A&E 3 Final Exam questions and answers
100% verified 2025/2026
Anemia - Answer • Common disorder of aging
• Clinical sign → not a specific disease
• Falsely attributed to normal aging
• Vague symptoms until disease is severe
Anemia: causes - Answer o Dietary problems, genetic disorders, bone marrow disease, excessive
bleeding
Anemia: CM - Answer o Fatigue, low energy, shortness of breath, mental status change, pallor
o Severe anemia with: tachycardia, palpitations, systolic murmurs, angina, dyspnea, orthostatic
hypotension
Anemia: Diagnosis - Answer o Hemoglobin
• Males < 13
• Females < 12
• May be artificially higher in dehydrated older person, smokers, high altitudes
• 0.5 - 1.0 g/dL lower in African Americans and overhydrated
o Hematocrit
o Red blood cell count and indices
o Reticulocyte count
o White blood cell count and differential
o Platelet count
o Hgb and Hct are influenced by hydration
Iron Deficiency Anemia: treatment - Answer • Ferrous sulfate 325mg daily → take alone
• Excessive blood donation or frequent plebotomies
• Report new onset constipation or gastric irritation
,• Look at GI tract: black stools my indicate upper GI bleeding
Vitamin B12 Deficiency Anemia: causes - Answer Megaloblastic or Macrocytic Anemia
o Failed GI absorption → pernicious anemia (lack of intrinsic factor)
o Causes: poor nutrition, vegetarian diet, dairy lacking, GI problems with absorption, malignancy,
chronic renal failure
Serum B12 levels < 200
Vitamin B12 Deficiency Anemia: Symptoms - Answer o Pallor, glossitis (tongue develops smooth
appearance), fatigue, weight loss
o Neurological changes: cognitive impairment, depression, mania, peripheral neuropathies, numbness,
tingling and difficulty waling or maintaining balance
B12 Deficiency Anemia: Treatment - Answer • IM B12 if intrinsic factor problem
• Oral 1,000 to 2,000 mcg/day because of variable absorption
• Treatment can halt progression but may not reverse changes
Folic Acid deficiency anemia - Answer Macrocytic
o Serum folate < 4mg/mL
o Symptoms similar to B12 deficiency without neuro sx
o Found in pts with
• Malabsorption syndromes (Crohn's)
• Poor nutrition
• Alcoholism
• Underlying malignancies
• Drug treatment with anticonvulsants → blocks folic acid metabolism
Folic Acid Deficiency anemia: treatment - Answer • Folic acid 1 mg/day
• Dietary recommendations: liver, OJ, cereals, grains, beans, nuts, spinach
,Anemia & chronic infection/ inflammation - Answer • Disease and pathologic mechanisms
• 4-8 weeks of illness
• Decreased erythropoietin production
• Decreased RBC survival
• RBCs are of normal size and contain normal amounts of hgb but there are too few to carry O2
• Impaired transport of iron to the bone marrow
o Reticulocyte count low
o Serum iron normal or slightly reduced; serum ferritin is normal or elevated
Anemia & Renal insufficiency - Answer • Decreased erythropoiesis
• Decreased RBC survival
• Serum iron stores normal
• Epo is given IV or subq → can increase hgb levels
Anemia & chronic liver disease - Answer • Decreased RBC production and survival
• Large quantities of alcohol → toxic to the bone marrow and liver → decreased serum iron levels + total
iron binding capacity
Anemia & Cancer - Answer • Chemo can suppress bone marrow function, decrease appetite, cause N &
V, nutritional deficiencies → inadequate caloric, protein, and vitamin intake
Anemia: nursing interventions & collaborative care - Answer o Aim to reduce fatigue and improve RBC
count while treating underlying problem
• Nutrition/collaborate with Rd
• Packed RBC transfusion
• Drug therapy epoetin alfa or darbepoetin
• Energy management → may collaborate with PT
Polycythemia Vera - Answer • Sustained increased hemoglobin
• Cancer of the RBCs
, • > 60 years at diagnosis
• Common in Caucasian men of European Jewish ancestry
Polycythemia Vera: symptoms - Answer • HTN, vascular stasis, hyperkalemia, dizziness and visual
disturbances, night sweats, increased blood viscosity → greater risk for clots
Pruritis
Polycythemia Vera: treatment - Answer hydroxyurea periodic phlebotomy, increased fluid, promote
venous return, gentle starch baths
Multiple Myeloma - Answer • WBC cancer involving mature lymphocytes (plasma cells)
• Excessive antibody production
• Median age at dx is 65
• More frequent in African Americans and men
Multiple Myeloma: symptoms - Answer o Bone pain in lower ribs or back, pathological fractures, pallor,
dyspnea, fatigue, palpitations and night sweats, anemia, easy bruising, renal dysfunction
Multiple myeloma: treatment - Answer o Options vary
o Chemo, stem cell transplant
o All treatment is palliative
o Death is generally from infection
o Pain management and comfort measures
Aging: immune system changes - Answer • Decreased fever response
• Decline in cell-mediated immunity with possible disease reactivation (TB or herpes zoster)
• Impaired t-cell function; t-cells mature in the thymus gland which shrinks after adolescence; by middle
age only 15% its normal size
• Delayed or decreased hypersensitivity response
• Decreased inflammatory response as a precursor to granulation and skin healing
