ANCC AGACNP BARKLEY REVIEW QUESTIONS
AND THEIR CORRECT ANSWERS
Hemoglobin (Hgb) - CORRECT ANSWER-Main component of RBC's and the essential protein that
combines with and transports O2 to the body.
Males: 14-18 g/100 mL
Females: 12-16 g/100 mL
Hematocrit (Hct) - CORRECT ANSWER-Measures the percentage of a given volume of whole
blood that is occupied by erythrocytes: the amount of plasma to total RBC mass (RBC
concentration).
Females: 37-47%
Males: 40-54%
Total Iron Binding Capacity (TIBC) - CORRECT ANSWER-Increased levels indicate iron deficiency
(the greater their TIBC, the greater their need for iron).; Decreased levels may indicate anemia,
hemorrhage, hemolysis.
Normal: 250-450 mcg/dL
Serum iron - CORRECT ANSWER-Normal: 50-150 ug/dL
Mean Corpuscular Volume (MCV) - CORRECT ANSWER-Expression of the average volume and
size of individual erythrocytes.
Normal: 80-100 um3
Microcytic = < 80, Normocytic = 80-100, and Macrocytic = > 100.
Mean Corpuscular Hemoglobin (MCH) - CORRECT ANSWER-Expression of the average amount
and weight of Hgb contained in a single erythrocyte.
,Normal: 26-34 pg
Mean Corpuscular Hemoglobin Concentration (MCHC) - CORRECT ANSWER-Expression of the
average Hgb concentration or proportion of each RBC occupied by Hgb as a percentage; more
accurate measure than MCH.
Normal: 32-36%
Hypochromic < 32%, normochromic 32-36%, hyperchromic > 36%
Differential for low mean corpuscular volume (MCV) - CORRECT ANSWER-Iron deficiency anemia
and thalassemia.
Differential for high mean corpuscular volume (MCV) - CORRECT ANSWER-B12 or folate
deficiency (Megaloblastic anemia), alcoholism, liver failure, and drug effects.
Differential for normal mean corpuscular volume (MCV) - CORRECT ANSWER-Anemia of chronic
disease, sickle cell, renal failure, blood loss, and hemolysis.
Iron deficiency anemia is what type if anemia? - CORRECT ANSWER-Microcytic, Hypochromic.
Iron deficiency anemia - CORRECT ANSWER-A microcytic-hypochromic type of anemia
characterized by iron deficiency that affects the production of hemoglobin and is characterized
by small red blood cells containing low amounts of hemoglobin.
Signs and symptoms of iron deficiency anemia - CORRECT ANSWER-Usually few symptoms if Hct
is greater than 30. As Hct decreases, symptoms present: pica, dyspnea and mild fatigue with
exercise, HA, palpitations, weakness, tachycardia, postural hypotension, and pallor.
Laboratory findings in iron deficiency anemia - CORRECT ANSWER-Low Hgb, low Hct, low MCV,
low MCHC, low RBC, low serum iron, low serum ferritin (iron storage), high TIBC , *high RDW
(red cell distribution width.
*Indicates there is a large difference in size from the largest to smallest RBC.
How is iron deficiency anemia treated - CORRECT ANSWER-Ferrous sulfate orally 300-325 mg 1-
3 hour after meals. Do not take iron supplements with antacids, it can interfere with absorption.
Take with vitamin C containing juices.
,Increase iron intake: Raisins, green leafy vegetables, red meats, citrus products, and iron-
fortified bread and cereals.
What type of anemia is thalassemia - CORRECT ANSWER-Microcytic, hypochromic.
Thalassemia - CORRECT ANSWER-Genetic inherited disorders resulting in abnormal Hgb
production and microcytic, hypochromic anemia. Mostly found in Mediterranean, African
American, Middle Eastern, Indian, and Asian populations.
