NURS 316 UPDATED EXAM SCRIPT QUESTIONS AND
SOLUTIONS GRADED A+
✔✔RBC disorders - ✔✔Acute Blood loss anemia
Chronic blood loss anemia
hemoytic anemia
Red blood cell maturation defects
Polycythemia
✔✔Acute blood loss anemia - ✔✔Trauma, hemorrhage, clotting disorder
Diagnosis: NCNC with reticulocytotic, FOBT determine GI blood loss
Tx: For blood loss, establish hemostasis and fluid volume
S/S: <15% orthostatic hypotension and anxiety, 15-30% SNS activity, increased HR, 30-
40% HR greater than 120bpm hypotension urine output decrease, >40% severe
hypotension, decreased consciousness, HR greater than 140 no urine output.
✔✔Chronic blood loss anemia - ✔✔Causes: GI bleed, Medications
S/S: because blood loss slow, pt may report no noticeable changes
Diagnosis: Iron depletion often occurs, Microcytic and hypochromic anemia, Low iron,
low ferritin, increased TBIC
Tx: Remedy reason for blood loss, Replace iron: oral ferrous sulfate
✔✔Different types of Hemolytic Anemias - ✔✔Hemoglobinopathy
Sickle cell anemia
Thalassemia
Hereditary spherocytosis
BLood transfusion reactions
hemolytic disease of the newborn
Anemia Due to lead poising
✔✔Sickle Cell Anemia - ✔✔Autosomal hemoglobinopathy
SCA increases resistance to malaria, thus genetic epression has remained high
Signs od SCA do not appear until fetal Hgb levels begin to decline
After age 10 complications increase
Causes RBCs to be fragile and misshapen
Hypoxia, dehydration, severe stress and infection increase risk of disorted cell shapes
Abormal RBCs have lifespan of 10-20 days
Vasco-occlusive crises
S/S: anemia signs, hyperbillrubinemia and enlarged spleen
Diagnosis: electrophoresis revealing HbS
Tx: Avoid triggers, Folic acid supplements, Blood transfusions, Bone marrow transplant
✔✔Thalassemia - ✔✔Autosomal hemoglobinopathy
Genetic defect leads to abnormal polypeptide chains of Hb
S/S: Typical anemia signs, Bone pain, Hyperbilirubinemia and jaundice, Splenomegaly
, Heinz bodies may be present: Pathognomonic for thalassemia
Children "Chimpmunk" cheeks
Diagnosis: Electrophoresis
Tx: transdusions, Splenectomy my be needed
✔✔Different types of red blood cell maturation defects - ✔✔Iron deficiency anemia
Vitamin B12 deficiency
Folic Acid deficiency
Lack of bone marrow production of RBCs
Lack of erythropoietin
Aplastic Anemia
Anemia chronic disease
✔✔Iron deficiency anemia - ✔✔Most common cause of anemia worldwide
Women of childbearing age, infants, and children, elderly, vegetarians, those with GI
bleeding
Most common cause: menorrhagia, GI bleed, Inadequate iron intake
S/S: Hair loss, glossitis, nail changes, pica\
Diagnosis: CBC, Peripheral blood smear, Serum iron and ferritin are decreased, Fecal
occult blood test
Tx: Oral ferrous sulfate
✔✔B12 Deficiency - ✔✔Cofactor in RBC DNA synthesis and myelin sheath
Deficiency may develop due to: lack of intrinsic factor, Intrinsic factor needed for B12
absorption
Needed for folic acid metabolism and RBC DNA
Neurological system: numbness and tingling, unsteady gait
Diagnosis: CBC, Peripheral blood smear reveals large cells, Folate levels
Tx: Address underlying etiology, Intermuscular B12 injections may be needed
✔✔Folic Acid Deficiency - ✔✔Pts at risk include pregnant and lactating women, alcohol
abusers, celiac disease
Deficeiency causes megaloblastic anemia
Pt may be asymptomatic
Important to note both folic acid levels and vitamin B12 levels with megaloblastic
anemia
Tx: oral replacement of folic acid
✔✔Lack of Bone Marrow RBC production - ✔✔Lack of erythropoietin
Aplastic anemia: Bone marrow fails, Caused by infection, radiation, chemicals,
Diagnosis: begin with CBC, Blood transfusions necessary, Tx: bone marrow transplant
Anemia of chronic disease: Decreased RBC survival time, blunted EPO response, Lack
of iron makes response to EPO less than desirable, Transfusions not recommended,
EPO administration
✔✔Primary Polycythemia - ✔✔Polycythemia vera
SOLUTIONS GRADED A+
✔✔RBC disorders - ✔✔Acute Blood loss anemia
Chronic blood loss anemia
hemoytic anemia
Red blood cell maturation defects
Polycythemia
✔✔Acute blood loss anemia - ✔✔Trauma, hemorrhage, clotting disorder
Diagnosis: NCNC with reticulocytotic, FOBT determine GI blood loss
Tx: For blood loss, establish hemostasis and fluid volume
S/S: <15% orthostatic hypotension and anxiety, 15-30% SNS activity, increased HR, 30-
40% HR greater than 120bpm hypotension urine output decrease, >40% severe
hypotension, decreased consciousness, HR greater than 140 no urine output.
