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Exam 4 (Medsurg):Anemia

Total questions: 110

Worksheet time: 59mins

Name
Class
Date
1.

What is anemia a deficiency in?

a)

Number of RBCs

b)

Quantity of hemoglobin

c)

Volume of packed RBCs (hematocrit)

d)

All of the above

2.

Which of the following is NOT a cause of decreased RBC production?

a)

Deficient cobalamin

b)

Decreased erythropoietin

c)

Deficient tyramines

d)

Decreased iron availability

e)

Deficient folic acid

3.

SATA: Which of the following is a cause of increased RBC destruction?

a)

Hemolysis (ex: sickle cell anemia)

b)

Medication (ex: methyldopa)

c)

Incompatible blood

d)

Trauma (ex: CABG)

e)

Thrombocytopenia

4.

Anemia is considered a _____, rather than a specific disease.

a)

symptom

b)

side effect

c)

adverse effect

d)

prognosis

5.

Fill in the blank: RBCs carry ________ from tissues back to the lungs.

a)

carbon dioxide

b)

oxygen

c)

glucose

d)

nitrogen

6.

List two nutrients whose deficiency can cause decreased RBC production.

a)

Iron and Vitamin B12

b)

Calcium and Vitamin D

c)

Potassium and Vitamin C

d)

Sodium and Vitamin E

7.

What is the normal hemoglobin (Hgb) level for adult males?

a)

13.8-17.2 g/dL

b)

10.0-12.0 g/dL

c)

18.0-22.0 g/dL

d)

8.5-11.0 g/dL

8.

What is the normal hemoglobin (Hgb) level for adult females?

a)

12.1-15.1 g/dL

b)

10.0-12.0 g/dL

c)

15.5-18.0 g/dL

d)

8.0-11.0 g/dL

9.

What is the normal hemoglobin (Hgb) level for pregnant females?

a)

11-12 g/dL

b)

13-14 g/dL

c)

9-10 g/dL

d)

15-16 g/dL

10.

What is the normal hemoglobin (Hgb) level for children?

a)

11-16 g/dL

b)

8-10 g/dL

c)

16-20 g/dL

d)

6-9 g/dL

11.

Which of the following is an integumentary manifestation of anemia?

a)

Pallor: decreased Hgb, decreased blood flow to the skin

b)

Jaundice: increased concentration of serum bilirubin

c)

Pruritis: increased serum and skin bile salt concentrations

d)

All of the above

12.

Cardiac output in anemia is maintained by increasing both HR and SV, which manifests as ________.

a)

TACHYCARDIA

b)

BRADYCARDIA

c)

ARRHYTHMIA

d)

HYPOTENSION

13.

SATA: Which of the following is an acute intervention for anemia?

a)

Blood or blood product transfusions

b)

Drug therapy such as erythropoietin and vitamins

c)

Volume replacement

d)

Dietary and lifestyle changes, which can reverse SOME anemias

e)

Oxygen therapies

14.

What is the life span of an RBC?

a)

120 days

b)

60 days

c)

10 days

d)

200 days

15.

What percentage of ingested iron is absorbed in cases of inadequate dietary intake?

a)

5-10%

b)

15-20%

c)

20-30%

d)

1-2%

16.

Where is erythropoietin/EPO primarily produced?

a)

Kidneys

b)

Liver

c)

Bone marrow

d)

Spleen

17.

Which type of anemia is considered the MOST common?

a)

Iron-deficiency anemia

b)

Aplastic anemia

c)

Thalassemia

d)

Hemolytic anemia

18.

Heme accounts for portion of the body's iron?

a)

1/3rd

b)

2/3rds

c)

1/4th

d)

3/4ths

19.

____% of erythropoietin is produced in the liver.

a)

10

b)

20

c)

30

d)

50

20.

How much iron is contained in 2 ml of whole blood?

a)

1 mg

b)

0.1 mg

c)

5 mg

d)

10 mg

21.

Iron is present in all RBCs as ______ in hemoglobin and in a stored form.

a)

heme

b)

globin

c)

ferritin

d)

albumin

22.

Where does iron absorption occur?

a)

Duodenum

b)

Cecum

c)

Ileum

d)

Periosteum

23.