Etiology of thalassemia - CORRECT ANSWER-There is a decreased production of adult
hemoglobin (Hb A); The global part of Hb A has 4 protein sections called polypeptide chains - (1)
two of these chains are called alpha chains and are identical, (2) the other two are identical but
different from the alpha chains, called beta chains.
What is the most common type of thalassemia - CORRECT ANSWER-Beta thalassemia
What is the cause of beta thalassemia - CORRECT ANSWER-There is a reduction or absent
production of beta globin chains.
Thalassemia Minor - CORRECT ANSWER-Heterozygous form of beta thalassemia; they only have
one copy of the beta thalassemia gene with a normal beta chain gene.
Thalassemia Major (Cooley's Anemia) - CORRECT ANSWER-Homozygous form of beta
thalassemia; they have two genes for beta thalassemia and no normal beta chain gene.
Signs and symptoms of Thalassemia Major - CORRECT ANSWER-In early life: failure to thrive,
feeding difficulties, bouts of fever, diarrhea, hepatosplenomegaly and jaundice, maxillary
enlargement.
Laboratory findings in Thalassemia Major - CORRECT ANSWER-Decreased Hgb, Low MCV, low
MCHC, normal TIBC, normal ferritin, decreased alpha or beta Hgb chains.
Treatment for Thalassemia Major - CORRECT ANSWER-No treatment for mild or moderate
forms; RBC transfusion/splenectomy for more severe forms; Do not give iron, because of the
possibility of iron overload.
Folic acid deficiency - CORRECT ANSWER-A microcytic, normochromic anemia (Megaloblastic
anemia) resulting from folic acid deficiency.
What group of people often have folic acid deficiency - CORRECT ANSWER-Alcoholics; Can be
treated with Folic Acid, Vitamin B1 (Thiamin), and/or a banana bag.
Signs and symptoms of folic acid deficiency - CORRECT ANSWER-Fatigue, dyspnea on exertion,
pallor, headache, tachycardia, anorexia, and glossitis.
, * No neurological changes are noted, which is how B12 deficiency can be differentiated from
folic acid deficiency.
Glossitis - CORRECT ANSWER-Inflammation of the tongue.
Laboratory findings in folic acid deficiency - CORRECT ANSWER-Hct and RBC decreased, MCV
elevated (macrocytic), MCHC normal (normochromic), serum folate decreased, red blood cell
folate less than 100 ng/mL.
* Normal red blood cell folate 140-628 ng/mL
Treatment for folic acid deficiency - CORRECT ANSWER-Folate 1 mg orally every day; foods high
in folic acid: bananas, peanut butter, fish, green leafy vegetables, iron-fortified breads and
cereals.
Sickle Cell Anemia - CORRECT ANSWER-A genetic disorder that causes abnormal hemoglobin,
resulting in some red blood cells assuming an abnormal sickle shape. Sickle Cell Anemia affects
the African American population.
Cellular hypoxia causes acidosis and tissue ischemia. Pain occurs as a result of the ischemia and
blood hyperviscosity.
Sickle cell anemia crisis symptoms - CORRECT ANSWER-Sudden severe pain in extremities, back,
chest, and abdomen; aching joint pain; weakness; dyspnea.
What factors can cause sickling of the cells in sickle cell anemia - CORRECT ANSWER-Hypoxia,
infections, high altitudes, dehydration, physical or emotional stress, surgery, blood loss, and
acidosis.
Laboratory findings in sickle cell anemia - CORRECT ANSWER-Decreased hemoglobin (carries
oxygen), and peripheral blood smear shows sickle-shaped RBCs.
Treatment for sickle cell anemia - CORRECT ANSWER-Fluids for dehydration, pain medication
(Dilaudid), supplemental oxygen for hypoxemia.
Medication used for sickle cell anemia - CORRECT ANSWER-Hydroxyurea
Von Williebrand Disease - CORRECT ANSWER-A genetic disorder that results in the reduced
ability to create blood clots; caused by deficiency in von Williebrand factor and clotting factor
VIII (8).
