surgery.
B
Folate deficiency is usually related to poor intake or alcoholism and is less directly linked to gastric bypass. It is not the most likely cause here.
C
Iron deficiency can occur after bariatric surgery, but vitamin B12 deficiency is more classically associated with altered gastric anatomy. The history points more strongly to B12 malabsorption.
D
Sickle cell anemia is a genetic disorder present from childhood. It is unrelated to gastric bypass surgery.
After gastric bypass surgery, reduced intrinsic factor leads to impaired vitamin B12 absorption. On exams, history of gastric surgery = suspect vitamin B12 deficiency anemia.
QUESTION #10
Medical-Surgical Exam 1 Med-Surg
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 Brussel sprouts

Explanations

A
Whole grains contain little to no vitamin B12. They are not a reliable source.
B
Leafy greens are rich in folate, not vitamin B12. They do not provide adequate B12.
C
Vitamin B12 is found primarily in animal products such as meat, milk, eggs, and cheese. These are the best dietary sources.
D
These vegetables contain minimal B12 and are not significant sources.
Vitamin B12 is obtained almost exclusively from animal products. On exams, meat, eggs, and dairy = B12 sources.