(Capella) NURS6202 Advanced Pathophysiology
Final Exam Guide Q & A 2024
anemia - correct answersA condition in which the blood is deficient in red blood cells, in
hemoglobin, or in total volume. (Hgb and HCT)
can be blood loss, destruction (hemolysis, sickle cell disease, some meds, blood
mismatch, trauma) ,or decreased production of RBCs (iron deficiency, kidney disease)
normocytic normochromic anemia - correct answersCharacterized by red cells that are
relatively normal in size and hemoglobin content but insufficient in number
- caused by acute blood loss, CKD, hemolysis, sickle cell
MCH is size (mean corpuscular hemoglobin) MCV is color (mean corpuscular volume)
microcytic hypochromic anemia - correct answersanemia characterized by small, pale
red blood cells that lack adequate hemoglobin to carry oxygen; can be caused by
deficiency of iron or vitamin B6
low MCH and MCV
macrocytic normochromic anemia - correct answers- large cells (megaloblastic), normal
color
- usually folic acid or vitamin B12 deficiency anemia, liver disease
- pernicious anemia
- MCH and MCV high
anemia manifestations - correct answersweakness, fatigue, pallor, syncope, dyspnea,
tachycardia and murmurs from low blood viscosity, integumentary changes- pruritus
pallor and jaundice
Anemia manifestations - correct answersMild: Hemoglobin 10-12 (tired, pale nails and
MM)
Moderate/Severe: Hemoglobin BELOW 6g/dl is severe, 7-10 is moderate (more
stuggish, chest pain, eyes look pale)
between 12-16 is normal
Anemia: Cardiopulmonary Manifestations - correct answersResult from additional
attempts by heart and lungs to provide adequate O2 to the tissues
Cardiac output maintained by increasing the heart rate and stroke volume
low blood viscosity leads to murmur
Gerontologic Considerations - correct answersmore common, s/s not recognized bc
similar to normal aging
,decreased erythrocyte production - correct answersiron deficiency (tired and pale,
ischemia) megaloblastic (b12 deficiency, folic acid def.) - neuropathy, tingling around
mouth/hands/face/LE's, early graying of the hair w folic acid def.
iron deficiency - correct answersdecreased Hbg and Hct, MCV low, iron low
normal b12 and folate
treat underlying cause- lots of GI bleeds
iron replacement- good nutrition, blood transfusion of packed RBCs, meds
iron supplements- best absorbed before meals on empty stomach, liquid iron stains
teeth so use straw and dilute, take w vitamin c, can cause constipation, heartburn or
diarrhea
parental iron- IV or IM- im may stain skin, indicated for malabsorption or oral
intolerance, higher dose, poor pt compliance w oral
Cobalamin (B12) deficiency - correct answers-Found in strict vegetarians - gastric
system missing protein needed for absorption
-Pernicious anemia (weakness, sore tongue, apathy)- gastric mucosa not secreting
intrinsic factor in gut
can be GI alterations like surgery and chronic disease, chronic alcoholics, h12 blockers
and ppi long term use bc decreased acid and causes issues w absorption
s/s: beefy red tongue, n/v, abd pain, weakness, parethesia, confusion, decreased
senses, ataxia
- treatment: cobalamin parental or intranasal, lifelong if no gi absorption, neuromuscular
may not improve, b12 supplement may help a little bit but maybe not if absorption
problems, b12 injections
Folic acid deficiency - correct answersMacrocytic, megaloblastic anemia; no neurologic
Sx (as opposed to vitamin B12 deficiency). Most common vitamin deficiency in the USA.
Seen in alcoholism and pregnancy.
