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199 Cards in this Set

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Normal range for Hgb in females:

a) 12-14
b) 12-15
c) 12-16
d) 12-17
c) 12-16

hb female 12-16 male 13.5-17.5
Normal range for Hgb in males:

a) 13.5 - 14.5
b) 13.5 - 15.5
c) 13.5 - 16.5
d) 13.5 - 17.5
d) 13.5 - 17.5

hb female 12-16 male 13.5-17.5
Normal Hct for females:

a) 37-47
b) 37-57
c) 37-67
a) 37-47
Normal Hct for males:

a) 40-44
b) 40-54
c) 40-64
b) 40-54
RBC's normal in size:

a) normocytic
b) normochromic
a) normocytic
RBC's normal in amount of hgb:

a) normocytic
b) normochromic
b) normochromic
The most accurate classification for anemias is by:

a) morphology
b) etiology
a) morphology
Hgb of 10-14 g/dl is considered:

a) normal
b) mild anemia
c) moderate anemia
c) severe anemia
b) mild anemia

asymptomatic or palpatations, dyspnea, diaphoresis
Hgb of <6 g/dl is considered:

a) normal
b) mild anemia
c) moderate anemia
c) severe anemia
c) severe anemia

blood is usually given when below 8
many clinical symptoms involving multiple body systems
Hgb of 6-10 g/dl is considered:

a) normal
b) mild anemia
c) moderate anemia
c) severe anemia
c) moderate anemia

below 8: will prob give blood
cardiopulmonary symptoms increased while resting as well as with activity
The morphology associated with anemia from blood loss, prgnancy, malaria, cancer, renal, endocrine, & hemolysis:

a) normocytic/normochromic
b) macrocytic/normochromic
c) microcytic/hypochromic
a) normocytic/normochromic

erythrocytes normal size & normal color
The morphology associated with Cobalamin (B12) deficiency, folic acid deficiency, liver disease, alcoholhism, & postsplenectomy:

a) normocytic/normochromic
b) macrocytic/normochromic
c) microcytic/hypochromic
b) macrocytic/normochromic

large erythrocytes/normal color
The morphology associated with iron deficiency, thalasemia, & lead poisoning:

a) normocytic/normochromic
b) macrocytic/normochromic
c) microcytic/hypochromic
c) microcytic/hypochromic

small erythrocytes/ pale color
The majority of anemias are caused by:

a) blood loss
b) iron deficiency
c) nutritional deficiency
d) cancer
c) nutritional deficiency
For the patient w/upper GI bleeding & a mild anemia, the nurse expects the client to be treated with:

a) Dextran
b) Epogen
c) Iron salts
d) Vit B12
Iron
needed in the formation of hemoglobin
One of the most chronic hematologic disorders found in 30% of the world:

a) Cobalamin anemia
b) Folic Acid anemia
c) Iron deficiency anemia
d)Polycythemia
c) Iron deficiency anemia

Decreased RBC production
Iron is present in all RBC's as heme in hemoglobin & in a stored form as well. Heme accounts for :

a) 1/3 of the body's iron
b) 2/3 of the body's iron
b) 2/3 of the body's iron

the other 1/3 is stored ferritin & hemosiderin in bone marrow, macrophage, spleen & liver
Iron deficiency develops from inadequate dietary intake, blood loss, malabsorption or hemolysis. Iron is absorbed in the duodenum & only:

a) 2-5% of ingested iron is absorbed

b) 5-10% of ingested iron is absorbed

c) 10-20% of ingested iron is absorbed

d) 15-25% of ingested iron is absorbed
b) 5-10% of ingested iron is absorbed
Iron is best absorbed when taken with:

a) nothing
b) Vit C or juice
c) milk
d) food
b) Vit C or juice

absorbed best in an acidic environment
For stools to appear black:

a) blood loss of 10-20 ml in upper GI

b) blood loss of 25-50 ml in upper GI

c) blood loss of 50-75 ml in upper GI

d) blood loss of 75-100 ml in upper GI
c) blood loss of 50-75 ml in upper GI
The average monthly menstrual blood loss is aprx.:

a) 25 ml
b) 35 ml
c) 45 ml
d) 55 ml
c) 45 ml

accounts for loss of aprx. 22 mg iron
Iron can be administered by which methods listed below:

a) IM

b) IV
both
The most common clinical finding for iron deficiency anemia is:

a) pallor
b) headache
c) glossitis
d) chelitis
a) pallor (most common)

glossitis (inflammation of the tongue) is 2nd most common

chelitis (inflammation of the lips, headache, parasthesia, & burning sensation of the tongue
Good dietary sources of iron are all of the following except:

a) green leafy's
b) liver & muscle meats
c) fish & poultry
d) eggs & dried fruits
e) legumes & potaoes
f) whole grain & enriched breads & cereALS
c) fish & poultry
A client with a low Hb level which is attributed to a nutritional deficiency should be instructed to add which ofthe following to their diet (check all that apply):

a) raisens
b) squash
c) carrots
d) spinach
e) apricots
a) raisens
d) spinach

all others contain some iron but are not the best source
The daily dose of iron should provide how many mg's of elemental iron:

a) 50-75mg
b) 75-100 mg
c) 100-150 mg
d) 150-200 mg
d) 150-200 mg
Because iron may stain the skin when administered by IM all of the following measures should be taken except:

a) rotate injection sites
b) use separate needles for withdrawing & administering
c) approx. 0.5ml of air should be left in the syringe
d) give deep IM in upper quadrant of buttocks
e) use 2-3", 19- to 20- guage needle
f) use Z-track method
g) no more than 2ml in a single injection
h) massage site after injection
i) do not mix iron dextran w/other meds or add to parenteral solutions
i) give undiluted at rate of no more than 1ml/min
j)flush IV line w/NS
h) massage site after injection
To replinish the body's iron stores, iron therapy should be continued after Hgb levels return to normal for:

a) 1-2 weeks
b) 2-3 weeks
c) 1-2 months
d) 2-3 months
d) 2-3 months

monitor patients on life long therapy for potential liver problems r/t iron storage
Anemia caused by an autosomal recessive gene disorder of inadequate production of normal hemoglobin which is microcytic/hypochromatic:

a) Cobalamin anemia
b) Pancytopenia
c) Thalassemia
d) Sickle cell anemia
c) Thalassemia

involves problem w/globulin protein thus abnormal Hgb synthesis

**microcytic/hypochromatic
Type of anemia commonly found in members of ethnic groups with origins near the mediterranean sea & equatorial regions of Asia & Africa:

a) Cobalamin anemia
b) Pancytopenia
c) Thalassemia
d) Sickle cell anemia
c) Thalassemia

**microcytic/hypochromatic
Thalassemia minor is a mild form of Thalassemia,an autosomal recessive disorder causing inadequate production of normal hemoglobin:

a) heterozygous
b) homozygous
a) heterozygous

**microcytic/hypochromatic
Thalassemia major is a life threatening disease (an autosomal recessive disorder causing inadequate production of normal hemoglobin):

a) heterozygous
b) homozygous
b) homozygous

**microcytic/hypochromatic
A form of Thalessemia that adjusts to the gradually acquired chronic state of anemia & may develope splenomegaly & mild jaundice:

a) Thalassemia minor
b) Thalassemia major
a) Thalassemia minor

**microcytic/hypochromatic
A form of Thalessemia that is life threatening & of which symptoms develop in childhood. It causes retardation, pronounced splenomegaly,hepatomegaly & jaundice:

a) Thalassemia minor (heterozygous)
b) Thalassemia major (homozygous)
b) Thalassemia major (homozygous)
Tx for Thalassemia minor:

a) generally not required
b) blood transfusion
c) chelation therapy
a) generally not required
Tx for Thalassemia major is all of the following except:

a) generally not required
b) blood transfusion
c) chelation therapy
a) generally not required
There are no specific drug or diet therapies that effectively treat Thalassemia.