100% verified 2025/2026
Anemia - Answer • Common disorder of aging
• Clinical sign → not a specific disease
• Falsely attributed to normal aging
• Vague symptoms until disease is severe
Anemia: causes - Answer o Dietary problems, genetic disorders, bone marrow disease, excessive
bleeding
Anemia: CM - Answer o Fatigue, low energy, shortness of breath, mental status change, pallor
o Severe anemia with: tachycardia, palpitations, systolic murmurs, angina, dyspnea, orthostatic
hypotension
Anemia: Diagnosis - Answer o Hemoglobin
• Males < 13
• Females < 12
• May be artificially higher in dehydrated older person, smokers, high altitudes
• 0.5 - 1.0 g/dL lower in African Americans and overhydrated
o Hematocrit
o Red blood cell count and indices
o Reticulocyte count
o White blood cell count and differential
o Platelet count
o Hgb and Hct are influenced by hydration
Iron Deficiency Anemia: treatment - Answer • Ferrous sulfate 325mg daily → take alone
• Excessive blood donation or frequent plebotomies
• Report new onset constipation or gastric irritation
,• Look at GI tract: black stools my indicate upper GI bleeding
Vitamin B12 Deficiency Anemia: causes - Answer Megaloblastic or Macrocytic Anemia
o Failed GI absorption → pernicious anemia (lack of intrinsic factor)
o Causes: poor nutrition, vegetarian diet, dairy lacking, GI problems with absorption, malignancy,
chronic renal failure
Serum B12 levels < 200
Vitamin B12 Deficiency Anemia: Symptoms - Answer o Pallor, glossitis (tongue develops smooth
appearance), fatigue, weight loss
o Neurological changes: cognitive impairment, depression, mania, peripheral neuropathies, numbness,
tingling and difficulty waling or maintaining balance
B12 Deficiency Anemia: Treatment - Answer • IM B12 if intrinsic factor problem
• Oral 1,000 to 2,000 mcg/day because of variable absorption
• Treatment can halt progression but may not reverse changes
Folic Acid deficiency anemia - Answer Macrocytic
o Serum folate < 4mg/mL
o Symptoms similar to B12 deficiency without neuro sx
o Found in pts with
• Malabsorption syndromes (Crohn's)
• Poor nutrition
• Alcoholism
• Underlying malignancies
• Drug treatment with anticonvulsants → blocks folic acid metabolism
Folic Acid Deficiency anemia: treatment - Answer • Folic acid 1 mg/day
• Dietary recommendations: liver, OJ, cereals, grains, beans, nuts, spinach
,Anemia & chronic infection/ inflammation - Answer • Disease and pathologic mechanisms
• 4-8 weeks of illness
• Decreased erythropoietin production
• Decreased RBC survival
• RBCs are of normal size and contain normal amounts of hgb but there are too few to carry O2
• Impaired transport of iron to the bone marrow
o Reticulocyte count low
o Serum iron normal or slightly reduced; serum ferritin is normal or elevated
Anemia & Renal insufficiency - Answer • Decreased erythropoiesis
• Decreased RBC survival
• Serum iron stores normal
• Epo is given IV or subq → can increase hgb levels
Anemia & chronic liver disease - Answer • Decreased RBC production and survival
• Large quantities of alcohol → toxic to the bone marrow and liver → decreased serum iron levels + total
iron binding capacity
Anemia & Cancer - Answer • Chemo can suppress bone marrow function, decrease appetite, cause N &
V, nutritional deficiencies → inadequate caloric, protein, and vitamin intake
Anemia: nursing interventions & collaborative care - Answer o Aim to reduce fatigue and improve RBC
count while treating underlying problem
• Nutrition/collaborate with Rd
• Packed RBC transfusion
• Drug therapy epoetin alfa or darbepoetin
• Energy management → may collaborate with PT
Polycythemia Vera - Answer • Sustained increased hemoglobin
• Cancer of the RBCs
, • > 60 years at diagnosis
• Common in Caucasian men of European Jewish ancestry
Polycythemia Vera: symptoms - Answer • HTN, vascular stasis, hyperkalemia, dizziness and visual
disturbances, night sweats, increased blood viscosity → greater risk for clots
Pruritis
Polycythemia Vera: treatment - Answer hydroxyurea periodic phlebotomy, increased fluid, promote
venous return, gentle starch baths
Multiple Myeloma - Answer • WBC cancer involving mature lymphocytes (plasma cells)
• Excessive antibody production
• Median age at dx is 65
• More frequent in African Americans and men
Multiple Myeloma: symptoms - Answer o Bone pain in lower ribs or back, pathological fractures, pallor,
dyspnea, fatigue, palpitations and night sweats, anemia, easy bruising, renal dysfunction
Multiple myeloma: treatment - Answer o Options vary
o Chemo, stem cell transplant
o All treatment is palliative
o Death is generally from infection
o Pain management and comfort measures
Aging: immune system changes - Answer • Decreased fever response
• Decline in cell-mediated immunity with possible disease reactivation (TB or herpes zoster)
• Impaired t-cell function; t-cells mature in the thymus gland which shrinks after adolescence; by middle
age only 15% its normal size
• Delayed or decreased hypersensitivity response
• Decreased inflammatory response as a precursor to granulation and skin healing
