Final Test Session

2nd Professional BSN,4 year Programme

Subject: Adult Health Nursing I

Topic: Unit V (Hematologic disorders)

Name:_______________ Roll No._____________ Date:_____________ Total Marks:65

(Objective Section)

Encircle the correct answer:

1. Which of the following is NOT a cause of microcytic anemia?

a. Thalassemia
b. Anemia of chronic disease
c. Iron deficiency anemia
d. Pancytopenia
2. The lab reports for a patient with low mean cell volume show high serum ferritin and low total
iron binding capacity. What is the most likely cause for this patient’s anemia?
a. Fe deficiency
b. Anemia secondary to inflammation
c. Thalassemia
d. Hemoglobinopathy
3. Fe is absorbed in the
a. Stomach
b. Duodenum
c. Jejunum
d. Ileum
4. Where is most nonheme iron found in the body?
a. Bound to IF
b. Bound to transferrin
c. Free in plasma
d. Stored in liver
5. Select the following that enhance Fe absorption
a. Citric acid
b. Polyphenols (tea)
c. Ascorbic acid
d. B & C
6. What is the most important test for Fe stores?
a. Serum iron
b. TIBC
 c. Serum ferritin
d. None of the above
7. Which of the following is not an etiology of Fe deficiency anemia?
a. Chronic blood loss
b. Increased requirement
c. Infection
d. Malabsorption
8. TIBC increases in iron deficiency anemia because
a. Inflammatory response to deficiency
b. Compensation by other factors
c. Ability to absorb increases
d. None of the above
9. Pica, a clinical presentation for Fe deficiency anemia, is
a. Itchiness
b. ED
c. Desire to eat weird things
d. A small woodland creature
10. Which lab investigations would you order if you suspect Fe deficiency anemia?
a. CBC
b. Blood smear
c. Serum iron
d. All of the above
11. Where is beta-thalassemia most common?
a. Mediterranean
b. Arabian Peninsula
c. South East Asia
d. All of the above
12. What is the difference between beta-thalassemia major and beta-thalassemia minor?
a. Homozygous vs heterozygous
b. Acute vs chronic
c. Legal drinking age
d. None of above
13. Heinz bodies are made of
a. Excess gamma chains
b. Excess alpha chains
c. Excess beta chains
d. Excess ketchup
14. Which would you expect to see on a blood smear for beta-thalassemia?
a. Heinz bodies
b. Target cells
c. Hypochromic microcytic cells
d. All of the above
15. What is the treatment for beta-thalassemia minor?
a. Blood transfusions
b. Iron chelation
 c. Bone marrow transplant
d. None of the above
16. On a CBC for alpha-thalassemia, you would see anemia and reticulocytosis. On the blood
smear, you would see Heinz bodies, hypochromic microcytic cells, and occasional target cells.
Select the others that you would see increase:
a. LDH
b. Unconjugated bilirubin
c. Urine urobilinogen
d. All of the above
17. Aplastic anemia can be acquired (more common) and inherited. What are some of the ways it
can be acquired?
a. Ionizing radiation
b. Drugs and chemicals
c. Idiopathic
d. All of above
18. Aside from the gradual onset signs of anemia, what other clinical presentations would you see
with aplastic anemia?
a. Associated thrombocytopenia, e.g., history of bleeding from the gums
b. Neutropenia, e.g., repeated bacterial infections
c. Purpura
d. All of the above
19. How would you diagnose aplastic anemia?
a. Blood smear
b. Bone marrow biopsy
c. Spleen biopsy
d. CBC
20. Select treatment options for aplastic anemia
a. IV equine ATG
b. Bone marrow transplant
c. Immune suppression
d. All of the above
21. A diagnosis of Hodgkin’s disease was made to a 58- year old man and is admitted for the initial
cycle of chemotherapy. During the hospitalization, the nurse should watch out for the
following complication, except?
a. Fertility problems
b. Benign prostatic hyperplasia
c. Secondary cancer
d. Infection
22. The nurse is reviewing the chart of a client who is newly diagnosed with chronic lymphocytic
leukemia. Which of the following laboratory values is expected to be seen?
a. Elevated aspartate aminotransferase and alanine aminotransferase levels
b. Thrombocytopenia and increased lymphocytes
c. Elevated sedimentation rate
d. Uncontrolled proliferation of granulocytes
23. Maria was recently diagnosed with Hodgkin’s lymphoma. Upon the early diagnosis, the nurse
will expect which of the following areas is often involved?
a. Chest
b. Neck
c. Groin
d. Pelvis
24. According to a standard staging classification of Hodgkin’s disease, which of the following
criteria reflects stage III?
a. Involvement of lymph node regions or structures on both sides of the diaphragm
b. Involvement of two or more lymph node regions or structures
c. Involvement of single lymph node region or structure
d. Involvement of extralymphatic organs or tissues
25. Angela, a clinical instructor is conducting a lecture about chemotherapy. Which of the
following statements is correct about the rate of cell growth in relation to chemotherapy?
a. Faster growing cells are more susceptible to chemotherapy
b. Faster growing cells are less susceptible to chemotherapy
c. Slower growing cells are more susceptible to chemotherapy
d. Non-dividing cells are more susceptible to chemotherapy
26. A 40-year-old male diagnosed with acute lymphocytic leukemia finished his first cycle of
chemotherapy. Which of the following statements by the nurse is wrong?
a. “You can eat soft cheeses from pasteurized milk”