Which systems does chronic blood loss MOST COMMONLY occur through in iron-deficiency anemia?

a)

A) Respiratory and cardiovascular systems

b)

B) GI and GU systems

c)

C) Nervous and endocrine systems

d)

D) Musculoskeletal and integumentary systems

24.

Which of the following is a contributing factor to iron-deficiency anemia?

a)

Diabetes

b)

Pregnancy

c)

Hypertension

d)

Hyperthyroidism

25.

What is the most common clinical manifestation of iron-deficiency anemia?

a)

Glossitis

b)

Pallor

c)

Cheilitis

d)

Fatigue

26.

Fill in the blank: Glossitis (________ inflammation) is the second most common finding in iron-deficiency anemia.

a)

tongue

b)

skin

c)

bone

d)

joint

27.

Cheilitis refers to inflammation of which part of the body?

a)

A) Tongue

b)

B) Lips

c)

C) Cheeks

d)

D) Gums

28.

Lab findings in iron-deficiency anemia typically show ______ H+H.

a)

LOW

b)

HIGH

c)

NORMAL

d)

ABSENT

29.

Which of the following is NOT a diagnostic method for iron-deficiency anemia?

a)

Stool guaiac test

b)

Endoscopy

c)

Colonoscopy

d)

MRI

30.

SATA: Iron therapy comes in which forms/routes?

a)

Oral/PO

b)

Parenteral/IV and IM

c)

Transdermal/SQ

d)

Intrathecal/Epidural

31.

Efforts in treating iron-deficiency anemia are aimed at ______ iron.

a)

REPLACING

b)

REMOVING

c)

REDUCING

d)

RESTRICTING

32.

Which type of therapy is NOT mentioned as a treatment for iron-deficiency anemia?

a)

Nutritional therapy

b)

Oral or parenteral iron supplements

c)

Transfusion of packed RBCs

d)

Chemotherapy

33.

What is the recommended daily dose of oral iron for iron-deficiency anemia?

a)

50-100 mg

b)

100-150 mg

c)

150-200 mg

d)

200-250 mg

34.

Ferrous sulfate is BEST absorbed in which type of environment?

a)

Alkaline

b)

Neutral

c)

Acidic

d)

Basic

35.

Liquid iron should be diluted and ingested through a _______.

a)

straw

b)

spoon

c)

cup

d)

bottle

36.

Which of the following are side effects of iron therapy?

a)

Heartburn

b)

Constipation

c)

Diarrhea

d)

All of the above

37.

Black stools as a side effect of iron replacement are a sign of melena.

a)

True

b)

False

38.

Parenteral iron is indicated for which of the following?

a)

Malabsorption

b)

Oral iron intolerance

c)

Need for iron beyond normal limits

d)

Poor patient compliance

e)

All of the above

39.

IM administration of parenteral iron may _______ the skin.

a)

stain

b)

heal

c)

cool

d)

soften

40.

Which of the following are considered at-risk groups for iron deficiency?

a)

Older adults

b)

Persons from low SES backgrounds

c)

Pregnant women

d)

Premenopausal women

e)

All of the above

41.

Patient teaching for iron therapy includes diet teaching, supplemental iron, discussing diagnostic studies, and emphasizing _______.

a)

compliance

b)

hydration

c)

exercise

d)

rest

42.

Iron therapy should be continued for _______ months after Hgb level returns to normal.

a)

2-3

b)

6-8

c)

1-2

d)

4-5

43.

Thalassemia is a group of diseases involving inadequate production of normal _______.

a)

hemoglobin

b)

iron

c)

platelets

d)

antibodies

44.

Thalassemia leads to decreased _______ production.

a)

RBC

b)

WBC

c)

Platelet

d)

Plasma

45.

Thalassemia is common in ethnic groups near the Mediterranean and in equitorial/near-equitorial regions of _______.

a)

Asia

b)

Middle East

c)

Africa

d)

All of the above

46.

Thalassemia is a genetic problem with _______ protein.

a)

globulin

b)

albumin

c)

keratin

d)

collagen

47.

What is the group of disorders characterized by impaired DNA synthesis and presence of megaloblasts?

a)

A) Megaloblastic Anemias

b)

B) Hemolytic Anemias

c)

C) Iron Deficiency Anemia

d)

D) Sickle Cell Anemia

48.

