College Exams & Notes

Master your nursing exams with comprehensive practice questions and detailed explanations

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QUESTION #1
Medical-Surgical Exam 1 Med-Surg
The client diagnosed with SCD comes to the ED with a temperature of 101.4°F (38.6°C) and tells the nurse they are having a sickle cell crisis. Which diagnostic test should the nurse anticipate the ED doctor ordering for the client?
A Spinal tap
B Hemoglobin electrophoresis
C Sickle cell screen
D Blood cultures

Explanations

A
A lumbar puncture is not routinely indicated unless meningitis is suspected. Fever alone in SCD does not justify this test.
B
This test confirms the diagnosis of SCD, which is already known. It is not useful for acute management.
C
Screening is used for diagnosis, not for evaluating acute fever in a known SCD patient.
D
Clients with SCD are highly susceptible to infection, and fever is an emergency. Blood cultures help identify sepsis, a life-threatening complication.
Fever in a client with sickle cell disease is treated as possible sepsis. On exams, fever + SCD = blood cultures and antibiotics.
QUESTION #2
Medical-Surgical Exam 1 Med-Surg
Which clinical manifestation will the nurse expect to assess in the client diagnosed with a vaso-occlusive sickle cell crisis?
A Lordosis
B Epistaxis
C Hematuria
D Petechiae

Explanations

A
Lordosis is a spinal curvature and is unrelated to vaso-occlusion or sickle cell crisis.
B
Nosebleeds are not a typical manifestation of vaso-occlusive crisis. They are more related to mucosal irritation or bleeding disorders.
C
Vaso-occlusion in the renal medulla can cause ischemia and blood in the urine. Hematuria is a known complication of sickle cell disease.
D
Petechiae indicate platelet or clotting disorders, not sickle cell–related vaso-occlusion.
Vaso-occlusion in sickle cell disease commonly affects the kidneys, causing hematuria. On exams, blood in urine = sickle cell complication.
QUESTION #3
Medical-Surgical Exam 1 Med-Surg
The client diagnosed with SCD asks the nurse, “Should I join the Sickle Cell Foundation? I received some information from the Sickle Cell Foundation. What kind of group is it?” Which statement is the best response by the nurse?
A “It is a foundation that deals primarily with research for a cure for SCD.”
B “It provides information on the disease and on support groups in this area.”
C “I recommend joining any organization that will help deal with your disease.”
D “The foundation arranges for families that have children with sickle cell to meet.”

Explanations

A
Research is part of the foundation’s mission, but this does not fully describe its primary role for patients. It is incomplete information.
B
The Sickle Cell Foundation focuses on education, resources, advocacy, and support for individuals and families. This directly answers the client’s question.
C
This response is vague and does not provide specific, useful information. It avoids directly addressing the foundation.
D
While family support may occur, the foundation serves a broader population than just families with children. This is too narrow.
Disease-specific foundations often provide education, resources, and support groups. On exams, choose answers that clearly explain the purpose and benefits of the organization.
QUESTION #4
Medical-Surgical Exam 1 Med-Surg
The nurse is completing discharge teaching for the client diagnosed with a sickle cell crisis. The nurse recommends the client get the flu and pneumonia vaccines. The client asks, “Why should I take those shots? I hate shots.” Which statement by the nurse is the best response?
A “These vaccines promote health for clients diagnosed with chronic illnesses.”
B “You are susceptible to infections. These shots may help prevent a crisis.”
C “The vaccines will help your blood from sickling secondary to viruses.”
D “The doctor wanted to make sure that I discussed the vaccines with you.”

Explanations

A
This response is true but too general. It does not explain why vaccines are especially important for sickle cell disease.
B
Clients with SCD are at high risk for infection, which can trigger sickle cell crises. Vaccines help prevent infections and subsequent crises.
C
Vaccines do not directly prevent red blood cell sickling. This explanation is inaccurate.
D
This response deflects responsibility and provides no patient education. It is not therapeutic.
Infection is a major trigger for sickle cell crises. Note that vaccines are emphasized because they reduce infection risk and prevent crises.
QUESTION #5
Medical-Surgical Exam 1 Med-Surg
Which is a potential complication that occurs specifically to a male client diagnosed with SCD during a sickle cell crisis?
A Chest syndrome.
B Compartment syndrome.
C Priapism.
D Hypertensive crisis.

Explanations

A
Acute chest syndrome can occur in any client with SCD. It is not specific to males.
B
This can occur from severe swelling but is not gender-specific. It is a general complication.
C
Priapism is a prolonged, painful erection caused by vaso-occlusion in penile blood vessels. This complication occurs specifically in males with SCD.
D
Hypertension is not a characteristic or specific complication of sickle cell crisis. It is unrelated to male anatomy.
Male clients with SCD are at risk for priapism due to vaso-occlusion of penile vessels. On exams, male-only complication = priapism.
QUESTION #6
Medical-Surgical Exam 1 Med-Surg
The nurse is caring for the client recovering from a sickle cell crisis. The client tells the nurse about a planned family trip to mountainous Yellowstone National Park. Which response would be best for the nurse?
A “That sounds like a wonderful trip to take this summer.”
B “Have you talked to your doctor about taking the trip?”
C “You really should not take a trip to areas with high altitudes.”
D “Why do you want to go to Yellowstone National Park?”

