NUR 2356 ACTUAL TEST PAPER QUESTIONS AND
ANSWERS SET A+
✔✔Lead poisoning diagnostics - ✔✔Blood lead level (BBL) test
-5mcg/dL = lead exposure
-45 mcg/dL = medical treatment required with chelation therapy
->70= mcg/dL = severe lead toxicity
✔✔Therapeutic management of lead poisoning - ✔✔-Decontamination
-Chelation
-Supportive therapy
-Deterrence and prevention
✔✔How do you decontaminate a person with lead poisoning? - ✔✔Xray of GI tract to
see of lead is there. if it is, they flush it out to stop absorption
✔✔when to use Chelation therapy for lead poisoning - ✔✔-45-69 mcg/dL outpatient
therapy with oral succorer and parenteral disodium calcium edetate
->70 Hospitalization with dimercaprol and disodium calcium EDTA
-Monitor urinary output (possibly on 24 hour urine collection)
✔✔What do patients who have lead poisoning need in their diet? - ✔✔Adequate
calcium, iron, and vitamin C
✔✔Chelation drugs - ✔✔1.Edetate calcium disodium (CaNA2EDTA)
2.Succimer (Chemet)
3.Dimercaprol (BAL in Oil)
✔✔Information on Chelation drug Edetate calcium disodium (CaNA2EDTA) - ✔✔-Given
IM or IV for 5 days
- Increase lead concentrations in CNS resulting in encephalopathy in its with BLL >70
mcg/dL, used in combination with dimercaprol
,✔✔Information on chelation drug Succimer (Chemet) - ✔✔-Given po every 8hrs x 5
days, then every 12 hours x 2 wks
-Capsules contain small beads that can be mixed with food. Cannot be given through a
syringe
✔✔Information on chelation drug Dimercaprol (BAL in Oil) - ✔✔-Drug of choice in
severe lead toxicity cases (BLL >70)
-IM every 4 hours with CaNA2EDTA started with dose 2
-Do not give with peanut allergy because it is made with peanut oil
-No iron supplements if receiving Dimercaprol because it can form toxic complex if
mixed with iron
✔✔Nursing interventions with lead poisoning - ✔✔Monitoring parameters
-Blood lead levels
-Monitor fluid intake and urine output
-Seizure precautions
Dietary Considerations
-High iron
-Limit milk intake to 24 hours
-Adequate calcium and vitamin c
Prevention - screening
-Nutrition education: iron rich foods, calcium rich foods, vitamin c rich foods
✔✔Define sickle cell disease - ✔✔Sickle cell disease is a group of disorders that affects
hemoglobin. People with this disorder have atypical hemoglobin molecules called
hemoglobin S, which can distort red blood cells into a sickle or crescent shape
✔✔What is normal adult hemoglobin? - ✔✔Hemoglobin A
✔✔What is the primary hemoglobin produced by the fetus? - ✔✔Hemoglobin F
✔✔When does Hemoglobin F transfer into Hemoglobin A? - ✔✔Around 1-2 years old
✔✔Hemoglobin F does what to sickling of red blood cells? - ✔✔inhibits the sickling
✔✔Define hemoglobinopathy - ✔✔A hemoglobin abnormality is a variant form of
hemoglobin that is often inherited and may cause a blood disorder
(abnormal production or structure of hemoglobin molecules)
✔✔What is the primary hemoglobin in patients with sickle cell anemia? -
✔✔Hemoglobin S
✔✔What causes increased production of Hemoglobin F? And why? - ✔✔Hydroxurea
because it causes immunosuppression and it acts like a chemo drug
,✔✔Define sickle cell trait - ✔✔describes a condition in which the person has one
abnormal allele of the hemoglobin gene (is heterozygous), but does not display the
severe symptoms of sickle cell disease that occur in a person who has two copies of
that allele (is homozygous)
(They carry only one gene of sickle cell but don't actually have the disease, they are just
a carrier of it.)