Majority of megaloblastic anemias result from deficiency in which vitamins?

a)

Vitamin C and Vitamin D

b)

Vitamin B12 and Folate

c)

Vitamin A and Iron

d)

Vitamin K and Vitamin B6

49.

Fill in the blank: Intrinsic factor (IF) is a protein secreted by the ________ mucosa.

a)

gastric

b)

intestinal

c)

oral

d)

esophageal

50.

IF is required for cobalamin absorption in the distal ileum.

a)

True

b)

False

51.

If IF is NOT secreted, cobalamin will NOT be absorbed.

a)

True

b)

False

52.

What is the most common cause of cobalamin deficiency?

a)

Pernicious anemia

b)

Iron deficiency

c)

Chronic blood loss

d)

Sickle cell disease

53.

Pernicious anemia is caused by an absence of which substance?

a)

Hemoglobin

b)

Intrinsic Factor

c)

Folic Acid

d)

Vitamin C

e)

Tumor Necrosis Factor

54.

Which of the following is NOT a GI manifestation of cobalamin deficiency?

a)

Sore tongue

b)

Anorexia

c)

Nausea/Vomiting

d)

Reflux

55.

SATA: Neuromuscular manifestations of pernicious anemia include:

a)

paresthesias of feet and hands

b)

decreased vibratory and position senses

c)

muscle weakness

d)

impaired thought processes

e)

clonus and hyperreflexia

56.

SATA: Cobalamin deficiency can occur in which of the following situations?

a)

GI surgery, chronic diseases of the GI tract

b)

Chronic alcoholics, strict vegetarians

c)

Long term users of H2RBs and PPIs

d)

Long-term corticosteroid and mineralocorticoid use

57.

Cobalamin replacement is the treatment of choice for cobalamin deficiency. Which two routes can cobalamin be administered?

a)

PO, Parenteral

b)

PO, Transdermal

c)

Parenteral, Intranasal

d)

PO, Intranasal

e)

Transdermal, Parenteral

58.

Patients will die in 1-3 years without treatment for cobalamin deficiency.

a)

True

b)

False

59.

Pernicious anemia can be reversed with ongoing treatment, but long-standing neuromuscular complications may not be reversible.

a)

True

b)

False

60.

Fill in the blank: Folic acid is required for DNA synthesis, RBC formation and RBC ________.

a)

maturation

b)

digestion

c)

respiration

d)

excretion

e)

destruction

61.

Which clinical manifestation differentiates folic acid deficiency from cobalamin deficiency?

a)

Presence of neurologic problems

b)

Absence of neurologic problems

c)

Presence of genitourinary problems

d)

Absence of malabsorption syndromes

e)

Absence of genitourinary problems

62.

In folic acid deficiency, serum folate is low (Normal: 3-25 mg/ml), but serum cobalamin is _______.

a)

normal

b)

high

c)

low

d)

absent

63.

What is the usual dose of folic acid per day for replacement therapy?

a)

0.5 mg

b)

1 mg

c)

2 mg

d)

5 mg

64.

What is pancytopenia?

a)

Decrease in all blood cell types

b)

Decrease in red blood cells

c)

Decrease in platelets

d)

Decrease in white blood cells

e)

Decrease in all cell types

65.

Aplastic anemia is characterized by:

a)

Hypercellular bone marrow

b)

Hypocellular bone marrow

c)

Increased platelet values

d)

High serum folate

66.

What are the two major types of etiology for aplastic anemia?

a)

Congenital and acquired

b)

Viral and bacterial

c)

Chemical and radiation

d)

Chronic and acute

67.

Symptoms of aplastic anemia are caused by suppression of any or all _______ elements.

a)

bone marrow

b)

red blood cell

c)

platelet

d)

white blood cell

68.

SATA: Which of the following are manifestations in aplastic anemia?

a)

Fatigue

b)

Dyspnea

c)

Neutropenia

d)

Prolonged bleeding time

e)

Low reticulocyte count

69.

Fill in the blank: Aplastic anemia is characterized by ________ count and prolonged bleeding time.

a)

Low reticulocyte

b)

High reticulocyte

c)

High platelet

d)

High neutrophil

70.