True or False?
True
Thalassemia major can be fatal without TX.

True or False?
True
is most often fatal even with TX
Anemia caused by impaired DNA synthesis & characterixed by large RBC's:

a) Aplastic anemia's
b) SIckle Cell
c) Megaloblastic Anemia's
d) Thalassemia
c) Megaloblastic Anemia's

Mega = large

Megaloblastic =
Cobalamin & Folic Acid deficiencies


easily destroyed due to fragile membranes
Usual causes of Megaloblastic (macrocytic) anemia's are all of the following except:

a) Foic acid deficiency
b) Vit B12 deficiency
c) impaired DNA synthesis
d) iron deficiency
d) iron deficiency
Cobalamin (B12) deficiency is a megaloblastic anemia.

true or false
true
The most common CAUSE for cobalamin deficiency is:

a) megaloblastic anemia
b) macroctic anemia
c) folic acid deficiency
d) pernicious anemia
d) pernicious anemia

**pernicious anemia is caused by gastric mucosa not secreting intrinsic factor

**Cobalamin is normally absorbed by the distal ileum & deficiency usually caused by GI surgery such as gastrectomy, resection of small bowel, diverticuli, Crohns, etc.
With pernicious anemia, the most common cause for cobalamin (B12) deficiency, the parietal cells of the stomach:

a) secrete intrinsic factor
b) do not secrete intrinsic factor
b) do not secrete intrinsic factor

intrinsic factor is needed for Vitamin B12 (cobalamin) absorption.
Cobalamin deficiency (megaloblastic/pernicious anemia) occurs most frequently in:

a) Easterm Europeans & Scandinavians

b) Northern Europeans & Asians

c) Northern Europeans, especially Scandinavians, and African-Americans
c) Northern Europeans, especially Scandinavians, and African-Americans
Cobalamin deficiency (megaloblastic/pernicious anemia) occurs early in life & more severely in:

a) Northern Europeans
b) Scandinavians
c) African-Americans
c) African-Americans
Manifestations of Cobalamin deficiency are due to tissue hypoxia & include all of the following except:

a) weakness
b) paresthesia
c) ataxia
d) vibratory & position senses
e) impaired thought processes
f) sore tongue
g) obesity
h) Nausea, vomiting abdominal pain
g) obesity

anorexia is a symptom, not obesity
TX for cobalamin deficiency is all of the following except:

a) B12 IV, SubQ, Intranasal
b) diet rich in B12
c) cyanocobalamin 30-100mcg IM daily for 1 week followed by 100-200 mcg IM each month for life
b) diet rich in B12
Longstanding neuromuscular effects associated with cobalamin deficiency will not be reversed by B12 therapy.

true or false?
true
Without TX, cobalamin defeciency will result in death in 1-3 years.

true or false?
true
The difference between cobalamin deficiency & folic acid deficiency is there are no neurological involvment associated with folic acid deficiency.

true or false?
true
Symptoms of folic acid deficiency are all of the following except:

a) Dyspepsia
b) Smooth, beefy red tongue
c) Same as other symptoms of cobalamin deficiency
d) neurological disorders
d) neurological disorders
Good dietary sources of B12 (cobalamin) are all of the following except:

a) meats, especially pork & liver
b) green leafy's & citus fruits
c) wheat germ & cornmeal
d) potatoes & bananas
b) green leafy's & citus fruits
TX for folic acid deficiency include all of the following except:

a) Supplementation of 1mg daily by mouth
b) supplimentation of 5mg by mouthdaily for malabsorption states
c) dietary supplimentation
d) 100mg daily or 200mg daily for malabsorption states
d) 100mg daily or 200mg daily for malabsorption states
Food sources high in Folic Acid are all of the following except:

a) Meat, liver, fish
b) legumes & whole grains
c) green leafy vegetables
d) eggs & milk
d) eggs & milk
A rare life-threatening anemia (normocytic/normochromic)
in which there is a decrease in all blood cell types & all bone marrow elements are suppressed or destroyed causing cell production to decrease, but cells are otherwise normal:

a) SIckle cell
b) Thalassemia
c) Pancytopenia
d) Hemolytic anemia
c) Pancytopenia

Aplastic anemia
(normocytic/normochromic)
There are 2 types of Aplastic anemia (pancytopenia [normocytic/normochromic]) which are identified as congenital & acquired. Fanconi syndrome is:

a) congenital
b) acquired
a) congenital
There are 2 types of Aplastic anemia (pancytopenia) which are identified as congenital & acquired. Chemical agents, toxins, drugs, idiopathis, pregnancy, radiation, viral & bacterial infections are:

a) congenital
b) acquired
b) acquired
Pancytopenia (Aplastic Anemia) is:

a) life threatening
b) not life threatening
a) life threatening
Symptoms of pancytopenia (aplastic anemia) are fatigue, dyspnea, febrile, increased susceptibility to infection. Thrombocytopenia with increased bleeding tendencies, bruising, petechaie. TX includes all of the following except:

a)identifying & removing causative agents
b)prevention of infection & hemorrhage
c) bone marrow transplants & immunosuppressive therapy improve outcomes
d) Adults < 45 years of age bone marrow transplant
e) Adults > 45 years of age immunosuppressive therapy
all are correct
Diagnostic studies for pancytopenia (aplastic anemia) will reveal all of the following except:

a) serum iron & total iron binding capcity are decreased
b) bone marrow is hyopercellular
c) increased yellow marrow "dry tap"
d) reticulocte count is low
a) serum iron & total iron binding capcity are decreased

serum iron & total iron biinding capcity are INCREASED
2 clinical concerns with acute blood loss anemia are hypovolemic shock & ____?
if acute loss is gradual the body attempts to maintain blood volume by increasing plasma volume & even though the circulating volume is preserved the number of RBC's are decreased thus 02 is significantly diminished
TX for acute blood loss is all of the following except:

a) Keep patient in bed!
b) keep patient warm
c) monitoring 02 saturation
d) monitor anxiety level
all are correct
A type of anemia that is an autosomal recessive genetic disorder of which an abnormal Hbg in the erythrocyte is characteristic & patient will be asymptomatic until an episode occurs. This disease is predominant in African-Americans & has different forms that are homozygous or heterozygous for hemoglobin S:

a) Cobalamin deficiency
b) Polycythermia vera
c) Sickle Cell Disease
d) Hemochromotosis
c) Sickle Cell Disease

**hemolytic anemia
Sickle Cell disease that is homozygous for hemoglobin S (Hbss) is inheirited by:

a) 1 parent
b) 1 parent with HbS & 1 parent with abnormal hemoglobin such as thalessemia or hemoglobin C
c) 1 parent with HbS & 1 parent with normal hemoglobin (hemoglobin A)
d) inheirited hemoglobin S from both parents (hbSS) (Anemia)
d) inheirited hemoglobin S from both parents

HbSS=
both parents pass on hbS
Sickle Cell-Thalessemia & sickle cell Hbc is inheirited by:

a) 1 parent
b) 1 parent with HbS & 1 parent with abnormal hemoglobin such as thalessemia or hemoglobin C
c) 1 parent with HbS & 1 parent with normal hemoglobin (hemoglobin A)
d) inheirited hemoglobin S from both parents (hbSS) (Anemia)
b) 1 parent with HbS & 1 parent with abnormal hemoglobin such as thalessemia or hemoglobin C

less common & less severe than Sickle Cell anemia
Sickle Cell HbSS, Sickle Cell HbC, Sickle Cell Thalessemia, & Sickle Cell Trait are more or less severe than Sickle Cell Anemia.