commonly caused by dietary deficiency and malabsorption, drugs, increased
requirement, alcohol abuse, anorexia, hemodialysis loss
treat w folic acid supplement and diet rich in folic acid
megaloblastic anemia nursing management - correct answershx of pernicious anemia
for early detection, ensure safety w diminished sensations to heat and pain from neuro
impairment, protect from burns/falls/trauma, frequent medical screening for risk of dev
gastric cancers
Sickle Cell Disease (SCD) - correct answersa group of inherited, autosomal recessive
disorders characterized by the presence of an abnormal form of hemoglobin in the
erythrocyte
Hbg S destruction, severe pain often undertreated and can be fatal bc it sickles and cuts
off oxygen and cause damage to joints and organs
goal is to prevent
a/s: asymptomatic except during sickling, pain, pallor, jaundice d/t blood cell destruction
and liver breaking them down and bilirubin spills in bloodstream bc liver can't keep up,
, complications when organs affected by hypoxia and infection, make sure patient is
oxygenated and given IV fluids and need pain meds
Sickling episodes are triggered by - correct answerslow O2 in the blood
can lead to crisis, and necrosis and go into shock bc low fluid volume and oxygenation
sickle cell crisis - correct answerscondition in sickle cell anemia in which the sickled
cells interfere with oxygen transport, obstruct capillary blood flow, and cause fever and
severe pain in the joints and abdomen
need pain treatment, oxygen, watch for respiratory failure, rest, dvt prophylaxis, f/e,
transfusions
sickle cell management - correct answerspain management - often tolerant to pain
meds, requires continuous and breakthrough analgesia
preventative meds- folic acid and hydrea an anti sickling agent
hematopoietic stem cell transplant
prevent infection and get vaccinated, avoid high altitudes, stay hydrated, prompt med
attention and treat infections early, counseling and support groups, med alert bracelet
Thrombocytopenia - correct answerslow platelet count <150,000, abnormal hemostasis,
prolonged or spontaneous bleeding, primarily an acquired disorder
mucosal bleeding or cutaneous bleeding, petichae, prolonged bleeding w routine
procedures when less than 50,000
hemorrhage risk when less than 20,000
Immune Thrombocytopenic Purpura (ITP) - correct answersAutoimmune platelet
destruction is a common cause of thrombocytopenia and should be supsected in
patients with echymoses, petechiae, mucosal bleeding, and no other obvious causes of
thrombocytopenia (ex- medications, bone marrow failure) abnormal destruction of
platelets
avoid aspirin, need corticosteroids, splenectomy if not responding to treatments, platelet
transfusion if less than 10,000 or if actively bleeding or prophylactically for planned
procedure
thrombocytopenia nursing management - correct answers- treat bleeding and evaluate
and avoid anything that causes bleeding, like sq/im injections avoided, monitor labs-
platelets/pt/aptt time/coag studies,hbg/hct
teach self care to reduce bleeding risk, prompt treatment for s/s of bleeding, awareness
of cancer drugs causing this, heparin, and otc meds
leukemia - correct answerscancer of white blood cells, affects bone marrow, lymph, and
spleen
acute: immature hematopoietic cells proliferate, abrupt onset
chronic: more mature form of WBCs, gradual onset
acute myelogenous (usually presents as bleeding or infection, hyperplasia of bone
marrow and spleen, 80%, 1 in 4 survive), acute lymphocytic, chronic myelogenous,
Final Exam Guide Q & A 2024
anemia - correct answersA condition in which the blood is deficient in red blood cells, in
hemoglobin, or in total volume. (Hgb and HCT)
can be blood loss, destruction (hemolysis, sickle cell disease, some meds, blood
mismatch, trauma) ,or decreased production of RBCs (iron deficiency, kidney disease)
normocytic normochromic anemia - correct answersCharacterized by red cells that are
relatively normal in size and hemoglobin content but insufficient in number
- caused by acute blood loss, CKD, hemolysis, sickle cell
MCH is size (mean corpuscular hemoglobin) MCV is color (mean corpuscular volume)
microcytic hypochromic anemia - correct answersanemia characterized by small, pale
red blood cells that lack adequate hemoglobin to carry oxygen; can be caused by
deficiency of iron or vitamin B6
low MCH and MCV
macrocytic normochromic anemia - correct answers- large cells (megaloblastic), normal
color
- usually folic acid or vitamin B12 deficiency anemia, liver disease
- pernicious anemia
- MCH and MCV high
anemia manifestations - correct answersweakness, fatigue, pallor, syncope, dyspnea,
tachycardia and murmurs from low blood viscosity, integumentary changes- pruritus
pallor and jaundice
Anemia manifestations - correct answersMild: Hemoglobin 10-12 (tired, pale nails and
MM)
Moderate/Severe: Hemoglobin BELOW 6g/dl is severe, 7-10 is moderate (more
stuggish, chest pain, eyes look pale)
between 12-16 is normal
Anemia: Cardiopulmonary Manifestations - correct answersResult from additional
attempts by heart and lungs to provide adequate O2 to the tissues
Cardiac output maintained by increasing the heart rate and stroke volume
low blood viscosity leads to murmur
Gerontologic Considerations - correct answersmore common, s/s not recognized bc
similar to normal aging
,decreased erythrocyte production - correct answersiron deficiency (tired and pale,
ischemia) megaloblastic (b12 deficiency, folic acid def.) - neuropathy, tingling around
mouth/hands/face/LE's, early graying of the hair w folic acid def.
