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WorksheetsExam 4 (Medsurg):Anemia
Total questions: 110
Worksheet time: 59mins
What is anemia a deficiency in?
Number of RBCs
Quantity of hemoglobin
Volume of packed RBCs (hematocrit)
All of the above
Which of the following is NOT a cause of decreased RBC production?
Deficient cobalamin
Decreased erythropoietin
Deficient tyramines
Decreased iron availability
Deficient folic acid
SATA: Which of the following is a cause of increased RBC destruction?
Hemolysis (ex: sickle cell anemia)
Medication (ex: methyldopa)
Incompatible blood
Trauma (ex: CABG)
Thrombocytopenia
Anemia is considered a _____, rather than a specific disease.
symptom
side effect
adverse effect
prognosis
Fill in the blank: RBCs carry ________ from tissues back to the lungs.
carbon dioxide
oxygen
glucose
nitrogen
List two nutrients whose deficiency can cause decreased RBC production.
Iron and Vitamin B12
Calcium and Vitamin D
Potassium and Vitamin C
Sodium and Vitamin E
What is the normal hemoglobin (Hgb) level for adult males?
13.8-17.2 g/dL
10.0-12.0 g/dL
18.0-22.0 g/dL
8.5-11.0 g/dL
What is the normal hemoglobin (Hgb) level for adult females?
12.1-15.1 g/dL
10.0-12.0 g/dL
15.5-18.0 g/dL
8.0-11.0 g/dL
What is the normal hemoglobin (Hgb) level for pregnant females?
11-12 g/dL
13-14 g/dL
9-10 g/dL
15-16 g/dL
What is the normal hemoglobin (Hgb) level for children?
11-16 g/dL
8-10 g/dL
16-20 g/dL
6-9 g/dL
Which of the following is an integumentary manifestation of anemia?
Pallor: decreased Hgb, decreased blood flow to the skin
Jaundice: increased concentration of serum bilirubin
Pruritis: increased serum and skin bile salt concentrations
All of the above
Cardiac output in anemia is maintained by increasing both HR and SV, which manifests as ________.
TACHYCARDIA
BRADYCARDIA
ARRHYTHMIA
HYPOTENSION
SATA: Which of the following is an acute intervention for anemia?
Blood or blood product transfusions
Drug therapy such as erythropoietin and vitamins
Volume replacement
Dietary and lifestyle changes, which can reverse SOME anemias
Oxygen therapies
What is the life span of an RBC?
120 days
60 days
10 days
200 days
What percentage of ingested iron is absorbed in cases of inadequate dietary intake?
5-10%
15-20%
20-30%
1-2%
Where is erythropoietin/EPO primarily produced?
Kidneys
Liver
Bone marrow
Spleen
Which type of anemia is considered the MOST common?
Iron-deficiency anemia
Aplastic anemia
Thalassemia
Hemolytic anemia
Heme accounts for portion of the body's iron?
1/3rd
2/3rds
1/4th
3/4ths
____% of erythropoietin is produced in the liver.
10
20
30
50
How much iron is contained in 2 ml of whole blood?
1 mg
0.1 mg
5 mg
10 mg
Iron is present in all RBCs as ______ in hemoglobin and in a stored form.
heme
globin
ferritin
albumin
Where does iron absorption occur?
Duodenum
Cecum
Ileum
Periosteum
Which systems does chronic blood loss MOST COMMONLY occur through in iron-deficiency anemia?
A) Respiratory and cardiovascular systems
B) GI and GU systems
C) Nervous and endocrine systems
D) Musculoskeletal and integumentary systems
Which of the following is a contributing factor to iron-deficiency anemia?
Diabetes
Pregnancy
Hypertension
Hyperthyroidism
What is the most common clinical manifestation of iron-deficiency anemia?
Glossitis
Pallor
Cheilitis
Fatigue
Fill in the blank: Glossitis (________ inflammation) is the second most common finding in iron-deficiency anemia.
tongue
skin
bone
joint
Cheilitis refers to inflammation of which part of the body?
A) Tongue
B) Lips
C) Cheeks
D) Gums
Lab findings in iron-deficiency anemia typically show ______ H+H.