a) less severe
b) more severe
a) less severe

less common & less severe than Sickle Cell anemia
Sickle Cell Trait occurs when a person is heterozygous for hemoglobin S & this form of Sickle Cell disease is inheirited by:

a) 1 parent
b) 1 parent with HbS & 1 parent with abnormal hemoglobin such as thalessemia or hemoglobin C
c) 1 parent with HbS & 1 parent with normal hemoglobin (hemoglobin A)
d) inheirited hemoglobin S from both parents (hbSS) (Anemia)
c) 1 parent with HbS & 1 parent with normal hemoglobin (hemoglobin A)

very mild
asymptomatic
A disease that is painful with an acute exacerbation of symptoms causing a vasocclusive crisis of which hypoxia & tissue death occur & of which onset can be sudden & occur anywhere in body. It causes SEVERE pain & persists for days or weeks:

a) Thalessemia
b) Pernicious Anemia
c) Hypochromatosis
d) Sickle Cell Anemia
d) Sickle Cell Anemia

**hemolytic anemia
A severe condition with symptoms of Hand & foot pain, Autosplenectomy, chronic leg ulcers (esp. ankles), Priapism (prolonged penile erection), Bone changes, Jaundice, Thrombosis, Hepatomegaly.

a) Thalessemia
b) Pernicious Anemia
c) Hypochromatosis
d) Sickle Cell Anemia
d) Sickle Cell Anemia

**hemolytic
One of the most common chronic hematologic disorders:

a) Thalassemia
b) Cobalamin deficiency
c) Iron deficiency
d) Folic acid deficiency
c) Iron deficiency

**30% of world population
Thalassemia, Iron deficiency anemia & lead poisoning have:

a) RBC's with a normal shape
b) RBC's with an abnormal shape
b) RBC's with an abnormal shape

**microcytic/hypochromic
Cobolamin deficiency, Folic acid deficiency, Liver disease, & post splenectomy have:

a) RBC's with a normal color
b) RBC's with abnormal color
a) RBC's with a normal color
The most susceptible group of people for Iron deficiency are all of the following except:

a) rich women who undergo alot of cosmetic surgery
b) healthy women of child bearing age
c) people of poor nutritional status
d) very young
d) rich women who undergo alot of cosmetic surgery

Just being creative.
Identify the incorrect statement about taking iron:

a) can be given IM or IV
b) take with vit C or citrus juice
c) take with food
d) should be diluted & taken thru a straw
c) take with food

not absorbed well when taken with food
A life threatening disease of which symptoms develop in childhood, retard physical & mental growth, & for which no specific drug or diet treats effectively.

a) Sickle Cell (HbSS)
b) Polycythemia
c) Thalassemia Major
d) Congenital Aplasitc Anemia
c) Thalassemia Major

**microcytic/hypochromic
A megaloblastic anemia caused by impaired DNA synthesis that occurs in Northern Europeans, especially Scandanavians, but occurs early in life & more severely in African Americans.

a) Thalassemia
b) Cobalamin deficiency
c) Sickle Cell Anemia
d) Folic Acid Deficiency
e) Pernicious Anemia
e) Pernicious Anemia

**Term "pernicious anemia" should only be used when intrinsic factor is not secreted by the gastric mucosa (mucosal atrophy or autoimmune destruction of parietal cells decreasing hydrochloric acid in stomach)

**Cobalamin deficiency occurs with gastrectomy, small bowel resection involving the ilium & patients w/Crohns disease, ileitis, diverticuli of sm. intestine, &/or chronic atrophic gastritis & long term use of H2 histamine receptor blockers

**Pernicious anemia has an insidious onset of middle age or later (usually after 40yrs & 60yrs being the most common age at diagnosis. can occur w/ Gastrectomy, small bowel resection & Crohns disease due to loss of IF (intrinsic factor) secreting cells or impaired absorption of cobalamin from the ilium
The most common deficiency due to parietal cells of the stomach not secreting intrinsic factor:

a) Thalassemia
b) Cobalamin deficiency
c) Pernicious anemia
d) Folic Acid Deficiency
c) Pernicious anemia

IF (intrinsic factor is needed for B12 absorption.
When lab results show a normal folate level & a low cobalamin level a B12 deficiency is indicated. A radioactive cobalamine test used to measure cobalamin in the urine of which indicates cobalamin cannot be absorbed when cobalamine excretion is low is a:

a) Gibbons test
b) Schilling test
c) Hartgrave test
d) Peterson test
b) Schilling test
The usual causes for megaloblastic anemia's are all of the following except:

a) iron deficiency
b) vit B12 deficiency
c) folic acid deficiency
a) iron deficiency

**The MOST COMMON cause of cobalamin deficiency is PERNICIOUS ANEMIA from which intrinsic factor is not secreted by the GASTRIC MUCOSA

**Cobalamin deficiency (B12) is absorbed by the DISTAL ILEUM. Deficiency usually occurs as a result of GI surgeries, sm. bowel resection, Crohns, diverticulitis, gastritis, H2-histamine blockers, nutritional deficiency, & herif=ditary enzymatic defects of cobalamin utilization

**Folic acid deficiency is also a megaloblastic anemia
A nurse is caring for a patient with chronic gastritis & anticipates this client is at risk for which vitamin deficiency:

a) A
b) B12
c) C
d) E
b) B12
Deterioration & atrophy of the lining od stomach lead to loss of fucntion of parietal cells. When acid secrition decreases the source of intrinsic factor is lost which leads to loss of B12 which in effect leads to the development of pernicious anemia.
A condition from which neuromuscular symptoms such as weakness, parasthesias of hands & feet, vibratory & position senses & confusion develop. The onset is insidious & death can occur in 1-3 years without TX.

a) Folic Acid deficiency
b) Pancytopenia
c) Thalassemia
d) Cobalamin deficiency
d) Cobalamin deficiency
Type of anemia in which erythrocytes do not posses sufficient hemoglobin

a) hyperchromic macrocytic
b) hypochromic microcytic
c) normochromic macrocytic
d) normochromic microcytic
-MOST COMMON

**(tiny cells so they can't hold enough hemoglobin)

**Hypochromic microcytic anemia
Most common form of anemia is...

a) microcytic
b) macrocytic
c) hypochromic microcytic
d) hypochromic macrocytic
iron deficiency anemia

hypochromic microcytic anemia
In general, normocytic normochromic anemias typically indicate:

a) acute conditions
b) sickle cell anemia
c) chronic disease or bleeding
c) chronic disease or bleeding
Most common cause of microcytic anemia is...

a) B12 deficiency
b) Folic Acid deficiency
c) Intrinsic Factor
d) genetics
e) iron deficiency
e) iron deficiency
Iron deficiency can be ruled out if it doesn't meet the following criteria:

a)low serum iron
b)low ferritin
c)high iron binding capacity
All of these are the criteria for iron deficiency

-low serum iron
-low ferritin
-high iron binding capacity
If iron deificiency is ruled out, consider which of the 2 following:

a) Pancytopenia
b) Thalassemia
c) Polycythemia
d) Sickle Cell
-thalassemia
-hemoglobinopathy (eg sickle cell)
Causes of Iron deficiency anemia in adults is rarely due to:

a) menstruation
b) pregnancy
c) trauma
d) inadequate intake
d) inadequate intake

VERY RARELY DUE TO INADEQUATE INTAKE
Type of anemias resulting from deficiceny in vitamin B12 and follc acid:
Megaloblastic anemia
The female patient has a low Hb level which is attributed to a nutritional deficiency. The nurse should recommend an increase of which foods in her diet:

a) beef
b) liver
c) prunes
d) broccoli
b) liver

iron is contained in all the others but are not as rich in in aron as liver
A pt with a hemoglobin level of 7.8 g/dl has cardiac palpations, a heart rate of 102, and an increased reticulocyte count. At this severeity of anemia, the nurse would also expect the patient to manifest:
a. pallor
b. dyspnea
c. a smooth tongue
d. sensitivity to cold
b. The pt's Hb level indicates a moderate anemia, and at this severity, additional findings ususally include dyspnea and fatigue. Pallor, smooth tongue, and sensitivity to cold usually manifest in severe anemia when the Hb level is below 6 gm/dl.
A 76-yr-old woman has an Hb of 7.3 g/dl and is experiencing ataxia (inability to coordinate movement) & confusion. During assessment of the pt, it is most important for the nurse to ask about:

a. food and drug intake
b. a family hx of anemia
c. any exposure to chemical toxins
d. the presence of postmenopausal bleeding
a. Nutritional deficiencies account for the majority of anemia seen in older adults, and the drugs that many older adults use for chronic illness may contribute to anemia. Anemias that are familial usually manifest before older adulthood, and exposure to chemical toxins as a source of anemia is not as common as nutritional deficiencies. Although postmenopausal bleeding can contribute to anemia in a susceptible older woman, it is rarely significant.
On physical assessment of the pt with severe anemia, the nurse would expect to find:
a. nervousness and agitation
b. fever and tenting of the skin
c. systolic murmurs and tachycardia
d. bluish mucous membranes and reddened skin
c. Tachycardia occurs in severe anemia as the body compensates for hypoxemia and the low viscosity of the blood contributes to the development of systolic murmurs and bruits. Depression of the CNS is common with fatigue, lethargy, and malaise. Poor skin turgor may be present, but fever is not associated with anemia. The skin and mucous membranes are pale, with a bluish tinge to the sclera.
A nursing diagnosis that is appropriate for pts with moderate to severe anemia of any etiology is:
a. impaired skin integrity r/t edema and pruritis
b. disurbed body image r/t changes in appearance and body function
c. imbalanced nutrition: less than body requirements r/t lack of knowledge of adequate nutrition
d. activity intolerance r/t decreased Hgb and imbalance between oxygen supply and demand
d. Pts with any type of anemia have decreased hemoglobin and symptoms of hypoxemia, leading to activity intolerance. Impaired skin integrity and body image disturbance may be appropriate for pts with jaundice from hemolytic anemias, and altered nutrition is indicated when iron, folic acid, or vitamin B intake is deficient.
Etiologic and morphologic classification for...

Acute trauma

ETIOLOGIC:
1. decreased RBC production
2. blood loss
3. increased RBC destruction

MORPHOLOGIC:
4. normocytic, normochromic
5. macrocytic, normochromic
6. microcytic, hypochromic
2. blood loss

4. normocytic, normochromic
To prevent a common side effect of oral iron supplements, the nurse teaches the pt to:
a. take the iron preparations with meals
b. increase fluid and dietary fiber intake
c. report the presence of black stools to the physician
d. use enteric-coated preparations taken with orange juic
b. Constipation is a common side effect of oral iron supplementation, increased fluids & fiber should be consumed to prevent this effect. Because iron can be bound in the GI tract by food, it should be taken before meals unless gastric side effects of the supplements necessitate its ingestion with food. Black stools are an expected result of oral iron preparations. Taking iron with ascorbic acid or orange juice enhances absorption of the iron, but enteric-coated iron often is ineffective because of unpredictable release of the iron in areas of the GI tract where it can be absorbed.
To administer iron IM, the nurse should:
a. use a short, fine needle to avoid pain
b. massage the site after the injection to promote absorption
c. include 0.5 ml of air in the syringe to clear the iron from the needle
d. administer the injection in the vastus lateralis to prevent nerve damage
c. Parenteral iron is very irritating and can stain the skin, so needles are changed between withdrawing and administering the medication; 0.5 ml of air is left in the syringe to completely clear the solution from the syringe during administration; it is administered Z-track in the large upper outer quad of the buttocks; and the site is not massaged after administration.
The nurse evaluates that teaching for the pt with iron deficiency anemia has been effective when the pt states:
a. "I will need to take the iron supplements the rest of my life"
b. "I will increase my dietary intake of milk and milk products"
c. "I should increase my activity to increase my aerobic capacity"
d. "I should take the iron for several months after my blood is normal"
d. To replace the body's iron stores, iron supplements should be continued for 2 to 3 months after the hemoglobin (Hb) level returns to normal, but if the cause of the iron deficiency is corrected, the supplements do not need to be taken for a lifetime. Milk and milk products are poor sources of dietary iron. Activity should be gradually increased as Hb levels return to normal since aerobic capacity can only be increased when adequate Hb is available.
In teaching the pt with pernicious anemia about the disease, the nurse explains that it results from a lack of:
a. folic acid
b. intrinsic factor from gastric mucosa
c. intrinsic factor from distal ilem
d. cobalamine intake
b. intrinsic factor from gastric mucosa

**Pernicious anemia is a type of cobalamin (vit B12) deficiency that results when parietal cells in the stomach fail to secrete enough intrinsic factor to absorb ingested cobalamin. Extrinsic factor IS cobalamin and may be a factor in some cobalamin deficiencies but not in pernicious anemia.
In addition to the general symptoms of anemia, the pt with pernicious anemia also manifests:
a. neurologic symptoms
b. coagulation deficiencies
c. cardiovascular disturbances
d. a decreased immunologic response
a. Neurologic manifestations of weakness, paresthesias of the feet and hands, and impaired thought processes are characteristic of pernicious anemia. Cardiovascular effects are most common with acute blood loss, and aplastic anemias include a leukopenia that leads to decreased immunologic response.
The nurse explains to the pt with pernicious anemia that:
a. death can be prevented by cobalamin supplementation for the rest of the pt's life
b. the syptoms of the disease can be completely reversed with cobalamin (vit B12) therapy
c. bone marrow transplantation to change the defective marrow cells is an alternative therapy for pernicious anemia
d. dietary intake of foods high in cobalamin is the most inexpensive and convenient treatment of pernicious anemia
a. Without cobalamin replacement, individuals with pernicious anemia will die in 1 to 3 years, but the disease can be controlled with cobalamin supplements for life. Hematologic manifestations can be completely reveresed with therapy, but long-standing neuromuscular complications may not be reversed. Since pernicious anemia results from an inability to absorb cobalamin, dietary intake of the vitamin is not a treatment option, nor is a bone marrow transplant.
Lab and diagnostic findings the nurse would expect in an anemic pt with chronic alcoholism include:
a. achlorhydria and macrocytic erythrocytes
b. decreased serum folate and increased MCHC
c. increased indirect bilirubin and increased reticulocytes
d. decreased total iron binding capacity and increased MCH
b. A common cause of folic acid deficiency is chronic alcohol abuse. Lab results in folic acid deficiency include decreased serum folate levels and increased mean corpuscular hemoglobin concentration (MCHC) due to the large cell size. Achlorhydria and macrocytic RBCs are characteristic of pernicious anemia, and increased indirect bilirubin and increased reticulocytes are characteristic of thalassemia and sickle cell anemia.
The strict vegetarian is at highest risk for the development of:
a. thalassemias
b. iron deficiency anemia
c. folic acid deficiency anemia
d. cobalamin deficiency anemia
d. Because red meats are the primary dietary source of cobalamin, a strict vegetarian is most at risk for cobalamin-deficiency anemia. Meats are also an important source of iron and folic acid, but whole grains, legumes, and green leafy vegetables also supply these nutrients. Thalassemia is not related to dietary deficiencies.
A nursing diagnosis that is appropriate for the effects of the deficiency of all of the cells associated with aplastic anemia is:
a. risk for injury: falls
b. impaired physical mobility
c. risk for impaired skin integrity
d. risk for impaired oral mucous membrane
d. The anemia of aplastic anemia may cause an inflamed, painful tongue; the thrombocytopenia may contribute to blood-filled bullae in the mouth and gingival bleeding; and the leukopenia may lead to stomatitis and oral ulcers and infections.
Nursing interventions for the pt with aplastic anemia are directed toward the prevention of the complications of:
a. fatigue and dyspnea
b. hemorrhage and infection
c. thromboemboli and gangrene
d. cardiac arrhythmias and heart failure
b. Hemorrhage from thrombocytopenia and infection from neutropenia are the greatest risks for the pt with aplastic anemia. The pt will experience fatigue from anemia, but bleeding and infection are the major causes of death in aplastic anemia.
The most reliable way to evaluate the effect and degree of blood loss in a pt with hemorrhage is with LABORATORY DATA.
The most reliable way to evaluate the effect and degree of blood loss in a pt with hemorrhage is with CLINICAL SYMPTOMS.
A pt with acute blood loss that has normal VS at rest but has increased HR and postural hypotension with exercise has lost approximately 30% of the total blood volume.

true or false?
True
The anemia that follows acute blood loss is most frequently treated with INCREASED DIETARY IRON INTAKE.

true or false?
False

The anemia that follows acute blood loss is most frequently treated with BLOOD TRANSFUSIONS OR IRON SUPPLEMENTS
In addition to the general symptoms of anemia, the pt with a hemolytic anemia also manifests JAUNDICE.