iron deficiency - correct answersdecreased Hbg and Hct, MCV low, iron low
normal b12 and folate
treat underlying cause- lots of GI bleeds
iron replacement- good nutrition, blood transfusion of packed RBCs, meds
iron supplements- best absorbed before meals on empty stomach, liquid iron stains
teeth so use straw and dilute, take w vitamin c, can cause constipation, heartburn or
diarrhea
parental iron- IV or IM- im may stain skin, indicated for malabsorption or oral
intolerance, higher dose, poor pt compliance w oral
Cobalamin (B12) deficiency - correct answers-Found in strict vegetarians - gastric
system missing protein needed for absorption
-Pernicious anemia (weakness, sore tongue, apathy)- gastric mucosa not secreting
intrinsic factor in gut
can be GI alterations like surgery and chronic disease, chronic alcoholics, h12 blockers
and ppi long term use bc decreased acid and causes issues w absorption
s/s: beefy red tongue, n/v, abd pain, weakness, parethesia, confusion, decreased
senses, ataxia
- treatment: cobalamin parental or intranasal, lifelong if no gi absorption, neuromuscular
may not improve, b12 supplement may help a little bit but maybe not if absorption
problems, b12 injections
Folic acid deficiency - correct answersMacrocytic, megaloblastic anemia; no neurologic
Sx (as opposed to vitamin B12 deficiency). Most common vitamin deficiency in the USA.
Seen in alcoholism and pregnancy.
commonly caused by dietary deficiency and malabsorption, drugs, increased
requirement, alcohol abuse, anorexia, hemodialysis loss
treat w folic acid supplement and diet rich in folic acid
megaloblastic anemia nursing management - correct answershx of pernicious anemia
for early detection, ensure safety w diminished sensations to heat and pain from neuro
impairment, protect from burns/falls/trauma, frequent medical screening for risk of dev
gastric cancers
Sickle Cell Disease (SCD) - correct answersa group of inherited, autosomal recessive
disorders characterized by the presence of an abnormal form of hemoglobin in the
erythrocyte
Hbg S destruction, severe pain often undertreated and can be fatal bc it sickles and cuts
off oxygen and cause damage to joints and organs
goal is to prevent
a/s: asymptomatic except during sickling, pain, pallor, jaundice d/t blood cell destruction
and liver breaking them down and bilirubin spills in bloodstream bc liver can't keep up,
, complications when organs affected by hypoxia and infection, make sure patient is
oxygenated and given IV fluids and need pain meds
Sickling episodes are triggered by - correct answerslow O2 in the blood
can lead to crisis, and necrosis and go into shock bc low fluid volume and oxygenation
sickle cell crisis - correct answerscondition in sickle cell anemia in which the sickled
cells interfere with oxygen transport, obstruct capillary blood flow, and cause fever and
severe pain in the joints and abdomen
need pain treatment, oxygen, watch for respiratory failure, rest, dvt prophylaxis, f/e,
transfusions
sickle cell management - correct answerspain management - often tolerant to pain
meds, requires continuous and breakthrough analgesia
preventative meds- folic acid and hydrea an anti sickling agent
hematopoietic stem cell transplant
prevent infection and get vaccinated, avoid high altitudes, stay hydrated, prompt med
attention and treat infections early, counseling and support groups, med alert bracelet
Thrombocytopenia - correct answerslow platelet count <150,000, abnormal hemostasis,
prolonged or spontaneous bleeding, primarily an acquired disorder
mucosal bleeding or cutaneous bleeding, petichae, prolonged bleeding w routine
procedures when less than 50,000
hemorrhage risk when less than 20,000
Immune Thrombocytopenic Purpura (ITP) - correct answersAutoimmune platelet
destruction is a common cause of thrombocytopenia and should be supsected in
patients with echymoses, petechiae, mucosal bleeding, and no other obvious causes of
thrombocytopenia (ex- medications, bone marrow failure) abnormal destruction of
platelets
avoid aspirin, need corticosteroids, splenectomy if not responding to treatments, platelet
transfusion if less than 10,000 or if actively bleeding or prophylactically for planned
procedure
thrombocytopenia nursing management - correct answers- treat bleeding and evaluate
and avoid anything that causes bleeding, like sq/im injections avoided, monitor labs-
platelets/pt/aptt time/coag studies,hbg/hct
teach self care to reduce bleeding risk, prompt treatment for s/s of bleeding, awareness
of cancer drugs causing this, heparin, and otc meds
leukemia - correct answerscancer of white blood cells, affects bone marrow, lymph, and
spleen
acute: immature hematopoietic cells proliferate, abrupt onset
chronic: more mature form of WBCs, gradual onset
acute myelogenous (usually presents as bleeding or infection, hyperplasia of bone
marrow and spleen, 80%, 1 in 4 survive), acute lymphocytic, chronic myelogenous,