LOW
HIGH
NORMAL
ABSENT
Which of the following is NOT a diagnostic method for iron-deficiency anemia?
Stool guaiac test
Endoscopy
Colonoscopy
MRI
SATA: Iron therapy comes in which forms/routes?
Oral/PO
Parenteral/IV and IM
Transdermal/SQ
Intrathecal/Epidural
Efforts in treating iron-deficiency anemia are aimed at ______ iron.
REPLACING
REMOVING
REDUCING
RESTRICTING
Which type of therapy is NOT mentioned as a treatment for iron-deficiency anemia?
Nutritional therapy
Oral or parenteral iron supplements
Transfusion of packed RBCs
Chemotherapy
What is the recommended daily dose of oral iron for iron-deficiency anemia?
50-100 mg
100-150 mg
150-200 mg
200-250 mg
Ferrous sulfate is BEST absorbed in which type of environment?
Alkaline
Neutral
Acidic
Basic
Liquid iron should be diluted and ingested through a _______.
straw
spoon
cup
bottle
Which of the following are side effects of iron therapy?
Heartburn
Constipation
Diarrhea
All of the above
Black stools as a side effect of iron replacement are a sign of melena.
True
False
Parenteral iron is indicated for which of the following?
Malabsorption
Oral iron intolerance
Need for iron beyond normal limits
Poor patient compliance
All of the above
IM administration of parenteral iron may _______ the skin.
stain
heal
cool
soften
Which of the following are considered at-risk groups for iron deficiency?
Older adults
Persons from low SES backgrounds
Pregnant women
Premenopausal women
All of the above
Patient teaching for iron therapy includes diet teaching, supplemental iron, discussing diagnostic studies, and emphasizing _______.
compliance
hydration
exercise
rest
Iron therapy should be continued for _______ months after Hgb level returns to normal.
2-3
6-8
1-2
4-5
Thalassemia is a group of diseases involving inadequate production of normal _______.
hemoglobin
iron
platelets
antibodies
Thalassemia leads to decreased _______ production.
RBC
WBC
Platelet
Plasma
Thalassemia is common in ethnic groups near the Mediterranean and in equitorial/near-equitorial regions of _______.
Asia
Middle East
Africa
All of the above
Thalassemia is a genetic problem with _______ protein.
globulin
albumin
keratin
collagen
What is the group of disorders characterized by impaired DNA synthesis and presence of megaloblasts?
A) Megaloblastic Anemias
B) Hemolytic Anemias
C) Iron Deficiency Anemia
D) Sickle Cell Anemia
Majority of megaloblastic anemias result from deficiency in which vitamins?
Vitamin C and Vitamin D
Vitamin B12 and Folate
Vitamin A and Iron
Vitamin K and Vitamin B6
Fill in the blank: Intrinsic factor (IF) is a protein secreted by the ________ mucosa.
gastric
intestinal
oral
esophageal
IF is required for cobalamin absorption in the distal ileum.
True
False
If IF is NOT secreted, cobalamin will NOT be absorbed.
True
False
What is the most common cause of cobalamin deficiency?
Pernicious anemia
Iron deficiency
Chronic blood loss
Sickle cell disease
Pernicious anemia is caused by an absence of which substance?
Hemoglobin
Intrinsic Factor
Folic Acid
Vitamin C
Tumor Necrosis Factor
Which of the following is NOT a GI manifestation of cobalamin deficiency?
Sore tongue
Anorexia
Nausea/Vomiting
Reflux
SATA: Neuromuscular manifestations of pernicious anemia include:
paresthesias of feet and hands
decreased vibratory and position senses
muscle weakness
impaired thought processes
clonus and hyperreflexia
SATA: Cobalamin deficiency can occur in which of the following situations?
GI surgery, chronic diseases of the GI tract
Chronic alcoholics, strict vegetarians
Long term users of H2RBs and PPIs
Long-term corticosteroid and mineralocorticoid use
Cobalamin replacement is the treatment of choice for cobalamin deficiency. Which two routes can cobalamin be administered?
PO, Parenteral
PO, Transdermal
Parenteral, Intranasal
PO, Intranasal
Transdermal, Parenteral
Patients will die in 1-3 years without treatment for cobalamin deficiency.