AND THEIR CORRECT ANSWERS
Hemoglobin (Hgb) - CORRECT ANSWER-Main component of RBC's and the essential protein that
combines with and transports O2 to the body.
Males: 14-18 g/100 mL
Females: 12-16 g/100 mL
Hematocrit (Hct) - CORRECT ANSWER-Measures the percentage of a given volume of whole
blood that is occupied by erythrocytes: the amount of plasma to total RBC mass (RBC
concentration).
Females: 37-47%
Males: 40-54%
Total Iron Binding Capacity (TIBC) - CORRECT ANSWER-Increased levels indicate iron deficiency
(the greater their TIBC, the greater their need for iron).; Decreased levels may indicate anemia,
hemorrhage, hemolysis.
Normal: 250-450 mcg/dL
Serum iron - CORRECT ANSWER-Normal: 50-150 ug/dL
Mean Corpuscular Volume (MCV) - CORRECT ANSWER-Expression of the average volume and
size of individual erythrocytes.
Normal: 80-100 um3
Microcytic = < 80, Normocytic = 80-100, and Macrocytic = > 100.
Mean Corpuscular Hemoglobin (MCH) - CORRECT ANSWER-Expression of the average amount
and weight of Hgb contained in a single erythrocyte.
,Normal: 26-34 pg
Mean Corpuscular Hemoglobin Concentration (MCHC) - CORRECT ANSWER-Expression of the
average Hgb concentration or proportion of each RBC occupied by Hgb as a percentage; more
accurate measure than MCH.
Normal: 32-36%
Hypochromic < 32%, normochromic 32-36%, hyperchromic > 36%
Differential for low mean corpuscular volume (MCV) - CORRECT ANSWER-Iron deficiency anemia
and thalassemia.
Differential for high mean corpuscular volume (MCV) - CORRECT ANSWER-B12 or folate
deficiency (Megaloblastic anemia), alcoholism, liver failure, and drug effects.
Differential for normal mean corpuscular volume (MCV) - CORRECT ANSWER-Anemia of chronic
disease, sickle cell, renal failure, blood loss, and hemolysis.
Iron deficiency anemia is what type if anemia? - CORRECT ANSWER-Microcytic, Hypochromic.
Iron deficiency anemia - CORRECT ANSWER-A microcytic-hypochromic type of anemia
characterized by iron deficiency that affects the production of hemoglobin and is characterized
by small red blood cells containing low amounts of hemoglobin.
Signs and symptoms of iron deficiency anemia - CORRECT ANSWER-Usually few symptoms if Hct
is greater than 30. As Hct decreases, symptoms present: pica, dyspnea and mild fatigue with
exercise, HA, palpitations, weakness, tachycardia, postural hypotension, and pallor.
Laboratory findings in iron deficiency anemia - CORRECT ANSWER-Low Hgb, low Hct, low MCV,
low MCHC, low RBC, low serum iron, low serum ferritin (iron storage), high TIBC , *high RDW
(red cell distribution width.
*Indicates there is a large difference in size from the largest to smallest RBC.
How is iron deficiency anemia treated - CORRECT ANSWER-Ferrous sulfate orally 300-325 mg 1-
3 hour after meals. Do not take iron supplements with antacids, it can interfere with absorption.
Take with vitamin C containing juices.
,Increase iron intake: Raisins, green leafy vegetables, red meats, citrus products, and iron-
fortified bread and cereals.
What type of anemia is thalassemia - CORRECT ANSWER-Microcytic, hypochromic.
Thalassemia - CORRECT ANSWER-Genetic inherited disorders resulting in abnormal Hgb
production and microcytic, hypochromic anemia. Mostly found in Mediterranean, African
American, Middle Eastern, Indian, and Asian populations.
