NUR 2356 FINAL EXAM 2 LATEST VERSIONS 2026 MULTIDIMENSIONAL CARE 1 FINAL/ MDC 1 FINAL EXAM QUESTIONS AND CORRECT
ANSWERS
Red blood cell production is stimulated by:
1. Tachycardia
2. Tachypnea
3. Renin angiotensin
4. Hypoxia ✔️Hypoxia
4 Main components of blood composition ✔️RBC, WBC, platelets, plasma
What is the composition of plasma ✔️90% H2O
10% solutes - glucose, protein, albumin, hormones, etc
Where is bone marrow aspiration in infants? ✔️Tibia
Where is bone marrow aspiration in toddlers and preschoolers? ✔️femur and tibia
Where is bone marrow aspiration in children over 5? ✔️pelvis (iliac crest)
Where is bone marrow production in young adults/adults? ✔️ribs, sternum, vertebra, pelvis, skull, clavicle, scapula
what is anemia ✔️a condition in which levels of red blood cells and hemoglobin are lower than normal
4 types of anemia ✔️Iron deficiency
lead poisoning
sickle cell
B-thalassemia
Define iron deficiency anemia ✔️reduction in the iron stores of the body causing an inadequate production of hemoglobin
What is iron needed for? ✔️to make hgb
signs and symptoms of iron deficiency anemia ✔️pallor
tachycardia
tachypnea
lethargy
fatigue
irritability
Why are neonates at risk for iron deficiency anemia? ✔️-lack the maternal iron stores
-Full term infants have maternal iron stores until approximately 6 months of age
-Havent had the time in utero to store up the needed iron supply (preterm)
How can you treat a neonate with iron deficiency anemia? ✔️Iron fortified formula
What are risk factors for iron deficiency anemia in infants and children? ✔️1.inadequate iron intake
2.Malabsorption of iron in GI tract
,3.Chronic blood loss
Food with good sources of iron ✔️red meat, egg yolk, leafy greens, dried fruits, fortified cereals/formulas, beef, chicken, fish, beans, nuts, seeds,
peanut butter, eggs, prunes, whole grain bread
How is iron deficiency anemia diagnosed? ✔️Serum lab evaluation:
-Red blood cell count = microcytic (small) and hypo chronic (pale in color)
-low hemoglobin
-low hematocrit
-low reticulocyte count
-low serum iron concentration
-high total iron binding capacity
What is the goal of treatment for iron deficiency anemia ✔️treat medical problem causing malabsorption or blood loss/ identify cause
What is the treatment method for iron deficiency anemia? ✔️Increase iron take
~ Dietary sources
~Medication supplement (ferrosol or ferrous sulfate)
What should nurses and parents know about administering iron to children? ✔️-Administer to back of mouth because it stains teeth, can cause
constipation, and black/green stool
-Give with orange juice or citric acid to help with absorption
-Do not give with milk or antacids
-Give on empty stomach unless GI distress
Lead Poisoning Risks ✔️-Children under the age of 6
-Children living at or below the poverty line who live in older (prior to 1978) housing
-Children adopted from other countries where there are less strict environmental regulations
Environmental causes of lead poisoning ✔️-Lead based paint
-Plumbing from lead pipes
-soil
Dietary factors of lead poisoning ✔️-iron deficiency
-calcium deficiency
Patient-child interactions ✔️-Job or hobby exposure
-home remedies or cultural practices
How does lead poisoning cause anemia ✔️lead can replace iron on Hgb causing O2 to not be delivered causing anemia
Clinical manifestation of lead poisoning ✔️-Asymptomatic
-Signs of anemia
-Growth and developmental lags
-Behavioral changes
-Neurologic changes
,-Gastrointestinal changes
can someone be asymptomatic if they have lead poisoning ✔️yes
signs of anemia (lead poisoning) ✔️pallor, fatigue, weakness, shortness of breath, headache, tachycardia - because lead replaces iron in Hgb
causing anemia
Growth and developmental lags in lead poisoning ✔️learning difficulties
Neurologic signs and symptoms of lead poisoning ✔️-Headache, irritability, difficulty concentrating, loss of motor skills, paralysis, tremors
High levels: encephalopathy, seizures, and brain damage
Gastrointestinal signs and symptoms of lead poisoning ✔️abdominal pain, failure to gain weight, weight loss, vomiting, constipation