True
False
Pernicious anemia can be reversed with ongoing treatment, but long-standing neuromuscular complications may not be reversible.
True
False
Fill in the blank: Folic acid is required for DNA synthesis, RBC formation and RBC ________.
maturation
digestion
respiration
excretion
destruction
Which clinical manifestation differentiates folic acid deficiency from cobalamin deficiency?
Presence of neurologic problems
Absence of neurologic problems
Presence of genitourinary problems
Absence of malabsorption syndromes
Absence of genitourinary problems
In folic acid deficiency, serum folate is low (Normal: 3-25 mg/ml), but serum cobalamin is _______.
normal
high
low
absent
What is the usual dose of folic acid per day for replacement therapy?
0.5 mg
1 mg
2 mg
5 mg
What is pancytopenia?
Decrease in all blood cell types
Decrease in red blood cells
Decrease in platelets
Decrease in white blood cells
Decrease in all cell types
Aplastic anemia is characterized by:
Hypercellular bone marrow
Hypocellular bone marrow
Increased platelet values
High serum folate
What are the two major types of etiology for aplastic anemia?
Congenital and acquired
Viral and bacterial
Chemical and radiation
Chronic and acute
Symptoms of aplastic anemia are caused by suppression of any or all _______ elements.
bone marrow
red blood cell
platelet
white blood cell
SATA: Which of the following are manifestations in aplastic anemia?
Fatigue
Dyspnea
Neutropenia
Prolonged bleeding time
Low reticulocyte count
Fill in the blank: Aplastic anemia is characterized by ________ count and prolonged bleeding time.
Low reticulocyte
High reticulocyte
High platelet
High neutrophil
Fill in the blank: In aplastic anemia, serum iron and TIBC are ________.
elevated
decreased
absent
unchanged
Fill in the blank: Hypocellular bone marrow with increased fat content is also known as ________ marrow.
yellow
red
white
spongy
The prognosis for a patient with severe aplastic anemia is _____, but certain immune therapies and bone marrow transplantations can be _______.
poor, palliative
poor, curative
poor, supportive
promising, supportive
promising, palliative
Fill in the blank: Hypovolemic shock is a condition that disrupts ________ integrity and can lead to blood loss anemia.
vascular
cellular
neural
muscular
Clinical signs and symptoms are more important than laboratory values in acute blood loss.
True
False
Fill in the blank: S/S of blood loss include _____ of the eyes.
yellowing
dilated pupils
redness
swelling
Fill in the blank: Cardiac S/S of blood loss includes _____ and ______.
palpitations, tachycardia
palpitations, bradycardia
cor pulomanle, tachycardia
cor pulmonale, bradycardia
SATA: Select the symptoms of acute blood loss.
fatigue and dizziness
changed stool color
shortness of breath
splenomegaly and hypotension
muscle weakness
SATA: Select the symptoms of SEVERE blood loss.
fainting
angina
myocardial infarction
hypertensive crisis
stroke
Blood loss may be impossible to prevent if caused by _____.
Trauma
Thalassemia
Cobalamin Deficiency
Folate Deficiency
SATA: Select the sources of CHRONIC blood loss.
ulcers
hemorrhoids
menstruation
laceration
trauma
Hemolytic anemia is defined as _____ or hemolysis of RBCs of a rate that _______.
destruction, exceeds production
genesis, exceeds destruction
absorption, exceeds reabsorption
reabsorption, exceeds absorption
What is a specific manifestation that distinguishes hemolytic anemia from other types of anemia?
angina
hypotension
jaundice
respiratory failure
stool color change
With sudden blood loss, lab values may seem ______ for 2-3 days.
NORMAL
LOW
HIGH
UNSTABLE
Once plasma volume is replaced after an acute hemorrhage, what becomes evident?