Etiology of thalassemia - CORRECT ANSWER-There is a decreased production of adult
hemoglobin (Hb A); The global part of Hb A has 4 protein sections called polypeptide chains - (1)
two of these chains are called alpha chains and are identical, (2) the other two are identical but
different from the alpha chains, called beta chains.
What is the most common type of thalassemia - CORRECT ANSWER-Beta thalassemia
What is the cause of beta thalassemia - CORRECT ANSWER-There is a reduction or absent
production of beta globin chains.
Thalassemia Minor - CORRECT ANSWER-Heterozygous form of beta thalassemia; they only have
one copy of the beta thalassemia gene with a normal beta chain gene.
Thalassemia Major (Cooley's Anemia) - CORRECT ANSWER-Homozygous form of beta
thalassemia; they have two genes for beta thalassemia and no normal beta chain gene.
Signs and symptoms of Thalassemia Major - CORRECT ANSWER-In early life: failure to thrive,
feeding difficulties, bouts of fever, diarrhea, hepatosplenomegaly and jaundice, maxillary
enlargement.
Laboratory findings in Thalassemia Major - CORRECT ANSWER-Decreased Hgb, Low MCV, low
MCHC, normal TIBC, normal ferritin, decreased alpha or beta Hgb chains.
Treatment for Thalassemia Major - CORRECT ANSWER-No treatment for mild or moderate
forms; RBC transfusion/splenectomy for more severe forms; Do not give iron, because of the
possibility of iron overload.
Folic acid deficiency - CORRECT ANSWER-A microcytic, normochromic anemia (Megaloblastic
anemia) resulting from folic acid deficiency.
What group of people often have folic acid deficiency - CORRECT ANSWER-Alcoholics; Can be
treated with Folic Acid, Vitamin B1 (Thiamin), and/or a banana bag.
Signs and symptoms of folic acid deficiency - CORRECT ANSWER-Fatigue, dyspnea on exertion,
pallor, headache, tachycardia, anorexia, and glossitis.
, * No neurological changes are noted, which is how B12 deficiency can be differentiated from
folic acid deficiency.
Glossitis - CORRECT ANSWER-Inflammation of the tongue.
Laboratory findings in folic acid deficiency - CORRECT ANSWER-Hct and RBC decreased, MCV
elevated (macrocytic), MCHC normal (normochromic), serum folate decreased, red blood cell
folate less than 100 ng/mL.
* Normal red blood cell folate 140-628 ng/mL
Treatment for folic acid deficiency - CORRECT ANSWER-Folate 1 mg orally every day; foods high
in folic acid: bananas, peanut butter, fish, green leafy vegetables, iron-fortified breads and
cereals.
Sickle Cell Anemia - CORRECT ANSWER-A genetic disorder that causes abnormal hemoglobin,
resulting in some red blood cells assuming an abnormal sickle shape. Sickle Cell Anemia affects
the African American population.
Cellular hypoxia causes acidosis and tissue ischemia. Pain occurs as a result of the ischemia and
blood hyperviscosity.
Sickle cell anemia crisis symptoms - CORRECT ANSWER-Sudden severe pain in extremities, back,
chest, and abdomen; aching joint pain; weakness; dyspnea.
What factors can cause sickling of the cells in sickle cell anemia - CORRECT ANSWER-Hypoxia,
infections, high altitudes, dehydration, physical or emotional stress, surgery, blood loss, and
acidosis.
Laboratory findings in sickle cell anemia - CORRECT ANSWER-Decreased hemoglobin (carries
oxygen), and peripheral blood smear shows sickle-shaped RBCs.
Treatment for sickle cell anemia - CORRECT ANSWER-Fluids for dehydration, pain medication
(Dilaudid), supplemental oxygen for hypoxemia.
Medication used for sickle cell anemia - CORRECT ANSWER-Hydroxyurea
Von Williebrand Disease - CORRECT ANSWER-A genetic disorder that results in the reduced
ability to create blood clots; caused by deficiency in von Williebrand factor and clotting factor
VIII (8).
