1
RNSG 2539 FINAL EXAM LATEST ACTUAL
EXAM 160 QUESTIONS AND CORRECT
DETAILED ANSWERS
causes of anemia - (ANSWER)● Blood loss
● Inadequate RBC production (hypoproliferative) ● Increased RBC destruction
(hemolytic)
● Deficiency of necessary components such as folic acid, iron, erythropoietin,
and/or vitamin B12
anemia risk factors - (ANSWER)acute or chronic blood loss, increased hemolysis,
inadequate dietary intake or malabsorption, bone marrow suppression, age
anemia expected findings - (ANSWER)● Possibly asymptomatic in mild cases
● Pallor
● Fatigue
● Irritability
● Numbness and tingling of extremities
● Dyspnea on exertion
● Sensitivity to cold
● Pain and hypoxia with sickle-cell crisis
Anemia physical assessment findings - (ANSWER)● Shortness of breath/fatigue,
especially upon exertion
, 2
● Tachycardia and palpitations
● Dizziness or syncope upon standing or with exertion
● Pallor with pale nail beds and mucous membranes
● Nail bed deformities (spoon-shaped nails)
● Smooth, sore, bright-red tongue (vitamin B12 deficiency
Anemia: Laboratory Tests - (ANSWER)CBC count
RBC indices
Iron studies
Hgb electrophoresis
Sickle-cell test
Schilling test
Anemia diagnostic tests - (ANSWER)bone marrow biopsy
Anemia nursing care - (ANSWER)Encourage increased dietary intake of the
deficient nutrient (iron, vitamin B12, folic acid).
● Monitor oxygen saturation to determine a need for oxygen therapy.
● Administer medications, as prescribed, at the proper time for optimal
absorption, and using an appropriate technique.
● Teach the client and family about energy conservation in the client and the risk
of the client experiencing dizziness upon standing.
● Teach the client about the time frame for resolution.
, 3
Anemia Medications - (ANSWER)- Iron supplements (Ferrous sulfate, ferrous
fumarate, ferrous gluconate)
- Erythropoietin: epoetin alfa
- Vitamin B12 supplementation (cyanocobalamin
- Folic acid supplements
Iron supplements (Ferrous sulfate, ferrous fumarate, ferrous gluconate) -
(ANSWER)● Oral iron supplements are used to replenish serum iron and iron
stores. Iron is an essential component of Hgb, and subsequently, oxygen
transport.
● Parenteral iron supplements (iron dextran) are only given for severe anemia.
NURSING CONSIDERATIONS: Administer parenteral iron using the Z-track method
CLIENT EDUCATION
● Instruct to have hemoglobin checked in 4 to 6 weeks to determine efficacy.
● Vitamin C can increase oral iron absorption.
● Instruct the client to take iron supplements between meals to increase
absorption, if tolerated.
● Inform the client stools can appear green to black in color while taking iron
Erythropoietin: epoetin alfa - (ANSWER)A hematopoietic growth factor used to
increase productionof RBCs
NURSING CONSIDERATIONS
● Monitor for an increase in blood pressure.
, 4
● Monitor Hgb and Hct twice per week.
● Monitor for a cardiovascular event if Hgb increases too rapidly (greater than 1
g/dL in 2 weeks).
CLIENT EDUCATION:
Reinforce the importance of having Hgb and Hct evaluated on a twice‑per‑week
basis until targeted levels are reached.
Vitamin B12 supplementation (cyanocobalamin) - (ANSWER)● Vitamin B12 is
necessary to convert folic acid from its inactive form to its active form. All cells
rely on folic acid for DNA production.
● Vitamin B12 supplementation can be given orally if the deficit is due to
inadequate dietary intake. However, if deficiency is due to lack of intrinsic factor
being produced by the parietal cells of the stomach or malabsorption syndrome,
it must be administered parenterally or intranasally to be absorbed.
NURSING CONSIDERATIONS
● Administer vitamin B12 according to appropriate route related to cause of
vitamin B12 anemia (parenteral vs. oral).
● Administer parenteral forms of vitamin B12 IM or deep subcutaneous to
decrease irritation. Do not mix other medications in the syringe.
CLIENT EDUCATION
● Clients who lack intrinsic factor or have an irreversible-malabsorption syndrome
should be informed that this therapy must be continued for the rest of their life.
