Albany State University | NURS 5410 Feedback Davis Edge Week 7

NURS 5410 Feedback Davis Edge Week 7 Questions 1 to 16 of 16  1  Feedback Davis Edge Week 7 Score: 13 / 16 Feedback Report Question 1. Lorie, age 29, appears with the following signs: pale conjunctivae and nailbeds, tachycardia, heart murmur, cheilosis, stomatitis, splenomegaly, koilonychia, and glossitis. What do you suspect? Rationales [Page Reference: 1070] Course Topic: Hematologic and Immune Problems | Area of Practice: Adult-Gerontology Primary Care, Family Practice | APN Knowledge Area: Health Assessment | Testing Domain: Assess | Cognitive Level: Analysis [Analyzing] Question 2. Jimmy, age 6 months, is newly diagnosed with sickle cell disease. His mother brings him to the clinic for a well-baby visit. Which of the following should you do on this visit? Rationales  1. Vitamin B deficiency 2. Folate deficiency  3. Iron-deficiency anemia 4. Chronic fatigue syndrome 12 Option 1: Signs of vitamin B deficiency include weakness of the extremities, ataxia, pallor, loss of vibratory and position sense, memory loss, changes in mood, and hallucinations. 12 Option 2: Signs of a folate deficiency include weakness, pallor, and glossitis, with congestive heart failure occurring if the anemia is severe. Option 3: Lorie has the classic signs of iron-deficiency anemia: pale conjunctivae and nailbeds, tachycardia, heart murmur, cheilosis (reddened lips with fissures at the angles), stomatitis, splenomegaly, koilonychia (thin and concave fingernails with raised edges), and glossitis. Signs may also include esophageal webs (Plummer-Vinson syndrome), melena, and menorrhagia. Option 4: A person with chronic fatigue syndrome might have a fever, a sore throat, myalgia, and generalized headaches.  1. Tell his mother that Jimmy will not be immunized because of his diagnosis. 2. Tell his mother that Jimmy should not go to day care.  3. Immunize Jimmy with the diphtheria, tetanus, and pertussis (DTaP); Haemophilus influenzae type b (Hib); hepatitis B virus (HBV); and poliomyelitis vaccines. 4. Immunize Jimmy with the measles, mumps, and rubella; Haemophilus influenzae type b (Hib); and hepatitis B virus (HBV) vaccines only. Option 1: Jimmy will be immunized; his diagnosis has no effect on vaccinations. Option 2: Children with sickle cell disease should be treated like other children, and their activities should not be limited unless they are experiencing a painful sickle cell crisis. Option 3: At 6 months of age, Jimmy should be immunized with the DTaP, Hib, HBV, and poliomyelitis vaccines. Children with sickle cell disease should receive all the standard well-baby care, but in addition to the standard immunizations, they should receive the 3/1/25, 9:03 PM Feedback This study source was downloaded by from CourseH on :48:46 GMT -05:00 Course Topic: Hematologic and Immune Problems | Area of Practice: Family Practice, Pediatrics | APN Knowledge Area: Health Promotion and Patient Education, Population Health and Epidemiology, Disease Management | Testing Domain: Plan | Cognitive Level: Application [Applying] Question 3. Your patient Shirley has an elevated mean corpuscular volume (MCV). What should you be considering in terms of diagnosis? Rationales [Page Reference: 1080] Course Topic: Hematologic and Immune Problems | Area of Practice: Pediatrics, Adult-Gerontology Primary Care, Family Practice | APN Knowledge Area: Differential Diagnosis Clinical Decision-Making, Diagnostic Tests and Therapeutic Procedures | Testing Domain: Diagnose | Cognitive Level: Analysis [Analyzing] Question 4. Which is the best serum test for spotting an iron deficiency early, before it progresses to full-blown anemia? Rationales pneumococcal vaccine at age 2 years. There is no cure for sickle cell disease. Option 4: Jimmy should receive all the standard immunizations, and he should receive the pneumococcal vaccine at age 2 years.  