b. “You can enjoy the turkey on the day of thanksgiving party”
c. “Try eating sashimi in one of the famous Japanese restaurants around the city”
d. “ A medium well steak is a good idea of a sumptuous meal”
27. A client with leukemia has neutropenia. Which of the following functions must be frequently
assessed?
a. Heart sounds
b. Bowel sounds
c. Breath sounds
d. Blood pressure
28. Which of the following clients is most at risk for developing multiple myeloma?
a. A 60-year-old African-American man
b. A 52-year-old Hispanic woman
c. A 35-year-old White man
d. A 25-year-old Asian woman
29. Which of the following substances has abnormal values early in the course of multiple
myeloma (MM)?
a. Red blood cells
b. Immunoglobulins
c. White blood cells
d. Platelets
30. Nurse Andrei is caring for a client with multiple myeloma. During the review of the laboratory
results. The nurse will monitor the client for which of the following conditions?
a. Hypermagnesemia
b. Hyperkalemia
 c. Hypernatremia
d. Hypercalcemia
31. Which of the following may be an underlying condition that leads to DIC?
a. Trauma
b. Cancer
c. Complication of pregnancy
d. All of these conditions could lead to DIC
32. Nausea and vomiting are common adverse effects of radiation and chemotherapy. When
should a nurse administer antiemetics?
a. When therapy is completed
b. Immediately after nausea begins
c. With the administration of therapy
d. 30 minutes before the initiation of therapy
33. Sickle-shaped erythrocytes cause:
a. Cellular blockage in small vessels.
b. Decreased organ perfusion.
c. Tissue ischemia and infarction.
d. All of the above.
34. A person with sickle cell trait would:
a. Be advised to avoid fluid loss and dehydration.
b. Be protected from crisis under ordinary circumstances.
c. Experience hemolytic jaundice.
d. Have chronic anemia.
35. On the basis of the knowledge of the inheritance of the sickle cell gene, the nurse expects the
patient to be of what descent?
a. African.
b. Indian.
c. Middle Eastern.
d. Mediterranean.
36. On assessment, the nurse notes that the patient’s face and skull bones are enlarged. She
knows this is a compensatory response to:
a. Dehydration.
b. Anemia.
c. Pain.
d. Jaundice.
37. The nurse is caring for a female client experiencing neutropenia as a result of chemotherapy
and develops a plan of care for the client. The nurse plans to:
a. Teach the client and family about the need for hand hygiene
b. Insert an indwelling urinary catheter to prevent skin breakdown
c. Restrict fluid intake
d. Restrict all visitors
38. Choose the hemoglobin level in the newborn:
a. 110–130 g/l;
b. 120–140 g/l;
c. 140–160 g/l;
 d. 180–240 g/l.
39. Choose the most common cause of iron deficiency anemia in early childhood:
a. Chronic diseases
b. Nutritional factor
c. Chronic bleeding
d. Iron absorption disorders
40. Choose the laboratory result that is not characteristic for iron deficiency anemia:
a. Decreased serum iron level
b. Decreased serum ferritin level
c. Decreased mchc (mean corpuscular hemoglobin concentration) in red blood cells
d. Decreased total iron-binding capacity
41. Choose the factor that increase the iron absorption from oral iron supplements:
a. Acidity of gastric juice;
b. Activity of salivary amylase;
c. Secretory function of the stomach;
d. Characteristics of iron from oral iron supplementation preparations;
42. Select the food from which irons is easier absorbed:
a. Meat
b. Fruits
c. Vegetables
d. Cereals
43. Choose the feature that is not characteristic for B12 - deficiency anemia:
a. Disorder of the intrinsic factor (castle factor) secretion
b. Hyperchromy
c. Insufficient intake of vit. B12 with food
d. increased serum iron level
44. Enumerate diseases that determine reduced iron absorption in the gastrointestinal tract:
a. Cystic fibrosis
b. Helminthes infestation
c. Rickets
d. Cholecystitis
45. The nurse is caring for a female client experiencing neutropenia as a result of chemotherapy
and develops a plan of care for the client. The nurse plans to:
a. Teach the client and family about the need for hand hygiene
b. Insert an indwelling urinary catheter to prevent skin breakdown
c. Restrict fluid intake
d. Restrict all visitors
46. Which of the following is a defining characteristic of anemia?
a. Thrombocytopenia
b. Decreased leukocytes
c. Elevated erythrocyte count
d. Hemoglobin (Hgb) less than 12 g/dL for women and less than 13 g/dL for men
47. Of the following, which is the most prevalent cause of anemia in the elderly?
a. Folate deficiency
b. Endocrinopathies
 c. Chronic kidney disease
d. Chronic disease/inflammation
48. What is the most common cause of iron- deficiency anemia in the elderly?
a. Malnutrition
b. Chronic kidney disease
c. Medication side effects
d. Gastrointestinal blood loss
49. Pernicious anemia is an autoimmune disorder that causes
a. Hemolysis.
b. Folate excess.
c. Vitamin b12 deficiency.
d. Elevated serum ferritin level.
50. Which of the following are good food sources of folate?
a. Beer and lamb
b. Liver and beans
c. Milk and cheese
d. Chicken and mashed potatoes
(Objective Section)

1. List down the causes of anemia

2. Write down the management of DIC
3. Define aplastic anemia and write down the nursing interventions for the patient