NURSEZONE

4th Floor Florentine Bldg. Bonifacio St., Davao City

Tel No. 300 – 1702 and 303 – 0773

SUBJECT: MEDICAL – SURGICAL NURSING

BLOOD AND IMMUNITY
EXAM CODE: CGFNS / NCLEX REVIEW JUNE

PREPARED BY: MR. ALLAN ALDRICH J. OCAMPO, RMT, RN

1. A client with upper gastrointestinal bleeding develops a mild anemia. The nurse should expect the client to be treated
with:
A. Dextran B. Epogen C. Iron salts D. Vitamin B12

2. The emergency department nurse is admitting a client following an automobile accident. The client has lost a
considerable amount of blood, and early stage hypovolemic shock is suspected. An assessment finding the nurse would
expect this client to exhibit is:
A. A distention of the neck veins C. An output of 50 ml urine per hour
B. An apical heart rate of 142 bpm D. A blood pressure of 150/90 mm Hg

3. The physician orders 3 units of whole blood for a client in hypovolemic shock after a gastrointestinal hemorrhage. When
administering blood, the nurse first verifies the type and cross-match and then:
A. Warms the blood to body temperature to prevent chills
B. Uses an infusion pump to increase the accuracy of the infusion
C. Draws blood samples from the client before and after each unit is transfused
D. Runs the blood at a slower rate during the first 5 to 10 minutes of the transfusion
4. During a blood transfusion a client develops chills and headache. The nurse's best action is to:
A. Lightly cover the client C. Stop the transfusion immediately
B. Notify the physician stat D. Slow the blood flow to keep vein open

5. An example of primary health care by the nurse would be:

A. Prevention of disabilities C. Establishing goals for rehabilitation
B. Correction of dietary deficiencies D. Assisting in immunization programs

6. In general, the higher the red blood cell count:

A. The higher the blood pH C. The greater the blood viscosity
B. The lower the hematocrit D. The less it contributes to immunity

7. The nurse understands that the only molecules that cannot pass through the capillary endothelium are:
A. Blood gases C. Glucose and ions
B. Plasma proteins D. Amino acids and water

8. When caring for a client with an impaired immune system, the nurse recognizes that the blood protein involved is:
A. Albumin B. Globulin C. Thrombin D. Hemoglobin

9. Antibodies are produced by:

A. Eosinophils B. Plasma cells C. Erythrocytes D. Lymphocytes

10. Infection with Group A beta-hemolytic streptococci is associated with:

A. Rheumatic fever C. Spinal meningitis
B. Hepatitis Type A D. Rheumatoid arthritis

11. A client is concerned about contracting malaria while visiting relatives in Southeast Asia. The nurse explains that the
best way to prevent malaria is to avoid:
A. Mosquito bites C. Undercooked food
B. Untreated water D. Over-populated areas

12. The nurse is reviewing the physical examination and laboratory tests of a client with malaria. The nurse understands
that an important finding in malaria is:
A. Leukocytosis C. Splenomegaly
B. Erythrocytosis D. Elevated sedimentation rate

13. When caring for a client with malaria, the nurse should know that:
A. Seizure precautions must be followed D. Nutrition should be provided between
B. Peritoneal dialysis is usually indicated paroxysms
C. Isolation is necessary to prevent cross-infection

14. When teaching a client about drug therapy against Plasmodium falciparum, the nurse should include the fact that:
A. The infections are controlled C. The infections can generally be eliminated
B. Immunity will prevent reinfestation D. Transmission by the Anopheles mosquito can occur
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 NURSEZONE
4th Floor Florentine Bldg. Bonifacio St., Davao City
Tel No. 300 – 1702 and 303 – 0773

15. Blackwater fever occurs in some clients with malaria; therefore, the nurse should observe client with chronic malaria
for:
A. Diarrhea C. Low-grade fever
B. Dark red urine D. Coffee ground emesis

