Exam 4: PNR 206/ PNR206 (Latest 2024/ 2025 Updates
STUDY BUNDLE WITH COMPLETE SOLUTIONS) Medical-
Surgical Nursing II | Questions and Verified Answers|
100% Correct| Grade A- Fortis
Blood - ANSWERA connective tissue consisting of plasma (the liquid component) and
formed elements (cells and cell fragments).
Blood Vessels - ANSWERIncludes arteries, veins, and capillaries, which transport
blood throughout the body
Bone Marrow - ANSWERThe primary site for hematopoiesis (blood cell production).
It is located in the medullary cavities of bones.
Spleen: - ANSWERFilters blood, removes old or damaged blood cells, and plays a role
in immune response.
Liver - ANSWERProduces clotting factors and helps in the breakdown of old red
blood cells.
Lymphatic System: - ANSWERIncludes lymph nodes and lymphatic vessels that play a
role in immune response and fluid balance.
Hematopoiesis - ANSWERThe process of blood cell production, including red blood
cells (erythrocytes), white blood cells (leukocytes), and platelets (thrombocytes). It
occurs primarily in the bone marrow.
Red Blood Cells (RBCs) - ANSWERCarry oxygen from the lungs to tissues and carbon
dioxide from tissues to the lungs. They contain hemoglobin.
White Blood Cells (WBCs) - ANSWERPart of the immune system; they protect the
body against infection and foreign substances.
Platelets - ANSWERPlay a crucial role in blood clotting and wound repair.
Assessment of Patients with Hematologic Disorders - ANSWER1. Patient History:
Symptoms: Assess for fatigue, pallor, bleeding tendencies, bruising, pain, or swelling.
Medical History: Include past illnesses, surgeries, or conditions affecting blood cell
production.
Family History: Inquire about hereditary blood disorders or conditions.
2. Physical Examination:
Skin and Mucous Membranes: Check for pallor, jaundice, or petechiae (small red or
purple spots).
Lymph Nodes: Palpate for swelling or tenderness, indicating possible lymphoma or
infection.
,Spleen and Liver: Assess for enlargement (hepatosplenomegaly).
Joints: Examine for swelling or pain related to bleeding disorders.
Diagnostic Procedures for Hematologic Disorders - ANSWERComplete Blood Count
(CBC):
Purpose: Measures levels of red blood cells, white blood cells, platelets, hemoglobin,
and hematocrit.
Components:
Hemoglobin (Hb): Measures the oxygen-carrying capacity of the blood.
Hematocrit (Hct): Indicates the proportion of blood volume occupied by red blood
cells.
White Blood Cell Count (WBC): Assesses immune function and infection.
Platelet Count: Evaluates blood clotting ability.
2. Peripheral Smear:
Purpose: Examines blood cells under a microscope to identify abnormalities in cell
shape, size, and number.
Components:
Red Blood Cells (RBCs): Look for signs of anemia or other disorders.
White Blood Cells (WBCs): Check for abnormal cell types or counts.
Platelets: Assess for any abnormalities in platelet number or appearance.
3. Bone Marrow Aspiration and Biopsy:
Purpose: Evaluates bone marrow function and assesses for conditions like leukemia
or aplastic anemia.
Procedure: A needle is inserted into the bone (usually the hip) to extract a sample of
bone marrow for examination.
Anemia - ANSWERAnemia
Anemia is '' Decrease in number of red blood cells (RBCs) or less than the normal
quantity of Hemoglobin in the blood.
WHO Grading of Anemia - ANSWER❖Grade 1 (Mild Anemia): 10 g/dl
❖Grade 2 (Moderate Anemia): 7-10 g/dl
❖Grade 3 (Severe Anemia): below 7 g/dl
Classification of anemia - ANSWERClassification
❑On The Basis of Cause
A. Hypo proliferative (Resulting From Defective RBC Production)
B. Haemorrhagic (Resulting from RBC Loss)
C. Haemolytic Anaemia (Resulting From RBC Destruction)
❑ On the Basis of Morphology
A. Microcytic Anemia (Cells are smaller than normal under 80 fl)
B. Macrocytic Anaemia (cells are larger than normal over 100 fl)
C. Normocytic Anaemia (Cells are normal size 80-100 fl)
1.Microcytic Anaemia - ANSWERIt Occurs in Iron Deficiency Anemia and Ineffective
RBC Production a result of Hemoglobin synthesis failure/insufficiency.
,▪Cells are smaller than normal under 80 fl Heme synthesis defect
- Iron Deficiency Anaemia
▪Globin Deficiency Defect
- Thalassemia
2. Macrocytic Anaemia - ANSWERAn Abnormally Large RBC, cells are larger than
normal over 100 fl
▪ It Occurs as Nutritional Deficiency. E.g.Vit.B12 , Folates and Protein
▪It's also occurs due to Drug toxicity (phenytoin), Liver Disease, Alcolism,
Hypothyrodism,
Chronic Haemolytic Anaemia , Leukemia &Gastric Bypass surgery
3. Normocytic Anaemia - ANSWER▪Overall Haemoglobin levels are decreased but the
red blood cell size(MCV)
remains normal.
