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During a flu shot clinic, one of the questions the student nurse asks relates to whether the patient has had Guillain-Barré syndrome in his medical history. The patient asks, “What is that?” How should the nursing student reply?


A. “A type of paralysis that affects movement on both sides of the body that may even involve the respiratory muscles” 

B. “Influenza-like illness where you had fever and chills for 2 to 3 days after your last flu shot” 

C. “A degenerative disease where you have trouble walking without the help of a cane or walker” 

D. “Swelling of your arm where you got your flu shot, and maybe your eyes and lips had some swelling as well” 

Question 22 

A 22-year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem? 


A. Excess acetylcholinesterase production; treatment with thymectomy 

B. A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins 

C. Cerebellar lesions; surgical and immunosuppressive treatment 

D. Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids 

Question 23 

A baseball player was hit in the head with a bat during practice. In the emergency department, the physician tells the family that he has a “coup”injury. How will the nurse explain this to the family so they can understand? 


A. “It’s like squeezing an orange so tight that the juice runs out of the top.” 

B. “When the bat hit his head, his neck jerked backward causing injury to the spine.” 

C. “Your son has a contusion of the brain at the site where the bat hit his head.” 

D. “Your son has a huge laceration inside his brain where the bat hit his skull.” 

Question 24 

Which of the following glycoproteins is responsible for treating such diseases as bone marrow failure following chemotherapy and hematopoietic neoplasms such as leukemia? Answers: 

A. Growth factors and cytokines 

B. T lymphocytes and natural killer cells 

C. Neutrophils and eosinophils 

D. Natural killer cells and granulocytes 

Question 25 

While being on subcutaneous heparin injections for deep vein thrombosis during her latter pregnancy, a patient begins to experience major side effects. Her OB-GYN physician has called in a specialist who thinks that the patient is experiencing heparin-induced thrombocytopenia. The nurse should anticipate which of the following orders? 


A. Immediately discontinue the heparin therapy 

B. Switch to Coumadin 2.5 mg once/day 

C. Decrease the dose of heparin from 5000 units b.i.d to 3000 units b.i.d 

D. Infuse FFP stat 

Question 26 

Which of the following individuals would most likely experience global ischemia to his or her brain? 


A. A woman who is being brought to hospital by ambulance following suspected carbon monoxide poisoning related to a faulty portable heater 

B. A male client who has just had an ischemic stroke confirmed by CT of his head 

C. A woman who has been admitted to the emergency department with a suspected intracranial bleed 

D. A man who has entered cardiogenic shock following a severe myocardial infarction 

Question 27 

A new mother and father are upset that their 2-day-old infant is requiring phototherapy for hyperbilirubinemia. The pediatrician who has followed the infant since birth is explaining the multiplicity of factors that can contribute to high serum bilirubin levels in neonates. Which of the following factors would the physician be most likely to rule out as a contributor? 


A. Transitioning of hemoglobin F (HbF) to hemoglobin A (HbA) 

B. Hepatic immaturity of the infant 

C. Hypoxia 

D. The fact that the infant is being breast-fed 

Question 28 

A 14-year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms? 


A. Viruses are killing some of his B cells and becoming incorporated into the genome of others. 

B. The Epstein-Barr virus (EBV) is lysing many of the boy’s neutrophils. 

C. The virus responsible for mononucleosis inhibits the maturation of myeloblasts into promyelocytes. 

D. The EBV inhibits the maturation of white cells within his peripheral lymph nodes. 

Question 29 

A 16-year-old female has been brought to her primary care physician by her mother due to the girl’s persistent sore throat and malaise. Which of the following facts revealed in the girl’s history and examination would lead the physician to rule out infectious mononucleosis? 


A. Chest auscultation reveals crackles in her lower lung fields bilaterally. 

B. Her liver and spleen are both enlarged. 

C. Blood work reveals an increased white blood cell count. 

D. The girl has a temperature of 38.1°C (100.6°F) and has enlarged lymph nodes. 

Question 30 

A 30-year-old woman who has given birth 12 hours prior is displaying signs and symptoms of disseminated intravascular coagulation (DIC). The client’s husband is confused as to why a disease of coagulation can result in bleeding. Which of the nurse’s following statements best characterizes DIC? 


A. “The same hormones and bacteria that cause clotting also cause bleeding.” 

B. “Massive clotting causes irritation, friction, and bleeding in the small blood vessels.” 

C. “So much clotting takes place that there are no available clotting components left, and bleeding ensues.” 

D. “Excessive activation of clotting causes an overload of vital organs, resulting in bleeding.” 

Question 31 

A 20-year-old has been diagnosed with an astrocytic brain tumor located in the brain stem. Which of the following statements by the oncologist treating the client is most accurate? 


A. “Our treatment plan will depend on whether your tumor is malignant or benign.” 

B. “This is likely a result of a combination of heredity and lifestyle.” 

C. “The major risk that you face is metastases to your lungs, liver, or bones.” 

D. “Your prognosis will depend on whether we can surgically resect your tumor.” 

Question 32 

A patient diagnosed with low-risk chronic lymphocytic leukemia (CLL) has recently developed thrombocytopenia. One of the medications utilized to treat this would be Answers: 

A. cisplatin, a chemotherapeutic. 

B. vincristine, a Vinca alkaloid. 

C. dexamethasone, a corticosteroid. 

D. doxorubicin, a cytotoxic antibiotic. 

Question 33 

Two nursing students are attempting to differentiate between the presentations of immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP). Which of the students’ following statements best captures an aspect of the two health problems? Answers: 

A. “ITP can be either inherited or acquired, and if it’s acquired, it involves an enzyme deficiency.” 

B. “Both of them involve low platelet counts, but in TTP, there can be more, not less, hemostasis. 

C. “TTP can be treated with plasmapheresis, but ITP is best addressed with transfusion of fresh frozen plasma.” 

D. “Both diseases can result from inadequate production of thrombopoietin by megakaryocytes.” 

Question 34 

A physician is explaining to a 40-year-old male patient the importance of completing his course of antibiotics for the treatment of tuberculosis. The physician explains the damage that could occur to lung tissue by Mycobacterium tuberculosis. Which of the following phenomena would underlie the physician’s explanation? 