✔✔Chronic blood loss anemia - ✔✔Causes: GI bleed, Medications
S/S: because blood loss slow, pt may report no noticeable changes
Diagnosis: Iron depletion often occurs, Microcytic and hypochromic anemia, Low iron,
low ferritin, increased TBIC
Tx: Remedy reason for blood loss, Replace iron: oral ferrous sulfate
✔✔Different types of Hemolytic Anemias - ✔✔Hemoglobinopathy
Sickle cell anemia
Thalassemia
Hereditary spherocytosis
BLood transfusion reactions
hemolytic disease of the newborn
Anemia Due to lead poising
✔✔Sickle Cell Anemia - ✔✔Autosomal hemoglobinopathy
SCA increases resistance to malaria, thus genetic epression has remained high
Signs od SCA do not appear until fetal Hgb levels begin to decline
After age 10 complications increase
Causes RBCs to be fragile and misshapen
Hypoxia, dehydration, severe stress and infection increase risk of disorted cell shapes
Abormal RBCs have lifespan of 10-20 days
Vasco-occlusive crises
S/S: anemia signs, hyperbillrubinemia and enlarged spleen
Diagnosis: electrophoresis revealing HbS
Tx: Avoid triggers, Folic acid supplements, Blood transfusions, Bone marrow transplant
✔✔Thalassemia - ✔✔Autosomal hemoglobinopathy
Genetic defect leads to abnormal polypeptide chains of Hb
S/S: Typical anemia signs, Bone pain, Hyperbilirubinemia and jaundice, Splenomegaly
, Heinz bodies may be present: Pathognomonic for thalassemia
Children "Chimpmunk" cheeks
Diagnosis: Electrophoresis
Tx: transdusions, Splenectomy my be needed
✔✔Different types of red blood cell maturation defects - ✔✔Iron deficiency anemia
Vitamin B12 deficiency
Folic Acid deficiency
Lack of bone marrow production of RBCs
Lack of erythropoietin
Aplastic Anemia
Anemia chronic disease
✔✔Iron deficiency anemia - ✔✔Most common cause of anemia worldwide
Women of childbearing age, infants, and children, elderly, vegetarians, those with GI
bleeding
Most common cause: menorrhagia, GI bleed, Inadequate iron intake
S/S: Hair loss, glossitis, nail changes, pica\
Diagnosis: CBC, Peripheral blood smear, Serum iron and ferritin are decreased, Fecal
occult blood test
Tx: Oral ferrous sulfate
✔✔B12 Deficiency - ✔✔Cofactor in RBC DNA synthesis and myelin sheath
Deficiency may develop due to: lack of intrinsic factor, Intrinsic factor needed for B12
absorption
Needed for folic acid metabolism and RBC DNA
Neurological system: numbness and tingling, unsteady gait
Diagnosis: CBC, Peripheral blood smear reveals large cells, Folate levels
Tx: Address underlying etiology, Intermuscular B12 injections may be needed
✔✔Folic Acid Deficiency - ✔✔Pts at risk include pregnant and lactating women, alcohol
abusers, celiac disease
Deficeiency causes megaloblastic anemia
Pt may be asymptomatic
Important to note both folic acid levels and vitamin B12 levels with megaloblastic
anemia
Tx: oral replacement of folic acid
✔✔Lack of Bone Marrow RBC production - ✔✔Lack of erythropoietin
Aplastic anemia: Bone marrow fails, Caused by infection, radiation, chemicals,
Diagnosis: begin with CBC, Blood transfusions necessary, Tx: bone marrow transplant
Anemia of chronic disease: Decreased RBC survival time, blunted EPO response, Lack
of iron makes response to EPO less than desirable, Transfusions not recommended,
EPO administration
✔✔Primary Polycythemia - ✔✔Polycythemia vera
