Lewis: Medical-Surgical Nursing, 9th Edition

Chapter 31
Rationales for Bridge to NCLEX Examination questions
1. Correct answer: a
Rationale: Patients with severe anemia (hemoglobin level, less than 6 g/dL) exhibit the
following cardiovascular and pulmonary manifestations: tachycardia, increased pulse pressure,
systolic murmurs, intermittent claudication, angina, heart failure, myocardial infarction,
tachypnea, orthopnea, and dyspnea at rest.
2. Correct answer: b
Rationale: Iron-deficiency anemia is a microcytic, hypochromic anemia.
3. Correct answers: a, b
Rationale: Stool guaiac test is performed to determine the cause of iron-deficiency anemia that
is related to gastrointestinal bleeding. Iron is increased in the diet. Teach the patient which foods
are good sources of iron. If nutrition is already adequate, increasing iron intake by dietary means
may not be practical. The patient with iron deficiency related to acute blood loss may require a
transfusion of packed red blood cells (RBCs).
4. Correct answers: a, b, c, d
Rationale: Complete blood count (CBC) is monitored. Infections are common with elevated
white blood cell counts, and anemia may occur with low hemoglobin levels and low RBC
counts. Oxygen may be administered to treat hypoxia and control sickling. Rest may be instituted
to reduce metabolic requirements, and prophylaxis for deep vein thrombosis (with
anticoagulants) is prescribed. Transfusion therapy is indicated when an aplastic crisis occurs.
Patients may require iron chelation therapy to reduce transfusion-produced iron overload. Pain
occurring during an acute crisis is usually undertreated; patients should have optimal pain control
with opioid analgesics, nonsteroidal antiinflammatory agents, antineuropathic pain medications,
local anesthetics, or nerve blocks.
5. Correct answer: a
Rationale: The patient with polycythemia may experience angina, heart failure, intermittent
claudication, and thrombophlebitis, which may be complicated by embolization. These
manifestations are caused by blood vessel distention, impaired blood flow, circulatory stasis,
thrombosis, and tissue hypoxia, caused by the hypervolemia and hyperviscosity. The most
common serious acute complication is stroke, caused by thrombosis.
6. Correct answer: a
Rationale: Patients with thrombocytopenia should avoid aspirin because it reduces platelet
adhesiveness, which contributes to bleeding. Patients should not perform vigorous exercise or lift
weights. If a patient is weak and at risk for falling, supervise the patient when he or she is out of
bed. Blowing the nose forcefully should be avoided. The patient should gently pat the nose with
a tissue if needed. Instruct patients not to shave with a blade; an electric razor should be used.
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Rationales for Bridge to NCLEX Examination questions

7. Correct answer: d
Rationale: von Willebrand disease involves deficiency of the von Willebrand coagulation
protein, variable factor VIII deficiencies, and platelet dysfunction. Treatment includes
administration of von Willebrand factor and factor VIII.
8. Correct answer: c
Rationale: In disseminated intravascular coagulation (DIC), the coagulation process is
stimulated, with resultant thrombosis and depletion of clotting factors, which leads to diffuse
clotting and hemorrhage. The paradox of this condition is characterized by the profuse bleeding
that results from the depletion of platelets and clotting factors.
9. Correct answers: a, b, c, d
Rationale: Early identification of an infective organism is a priority, and cultures should be
obtained from various sites. Serial blood cultures (at least two) or one from a peripheral site and
one from a venous access device should be obtained promptly. In a febrile neutropenic patient,
antibiotics should be started immediately (within 1 hour). Cultures of the nose, throat, sputum,
urine, stool, obvious lesions, and blood may be indicated. Ongoing febrile episodes or a change
in the patients assessment findings (or vital signs) necessitates a call to the physician for
additional cultures, diagnostic tests, addition of antimicrobial therapies, or a combination of
these.
10. Correct answer: d
Rationale: Myelodysplastic syndrome (MDS) commonly manifests as infection and bleeding. It
is caused by inadequate numbers of ineffective functioning circulating granulocytes or platelets.
11. Correct answer: d
Rationale: Chronic lymphocytic leukemia is a disease primarily of older adults.
12. Correct answer: d
Rationale: Combination therapy is the mainstay of treatment for leukemia. The three purposes
for using multiple drugs are to (1) decrease drug resistance, (2) minimize the drug toxicity to the
patient by using multiple drugs with varying toxic effects, and (3) interrupt cell growth at
multiple points in the cell cycle.
13. Correct answer: c
Rationale: Non-Hodgkins lymphoma can originate outside the lymph nodes, the method of
spread can be unpredictable, and most affected patients have widely disseminated disease.
14. Correct answer: c
Rationale: Bone degeneration in multiple myeloma causes calcium to be lost from bones, which
eventually results in hypercalcemia. Hypercalcemia may cause renal, gastrointestinal, or
neurologic manifestations, such as polyuria, anorexia, or confusion, and may ultimately cause
seizures, coma, and cardiac problems.
15. Correct answer: d

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Rationales for Bridge to NCLEX Examination questions

Rationale: Splenectomy can have a dramatic effect in increasing peripheral RBC, white blood
cell, and platelet counts.
16. Correct answer: d
Rationale: Infectious viruses, such as human immunodeficiency virus (HIV), human
herpesvirus, hepatitis B and C type 6 (HCV-6), Epstein-Barr virus (EBV), human T-cell leukemia
virus type 1 (HTLV-1), and cytomegalovirus (CMV), and other agents, such as the agent that
causes malaria, can be transmitted by blood transfusion. Leukocyte-reduced blood products
drastically reduce the risk for viral infections associated with blood transfusions, including CMV.

Copyright 2014 by Mosby, an imprint of Elsevier Inc.