16. When caring for a client who is HIV positive primary responsibility of the nurse is to explain how the client can prevent:
A. AIDS C. Other infections
B. Social isolation D. Kaposi's sarcoma

17. When a trauma victim expresses fear that AIDS may develop as a result of a blood transfusion the nurse should
explain that:
A. Blood is treated with radiation to kill the v
B. Screening for the HIV antibodies has minimized this risk
C. The ability to directly identify HIV has eliminated this concern
D. Consideration should be given to done own blood for transfusion
18. A mother with the diagnosis of AIDS states she has been caring for her little baby eventhough she has not been
feeling well. The nurse should ask her:
A. If she is breastfeeding the baby C. When the baby last received antibiotics
B. If she has hugged or kissed the baby D. How long she has been caring for the baby
19. When providing discharge teaching to the family of a client with AIDS, the nurse should teach the family:
A. "You need to boil the dishes for 30 minutes after use."
B. "Let the client eat from paper plates and discard them."
C. "Wash the dishes in hot soapy water as you usually do."
D. "Let the dishes soak in hot water overnight before washing."
20. During an AIDS education class, a client state "Vaseline works great when I use condoms." The nurse recognizes that
this statement indicates:
A. An understanding of safer sex C. Ignorance concerning the transmission of HIV
B. The ability to assume self-responsibility D. A lack of information concerning correct condom use
21. A client has a bone marrow aspiration performed. Immediately after the procedure, the nurse should:
A. Position the client on the affected side C. Cleanse the site with an antiseptic solution
B. Begin frequent monitoring of vital signs D. Briefly apply pressure over the aspiration site.
22. With Hodgkin's disease the lymph nodes usually affected first are the:
A. Axillary B. Inguinal C. Cervical D. Mediastinal

23. The highest incidence of Hodgkin's disease is in:

A. Children C. Elderly persons
B. Young adults D. Middle-aged persons
24. A client is to have whole-body radiation for Hodgkin's disease. The nurse's teaching plan should center around the
likely occurrence of increased:
A. Blood viscosity C. Red blood cell production
B. Susceptibility to infection D. Tendency for pathologic fractures
25. Fragments of cells in the bloodstream that break down on exposure to injured tissue and begin the chain reaction
leading to a blood clot are known as:
A. Platelets B. Leukocytes C. Erythrocytes D. Red blood cells

26. The nurse understands that thromboplastin, which initiates the clotting process is found in:
A. Bile B. Plasma C. Platelets D. Erythrocytes

27. When assessing a wound that exhibits signs of blood coagulation and healing, the nurse understands that the soluble
substance that becomes an insoluble gel is:
A. Fibrin B. Thrombin C. Fibrinogen D. Prothrombin

28. The nurse understands that blood clotting requires the presence of the catalyst:
A. F¯ B. CI¯ C. Ca++ D. Fe+++

29. Vitamin K is essential for normal blood clotting because it promotes:

A. Platelet aggregation C. Fibrinogen formation by the liver
B. lonization of blood calcium D. Prothrombin formation by the liver

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 NURSEZONE
4th Floor Florentine Bldg. Bonifacio St., Davao City
Tel No. 300 – 1702 and 303 – 0773

30. The increased tendency toward coronary and cerebral thromboses seen in individuals with polycythemia vera is
attributable to the:
A. Increased viscosity C. Elevated blood pressure
B. Fragility of the cells D. Immaturity of red blood cells

31. A serum bilirubin is performed on a client who is weak, dyspneic and jaundiced. A bilirubin level above 2 mg/100 ml
blood volume could indicate:
A. Hemolytic anemia C. Decreased rate of red cell destruction
B. Pernicious anemia D. Low oxygen-carrying capacity of erythrocytes