Fill in the blank: In aplastic anemia, serum iron and TIBC are ________.

a)

elevated

b)

decreased

c)

absent

d)

unchanged

71.

Fill in the blank: Hypocellular bone marrow with increased fat content is also known as ________ marrow.

a)

yellow

b)

red

c)

white

d)

spongy

72.

The prognosis for a patient with severe aplastic anemia is _____, but certain immune therapies and bone marrow transplantations can be _______.

a)

poor, palliative

b)

poor, curative

c)

poor, supportive

d)

promising, supportive

e)

promising, palliative

73.

Fill in the blank: Hypovolemic shock is a condition that disrupts ________ integrity and can lead to blood loss anemia.

a)

vascular

b)

cellular

c)

neural

d)

muscular

74.

Clinical signs and symptoms are more important than laboratory values in acute blood loss.

a)

True

b)

False

75.

Fill in the blank: S/S of blood loss include _____ of the eyes.

a)

yellowing

b)

dilated pupils

c)

redness

d)

swelling

76.

Fill in the blank: Cardiac S/S of blood loss includes _____ and ______.

a)

palpitations, tachycardia

b)

palpitations, bradycardia

c)

cor pulomanle, tachycardia

d)

cor pulmonale, bradycardia

77.

SATA: Select the symptoms of acute blood loss.

a)

fatigue and dizziness

b)

changed stool color

c)

shortness of breath

d)

splenomegaly and hypotension

e)

muscle weakness

78.

SATA: Select the symptoms of SEVERE blood loss.

a)

fainting

b)

angina

c)

myocardial infarction

d)

hypertensive crisis

e)

stroke

79.

Blood loss may be impossible to prevent if caused by _____.

a)

Trauma

b)

Thalassemia

c)

Cobalamin Deficiency

d)

Folate Deficiency

80.

SATA: Select the sources of CHRONIC blood loss.

a)

ulcers

b)

hemorrhoids

c)

menstruation

d)

laceration

e)

trauma

81.

Hemolytic anemia is defined as _____ or hemolysis of RBCs of a rate that _______.

a)

destruction, exceeds production

b)

genesis, exceeds destruction

c)

absorption, exceeds reabsorption

d)

reabsorption, exceeds absorption

82.

What is a specific manifestation that distinguishes hemolytic anemia from other types of anemia?

a)

angina

b)

hypotension

c)

jaundice

d)

respiratory failure

e)

stool color change

83.

With sudden blood loss, lab values may seem ______ for 2-3 days.

a)

NORMAL

b)

LOW

c)

HIGH

d)

UNSTABLE

84.

Once plasma volume is replaced after an acute hemorrhage, what becomes evident?

a)

Low RBC count

b)

High BP

c)

High Hgb count

d)


Changed stool color

e)

High WBC count

85.

Care of Acute Blood Loss includes:

a)

Replacing blood volume to prevent shock

b)

Identifying the source of the hemorrhage and stopping blood loss

c)

Providing supplemental iron

d)

All of the above

86.

SATA: Anemia is classified by:

a)

CBC

b)

Reticulocyte Count

c)

Peripheral Blood Smear

d)

BMP

e)

LFTs

87.

A patient taking iron supplements is concerned about a new onset of black stools. The RN recognizes that:

a)

this is a sign of anemia r/t an upper GI bleed and a medical emergency

b)

this is a sign of anemia r/t an lower GI bleed and a medical emergency

c)

this is a sign of megaloblastic anemia and is not an emergency, but worthy basis for hospital admission

d)

this is completely normal and expected, considered a good sign of iron replacement therapy

88.

Maintenance of renal function is a MAJOR focus of treatment of which type of anemia?

a)

Thalassemia

b)

Pernicious anemia

c)

Hemolytic anemia

d)

Aplastic anemia

89.

_______ are a group of inherited, autosomal recessive disorders characterized by the presence of abnormal forms of Hgb in RBCs.

a)

Thalassemias

b)

Aplastic anemias

c)

Megaloblastic anemias

d)

Sickle cell anemias

90.

With enough replacement therapy and compliance, sickle cell anemia is curable.

a)

True

b)

False

91.