1. Iron-deficiency anemias 2. Hemolytic anemias 3. Lead poisoning  4. Liver disease Option 1: The MCV is decreased (microcytic) in iron-deficiency anemias. Option 2: The MCV is decreased (microcytic) in hemolytic anemias. Option 3: The MCV is decreased (microcytic) in defects involving porphyrin synthesis, such as those caused by lead poisoning. Option 4: The MCV indicates the average size of individual red blood cells. The normal (normocytic) range is 76 to 96 fL. The MCV is increased (macrocytic) in megaloblastic anemias (i.e., vitamin B deficiency and folate deficiency) and liver disease (such as that resulting from alcohol abuse), as well as with the use of some drugs (e.g., zidovudine). 12  1. Hemoglobin 2. Hematocrit  3. Ferritin 4. Reticulocytes Option 1: Hemoglobin is the iron-containing pigment of red blood cells that carries oxygen from the lungs to the tissues. Hemoglobin values reflect the level at a given time only, without regard for the body’s stores. Option 2: Hematocrit is the volume of erythrocytes packed in a given volume of blood. Hematocrit values reflect the level at a given time only, without regard for the body’s stores. Option 3: A serum measurement of ferritin, the body’s iron-storing protein, can reveal exactly how much iron is on hand in the body. It is the best way to spot an iron deficiency early, before it progresses to full-blown anemia. If the ferritin level is borderline, a dietary and supplemental regimen of iron will rebuild the iron stores. Option 4: Reticulocytes are the last immature stage of red blood cells. 3/1/25, 9:03 PM Feedback This study source was downloaded by from CourseH on :48:46 GMT -05:00 Course Topic: Hematologic and Immune Problems | Area of Practice: Pediatrics, Adult-Gerontology Primary Care, Family Practice | APN Knowledge Area: Diagnostic Tests and Therapeutic Procedures | Testing Domain: Diagnose | Cognitive Level: Analysis [Analyzing] Question 5. Sandra, age 19, is pregnant. She is complaining of breathlessness, tiredness, and weakness. She is also pale. After diagnosing iron-deficiency anemia, you order ferrous sulfate 325 mg tid and advise that she should take it: Rationales [Page Reference: 1073] Course Topic: Hematologic and Immune Problems | Area of Practice: Adult-Gerontology Primary Care, Family Practice | APN Knowledge Area: Health Promotion and Patient Education | Testing Domain: Plan | Cognitive Level: Application [Applying] Question 6. Stu, age 49, has slightly reduced hemoglobin and hematocrit readings. What is your next action after you ask him about his diet? Rationales [Page Reference: 1070]  1. Only with meals because it can be irritating to the stomach. 2. In the morning if she experiences morning sickness.  3. On an empty stomach. 4. At bedtime. Option 1: Taking iron with meals minimizes absorption. Option 2: Taking iron will not improve morning sickness and may actually exacerbate gastrointestinal distress. Option 3: Ferrous sulfate is best absorbed on an empty stomach, which may produce some discomfort for the patient. Counseling the patient regarding anticipated effects may improve adherence, and if necessary, she may take it with soluble fiber to improve tolerance. Option 4: Taking iron at bedtime will not affect absorption and may actually decrease it if there is any other gastrointestinal content present.  1. Repeat the laboratory tests.  2. Perform a fecal occult blood test. 3. Start him on an iron preparation. 4. Start him on folic acid. Option 1: There is no need to repeat the laboratory tests. Option 2: Tests for fecal occult blood should be done on all patients suspected of having iron-deficiency anemia. In the early stages of iron-deficiency anemia, both hemoglobin and hematocrit levels are normal to slightly reduced. It is necessary to determine whether the iron deficiency is related solely to inadequate dietary intake or to decreased absorption or chronic blood loss. Option 3: Before beginning treatment, it is necessary to determine the cause of the iron deficiency. Option 4: Before beginning treatment, it is necessary to determine the cause of the iron deficiency. 