NUR 258 Exam 4 EXPECTED QUESTIONS WITH
VERIFIED ANSWERS
Question 1.
anemia: three
types
ANSWER
Hypo-proliferative: Defective RBC production, bone marrow sup. or chemo Hemolytic: RBC
destruction, sickle cell disease
Bleeding/blood loss: GI, hemorrhage, heavy menstruation
Question 2.
anemia: manifestations
ANSWER
- fatigue
- dizzy
- syncope with standing/exertion
- pallor
- sensitivity to cold
- brittle/ridged/concave nails
- angular cheilosis of lips
- pica
- tongue changes
- vitals: HR, RR, SpO2, dyspnea, hypotension (bleeding)
- jaundice if from hemolysis(sickle cell anemia)
Question 3.
Complete Blood Count (CBC) Labs
ANSWER
Hemoglobin (Hgb): Transports O₂ to all tissues
Hematocrit (HCT): % of RBC in relation to blood volume
,Question 4.
diagnostics for hematologic disorders
ANSWER
Ferritin: iron stores
Sickle-cell test: sickling RBC
Bone marrow aspiration/biopsy: aplastic anemia and leukemia, performed on iliac crest, post-
op precautions for bleeding and infection
Question 5.
iron deficiency anemia Risks, Causes, Diagnostics:
ANSWER
Risks: inadequate intake of iron, vegan, vegetarian
Check ferritin level
Causes: blood loss, menorrhagia, pregnancy, alcohol abuse, IBD, NSAID & aspirin Diagnostics:
colonoscopies, history of heavy periods, dietary intake
Question 6.
iron deficiency anemia: management
ANSWER
Replace what is missing
Iron supplements:
- Vit C helps absorption
- food decreases absorption
- take between meals
- liquid supplement: stains teeth, brush teeth after, drink through straw
Diet: meat, seafood, legume, leafy vegetables, raisins
Question 7.
aplastic anemia
& SSx
ANSWER
damage to the bone marrow stem cells
Pancytopenia: anemia, leukopenia, thrombocytopenia
S/S: infections, purpura, petechiae, retinal hemorrhage, splenomegaly
,Question 8.
aplastic anemia
Tx
ANSWER
Tx:
- Hematopoietic stem cell transplantation (HSCT)
- Immunosuppressive therapy
- transfusions (prevent infection & bleeding)
Question 9.
megaloblastic/pernicious anemia &
SSx/Labs
ANSWER
large RBC
Deficient in: Vit B12 (no intrinsic factor) and folic acid
S/S: think neuro
- sore red tongue
- pallor
- paresthesia in legs and feet
- loss of balance
- loss of proprioception
- confusion (late sign)
Labs: folic acid, Vit B12, MCV
Question 10.
megaloblastic anemia: management
ANSWER
Lifelong
Vitamin B9: broccoli, eggs, legumes, avocados, oral supplement
- educate: large doses will turn urine dark yellow and can mask B12 deficiency Vitamin B12:
milk, almonds, fish, cheese, eggs, red meats
- IM or Sub Q for life
, Question 11.
sickle cell ane-
mia & SSx/Causes/Findings
ANSWER
blood is thick and sickling
Hypoxemia: occlusive/ischemia of organs
- Acute chest syndrome: ischemia of lungs and heart, emergency
S/S: Pain, Pallor, Fatigue
- sickled cells hemolyze (destruction of RBC)
- arrhythmias
- jaundice
- tissue hypoxia, damage, necrosis (slow healing wounds, poor perfusion to heal wound)
Causes: dehydration, infection, stressors
Expected findings: gallstones, splenomegaly
Question 12.
sickle cell vaso-occlusive
crisis & Tx
ANSWER
Periodic episodes of extreme pain, called pain crises
- hypoxia causes pain
- bone pain
- ischemia (may lead to strokes & heart attacks)
Accumulation of erythrocytes and leukocytes: restricted blood flow to organs
Tx:
- analgesics
- fluids
- oxygenate
- hydroxyurea
- transfusions
VERIFIED ANSWERS
Question 1.