Sickle cell anemia is often fatal.

a)

True

b)

False

92.

In sickle cell anemia, abnormal Hgb causes erythrocytes to take on a stiff and elongated "sickle" shape due to:

a)

increased bradykinin

b)

decreased histamine

c)

decreased O2

d)

decreased PO4-

93.

Sickle cells are stiff and angular, causing them to become _____ in small

capillaries.

a)

destroyed

b)

reabsorbed

c)

stuck

d)

separated

94.

Sickle cell crisis is a severe, painful, acute exacerbation of sickling that causes a __________ crisis.

a)

vasodilatory

b)

vasoocclusive

c)

vasopermeable

d)

vasodegenerative

95.

Sickle cell crisis leads to severe capillary ______, which causes tissue ______.

a)

hypoxia, necrosis

b)

hypotension, fibrinolitis

c)

hyperkalemia, arrhythmia

d)

hypomagnesemia, tremors

96.

The typical sickle cell patient is AYSMPTOMATIC EXCEPT during sickling episodes.

a)

True

b)

False

97.

Sickle cell patients are prone to:

a)

kidney stones

b)

gallstones

c)

cholecystitis

d)

hepatitis

98.

Which complication of sickle cell anemia is the MOST major cause of morbidity and mortality?

a)

jaundice

b)

splenomegaly

c)

occlusion

d)

infection

99.

Severe sickle-cell related infections can cause aplastic crisis, which in turn can lead to a

full-blown _________________.

a)

shutdown of WBC production

b)

shutdown of platelet production

c)

shutdown of RBC production

d)

shutdown of plasma production

100.

The most common sickle-cell related infection is:

a)

Clostridium difficile

b)

Pneumococcal pneumonia

c)

Staphylococcus aureus

d)

Streptococcus pneumoniae

101.

SATA: Select all of the diagnostic tests used to determine presence of sickle cell anemia.

a)

peripheral blood smear

b)

sickling test

c)

hemoglobin electrophoresis

d)

doppler studies

e)

MRIs and X-rays

102.

SATA: Select all of the extrinsic factors that can cause hemolysis of erythrocytes.

a)

macroangiopathic factors

b)

microangiopathic factors

c)

antibody reactions

d)

infectious agents and toxins

e)

megaangiopathic factors

103.

Macroangiopathic destruction of RBCs is due to exertion of extreme force on RBCs.

a)

True

b)

False

104.

SATA: Select all of the examples of MACROangiopathic destruction of RBCs.

a)

hemodialysis

b)

prosthetic heart valves

c)

extracorporeal circulation (ECMO)

d)

disseminated intravascular coagulopathy

e)

thrombotic thrombocytopenic purpura

105.

Microangiopathic destruction of RBCs is due to _______ of the cells as they try to pass by abnormal arterial or venous microcirculation.

a)

force

b)

fragmentation

c)

dissolution

d)

agglutination

106.

What is the cause of isoimmune RBC destruction?

a)

antibodies develop against their own RBCs

b)

blood donor reactions

c)

force exerted on cells

d)

sheared cells in deformed vasculature

107.

What is the cause of autoimmune RBC destruction?

a)

antibodies develop against their own RBCs

b)

blood donor reactions

c)

force exerted on cells

d)

cells sheared by deformed vasculature

108.

In microangiopathic destruction of erythrocytes, RBCs are sheared as they try to pass by EXCESSIVE PLATELET AGGREGATION and/or fibrin polymer formation. In which two hematologic conditions is this complication observed?

a)

thrombotic thrombocytopenic purpura and disseminated intravascular coagulopathy

b)

immune thrombocytopenia purpura and thalassemia

c)

heparin-induced thrombocytopenia and sickle cell anemia

d)

thrombotic thrombocytopenic purpura and aplastic anemia

109.

SATA: Select the ways infectious agents and toxins can cause hemolysis.

a)

Invade the RBC and destroy its contents

b)

Release hemolytic substances

c)

Generate and antigen-antibody reaction

d)

Disrupt production with globulin proteins

e)

Chromosomal alterations

110.

SATA: Select all of the treatments for acquired hemolytic anemia.

a)

hydration

b)

electrolyte replacement

c)

corticosteroids

d)

blood products

e)

splenectomy