3/1/25, 9:03 PM Feedback This study source was downloaded by from CourseH on :48:46 GMT -05:00 APN Knowledge Area: Differential Diagnosis Clinical Decision-Making | Testing Domain: Assess | Cognitive Level: Analysis [Analyzing] Question 7. In which of the following circumstances is the reticulocyte count elevated? Rationales [Page Reference: 1076] Course Topic: Hematologic and Immune Problems | Area of Practice: Pediatrics, Adult-Gerontology Primary Care, Family Practice | APN Knowledge Area: Diagnostic Tests and Therapeutic Procedures | Testing Domain: Assess | Cognitive Level: Comprehension [Understanding] Question 8. Mindy, age 6, was recently discharged from the hospital after a sickle cell crisis. You are teaching her parents to be alert to the manifestations of splenic sequestration and tell them to be alert to: Rationales [Page Reference: 1085] Course Topic: Hematologic and Immune Problems | Area of Practice: Family Practice, Pediatrics | APN Knowledge Area: Health Promotion and Patient Education | Testing Domain: Assess | Cognitive Level: Analysis [Analyzing]  1. Aplastic anemia 2. Iron-deficiency anemia 3. Poisoning  4. Acute blood loss Option 1: The reticulocyte count is decreased in aplastic anemia because the bone marrow has shut down all production of cells. Option 2: The reticulocyte count is decreased in disorders of red blood cell maturation, such as iron-deficiency anemia. Option 3: The reticulocyte count is decreased in poisonings. Option 4: The reticulocyte count indicates the percentage of newly maturing red blood cells (RBCs) released into the circulating blood from the bone marrow. As an RBC matures, it loses its endothelial reticulum. The reticulocyte count is elevated in cases of blood loss as the body tries to replace the loss; it might also be elevated during the treatment of anemias (e.g., iron, folic acid, and vitamin B ) and bone marrow disorders, when immature RBCs are displaced by other proliferating cells. 12  1. Vomiting and diarrhea. 2. Decreased mental acuity.  3. Abdominal pain, pallor, and tachycardia. 4. Abdominal pain and vomiting. Option 1: Vomiting and diarrhea do not necessarily accompany this complication. Option 2: A decrease in mental acuity does not necessarily accompany this complication. Option 3: Abdominal pain, pallor, and tachycardia are all manifestations of splenic sequestration. Early recognition of splenic sequestration can be a lifesaving skill. Parents can be taught to recognize the signs of increasing anemia and an enlarging spleen. Part of the educational plan for parents is teaching them how to recognize increasing abdominal girth or abdominal pain, as well as how to palpate the spleen. Option 4: Abdominal pain is a manifestation of splenic sequestration, but vomiting does not necessarily accompany this complication. 3/1/25, 9:03 PM Feedback This study source was downloaded by from CourseH on :48:46 GMT -05:00 sickle cell anemia? Rationales [Page Reference: 1084] Course Topic: Hematologic and Immune Problems | Area of Practice: Family Practice, Adult-Gerontology Acute Care, Adult-Gerontology Primary Care | APN Knowledge Area: Population Health and Epidemiology | Testing Domain: Assess | Cognitive Level: Knowledge [Remembering] Question 10. Tina, age 2, had a complete blood count (CBC) drawn at her last visit. It indicates that she has a microcytic hypochromic anemia. What should you do now at this visit? Rationales [Page Reference: 1070] Course Topic: Hematologic and Immune Problems | Area of Practice: Pediatrics, Adult-Gerontology Primary Care, Family Practice | APN Knowledge Area: Diagnostic Tests and Therapeutic Procedures | Testing Domain: Diagnose | Cognitive Level: Analysis [Analyzing] Question 11. Sherri’s blood work returns with a decreased mean corpuscular volume (MCV) and a decreased mean corpuscular hemoglobin concentration (MCHC). What should you do next?   1. Autosomal recessive 2. Autosomal dominant 3. X-linked dominant 4. X-linked recessive Option 1: Sickle cell anemia is an autosomal-recessive disorder, which means both parents must have the gene to pass it on to the child. Option 2: An example of an autosomal-dominant disorder is Huntington’s disease. Option 3: An example of an X-linked dominant disorder is fragile X syndrome. Option 4: An example of an X-linked recessive disorder is hemophilia.   