True or False?
True
A major concern in hemolytic anemias is maintenance of LIVER function.

True or False?
False

A major concern in hemolytic anemias is maintenance of KIDNEY function.
The anemia of sickle cell disease is caused by:
a. intravascular hemolysis of sickled RBCs
b. accelerated breakdown of abnormal RBCs
c. autoimmune antibody destruction of RBCs
d. isoimmune antibody-antigen reactions with RBCs
b. Because red cells are abnormal in sickle cell anemia, the mean RBC survival time is 10-15 days (rather than the normal 120 days) because of accelerated RBC breakdown by the liver and spleen. Antibody reactions with RBCs may be seen in other types of hemolytic anemias but are not present in sickle cell anemia.
A pt with sickle cell anemia asks the nurse why the sickling crisis does not stop when oxygen therapy is started. The nurse explains that:
a. sickling occurs in response to decreased blood viscosity, which is not affected by oxygen therapy
b. when red cells sickle, they occlude small vessels, which causes more local hypoxia and more sickling
c. the primary problem during a sickle cell crisis is destruction of the abnormal cells resulting in fewer RBCs to carry oxygen
d. oxygen therapy does not alter the shape of the abnormal ertythrocytes but only allows for increased oxygen concentration in hemoglobin
b. During a sickle cell crisis, the sickling cells clog small capillaries, and the resulting hemostasis promotes a self-perpetuating cycle of local hypoxia, deoxygenation of more erythrocytes, and more sickling. Administration of oxygen may help control further sickling, but additional oxygen does not reach areas of local hypoxia caused by occluded vessels.
A nursing intervention that is indicated for the pt during a sickle cell crisis is:
a. frequent ambulation
b. applicaiton of antiembolism hose
c. restriction of sodium and oral fluids
d. administration of large doses of continuous narcotic analgesics
d. Because pain usually accompanies a sickle cell crisis and may last for 4-6 days, pain control is an important part of tx. Rest is indicated to reduce metabolic needs, and fluids and electrolytes are administered to reduce blood viscosity and maintain renal function. Although thrombosis does occur in capillaries, elastic stockings that primarily affect venous circulation are not indicated.
During discharge teaching with a pt with newly diagnosed sickle cell disease, the nurse teaches the pt to decrease the risk of a sickle cell crisis by:
a. limiting fluid intake
b. avoiding hot, humid weather
c. eliminating exercise from the lifestyle
d. seeking early medical intervention for URI
d. The pt with sickle cell disease is particularly prone to infection, and infection can precipitate a sickle cell crisis. Pts should seek medical attention quickly to counteract URIs because pneumonia is the most common infection of the pt with sickle cell disease. Fluids should be increased to decrease blood viscosity, which may precipitate a crisis, and moderate activity is permitted.
Genetic counseling and family planning is indicated for couples when one of them has THALASSEMIA.

True or False?
True
Immune thrombocytopenic purpura is characterized by increased platelet destruction by the SPLEEN.
True
True or False?

Treatment of HEMACHROMATOSIS involves weekly phlebotomy for 2 to 3 years.

True or False?
True
In planning the care of a pt hospitalized with polycythemia vera, the nurse recognizes that a nursing intervention that is most likely to prevent organ damage or death is:
a. maintaing protective isolation
b. promoting leg exercises and ambulation
c. protecting the pt from injury or falls
d. promoting hydration with a large fluid intake
b. Thrombus and embolization are the major complications of polycythemia vera because of increased hypervolemia and hyperviscosity. Active or passive leg exercises and ambulation should be implemented to prevent thrombus formation. Hydration therapy is important to decrease blood viscosity, but because the pt already has hypervolemia, a careful balance of intake and output must be maintained and fluids are not injudiciously increased.
Manifestations of cobalamin deficiency are with an insidious onset & neuromuscular symptoms. Because diet is not effective to replace B12 it must be administered IM, SQ or intranasallt. Typical TX is:

a) cyanocobalamin 30-10 mcg IM daily for 4 weeks & then 100-200 mcg IM ea. mo. forever.
b) cyanocobalamin 30-100 mcg IM daily for 3 weeks & then 100-200 mcg IM ea. mo. forever.
c) cyanocobalamin 30-100 mcg IM daily for 2 weeks & then 100-200 mcg IM ea. mo. forever.
d) cyanocobalamin 30-100 mcg IM daily for 1 week & then 100-200 mcg IM ea. mo. forever.
d) cyanocobalamin 30-100 mcg IM daily for 1 week & then 100-200 mcg IM ea. mo. forever.
The difference in S&S for Cobalamin & Folic Acid deficiencies is?
Cobalamin presents with:

general anemia symptoms with neuromuscular symptoms

Folic Acid deficiency presents with:

Dyspepsia (upset stomach)
Smooth, beefy red tongue
NO neurologic symptoms
B12 must be administered by injection when the cause of deficiency is from an illness or disease involving intrinsic factor.

True or False?
True
A severe form of a very rare life threatening anemia in which there is a decrease in all blood cell types but of which are otherwise normal & usually detected before the age of 30:

a) Sickle Cell anemia
b) Thalessemia
c) Aplastic Anemia
d) Fanconi Syndrome
d) Fanconi Syndrome

Fanconi syndrome is a severe form of Aplastic Anemia (Pancytopenia).

Aplastic (pancytopenia).
A form of anemia in which all bone marrow elements are suppressed or destroyed which decreases cell production but of which cells are otherwise normal.

a) Sickle Cell Anemia
b) Thalessemia
c) Pancytopenia
d) Polycythemia
c) Pancytopenia

Aplastic Anemia
A client is to have a sickle cell turbidity test to screen for sickle cell anemia. The nurse explains that this test screens for:

a) HbA
b) HbS
c) AIC
d) HBV
b) HbS
A pediatric nursing instructor asks the student to describe the cause of clinical manifestations that occur with sickle cell disease. Which of the following is the correct response:

a) sickled cells increase the blood flow thru the body causing a great deal of pain
b) sickled cells mix with unsickled cells which depress the immune sysytem
c) bone marrow depression occurs because of the development of sickled cells
d) sickled cells are unable to flow easily thru the microvasculature & their clumping obstructs blood flow
d) sickled cells are unable to flow easily thru the microvasculature & their clumping obstructs blood flow

with reoxygenation mmost of the sickled red blood cells resume their normal shape
A nurse is reviewing orders for a child with sickle cell anemia admitted to the hospital for vasocclusive crisis. WHich of the following orders would the nurse expect to note written in the clients chart:

a) increase oral fluid intake
b) intravenous IV fluids of normal saline at 50 ml/h
c) administer 02 at 2L/min
d) elevate head of bed 60 degrees at all times
e) administer meperidine (Demerol) 25mg IM for pain
a) increase oral fluid intake
b) intravenous IV fluids of normal saline at 50 ml/h
c) administer 02 at 2L/min

vasocclusive crisis is caused by stasis of blood with clumping of cells in the microcirculation, ischemia, & infarction