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
ANSWERS
Red blood cell production is stimulated by:
1. Tachycardia
2. Tachypnea
3. Renin angiotensin
4. Hypoxia ✔️Hypoxia
4 Main components of blood composition ✔️RBC, WBC, platelets, plasma
What is the composition of plasma ✔️90% H2O
10% solutes - glucose, protein, albumin, hormones, etc
Where is bone marrow aspiration in infants? ✔️Tibia
Where is bone marrow aspiration in toddlers and preschoolers? ✔️femur and tibia
Where is bone marrow aspiration in children over 5? ✔️pelvis (iliac crest)
Where is bone marrow production in young adults/adults? ✔️ribs, sternum, vertebra, pelvis, skull, clavicle, scapula
what is anemia ✔️a condition in which levels of red blood cells and hemoglobin are lower than normal
4 types of anemia ✔️Iron deficiency
lead poisoning
sickle cell
B-thalassemia
Define iron deficiency anemia ✔️reduction in the iron stores of the body causing an inadequate production of hemoglobin
What is iron needed for? ✔️to make hgb
signs and symptoms of iron deficiency anemia ✔️pallor
tachycardia
tachypnea
lethargy
fatigue
irritability
Why are neonates at risk for iron deficiency anemia? ✔️-lack the maternal iron stores
-Full term infants have maternal iron stores until approximately 6 months of age
-Havent had the time in utero to store up the needed iron supply (preterm)
How can you treat a neonate with iron deficiency anemia? ✔️Iron fortified formula
What are risk factors for iron deficiency anemia in infants and children? ✔️1.inadequate iron intake
2.Malabsorption of iron in GI tract
,3.Chronic blood loss
Food with good sources of iron ✔️red meat, egg yolk, leafy greens, dried fruits, fortified cereals/formulas, beef, chicken, fish, beans, nuts, seeds,
peanut butter, eggs, prunes, whole grain bread
How is iron deficiency anemia diagnosed? ✔️Serum lab evaluation:
-Red blood cell count = microcytic (small) and hypo chronic (pale in color)
-low hemoglobin
-low hematocrit
-low reticulocyte count
-low serum iron concentration
-high total iron binding capacity
What is the goal of treatment for iron deficiency anemia ✔️treat medical problem causing malabsorption or blood loss/ identify cause
What is the treatment method for iron deficiency anemia? ✔️Increase iron take
~ Dietary sources
~Medication supplement (ferrosol or ferrous sulfate)
What should nurses and parents know about administering iron to children? ✔️-Administer to back of mouth because it stains teeth, can cause
constipation, and black/green stool
-Give with orange juice or citric acid to help with absorption
-Do not give with milk or antacids
-Give on empty stomach unless GI distress
Lead Poisoning Risks ✔️-Children under the age of 6
-Children living at or below the poverty line who live in older (prior to 1978) housing
-Children adopted from other countries where there are less strict environmental regulations
Environmental causes of lead poisoning ✔️-Lead based paint
-Plumbing from lead pipes
-soil
Dietary factors of lead poisoning ✔️-iron deficiency
-calcium deficiency
Patient-child interactions ✔️-Job or hobby exposure
-home remedies or cultural practices
How does lead poisoning cause anemia ✔️lead can replace iron on Hgb causing O2 to not be delivered causing anemia
Clinical manifestation of lead poisoning ✔️-Asymptomatic
-Signs of anemia
-Growth and developmental lags
-Behavioral changes
-Neurologic changes
,-Gastrointestinal changes
can someone be asymptomatic if they have lead poisoning ✔️yes
signs of anemia (lead poisoning) ✔️pallor, fatigue, weakness, shortness of breath, headache, tachycardia - because lead replaces iron in Hgb
causing anemia
Growth and developmental lags in lead poisoning ✔️learning difficulties
Neurologic signs and symptoms of lead poisoning ✔️-Headache, irritability, difficulty concentrating, loss of motor skills, paralysis, tremors
High levels: encephalopathy, seizures, and brain damage
Gastrointestinal signs and symptoms of lead poisoning ✔️abdominal pain, failure to gain weight, weight loss, vomiting, constipation
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