✔✔What happens with the hemoglobin in sickle cell anemia? - ✔✔Sickle cell abnormal
Hemoglobin S (HbSS) replaces all or part of the normal adult hemoglobin (HbAA)
✔✔What is used to diagnose sickle cell anemia? - ✔✔Hemoglobin electrophoresis
✔✔What happens when RBCs change from round to sickle shaped? - ✔✔Results in
chronic hemolytic anemia and ischemic tissue injury
✔✔What are sickle cell triggers? - ✔✔extreme temperatures, exercise, dehydration,
infection, extreme stress
✔✔What are 2 issues of sickle cell anemia and define them? - ✔✔Obstruction - caused
by sickling RBCs causing micro-occlusion or vascular occlusion blocking blood flow
(hypoxia, ischemia, infarction [cell death])
Destruction - sickle cells have a short life span and body has to destroy them and it is a
lot of stress on the spleen
✔✔Ophthalmic complications of sickle cell - ✔✔vitreous hemorrhage, retinal
detachment, and blindness
✔✔Vaso-occlusive crisis of sickle cell
Chest syndrome
hand and foot syndrome
Cerebrovascular accident - ✔✔chest syndrome includes chest pain, fever, and cough
and can be precipitated by or result from pneumonia
hand and foot syndrome (dactylics may be the first symptom of vaso-occlusion
cerebrovascular accident is caused by vaso-occlusion of vessels in the brain, resulting
in cerebral infarction
✔✔Abdominal and GU complications of sickle cell - ✔✔abdominal pain and
genitourinary disfunction (dilute urine)
, ✔✔What is Splenic sequestration crisis of sickle cell - ✔✔Caused by pooled blood that
enlarges the spleen significantly
✔✔3 functions of the spleen - ✔✔1.filters blood and removes old and damaged RBCs
2.controls level of blood cells (white, red, and platelets)
3.contains WBCs
✔✔Define functional asplenia - ✔✔reduction in splenic function
✔✔Define the process in developing functional asplenia - ✔✔initially the spleen
becomes enlarged from congestion and engorgement with sickled cells and repeated
insult to the spleen leads to infarction - the functional cells are replaced by fibrotic
tissue.
✔✔what does functional asplenia cause patients to become - ✔✔immunocompromised
✔✔Infection prevention in sickle cell patients - ✔✔-Penicillin prophylaxis = oral penicillin
until 5 years old
-Immunization schedule modification
~ Routine PVC-13 given. two doses of 23-valent pneumococcal at age 2 and 5
~ Meningococcal vaccine 4 dose series: 2, 4, 6, 12 months
~Hemophilus influenzae type B (Hib) vaccine at age 2 years (additional dose)
~Annual flu vaccine
✔✔3 major crises seen in children with sickle cell anemia - ✔✔aplastic crisis
splenic sequestration
vast-occlusive crisis (VOC)
✔✔Define aplastic crisis - ✔✔Transient suppression of RBC production in the bone
marrow with hemolysis of all blood cells
(temporary shutdown of red blood cells)
✔✔What can cause aplastic crisis? - ✔✔-Infection = viral, especially human parvovirus
B19 (Fifths disease)
-Depletion of folic acid
✔✔What are the clinical manifestations of aplastic crisis? - ✔✔-Profound anemia, pallor
-Neutropenia - fever; Risk for infection
-Thrombocytopenia - risk for bleeding anywhere
✔✔What is the treatment for aplastic anemia? - ✔✔Packed RBC transfusion
ANSWERS SET A+
✔✔Lead poisoning diagnostics - ✔✔Blood lead level (BBL) test
-5mcg/dL = lead exposure
-45 mcg/dL = medical treatment required with chelation therapy
->70= mcg/dL = severe lead toxicity
✔✔Therapeutic management of lead poisoning - ✔✔-Decontamination
-Chelation
-Supportive therapy
-Deterrence and prevention
✔✔How do you decontaminate a person with lead poisoning? - ✔✔Xray of GI tract to
see of lead is there. if it is, they flush it out to stop absorption
✔✔when to use Chelation therapy for lead poisoning - ✔✔-45-69 mcg/dL outpatient
therapy with oral succorer and parenteral disodium calcium edetate
->70 Hospitalization with dimercaprol and disodium calcium EDTA
-Monitor urinary output (possibly on 24 hour urine collection)
✔✔What do patients who have lead poisoning need in their diet? - ✔✔Adequate
calcium, iron, and vitamin C
✔✔Chelation drugs - ✔✔1.Edetate calcium disodium (CaNA2EDTA)
2.Succimer (Chemet)
3.Dimercaprol (BAL in Oil)
✔✔Information on Chelation drug Edetate calcium disodium (CaNA2EDTA) - ✔✔-Given
IM or IV for 5 days
- Increase lead concentrations in CNS resulting in encephalopathy in its with BLL >70
mcg/dL, used in combination with dimercaprol
,✔✔Information on chelation drug Succimer (Chemet) - ✔✔-Given po every 8hrs x 5
days, then every 12 hours x 2 wks
-Capsules contain small beads that can be mixed with food. Cannot be given through a
syringe
✔✔Information on chelation drug Dimercaprol (BAL in Oil) - ✔✔-Drug of choice in
severe lead toxicity cases (BLL >70)
-IM every 4 hours with CaNA2EDTA started with dose 2
-Do not give with peanut allergy because it is made with peanut oil
-No iron supplements if receiving Dimercaprol because it can form toxic complex if
mixed with iron
✔✔Nursing interventions with lead poisoning - ✔✔Monitoring parameters
-Blood lead levels
-Monitor fluid intake and urine output
-Seizure precautions
Dietary Considerations
-High iron
-Limit milk intake to 24 hours
-Adequate calcium and vitamin c
Prevention - screening
-Nutrition education: iron rich foods, calcium rich foods, vitamin c rich foods
✔✔Define sickle cell disease - ✔✔Sickle cell disease is a group of disorders that affects
hemoglobin. People with this disorder have atypical hemoglobin molecules called
hemoglobin S, which can distort red blood cells into a sickle or crescent shape
✔✔What is normal adult hemoglobin? - ✔✔Hemoglobin A
✔✔What is the primary hemoglobin produced by the fetus? - ✔✔Hemoglobin F
✔✔When does Hemoglobin F transfer into Hemoglobin A? - ✔✔Around 1-2 years old
✔✔Hemoglobin F does what to sickling of red blood cells? - ✔✔inhibits the sickling
✔✔Define hemoglobinopathy - ✔✔A hemoglobin abnormality is a variant form of
hemoglobin that is often inherited and may cause a blood disorder
(abnormal production or structure of hemoglobin molecules)
✔✔What is the primary hemoglobin in patients with sickle cell anemia? -
✔✔Hemoglobin S
✔✔What causes increased production of Hemoglobin F? And why? - ✔✔Hydroxurea
because it causes immunosuppression and it acts like a chemo drug
,✔✔Define sickle cell trait - ✔✔describes a condition in which the person has one
abnormal allele of the hemoglobin gene (is heterozygous), but does not display the
severe symptoms of sickle cell disease that occur in a person who has two copies of
that allele (is homozygous)
(They carry only one gene of sickle cell but don't actually have the disease, they are just
a carrier of it.)