Low RBC count
High BP
High Hgb count
Changed stool color
High WBC count
Care of Acute Blood Loss includes:
Replacing blood volume to prevent shock
Identifying the source of the hemorrhage and stopping blood loss
Providing supplemental iron
All of the above
SATA: Anemia is classified by:
CBC
Reticulocyte Count
Peripheral Blood Smear
BMP
LFTs
A patient taking iron supplements is concerned about a new onset of black stools. The RN recognizes that:
this is a sign of anemia r/t an upper GI bleed and a medical emergency
this is a sign of anemia r/t an lower GI bleed and a medical emergency
this is a sign of megaloblastic anemia and is not an emergency, but worthy basis for hospital admission
this is completely normal and expected, considered a good sign of iron replacement therapy
Maintenance of renal function is a MAJOR focus of treatment of which type of anemia?
Thalassemia
Pernicious anemia
Hemolytic anemia
Aplastic anemia
_______ are a group of inherited, autosomal recessive disorders characterized by the presence of abnormal forms of Hgb in RBCs.
Thalassemias
Aplastic anemias
Megaloblastic anemias
Sickle cell anemias
With enough replacement therapy and compliance, sickle cell anemia is curable.
True
False
Sickle cell anemia is often fatal.
True
False
In sickle cell anemia, abnormal Hgb causes erythrocytes to take on a stiff and elongated "sickle" shape due to:
increased bradykinin
decreased histamine
decreased O2
decreased PO4-
Sickle cells are stiff and angular, causing them to become _____ in small
capillaries.
destroyed
reabsorbed
stuck
separated
Sickle cell crisis is a severe, painful, acute exacerbation of sickling that causes a __________ crisis.
vasodilatory
vasoocclusive
vasopermeable
vasodegenerative
Sickle cell crisis leads to severe capillary ______, which causes tissue ______.
hypoxia, necrosis
hypotension, fibrinolitis
hyperkalemia, arrhythmia
hypomagnesemia, tremors
The typical sickle cell patient is AYSMPTOMATIC EXCEPT during sickling episodes.
True
False
Sickle cell patients are prone to:
kidney stones
gallstones
cholecystitis
hepatitis
Which complication of sickle cell anemia is the MOST major cause of morbidity and mortality?
jaundice
splenomegaly
occlusion
infection
Severe sickle-cell related infections can cause aplastic crisis, which in turn can lead to a
full-blown _________________.
shutdown of WBC production
shutdown of platelet production
shutdown of RBC production
shutdown of plasma production
The most common sickle-cell related infection is:
Clostridium difficile
Pneumococcal pneumonia
Staphylococcus aureus
Streptococcus pneumoniae
SATA: Select all of the diagnostic tests used to determine presence of sickle cell anemia.
peripheral blood smear
sickling test
hemoglobin electrophoresis
doppler studies
MRIs and X-rays
SATA: Select all of the extrinsic factors that can cause hemolysis of erythrocytes.
macroangiopathic factors
microangiopathic factors
antibody reactions
infectious agents and toxins
megaangiopathic factors
Macroangiopathic destruction of RBCs is due to exertion of extreme force on RBCs.
True
False
SATA: Select all of the examples of MACROangiopathic destruction of RBCs.
hemodialysis
prosthetic heart valves
extracorporeal circulation (ECMO)
disseminated intravascular coagulopathy
thrombotic thrombocytopenic purpura
Microangiopathic destruction of RBCs is due to _______ of the cells as they try to pass by abnormal arterial or venous microcirculation.
force
fragmentation
dissolution
agglutination
What is the cause of isoimmune RBC destruction?
antibodies develop against their own RBCs
blood donor reactions
force exerted on cells
sheared cells in deformed vasculature
What is the cause of autoimmune RBC destruction?
antibodies develop against their own RBCs
blood donor reactions
force exerted on cells
cells sheared by deformed vasculature
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?
thrombotic thrombocytopenic purpura and disseminated intravascular coagulopathy
immune thrombocytopenia purpura and thalassemia
heparin-induced thrombocytopenia and sickle cell anemia
thrombotic thrombocytopenic purpura and aplastic anemia
SATA: Select the ways infectious agents and toxins can cause hemolysis.
Invade the RBC and destroy its contents
Release hemolytic substances
Generate and antigen-antibody reaction
Disrupt production with globulin proteins
Chromosomal alterations
SATA: Select all of the treatments for acquired hemolytic anemia.
hydration
electrolyte replacement
corticosteroids
blood products
splenectomy