S&S: fever, pain, tissue engorgement

Analgesics are prescribed but meperdine (demerol) is nopt recommended for child w/sickle cell because of the risk for normeeperdine seizures which is a metabolite of meperdine causing CNS stimulant

HOB is elevated no more than 30 degrees to prevent flexion of joints & strain on painful areas
A child suspected of sickle cell disease is seen & lab results are performed. The nurse knows the following would be incresed in this disease:

a) platelet count
b) Hct level
c) reticulocyte count
d) Hb level
c) reticulocyte count
A nurse instructs mother of child w/sickle cell disease regarding precipitating factors r/t pain crisis. Which of the following if identified by the mother as a precipitating factor indicates a need for further teaching:

a) infection
b) trauma
c) fluid overload
d) stress
c) fluid overload

mother should encourage fluid intake of 1.5 - 2 times the daily requirement to prevent dehydration
A nurse caring for a child with APLASTIC anemia reviews lab results & notes a WBC of 6000/ul & platelet count of 27,000/mm. Wich intervention will the nurse suggest to incorporate into the plan of care:

a) maintain strict isolation precautions
b) encourage naps
c) encourage diet high in iron
d) encourage quiet play activities
d) encourage quiet play activities

precautionary measures to prevent bleeding should be taken when child has a low platelet count

no injections
no rectal temps
use soft toothbrush
no contact sports or activities

strict isolation would be required if WBC was low

b& c are unrelated to risk of bleeding
A nursing student is presenting a clinical conference to discuss causative factors r/t b-thalessemia. The student explains the child at greatest risk for developing this disorder is:

a) child with poor intake of iron
b) child breastfed by mother w/chronic anemia
c) a child of meditereanean descent
d) child of mexican descent
c) a child of meditereanean descent
A client complains of fatigue & dyspnea & appears pale. The nurse questions the client about medications taken routinly. IN light of the symptoms, the nurse would be most concerned about:

a) multivitamin w/iron daily
b) methyldopa(Aldomet) 250mg 2x daily
c) aspirin 650mg 3x daily
d) levothyroxine (Synthroid) 150 mcg daily
b) methyldopa(Aldomet) 250mg 2x daily

associated w/ hemolytic anemia & should be discontinued
Whne caring for a client w/ impaired immune system, the nurse recognizes that the blood protein involved is:

a) albumin
b) globulin
c) thrombin
d) hemoglobin
b) globulin
Nutritional anemia, a problem encountered in children & adults, involves several different nutrients. The nutrients include proteins, iron, vit B12, &:

a) calcium
b) thiamine
c) folic acid
d) carbohydrates
c) folic acid

a necessary coenzyme of hemd, the iron containing protein in hemoglobin
Basic nutrients that are partners of iron in building RBC's:

a) calcium & vitamins
b) Vit D & ribovlavin
c) proteins & ascorbic acid
d) carbohydrates & thiamine
c) proteins & ascorbic acid
A pale, ;ethargic 1 year old who weighs 12.6kg (28lbs) has an enlarged heart & a Hb level of 8g/dl. The mother tells the nurse her infant spits out food fed w/a spoon, so she provides a quart of milk a day from a bottle. The nurse should encourage the mother to:

a) immediatly begin the weaning process
b) take infant to the metabolic clinic for a check up
c) give infant finger foods such as bread crusts & chopped meats
d) make a large hole in the nipple & add baby meats & vegetables to the milk
c) give infant finger foods such as bread crusts & chopped meats

making a large hole in the nipple & adding baby meats & vegetables to the milk would increase iron intake but is not approprate for a 1 year old
A child with sickle cell anemia has a sequestration crisis. The nurse is aware that this type of crisis is characterized by:

a) distal ischemia & pain
b) diminished RBC production
c) accelerated RBC destruction
d) decreased blood volume & signs of shock
d) decreased blood volume & signs of shock

there is pooling of blood in the liver & spleen w. decreased circulating blood volume & subsequent shock

painful episodes = vasocclusive crises

decreased RBC production & profound anemia that ensues is characteristic of = aplastic anemia

increased RBC destruction & cocomittant anemia, jaundice & reticulocytosi = hyperhemolytic crisis
The nurse caring for a child w/sickle cell anemia acts to prevent thrombus formation in the capillaries as well as other problems from stsis & clotting of blood in the sickling process by:

a) administer 02
b) administer prescribed anticoagulants
c) encourage child to maintain bed rest
d) increase fluids by mouth & use a humidifier
d) increase fluids by mouth & use a humidifier

hypertonicity of blood plasma increases the intracellular concentration of hemoglobin, dehydration promotes sickling

giving 02 will not prevent thrombus formation

antocoagulants do not help prevent thrombus formtion in sickle cell anemia

childs condition determines the activity level; although bed rest may be necessary in a pain episode, complete bed rest is rarely necessary
A 6 yr old is admitted w/severe anemia (Hb 6.4). The nurse's priority assessment would include observing for:

a) hemoglobinuria
b) a shift to the left
c) cardiac decompensation
d) presence of jaundice
c) cardiac decompensation

because the heart attempts to maintain tissue oxygenation by increasing its workload

Hb in urine suggests hemolytic anemia

jaundice can occur w/hemolytic anemia but is not the priority assessment
The outpatient nurse is caring for 7 yr old child w.sickle cell anemia who had a splenectomy at the age of 4. Priority nursing care would be:

a) assessing for jaundice
b) monitor serial Hct
c) frequent assessment of abdomen
d) keeping child away from infectious contacts
d) keeping child away from infectious contacts

the spleen plays a role in immunity
AN adolescent in sickle cell crisis (pain episode) is complaining of pain in knee. The best nursing intervention is:

a) decrease IV fluids
b) wrap knee in cold pack
c) apply warm soak to knee
d) give morphine 0.5 mg as ordered
c) apply warm soak to knee

warmth causes vasodilation which will lessen the pain of a vasoocclusive crises
Nursing care to help prevent both sickle cell crisis & celiac crisis is:

a) limit activity
b) protect from infection
c) high iron, low fat, high protwin diet
d) careful observation of all vitals
b) protect from infection
A 6 yr old w/sickle cell disease is admitted w/vasoocclusive crises of which the priority nursing concerns should be:

a) nutrition & hydration
b) nutrition & infection
c) pain management & infection
d) hydration & pain management
d) hydration & pain management
The nurse recognizes that an expected change in the hemologic system that occurs during the 2nd trimester is:

a) decreased WBC's
b) increased Hct
c) increased blood volume
d) decreased sedimentation rate
c) increased blood volume

increases by aprx. 50%
In a severly anemic patient the nurse would expect to find:

a) dyspnea & tachycardia
b) cyanosis & pulmonar edema
c) cardiomegaly & pulmonary fibrosis
d) ventricular arrhythmias & wheezing
a) dyspnea & tachycardia
When obtaining assessment data from a patient w/ a microcytic, normochromic anemia, the nurse would question the patient about:

a) folic acid intake
b) dietary intake of iron
c) history of gastric surgery
d) history of sickle cell anemia
b) dietary intake of iron
A nursing intervention for a patient with severe anemia of chronic kidney disease is:

a) monitoring stools for guiac
b) instructions in high iron diet
c) monitoring urine intake & output
d) teaching self injection of erythropoiten
d) teaching self injection of erythropoiten
The nursing management of a patient in sickle cell crisis is:

a) bed rest & heparin therapy
b) blood transfusions & iron replacement
c) agressive analgesic & 02 therapy
d) platelet administration & monitoring of CBC
c) agressive analgesic & 02 therapy
A complication of hyperviscosity of polycythemia:

a) thrombosis
b) cardiomyopathy
c) pulmonary edema
d) disseminated intravascular coagulation
a) thrombosis
When reviewing the patient's hematologic lab values after a splenectomy, the nurse would expect to find:

a) leukopenia
b) RBC abnormalities
c) decreased Hb
d) increased platelet count
d) increased platelet count
AN autosomal recessive disease characterized by increased intestinal iron absorption & as a result, increased tissue iron deposition.