✔✔What happens with the hemoglobin in sickle cell anemia? - ✔✔Sickle cell abnormal
Hemoglobin S (HbSS) replaces all or part of the normal adult hemoglobin (HbAA)
✔✔What is used to diagnose sickle cell anemia? - ✔✔Hemoglobin electrophoresis
✔✔What happens when RBCs change from round to sickle shaped? - ✔✔Results in
chronic hemolytic anemia and ischemic tissue injury
✔✔What are sickle cell triggers? - ✔✔extreme temperatures, exercise, dehydration,
infection, extreme stress
✔✔What are 2 issues of sickle cell anemia and define them? - ✔✔Obstruction - caused
by sickling RBCs causing micro-occlusion or vascular occlusion blocking blood flow
(hypoxia, ischemia, infarction [cell death])
Destruction - sickle cells have a short life span and body has to destroy them and it is a
lot of stress on the spleen
✔✔Ophthalmic complications of sickle cell - ✔✔vitreous hemorrhage, retinal
detachment, and blindness
✔✔Vaso-occlusive crisis of sickle cell
Chest syndrome
hand and foot syndrome
Cerebrovascular accident - ✔✔chest syndrome includes chest pain, fever, and cough
and can be precipitated by or result from pneumonia
hand and foot syndrome (dactylics may be the first symptom of vaso-occlusion
cerebrovascular accident is caused by vaso-occlusion of vessels in the brain, resulting
in cerebral infarction
✔✔Abdominal and GU complications of sickle cell - ✔✔abdominal pain and
genitourinary disfunction (dilute urine)
, ✔✔What is Splenic sequestration crisis of sickle cell - ✔✔Caused by pooled blood that
enlarges the spleen significantly
✔✔3 functions of the spleen - ✔✔1.filters blood and removes old and damaged RBCs
2.controls level of blood cells (white, red, and platelets)
3.contains WBCs
✔✔Define functional asplenia - ✔✔reduction in splenic function
✔✔Define the process in developing functional asplenia - ✔✔initially the spleen
becomes enlarged from congestion and engorgement with sickled cells and repeated
insult to the spleen leads to infarction - the functional cells are replaced by fibrotic
tissue.
✔✔what does functional asplenia cause patients to become - ✔✔immunocompromised
✔✔Infection prevention in sickle cell patients - ✔✔-Penicillin prophylaxis = oral penicillin
until 5 years old
-Immunization schedule modification
~ Routine PVC-13 given. two doses of 23-valent pneumococcal at age 2 and 5
~ Meningococcal vaccine 4 dose series: 2, 4, 6, 12 months
~Hemophilus influenzae type B (Hib) vaccine at age 2 years (additional dose)
~Annual flu vaccine
✔✔3 major crises seen in children with sickle cell anemia - ✔✔aplastic crisis
splenic sequestration
vast-occlusive crisis (VOC)
✔✔Define aplastic crisis - ✔✔Transient suppression of RBC production in the bone
marrow with hemolysis of all blood cells
(temporary shutdown of red blood cells)
✔✔What can cause aplastic crisis? - ✔✔-Infection = viral, especially human parvovirus
B19 (Fifths disease)
-Depletion of folic acid
✔✔What are the clinical manifestations of aplastic crisis? - ✔✔-Profound anemia, pallor
-Neutropenia - fever; Risk for infection
-Thrombocytopenia - risk for bleeding anywhere
✔✔What is the treatment for aplastic anemia? - ✔✔Packed RBC transfusion