1. Obtain a lead level. 2. Instruct Tina’s parents to increase the amount of milk in her diet.  3. Start Tina on ferrous sulfate (Feosol) and check the CBC in 6 weeks. 4. Recheck the CBC. Option 1: The provider should always check a lead level before starting iron supplementation in children because an elevated lead level will cause anemia despite a normal iron level. Option 2: Regular milk (cow’s milk) is often the cause of anemia in children; thus, a thorough diet history must be obtained. Children younger than age 1 year are usually on iron-fortified infant formulas, and when they switch to cow’s milk, they do not receive sufficient iron. Option 3: Before starting Tina on iron supplementation, it is important to determine why she has anemia. Supplementation can cause iron overload. Option 4: Rechecking the CBC will not add new information because the goal now is to determine why the patient has anemia.  3/1/25, 9:03 PM Feedback This study source was downloaded by from CourseH on :48:46 GMT -05:00 [Page Reference: 1070] Course Topic: Hematologic and Immune Problems | Area of Practice: Adult-Gerontology Primary Care, Family Practice | APN Knowledge Area: Diagnostic Tests and Therapeutic Procedures | Testing Domain: Diagnose | Cognitive Level: Analysis [Analyzing] Question 12. A 28-year-old female presents to your primary care office for an annual physical. She denies any complaints other than heavy menstrual bleeding, which is something she has experienced her whole life. On routine complete blood count (CBC) evaluation, her hemoglobin is 11.0. Other pertinent values include a decreased serum ferritin and elevated total iron-binding capacity (TIBC). Her mean corpuscular volume (MCV) is 75. Which of the following is the likely cause of her anemia? Rationales [Page Reference: 1068] Course Topic: Hematologic and Immune Problems | Area of Practice: Adult-Gerontology Acute Care, Adult-Gerontology Primary Care, Family Practice | APN Knowledge Area: Differential Diagnosis Clinical Decision-Making | Testing Domain: Diagnose | Cognitive Level: Analysis [Analyzing] Question 13. Julia asks how smoking increases the risk of folic acid deficiency. You respond that smoking: 1. Order a serum iron level and a total iron-binding capacity (TIBC) level. 2. Order a serum ferritin level. 3. Order a serum folate level.  4. Order a serum iron level, a total iron-binding capacity (TIBC) level, and a serum ferritin level. Option 1: A serum iron level, a TIBC level, and a serum ferritin level are needed to make a more final diagnosis. Option 2: A serum iron level, a total iron-binding capacity (TIBC) level, and a serum ferritin level are needed to make a more final diagnosis. Option 3: You would order a serum folate level if you had an elevated MCV and a normal MCHC because this is indicative of macrocytic anemia. Option 4: Decreased MCV and MCHC values are indicative of a microcytic hypochromic anemia. To make a more final diagnosis, you need to order a serum iron level, a TIBC level, and a serum ferritin level.   1. Iron-deficiency anemia 2. Thalassemia 3. Sideroblastic anemia 4. Anemia of chronic disease (ACD) Option 1: This patient’s lab values point toward microcytic anemia. With low iron stores and a high ability to bind iron, iron-deficiency anemia is the best choice. Option 2: Thalassemia is diagnosed via electrophoresis of a blood sample as well as a CBC. Option 3: A Prussian blue stain would need to be done in order to diagnose sideroblastic anemia. Option 4: The difference between iron-deficiency anemia and ACD is that ACD can also be normocytic and would have a low TIBC.  1. Causes small-vessel disease and constricts all vessels that transport essential nutrients. 