CLINICAL REASONING CASES IN
NURSING 7TH EDITION HARDING SNYDER
ACTUAL PAPER SOLVED QUESTIONS
◉ Chronic blood loss — common sources and mechanism of
causing anemia?
Answer: Most often GI tract lesions or gynecologic disturbances;
causes anemia when the loss rate exceeds marrow regenerative
capacity or depletes iron reserves, eventually leading to iron
deficiency
◉ Inherited causes of hemolytic anemia?
Answer: Membrane disorders (hereditary spherocytosis), enzyme
deficiencies (G6PD deficiency), and hemoglobinopathies (sickle
cell disease, thalassemia)
◉ Acquired causes of hemolytic anemia?
Answer: Immunohemolytic anemia (antibody-mediated),
paroxysmal nocturnal hemoglobinuria (acquired genetic defect),
and mechanical trauma (prosthetic valves, microangiopathic
disorders like DIC/TTP/HUS)
◉ Nutritional deficiency causes of decreased RBC production?
Answer: Lack of iron (most common), vitamin B12, or folate
,◉ Chronic disease causes of decreased RBC production?
Answer: Anemia of chronic inflammation (iron sequestration) and
renal failure (erythropoietin deficiency)
◉ Bone marrow failure causes of decreased RBC production?
Answer: Aplastic anemia (stem cell depletion) or myelophthisic
anemia (marrow replacement by tumors or granulomas)
◉ Reticulocyte count pattern: nutritional deficiency vs hemolytic
vs underproduction anemia?
Answer: Nutritional deficiency = typically low; Hemolytic =
characteristically elevated (reticulocytosis, compensatory);
Underproduction (marrow/renal/inflammation) = typically low
(reticulocytopenia)
◉ Morphology pattern: blood loss/nutritional vs hemolytic vs
underproduction anemia?
Answer: Blood loss/nutritional = microcytic/hypochromic (iron)
or macrocytic (B12/folate); Hemolytic = variable, often
normocytic (spherocytes, sickle cells); Underproduction = often
normocytic/normochromic (teardrop cells in myelophthisic
anemia)
◉ Iron status pattern: nutritional deficiency vs hemolytic vs
chronic inflammation anemia?
, Answer: Nutritional deficiency = depleted (low ferritin/iron);
Hemolytic = excessive (hemosiderosis from iron recycling);
Chronic inflammation = sequestered (high ferritin, low serum
iron)
◉ Key clinical signs of iron deficiency vs B12 deficiency?
Answer: Iron deficiency: pica, koilonychia, atrophic glossitis; B12
deficiency: neurologic damage
◉ Key clinical signs of hemolytic anemia?
Answer: Jaundice, splenomegaly, and pigment gallstones
◉ Key clinical signs of underproduction anemia?
Answer: Signs of the underlying disease (e.g., uremia, infection, or
malignancy)
◉ Adult chronic anemia — MCV morphologic classification:
microcytic causes?
Answer: Iron deficiency, thalassemias, and some cases of anemia
of chronic disease
◉ Adult chronic anemia — MCV morphologic classification:
normocytic causes?
Answer: Hemolysis, chronic inflammation, renal failure, and early
blood loss
NURSING 7TH EDITION HARDING SNYDER
ACTUAL PAPER SOLVED QUESTIONS
◉ Chronic blood loss — common sources and mechanism of
causing anemia?
Answer: Most often GI tract lesions or gynecologic disturbances;
causes anemia when the loss rate exceeds marrow regenerative
capacity or depletes iron reserves, eventually leading to iron
deficiency
◉ Inherited causes of hemolytic anemia?
Answer: Membrane disorders (hereditary spherocytosis), enzyme
deficiencies (G6PD deficiency), and hemoglobinopathies (sickle
cell disease, thalassemia)
◉ Acquired causes of hemolytic anemia?
Answer: Immunohemolytic anemia (antibody-mediated),
paroxysmal nocturnal hemoglobinuria (acquired genetic defect),
and mechanical trauma (prosthetic valves, microangiopathic
disorders like DIC/TTP/HUS)
◉ Nutritional deficiency causes of decreased RBC production?
Answer: Lack of iron (most common), vitamin B12, or folate
,◉ Chronic disease causes of decreased RBC production?
Answer: Anemia of chronic inflammation (iron sequestration) and
renal failure (erythropoietin deficiency)
◉ Bone marrow failure causes of decreased RBC production?
Answer: Aplastic anemia (stem cell depletion) or myelophthisic
anemia (marrow replacement by tumors or granulomas)
◉ Reticulocyte count pattern: nutritional deficiency vs hemolytic
vs underproduction anemia?
Answer: Nutritional deficiency = typically low; Hemolytic =
characteristically elevated (reticulocytosis, compensatory);
Underproduction (marrow/renal/inflammation) = typically low
(reticulocytopenia)
◉ Morphology pattern: blood loss/nutritional vs hemolytic vs
underproduction anemia?
Answer: Blood loss/nutritional = microcytic/hypochromic (iron)
or macrocytic (B12/folate); Hemolytic = variable, often
normocytic (spherocytes, sickle cells); Underproduction = often
normocytic/normochromic (teardrop cells in myelophthisic
anemia)
◉ Iron status pattern: nutritional deficiency vs hemolytic vs
chronic inflammation anemia?
, Answer: Nutritional deficiency = depleted (low ferritin/iron);
Hemolytic = excessive (hemosiderosis from iron recycling);
Chronic inflammation = sequestered (high ferritin, low serum
iron)
◉ Key clinical signs of iron deficiency vs B12 deficiency?
Answer: Iron deficiency: pica, koilonychia, atrophic glossitis; B12
deficiency: neurologic damage
◉ Key clinical signs of hemolytic anemia?
Answer: Jaundice, splenomegaly, and pigment gallstones
◉ Key clinical signs of underproduction anemia?
Answer: Signs of the underlying disease (e.g., uremia, infection, or
malignancy)
◉ Adult chronic anemia — MCV morphologic classification:
microcytic causes?
Answer: Iron deficiency, thalassemias, and some cases of anemia
of chronic disease
◉ Adult chronic anemia — MCV morphologic classification:
normocytic causes?
Answer: Hemolysis, chronic inflammation, renal failure, and early
blood loss