anemia: three
types
ANSWER
Hypo-proliferative: Defective RBC production, bone marrow sup. or chemo Hemolytic: RBC
destruction, sickle cell disease
Bleeding/blood loss: GI, hemorrhage, heavy menstruation
Question 2.
anemia: manifestations
ANSWER
- fatigue
- dizzy
- syncope with standing/exertion
- pallor
- sensitivity to cold
- brittle/ridged/concave nails
- angular cheilosis of lips
- pica
- tongue changes
- vitals: HR, RR, SpO2, dyspnea, hypotension (bleeding)
- jaundice if from hemolysis(sickle cell anemia)
Question 3.
Complete Blood Count (CBC) Labs
ANSWER
Hemoglobin (Hgb): Transports O₂ to all tissues
Hematocrit (HCT): % of RBC in relation to blood volume
,Question 4.
diagnostics for hematologic disorders
ANSWER
Ferritin: iron stores
Sickle-cell test: sickling RBC
Bone marrow aspiration/biopsy: aplastic anemia and leukemia, performed on iliac crest, post-
op precautions for bleeding and infection
Question 5.
iron deficiency anemia Risks, Causes, Diagnostics:
ANSWER
Risks: inadequate intake of iron, vegan, vegetarian
Check ferritin level
Causes: blood loss, menorrhagia, pregnancy, alcohol abuse, IBD, NSAID & aspirin Diagnostics:
colonoscopies, history of heavy periods, dietary intake
Question 6.
iron deficiency anemia: management
ANSWER
Replace what is missing
Iron supplements:
- Vit C helps absorption
- food decreases absorption
- take between meals
- liquid supplement: stains teeth, brush teeth after, drink through straw
Diet: meat, seafood, legume, leafy vegetables, raisins
Question 7.
aplastic anemia
& SSx
ANSWER
damage to the bone marrow stem cells
Pancytopenia: anemia, leukopenia, thrombocytopenia
S/S: infections, purpura, petechiae, retinal hemorrhage, splenomegaly
,Question 8.
aplastic anemia
Tx
ANSWER
Tx:
- Hematopoietic stem cell transplantation (HSCT)
- Immunosuppressive therapy
- transfusions (prevent infection & bleeding)
Question 9.
megaloblastic/pernicious anemia &
SSx/Labs
ANSWER
large RBC
Deficient in: Vit B12 (no intrinsic factor) and folic acid
S/S: think neuro
- sore red tongue
- pallor
- paresthesia in legs and feet
- loss of balance
- loss of proprioception
- confusion (late sign)
Labs: folic acid, Vit B12, MCV
Question 10.
megaloblastic anemia: management
ANSWER
Lifelong
Vitamin B9: broccoli, eggs, legumes, avocados, oral supplement
- educate: large doses will turn urine dark yellow and can mask B12 deficiency Vitamin B12:
milk, almonds, fish, cheese, eggs, red meats
- IM or Sub Q for life
, Question 11.
sickle cell ane-
mia & SSx/Causes/Findings
ANSWER
blood is thick and sickling
Hypoxemia: occlusive/ischemia of organs
- Acute chest syndrome: ischemia of lungs and heart, emergency
S/S: Pain, Pallor, Fatigue
- sickled cells hemolyze (destruction of RBC)
- arrhythmias
- jaundice
- tissue hypoxia, damage, necrosis (slow healing wounds, poor perfusion to heal wound)
Causes: dehydration, infection, stressors
Expected findings: gallstones, splenomegaly
Question 12.
sickle cell vaso-occlusive
crisis & Tx
ANSWER
Periodic episodes of extreme pain, called pain crises
- hypoxia causes pain
- bone pain
- ischemia (may lead to strokes & heart attacks)
Accumulation of erythrocytes and leukocytes: restricted blood flow to organs
Tx:
- analgesics
- fluids
- oxygenate
- hydroxyurea
- transfusions