● A client should receive vitamin B12 injections on a monthly basis
RNSG 2539 FINAL EXAM LATEST ACTUAL
EXAM 160 QUESTIONS AND CORRECT
DETAILED ANSWERS
causes of anemia - (ANSWER)● Blood loss
● Inadequate RBC production (hypoproliferative) ● Increased RBC destruction
(hemolytic)
● Deficiency of necessary components such as folic acid, iron, erythropoietin,
and/or vitamin B12
anemia risk factors - (ANSWER)acute or chronic blood loss, increased hemolysis,
inadequate dietary intake or malabsorption, bone marrow suppression, age
anemia expected findings - (ANSWER)● Possibly asymptomatic in mild cases
● Pallor
● Fatigue
● Irritability
● Numbness and tingling of extremities
● Dyspnea on exertion
● Sensitivity to cold
● Pain and hypoxia with sickle-cell crisis
Anemia physical assessment findings - (ANSWER)● Shortness of breath/fatigue,
especially upon exertion
, 2
● Tachycardia and palpitations
● Dizziness or syncope upon standing or with exertion
● Pallor with pale nail beds and mucous membranes
● Nail bed deformities (spoon-shaped nails)
● Smooth, sore, bright-red tongue (vitamin B12 deficiency
Anemia: Laboratory Tests - (ANSWER)CBC count
RBC indices
Iron studies
Hgb electrophoresis
Sickle-cell test
Schilling test
Anemia diagnostic tests - (ANSWER)bone marrow biopsy
Anemia nursing care - (ANSWER)Encourage increased dietary intake of the
deficient nutrient (iron, vitamin B12, folic acid).
● Monitor oxygen saturation to determine a need for oxygen therapy.
● Administer medications, as prescribed, at the proper time for optimal
absorption, and using an appropriate technique.
● Teach the client and family about energy conservation in the client and the risk
of the client experiencing dizziness upon standing.
● Teach the client about the time frame for resolution.
, 3
Anemia Medications - (ANSWER)- Iron supplements (Ferrous sulfate, ferrous
fumarate, ferrous gluconate)
- Erythropoietin: epoetin alfa
- Vitamin B12 supplementation (cyanocobalamin
- Folic acid supplements
Iron supplements (Ferrous sulfate, ferrous fumarate, ferrous gluconate) -
(ANSWER)● Oral iron supplements are used to replenish serum iron and iron
stores. Iron is an essential component of Hgb, and subsequently, oxygen
transport.
● Parenteral iron supplements (iron dextran) are only given for severe anemia.
NURSING CONSIDERATIONS: Administer parenteral iron using the Z-track method
CLIENT EDUCATION
● Instruct to have hemoglobin checked in 4 to 6 weeks to determine efficacy.
● Vitamin C can increase oral iron absorption.
● Instruct the client to take iron supplements between meals to increase
absorption, if tolerated.
● Inform the client stools can appear green to black in color while taking iron
Erythropoietin: epoetin alfa - (ANSWER)A hematopoietic growth factor used to
increase productionof RBCs
NURSING CONSIDERATIONS
● Monitor for an increase in blood pressure.
, 4
● Monitor Hgb and Hct twice per week.
● Monitor for a cardiovascular event if Hgb increases too rapidly (greater than 1
g/dL in 2 weeks).
CLIENT EDUCATION:
Reinforce the importance of having Hgb and Hct evaluated on a twice‑per‑week
basis until targeted levels are reached.
Vitamin B12 supplementation (cyanocobalamin) - (ANSWER)● Vitamin B12 is
necessary to convert folic acid from its inactive form to its active form. All cells
rely on folic acid for DNA production.
● Vitamin B12 supplementation can be given orally if the deficit is due to
inadequate dietary intake. However, if deficiency is due to lack of intrinsic factor
being produced by the parietal cells of the stomach or malabsorption syndrome,
it must be administered parenterally or intranasally to be absorbed.
NURSING CONSIDERATIONS
● Administer vitamin B12 according to appropriate route related to cause of
vitamin B12 anemia (parenteral vs. oral).
● Administer parenteral forms of vitamin B12 IM or deep subcutaneous to
decrease irritation. Do not mix other medications in the syringe.
CLIENT EDUCATION
● Clients who lack intrinsic factor or have an irreversible-malabsorption syndrome
should be informed that this therapy must be continued for the rest of their life.
● A client should receive vitamin B12 injections on a monthly basis