a) Thalassemia
b) Pernicious Anemia
c) Polycuthemia
d) Hemochromatosis
d) Hemochromatosis
The most common genitic disorder among whites with an incidence of 1 in 100 to 500 whites of European ancestry.

a) Thalassemia
b) Pernicious Anemia
c) Polycuthemia
d) Hemochromatosis
d) Hemochromatosis
The normal range for total body iron is:

a) 1-2 g
b) 2-4 g
c) 2-6 g
d) 2-8 g
c) 2-6 g IRON
Individuals with hemochromatosid can expect:

a) the disorder can be resolved
b) the disorder cnnot be resolved
a) the disorder can be resolved

**by removing 500ml blood ea. week for 2-3 years until iron stores are depleted & then less frequent removal to maintain iron within normal limits
Persons with hemochromatosis can have total body iron levels of up to:

a) 2 times than that of a normal person
b) 5 times than that of a normal person
c) 10 times than that of a normal person
d) 100 times than that of a normal person
c) 10 times than that of a normal person
Symptoms of hemochromatosis usually develop:

a) in childhood
b) adolescence to 30 yrs
c) 30-50 yrs
d) 40-60 yrs
d) 40-60 yrs
Though hemochromatosis is due primarily to a genetic defect, it also occurs secondary to other diseases such as thalessemia, sideroblastosis, &:

a) B12 deficiency
b) overproduction of intrinsic factor
c) hemodialysis
d) multiple blood transfusions
d) multiple blood transfusions
Initial symptoms of hemochromatosis are:

a) liver enlargement & cirrhosis
b) nausea & vomiting
c) bronzing
d) diabetes mellitus
a) liver enlargement & cirrhosis

**Liver enlargement & cirrhosis are initial signs

**then other organs become involved resulting in diabetes mellitus & bronzing of skin

**eventually cardiac changes, arthritis & testicular atrophy

**physical assessments usually rveal enlarged liver & spleen as well as bronzing
Diagnosis of hemochromatosis is made:

a) on appearance
b) genetic testing
c) serum iron, TIBC, & serum ferritin
d) liver biopsy
d) liver biopsy
TX for hemochroatosis:

a) chelitin therapy
b) ferrous sulfate
c) iron removal
d) Dextran
c) iron removal

**removal of 500 ml each week for 2-3 years until iron stores are depleted & then less frequently to maintain iron levels within normal limits
The common cause of death for those with hemochromatosis is:

a) cirrhosis
b) liver failure
c) hepatic carcinoma
d) cardiac failure
all of these are common causes

** although teacher says the most common cause is liver failure
Polycuthemia is:

a) the production & presence of increased WBC's & so much that blood circulation is impaired as a result of blood viscosity (hyperviscosity) & volume (hypervolemia).
b) the production & presence of increased granulocytes & so much that blood circulation is impaired as a result of blood viscosity (hyperviscosity) & volume (hypervolemia).
c) the production & presence of increased RBC's & so much that blood circulation is impaired as a result of blood viscosity (hyperviscosity) & volume (hypervolemia).
d) a) the production & presence of increased erythropoiten & so much that blood circulation is impaired as a result of blood viscosity (hyperviscosity) & volume (hypervolemia).
c) the production & presence of increased RBC's & so much that blood circulation is impaired as a result of blood viscosity (hyperviscosity) & volume (hypervolemia).
There are 2 types of polycythemia identified as polycythemia vera (primary) & secondary polycythemia. Their etiology & pathogenesis differ but complications & symptoms are similar. Polycythemia Vera is a:

a) myeloproliferative disorder (bone marrow produces too much blood) arising from chromosomal mutation

b) a physiologic response in which the body tries to compensate for a problem rather than a pathologic response as a result of hypoxia which in turn stimulates erythropoiten production
a) myeloproliferative disorder arising from chromosomal mutation

**RBC's, granulocytes & platelets are involved leading to increased production of each

**usually develops in 50yrs +
With polycythemia vera the patient is usually 50 yrs or older & has:

a) enhanced blood viscosity
b) enhanced blood volume
c) congestion of organs & tissues w.blood
d) splenomegaly
all of these
Symptoms in patients with polycythemia vera (primary) experience circulatory manifestations because of:

a) HTN caused by hypovolemia & hyperviscosity
b) HTN caused by hypervolemia & hyperviscosity
c) hypotension caused by hypovolemia & hyperviscosity
d) hypotension caused by hypervolemia & hyperviscosity
b) HTN caused by hypervolemia & hyperviscosity
Individuals with polycythemia vera will usually complain of all the following except:

a) headache,vertigo, dizzyness
b) tinnitus & visual disturbances
c) nose bleeds
d) nausea & vomiting
e) pruritis, petechaie, ecchymosis
d) nausea & vomiting

**PRURITIS may be a striking symptom related to histamine release due to increased basophils & hemmhorage due to vessel rupture
Clinical manifestations of polycythemia vera (primary) are all of the following except:

a) angina & CHF
b) Hyperurecemia & gout
c) intermittant claudication
d) Hemochromatosis
e) thrombophlebitis
f) hepatomegaly & splenomegaly due to engorgement
d) Hemochromatosis
Polycythemia vera is:

a) preventable
b) not preventable
b) not preventable
The most common serious complication of polycythemia is:

a) pulmonary emboism
b) thrombocytopenia
c) stroke
d) hemochromatosis
c) stroke

**secondary to thrombosis
TX for polycythemia vera is:

a) phlebotomy removing 300-500 ml blood every other day until Hct is WNL
b) hydration to reduce blood viscosity
c) restrict fluids due to hypervolemia
d) chemotherapy drugs to suppress RBC production
e ) Allopurinol for gout
c) restrict fluids due to hypervolemia
Secondary [polycythemia is:

a) preventable
b) not preventable
a) preventable
Secondary polycythemia is caused by:

a) genetics
b) chronic hypoxia
b) chronic hypoxia

**hypoxia stimulates erythropoiten production in the kidney & erythropoiten stimulates production of RBC

**secondary polycythemia is a physiological resonse to chronic hypoxia & IS PREVENTABLE
The nurse should advice patients with secondary polycythemia to do all the following except:

a) control chronic pulmonary disease
b) quit smoking
c) avoid high altitudes
d) take iron suppliments
d) take iron suppliments
Splenomegaly is seen in 90% of patients with:

a) polycythemia vera (primary)
b) secondary polycythemia
a) polycythemia vera (primary)
Lab results for polycythemia vera (primary) are:

a) increased: Hb, RBC, bone marrow hypercellularity, histamine & decreased: WBC, platelet, leukocyte, uric acid, & cobalamin
b) a) increased: Hb, RBC, bone marrow hypercellularity, histamine, WBC, platelet, leukocyte, uric acid, & cobalamin
b) a) increased: Hb, RBC, bone marrow hypercellularity, histamine, WBC, platelet, leukocyte, uric acid, & cobalamin
Treatment for polycythemia vera (primary) is all of the following except:

a) Phlebotomy of 300-500 ml evry other day to reduce Hct to less than 45%
b) iron supplementation
c) hydration therapy to to reduce blood viscosity
d) Myelosuppressive agents such as busulfan-Myleran, hydroxyurea-Hydrea, melphalan-Alkeran & radipactive phosphorus
e) Allopurinol
f) antiplatelet: aspirin, dipridymole-Persantine
b) iron supplementation
and . . .
f) antiplatelet: aspirin, dipridymole-Persantine
(contoversial due to irritation of gastric mucosa causing GI problems, including bleeding
Nursing management & teaching for patients w/polycythemia vera (primary) is all of the following except:

a) assist with or perform phlebotomy (re:inst. policy)
b) evaluate fluid intake & output during hydration therapy to avoid fluid overload & underhydration
c) teach medication effects & assess nutritional status
d) activity to decrease thrombus formation such as active or passive leg exercises & ambulation
e) controlling chronic pulmonary disease, quit smoking & avoid high altitudes
f) assess for signs of bleeding
e) controlling chronic pulmonary disease, quit smoking & avoid high altitudes