Explanations

A
This response is supportive but ignores a significant health risk. It does not provide necessary safety teaching.
B
Consulting the provider is appropriate, but the nurse should first educate about known risks. It delays essential teaching.
C
High altitudes reduce oxygen levels, increasing sickling and triggering crises. Avoidance is a key preventive measure.
D
This explores motivation but does not address the immediate health concern. Safety education should come first.
Low oxygen environments such as high altitudes can trigger sickle cell crises. On exams, patients with SCD should avoid high altitudes and hypoxic conditions.
QUESTION #7
Medical-Surgical Exam 1 Med-Surg
The nurse is assessing a Black client diagnosed with sickle cell crisis. Which assessment datum is most pertinent when assessing for cyanosis in clients with dark skin?
A Assess the client’s oral mucosa.
B Assess the client’s metatarsals.
C Assess the client’s capillary refill time
D Assess the sclera of the client’s eyes.

Explanations

A
Cyanosis is best detected in dark-skinned clients by examining mucous membranes such as the lips and oral mucosa. These areas show color changes more reliably than skin.
B
Metatarsals are not useful for identifying cyanosis. Bony areas do not reflect oxygenation status.
C
Capillary refill assesses perfusion, not cyanosis. It does not directly indicate oxygenation.
D
Sclera are assessed for jaundice, not cyanosis. They do not reliably show hypoxia-related color changes.
In clients with dark skin, cyanosis is most visible in mucous membranes, lips, and nail beds. On exams, oral mucosa = best indicator of cyanosis
QUESTION #8
Medical-Surgical Exam 1 Med-Surg
The client’s nephew has just been diagnosed with SCD. The client asks the nurse, “How did my nephew get this disease?” Which statement would be best response by the nurse?
A “Sickle cell disease is an inherited autosomal recessive disease.”
B “He was born with it, and both parents were carriers of the disease.”
C “At this time, the cause of sickle cell disease is unknown.”
D “Your sister was exposed to a virus while pregnant.”

Explanations

A
This is the etiology for SCD, but a layperson would not understand this explanation.
B
This explains the etiology in terms that a layperson could understand. When both parents are carriers of the disease, each pregnancy has a 25% chance of producing a child with SCD.
C
The cause of sickle cell disease is known and genetic. This statement is incorrect.
D
Viral exposure during pregnancy does not cause sickle cell disease. This is false information.
Sickle cell disease is inherited when both parents carry the sickle cell trait. On exams, when asked how someone got SCD, choose the option that explains carrier inheritance.
QUESTION #9
Medical-Surgical Exam 1 Med-Surg
The client diagnosed with SCD is experiencing a vaso-occlusive crisis. Which priority intervention should the nurse implement?
A Maintain IV fluids and administer pain medications.
B Encourage frequent ambulation in the hallways.
C Administer oxygen via nasal cannula at 10 L/min.
D Monitor the client’s RBC count every 4 hours.

Explanations

A
Hydration decreases blood viscosity and reduces sickling, while opioids treat severe ischemic pain. These are the cornerstone interventions during vaso-occlusive crisis.
B
Activity increases oxygen demand and can worsen pain and hypoxia. Rest is preferred during acute crisis.
C
Oxygen is used if hypoxia is present, but routine high-flow oxygen is not the first priority without evidence of desaturation.
D
Laboratory monitoring does not address the immediate, life-threatening pain and ischemia. Symptom management comes first.
Vaso-occlusive crisis priorities are hydration and aggressive pain control. On exams, choose IV fluids + opioids as the first-line nursing interventions.
QUESTION #10
Medical-Surgical Exam 1 Med-Surg
The nurse identified clotting as a concept related to SCD. Which intervention should the nurse implement?
A Assess for cerebrovascular findings.
B Keep the HOB elevated.
C Order a 2,000-mg sodium diet.
D Apply antiembolism stockings.

Explanations

A
Sickle cell disease increases the risk of vaso-occlusion and cerebrovascular accident (stroke). Neurologic assessment helps detect impaired cerebral circulation early.
B
Head elevation supports breathing but does not directly address clotting or vaso-occlusion. It is not the priority for this concept.
C
Sodium restriction is unrelated to clotting or sickle cell complications. This intervention does not reduce vaso-occlusion risk.
D
SCD causes microvascular occlusion from sickled cells, not venous stasis. Stockings do not prevent sickling-related clots.
Sickle cell disease causes vaso-occlusion, increasing the risk for stroke. On exams, clotting in SCD points to cerebrovascular assessment as the priority intervention.