32. As a result of a serious automobile accident, a client is admitted with multiple trauma including a ruptured spleen. A
splenectomy is performed because:
A. The spleen is a highly vascular organ C. The spleen is the largest lymphoid organ in the body
B. It is anatomically adjacent to the diaphragm D. Rupture of the spleen can cause diseases of the liver
33. In the immediate postoperative period following a splenectomy, the nurse specifically should observe the client for:
A. Shock and infection C. Hemorrhage and abdominal distention
B. Intestinal obstruction and bleeding D. Peritonitis and pulmonary complications

34. A client has a splenectomy following a motor vehicle accident. The consideration that is of primary importance after a
splenectomy is:
A. Early ambulation C. Adequate lung aeration
B. Pulmonary embolism D. Postoperative hemorrhage

35. Occurrence of an anaphylactic reaction after receiving penicillin indicates that the client has:
A. An acquired atopic sensitization
B. Passive immunity to the penicillin allergen
C. Antibodies to penicillin acquired after earlier use of the drug
D. Developed potent bivalent antibodies when the IV administration was started
36. A 35-year-old professional golfer is brought to the emergency room for a bee sting. The client has a history of allergies
to bees and is having trouble breathing. The nurse is aware that this client can expire from:
A. Ischemia B. Asphyxia C. Lactic acidosis D. Antihistamenia

37. A client has an anaphylactic reaction within the first half hour after an IV infusion containing ampicillin is started. The
nurse understands that the symptoms occurring during an anaphylactic reaction are the result of:
A. Respiratory depression and cardiac standstill
B. Constriction of capillaries and decreased cardiac output
C. Bronchial constriction and decreased peripheral resistance
D. Decreased cardiac output and dilation of major blood vessels
38. A client who was exposed to hepatitis A is given gamma globulin to provide passive immunity which:
A. Increases production of short-lived antibodies
B. Provides antibodies that neutralize the antigen
C. Accelerates antigen-antibody union at hepatic sites
D. Stimulates the lymphatic system to produce large numbers of antibodies
39. The spouse of a comatose client who has severe internal bleeding refuses to allow transfusions of whole blood
because they are Jehovah's Witnesses. The nurse involved in this situation should:
A. Phone the physician for a special administrative order to give the blood under these circumstances
B. Have the spouse sign a treatment refusal form and notify the physician so a court order can be obtained
C. Gently explain to the husband why the transfusion is necessary, emphasizing the implications of not having the
transfusion.
D. Institute the blood transfusion anyway, because the physician ordered it and the client's survival depends on
volume replacement

40. A client with hypothermia is brought to the emergency room. The family should be taught that treatment will include:
A. Core rewarming with warm fluids C. Frequent oral temperature assessment
B. Ambulation to increase metabolism D. Gastric tube feedings to increase fluids

41. When it is impossible to determine whether a client has been immunized against tetanus, the preparation of choice
used to produce passive immunity for several weeks with minimal danger of allergic reactions is:
A. DTP vaccine C. Tetanus antitoxin
B. Tetanus toxoid D. Tetanus immune globulin

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 NURSEZONE
4th Floor Florentine Bldg. Bonifacio St., Davao City
Tel No. 300 – 1702 and 303 – 0773

42. A client who is suspected of having tetanus ask the nurse about immunizations against tetanus. The nurse explains
that the major benefit in using tetanus antitoxin is that it:
A. Stimulates plasma cells directly C. Provides immediate active immunity
B. Provides a high titer of antibodies D. Stimulates long-lasting passive immunity

43. A female client has hemoglobin of 8.5 g/dl which is attributed to nutritional deficiency. The foods that the nurse should
recommend be increased in the client's diet include:
A. Carrots, beef, and apples C. Broccoli, pork, and apricots
B. Spinach, liver, and raisins D. Lima beans, squash, and prunes

44. While being prepared for surgery for a ruptured spleen, a client complains of feeling light headed. The client's color is
pale and the pulse is very rapid. The nurse assesses that the client may be:
A. Hyperventilating C. Extremely anxious
B. Going into shock D. Developing an infection