A. Tissue destruction results from neutrophil deactivation. 

B. Neutrophils are ineffective against the Mycobacterium tuberculosis antigens. 

C. Macrophages form a capsule around the Mycobacterium tuberculosis bacteria, resulting in immune granulomas. 

D. Nonspecific macrophage activity leads to pulmonary tissue destruction and resulting hemoptysis. 

Question 35 

A teenager, exposed to West Nile virus a few weeks ago while camping with friends, is admitted with headache, fever, and nuchal rigidity. The teenager is also displaying some lethargy and disorientation. The nurse knows which of the following medical diagnoses listed below may be associated with these clinical manifestations?


A. Encephalitis 

B. Lyme disease 

C. Rocky Mountain spotted fever 

D. Spinal infection 

Question 36 

A patient has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The patient asks the nurse what this test will tell the doctor. The nurse replies, 


A. “They are looking for the presence of antibody or complement on the surface of the RBC.” 

B. “They will look at your RBCs under a microscope to see if they have an irregular shape (poikilocytosis).” 

C. “They will wash your RBCs and then mix the cells with a reagent to see if they clump together.” 

D. “They will be looking to see if you have enough ferritin in your blood.” 

Question 37 

A 29-year-old construction worker got a sliver under his fingernail 4 days ago. The affected finger is now reddened, painful, swollen, and warm to touch. Which of the following hematological processes is most likely occurring in the bone marrow in response to the infection? 


A. Phagocytosis by myelocytes 

B. Increased segmented neutrophil production 

C. High circulatory levels of myeloblasts 

D. Proliferation of immature neutrophils 

Question 38 

A surgeon is explaining to the parents of a 6-year-old boy the rationale for the suggestion of removing the boy’s spleen. Which of the following teaching points would be most accurate? 


A.“We think that his spleen is inhibiting the production of platelets by his bone marrow.” 

B.“We believe that your son’s spleen is causing the destruction of many of his blood platelets, putting him at a bleeding risk.” 

C.“Your son’s spleen is holding on to too many of his platelets, so they’re not available for clotting.” 

D.“Your son’s spleen is inappropriately filtering out the platelets from his blood and keeping them from normal circulation.” 

Question 39 A nurse practitioner is providing care for a client with low levels of the plasma protein gamma globulin. The nurse would recognize that the client is at risk of developing which of the following health problems? 


A. Anemia 

B. Blood clots 

C. Jaundice 

D. Infections 

Question 40 

A 32-year-old woman presents at her neighborhood health clinic complaining of weakness and a feeling of abdominal fullness. She reports that 6 months earlier she noticed that she had difficulty in maintaining the high level of energy she has relied on during her aerobic workouts over the past few years. Because she felt that she was in overall good health, but knew that women often need additional iron, she added a multiple vitamin with iron and some meat and leafy greens to her diet. She followed her plan carefully but had no increase in energy. Upon examination, her spleen is noted to be enlarged. Which of the following is most likely to be the cause? 



B. Accelerated CML 

C. Infectious mononucleosis 

D. Stage A Hodgkin disease 

Question 41 

A nurse is providing care for several patients on an acute medical unit of a hospital.Which of the following patients would be most likely to benefit from hematopoietic growth factors? 


A. A 61-year-old female patient with end-stage renal cancer 

B. A 55-year-old obese male patient with peripheral neuropathy secondary to diabetes 

C. A 51-year-old female patient with liver failure secondary to hepatitis 

D. A 44-year-old man with a newly diagnosed brain tumor 

Question 42 

Misinterpreting her physician’s instructions, a 69-year-old woman with a history of peripheral artery disease has been taking two 325 mg tablets of aspirin daily. How has this most likely affected her hemostatic status? 


A. The binding of an antibody to platelet factor IV produces immune complexes. 

B. The patient’s prostaglandin (TXA2) levels are abnormally high. 

C. Irreversible acetylation of platelet cyclooxygenase activity has occurred. 

D. She is at risk of developing secondary immune thrombocytopenic purpura (ITP). 

Question 43 Which of the following teaching points would be most appropriate with a client who has a recent diagnosis of von Willebrand disease? 


A. “Make sure that you avoid taking aspirin.” 

B. “Your disease affects your platelet function rather than clot formation.” 

C. “Clotting factor VIII can help your body compensate for the difficulty in clotting.” 

D. “It’s important that you avoid trauma.” 

Question 44 

A nurse at a long-term care facility provides care for an 85-year-old man who has had recent transient ischemic attacks (TIAs). Which of the following statements best identifies future complications associated with TIAs? TIAs 


A. are caused by small bleeds that can be a warning sign of an impending stroke. 

B. are a relatively benign sign that necessitates monitoring but not treatment. 

C. are an accumulation of small deficits that may eventually equal the effects of a full CVA. D. resolve rapidly but may place the client at an increased risk for stroke. 

Question 45 

Following a motor vehicle accident 3 months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents? 


A. “If you or the care team notices any spontaneous eye opening, then we will change our treatment plan.” 

B. “Your daughter has lost all her cognitive functions as well as all her basic reflexes.” 

C. “Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change.” 

D. “Your daughter’s condition is an unfortunate combination with total loss of consciousness but continuation of all other normal brain functions.” 



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