NURS 6030 Exam 4 Practice Questions With Complete
Solutions
A 22 year old female presents with CC of fatigue and headache
for the past 6 months. She reports she has always had heavier
menstrual cycles and that has always been her "normal". She
recently began moving towards a vegetarian diet.
What are your differentials?
What is your treatment plan?
What patient education is important here?
Ddx: Anemia - microcytic, iron-deficiency s/t menorrhagia and
vegetarian diet
Treatment plan: Increase iron rich foods, consider oral iron
supplementation (slow release iron is better tolerated)
Education: increase iron rich foods (prune juice, olives,
mulberries, fortified breakfast cereals, white beans, soy beans,
spinach, lentils); enhance absorption of iron supplementation
with Vitamin C
A patient's labs return and the MCV is 68. How do you interpret
this value?
,An MCV of < 80 indicates microcytic anemia. Types of
microcytic anemia include iron deficiency, thalassemia, anemia
of chronic disease, sideroblastic anemia, or Hgb E disease
Chronic glossitis and cheilitis may be an indicator of what type
of anemia?
Microcytic anemia
You receive the lab results for a patient with suspected
microcytic anemia and the Hgb is 6 and the Hct is 28. The
patient is experiencing fatigue and weakness.
What is your treatment plan?
Urgent referral to the hospital for blood transfusion
A patient presents to your office with severe hypotension, cold
clammy skin, and bruising on the left flank. What is your first
action?
Immediate ED referral: concern for acute severe hemorrhage -
this is an emergent patient
A patient is currently taking an oral iron preparation 150mg 30
minutes before meals after being diagnosed with microcytic
iron-deficiency anemia. The patient calls into the clinic and
wants to discontinue the medication because it "isn't working".
Upon further history taking, it is revealed that the medication is
causing severe upset stomach and diarrhea. How would you
advise this patient?
, Slower releasing iron tablets tend to be easier tolerated.
Send in a new prescription for ferrous sulfate 325mg (iron
65mg) delayed release TID
Educate patient on possible side effects: nausea, constipation,
diarrhea, black stools, upper GI discomfort
Encourage patient to notify office with any additional questions
or concerns
A patient's lab results show a MCV of 123. What is your
interpretation?
Suggests overly large RBCs and is an indicator of macrocytic
anemia
A patient receives their lab results and wants to know the
interpretation of the MCV level, which is high. After you
explain macrocytic anemia to the patient, they ask you what may
be causing this type of anemia. How do you respond?
Macrocytic anemia may be caused by a lack of B12 or folate.
Sometimes this is secondary to alcoholism, a low protein diet,
pregnancy, lactation, or bariatric surgery (where part of the
stomach is removed -B12 absorbed in stomach).
Some medications, GI diseases leading to malabsorption,
Solutions
A 22 year old female presents with CC of fatigue and headache
for the past 6 months. She reports she has always had heavier
menstrual cycles and that has always been her "normal". She
recently began moving towards a vegetarian diet.
What are your differentials?
What is your treatment plan?
What patient education is important here?
Ddx: Anemia - microcytic, iron-deficiency s/t menorrhagia and
vegetarian diet
Treatment plan: Increase iron rich foods, consider oral iron
supplementation (slow release iron is better tolerated)
Education: increase iron rich foods (prune juice, olives,
mulberries, fortified breakfast cereals, white beans, soy beans,
spinach, lentils); enhance absorption of iron supplementation
with Vitamin C
A patient's labs return and the MCV is 68. How do you interpret
this value?
,An MCV of < 80 indicates microcytic anemia. Types of
microcytic anemia include iron deficiency, thalassemia, anemia
of chronic disease, sideroblastic anemia, or Hgb E disease
Chronic glossitis and cheilitis may be an indicator of what type
of anemia?
Microcytic anemia
You receive the lab results for a patient with suspected
microcytic anemia and the Hgb is 6 and the Hct is 28. The
patient is experiencing fatigue and weakness.
What is your treatment plan?
Urgent referral to the hospital for blood transfusion
A patient presents to your office with severe hypotension, cold
clammy skin, and bruising on the left flank. What is your first
action?
Immediate ED referral: concern for acute severe hemorrhage -
this is an emergent patient
A patient is currently taking an oral iron preparation 150mg 30
minutes before meals after being diagnosed with microcytic
iron-deficiency anemia. The patient calls into the clinic and
wants to discontinue the medication because it "isn't working".
Upon further history taking, it is revealed that the medication is
causing severe upset stomach and diarrhea. How would you
advise this patient?
, Slower releasing iron tablets tend to be easier tolerated.
Send in a new prescription for ferrous sulfate 325mg (iron
65mg) delayed release TID
Educate patient on possible side effects: nausea, constipation,
diarrhea, black stools, upper GI discomfort
Encourage patient to notify office with any additional questions
or concerns
A patient's lab results show a MCV of 123. What is your
interpretation?
Suggests overly large RBCs and is an indicator of macrocytic
anemia
A patient receives their lab results and wants to know the
interpretation of the MCV level, which is high. After you
explain macrocytic anemia to the patient, they ask you what may
be causing this type of anemia. How do you respond?
Macrocytic anemia may be caused by a lack of B12 or folate.
Sometimes this is secondary to alcoholism, a low protein diet,
pregnancy, lactation, or bariatric surgery (where part of the
stomach is removed -B12 absorbed in stomach).
Some medications, GI diseases leading to malabsorption,