3/1/25, 9:03 PM Feedback This study source was downloaded by from CourseH on :48:46 GMT -05:00 [Page Reference: 513] Course Topic: Hematologic and Immune Problems | Area of Practice: Adult-Gerontology Primary Care, Family Practice | APN Knowledge Area: Health Promotion and Patient Education | Testing Domain: Assess | Cognitive Level: Knowledge [Remembering] Question 14. Macrocytic normochromic anemias are caused by: Rationales [Page Reference: 1081] Course Topic: Hematologic and Immune Problems | Area of Practice: Adult-Gerontology Primary Care, Family Practice | APN Knowledge Area: Pathophysiology | Testing Domain: Assess | Cognitive Level: Comprehension [Understanding] Question 15. The gold standard for definitive diagnosis of sickle cell anemia is: Rationales  2. Decreases vitamin C absorption.  3. Affects the liver’s ability to store folic acid. 4. Causes nausea, thereby inhibiting the appetite and ingestion of foods rich in folic acid. Option 1: Although smoking does cause small-vessel disease, it does not cause folic acid deficiency. Option 2: Smoking decreases vitamin C absorption, which is necessary for folic acid absorption. Smoking increases vitamin requirements. Patients with a folic acid deficiency should be encouraged to eat foods that are high in folic acid (e.g., asparagus spears, beef liver, broccoli, mushrooms, oatmeal, peanut butter, and red beans) daily because the liver can store folic acid for only a limited time. Option 3: The liver can store folic acid for only a limited time. This is not affected by smoking. Option 4: Smoking does not typically cause nausea in smokers.  1. Acute blood loss. 2. An infection or tumor. 3. A nutritional deficiency of iron.  4. A deficiency of folic acid. Option 1: Acute blood loss and most hemolytic processes cause normocytic normochromic anemias in which the cell size is normal. Option 2: Infections or tumors may cause an anemia of chronic disease that produces a normocytic red blood cell. Option 3: Iron-deficiency anemias are microcytic hypochromic anemias and may result from dietary insufficiencies as well as acute blood loss. Option 4: A folic acid and/or vitamin B12 deficiency causes macrocytic normochromic anemias in which the cell size is large and irregular.  1. A reticulocyte count. 2. The sickle cell test.  3. Hemoglobin electrophoresis. 4. A peripheral blood smear. Option 1: The baseline reticulocyte count is markedly elevated in sickle cell anemia, but this is not specific to the condition. Option 2: The sickle cell test is a screening test. 3/1/25, 9:03 PM Feedback This study source was downloaded by from CourseH on :48:46 GMT -05:00 [Page Reference: 1086] Course Topic: Hematologic and Immune Problems | Area of Practice: Adult-Gerontology Primary Care, Family Practice, Pediatrics | APN Knowledge Area: Diagnostic Tests and Therapeutic Procedures | Testing Domain: Diagnose | Cognitive Level: Comprehension [Understanding] Question 16. Which of the following is the most common cause of megaloblastic anemia? Rationales [Page Reference: 1080] Course Topic: Hematologic and Immune Problems | Area of Practice: Adult-Gerontology Acute Care, Adult-Gerontology Primary Care, Family Practice | APN Knowledge Area: Differential Diagnosis Clinical Decision-Making | Testing Domain: Diagnose | Cognitive Level: Knowledge [Remembering] Option 3: The gold standard for the definitive diagnosis of sickle cell anemia is hemoglobin electrophoresis, a test that determines the presence of hemoglobin S. A patient with sickle cell anemia has a decreased hematocrit level and sickle-shaped cells on the smear. Option 4: A peripheral blood smear is used for red blood cell morphology. Additional testing is always required to define the hemoglobin phenotype.   1. Vitamin B deficiency  2. Pernicious anemia 3. Iatrogenesis 4. Folate deficiency 12 Option 1: Vitamin B deficiency is the most common cause of megaloblastic anemia. However, vitamin B deficiency is most commonly caused by the autoimmune disease pernicious anemia. 12 12 Option 2: Pernicious anemia is the most common cause of megaloblastic anemia because it causes vitamin B12 deficiency. Option 3: Medications, such as methotrexate, can cause megaloblastic anemia; however, this is not the most common cause. Option 4: Folate deficiency can cause megaloblastic anemia; however, it is not the most common cause. 3/1/25, 9:03 PM Feedback This study source was downloaded by from )