**these measures are important for patients experiencing SECONDARY polycythemia
Clinical manifestations of mild anemia w/Hb 10-14:

a) asymptomatic or palpatations, exertional dyspnea
b) bone pain, sensitivity to cold, weight loss, lethargy
c) glossitis, smooth tongue
d) headache, vertigo, sore mouth
a) asymptomatic or palpatations, exertional dyspnea
Clinical manifestations of moderate anemia w/Hb 6-10:

a) asymptomatic or palpatations, exertional dyspnea
b) bone pain, sensitivity to cold, weight loss, lethargy
c) increased palpatations, dyspnea, fatigue
d) headache, vertigo, sore mouth
c) increased palpatations, dyspnea, fatigue
Clinical manifestations of severe anemia w/Hb <6:

a) asymptomatic or palpatations, exertional dyspnea
b) bone pain, sensitivity to cold, weight loss, lethargy
c) increased palpatations, dyspnea, fatigue
d) headache, vertigo, sore mouth
b) bone pain, sensitivity to cold, weight loss, lethargy
and . . .
d) headache, vertigo, sore mouth
Identify mild/moderate/severe anemia w/ Hb:

a) 13-17 / 9-13 / <9
b) 12-14 / 8-12 / <8
c) 10-14 / 6-10 / <6
d) 8-10 / 6-8 / <6
c) 10-14 / 6-10 / <6

REMEMBER ANEMIA . . .

10-14/6-10/<6
Iron deficiency anemia is the most common CHRONIC anemia found in:

a) 10% of the world population
b) 20% of the world population
c) 30% of the world population
d) 40% of the world population
c) 30% of the world population
The most suseptible to iron defeciency is:

a) the very young
b) those on poor diets
c) healthy women of child bearing age
all of these
The most common cause of anemia in the elderly population is:

a) poor diet
b) injury
c) chronic illness
d) nutrition
d) nutrition
The most common clinical manifestation of iron deficiency anemia is:

a) pallor
b) glossitis
c) fatigue
d) headache
a) pallor
The heme in hemoglobin accounts for 2/3 of the body's iron. The other 1/2 is:

a) stored as erythropoiten
b) ferrous sulfate
c) ferrous gluconate
d) ferriten & hemosiderin
d) ferriten & hemosiderin

Ferriten & hemosiderin is in the bone marrow, spleen, liver & macrophage

**ferrous sulfate is a form of supplemental iron intake
**ferrous gluconate is an acceptable substitute for ferrous sulfate
**erythropoiten is glycoprotein hormone synthezized mainly by the kidneys; acts to stimulate & regulate the production of erythrocytes which increases 02 carrying capacity of blood
Iron is absorbed best from the:

a) stomach
b) duodenum
c) ileum
d) proximal jejunum
b) duodenum
and . . .
d) proximal jejunum
The most generally available parenteral iron administered IM or IV is:
a) erythropoiten
b) iron-dextran
c) ferrous sulfate
d) ferrous gluconate
b) iron-dextran
Thalessemia is an autosomal recessive gene disorder of inadequate production of normal hemoglobin that causes decreased erythrocyte production. In contrast to iron-deficiency, thalessemia involves a problem with the globin protein thus abnormal Hb synthesis. Though no drug or diet therapies are effective in treating thalessemia, the symptoms of thalessemia major are managed with all of the following except:

a) blood transfusions
b) IV Desferal
c) iron dextran
d) methotrexate
c) iron dextran
d) methotrexate

** Thalassemia major is managed with blood transfusions in conjunction with Desferal/deferoaximine

**Desferal/deferoaximine is a chealating agent that binds to iron & used to reduce iron overload that may occur with chronic transfusion therapy

** iron dextran is IM or IV form of iron used in iron deficiency

**methotrexate impedes the absorption of folic acid
Cobalamin deficiency is generally found when intrinsic factor of the distal ileum (cobalamin deficiency) cannot be absorbed or with Pernicious anemia when intrinsic factor is not secreted by the gastic mucosa. However, cobalamin deficiency can also occur with long term use of:

a) oral contraceptives
b) Nasocobal
c) H2-histamine blockers
d) hydroxocobalamin
c) H2-histamine blockers

**oral contraceptives impede the absorption of FOLIC ACID

**Nasocobal is a intranasal form of cobalamin (B12) used in treating Cobalamin deficiency & Pernicious Anemia

** hydroxocobalamin or cyancobalamin are the treatment of choice for Cobalamin deficiency & Pernicious anemia
With cobalamin deficiency or Pernicious anemia dietary intake of B12 cannot be absorbed. Without B12 administation patients will die in 1-3 yrs. The treatment of choice is parenteral administration of:

a) deferoxamine/Desferal
b) Epogen
c) cyancobalamin / hydroxocobalamin
d) cyclosporin
c) cyancobalamin / hydroxocobalamin

IM administration: 1000mg daily for 2 weeks & then monthly for life

**Nascobal: Intrasal form now available
Methotrexate, oral contraceptives, antiseizure drugs such as phenobarbital, & Dilantin, impede the absorption of:

a) iron
b) B12
c) Folic Acid
c) Folic Acid
Folic acid therapy is:

a) cyancobalamin 1-5 mg qd PO
b) epogen 1-5 mg qd PO
c) Desferal 1-5 mg qd O
c) folic acid 1-5 qd PO
c) folic acid 1-5 qd PO

*cyancobalamin TX for B12 deficiency

*epogen TX for anemia of chronic disease (renal & cancer therapy anemias)

* desferal TX for Thalessemia
Drug therapy used for anemia related to renal disease or anemia related to cancer therapies:

a) erythropoiten
b) epogen
c) epocrit
all of these
Primary concerns & nursing actions for patients with Aplasic anemia are directed at?
preventing complications from infxn & hemmhorage
The prognosis of untreated Aplastic anemia is:

a) 25% fatal
b) 30% ftal
c) 50% fatal
d) 75% fatal
d) 75% fatal
Medical advances such as bone marrow transplatation & immunosuppresive therapy with antithymocyte globin (ATG) & cyclosporine improve the outcomes of this anemia significantly:

a) Thalessemia
b) Aplastic anemia
c) Sickle cell anemia
d) Hemochromatosis
e) Polycythemia
b) Aplastic anemia

**Thalessemia TX: blood transfusions w/ Desferal (chealating agent)

**Sickle Cell anemia TX: no specific TX: hydroxyurea (Droxia); erythropoiten

** Hemochromatosis TX: Phlebotomy of 500ml ea week for 2-3 yrs

**Polycythemia TX:
Myelosuppressive agents (busulfan-Myleran/hydroxyurea-Hydrea/melphalan-Alkeran/radioactive phosporus/Allopurinol for gout
The only antisickling agent shown to be clinically benificial in the TX of sickle cell disease:

a) Desferal
b) Epocrit
c) Droxia
d) cyclosporin
c) Droxia

**Desferol-Thalessemia
**Epocrit- Chronic disease anemia
**Cyclosporin- Aplastic anemia
IV fluids used in acute blood loss include all of the following except:

a) dextran
b) hetastarch
c) albumin
d) LR
e) cyclosporin
e) cyclosporin
With acute blood loss, once volume replacement is established, attention can be directed to correcting RBC loss. To manufacture more RBC's in response to increased erythropoiten, the body needs:

a) 12-24 hrs
b) 1-3 days
c) 2-5 days
d) 4-7 days
c) 2-5 days