▪Cells are normal size 80-100 fl'
Causes
➢Acute blood loss
➢ Haemolytic Anaemia
➢ Aplastic Anaemia
CAUSES OF ANEMIA - ANSWER-increased requirements
menstruating females
pregnancy
lactation
growing infants and children
erythropoietin treatment
-increased loss
GI bleeding
menorrhagia persistent hematuria
intravascular hemolytic anemias
regular blood donors
parasitic infections
-decreased intake
vegetarian diet
socioeconomic factors
-decreased absorption
upper GI pathology(celiac disease and Crohn disease )gastrectomy medications
( antacids, zantac )
, causes continue.....anemia - ANSWERimpaired rbc production ( deficiency of
nutrition e.g., iron, vitamin B12 , vitamin B6, decreased erythropoietin production
increased destruction of RBC z9 hemolytic ( abnormal hemoglobin synthesis
( thalassemia )
enzymatic defect ( glucose- 6 phosphate deficiency
infection ( malaria)
antibody reaction ( RH or ABO iso immunizations
poisoning ( lead poisoning )
burns
splenomegaly
idiopathic
hereditary spherocytosis
•Due to Increased Blood Loss(Haemorrhagic) -Acute
(Trauma,Epistaxis,Scurvy,Hemophilia etc.) -Chronic(Chronic Dysentry,Bleeding
Piles,Haemorrhage etc.)
•Decreased RBC Production(Bone Marrow Depression)
- Hypoplasia ,Chronic Illness (Leukaemia & Nephritis)
- TB , Neoplastic Disease , Liver Disease
- Hypothyrodism
PATHOPHYSIOLOGY OF ANEMIA ( DDHS) - ANSWERdecrease in RBCs, HB, or HCT
diminished o2 carrying capacity
hypoxia and hypoxia induced effects on organ function
signs and symptoms of anemia
''Anemia occurs when there is a decrease in red blood cells (RBCs), hemoglobin (Hb),
or hematocrit (Hct), leading to a reduced oxygen-carrying capacity in the blood. This
diminished oxygen supply causes tissue hypoxia, which can impair the function of
various organs. A reduction in RBCs, hemoglobin, or hematocrit can result from
factors such as blood loss, destruction of RBCs (hemolysis), or decreased production
in the bone marrow. As oxygen delivery to tissues declines, symptoms like fatigue,
weakness, dizziness, and shortness of breath arise. Organs struggle to function
properly without sufficient oxygen, contributing to further symptoms like pallor,
increased heart rate, and difficulty breathing ''.
INVESTIGATIONS - ANSWERCBC ( Hb, hematocrit, rbc, mcv)
stool hemoglobin test
peripheral blood smear
iron levels
ferritin
folate
vitamin B12
bilirubin
lead level
hemoglobin
reticulocyte count
STUDY BUNDLE WITH COMPLETE SOLUTIONS) Medical-
Surgical Nursing II | Questions and Verified Answers|
100% Correct| Grade A- Fortis
Blood - ANSWERA connective tissue consisting of plasma (the liquid component) and
formed elements (cells and cell fragments).
Blood Vessels - ANSWERIncludes arteries, veins, and capillaries, which transport
blood throughout the body
Bone Marrow - ANSWERThe primary site for hematopoiesis (blood cell production).
It is located in the medullary cavities of bones.
Spleen: - ANSWERFilters blood, removes old or damaged blood cells, and plays a role
in immune response.
Liver - ANSWERProduces clotting factors and helps in the breakdown of old red
blood cells.
Lymphatic System: - ANSWERIncludes lymph nodes and lymphatic vessels that play a
role in immune response and fluid balance.
Hematopoiesis - ANSWERThe process of blood cell production, including red blood
cells (erythrocytes), white blood cells (leukocytes), and platelets (thrombocytes). It
occurs primarily in the bone marrow.
Red Blood Cells (RBCs) - ANSWERCarry oxygen from the lungs to tissues and carbon
dioxide from tissues to the lungs. They contain hemoglobin.
White Blood Cells (WBCs) - ANSWERPart of the immune system; they protect the
body against infection and foreign substances.
Platelets - ANSWERPlay a crucial role in blood clotting and wound repair.
Assessment of Patients with Hematologic Disorders - ANSWER1. Patient History:
Symptoms: Assess for fatigue, pallor, bleeding tendencies, bruising, pain, or swelling.
Medical History: Include past illnesses, surgeries, or conditions affecting blood cell
production.
Family History: Inquire about hereditary blood disorders or conditions.
2. Physical Examination:
Skin and Mucous Membranes: Check for pallor, jaundice, or petechiae (small red or
purple spots).
Lymph Nodes: Palpate for swelling or tenderness, indicating possible lymphoma or
infection.
,Spleen and Liver: Assess for enlargement (hepatosplenomegaly).
Joints: Examine for swelling or pain related to bleeding disorders.
Diagnostic Procedures for Hematologic Disorders - ANSWERComplete Blood Count
(CBC):
Purpose: Measures levels of red blood cells, white blood cells, platelets, hemoglobin,
and hematocrit.
Components:
Hemoglobin (Hb): Measures the oxygen-carrying capacity of the blood.
Hematocrit (Hct): Indicates the proportion of blood volume occupied by red blood
cells.
White Blood Cell Count (WBC): Assesses immune function and infection.
Platelet Count: Evaluates blood clotting ability.
2. Peripheral Smear:
Purpose: Examines blood cells under a microscope to identify abnormalities in cell
shape, size, and number.
Components:
Red Blood Cells (RBCs): Look for signs of anemia or other disorders.
White Blood Cells (WBCs): Check for abnormal cell types or counts.
Platelets: Assess for any abnormalities in platelet number or appearance.
3. Bone Marrow Aspiration and Biopsy:
Purpose: Evaluates bone marrow function and assesses for conditions like leukemia
or aplastic anemia.
Procedure: A needle is inserted into the bone (usually the hip) to extract a sample of
bone marrow for examination.
Anemia - ANSWERAnemia
Anemia is '' Decrease in number of red blood cells (RBCs) or less than the normal
quantity of Hemoglobin in the blood.
WHO Grading of Anemia - ANSWER❖Grade 1 (Mild Anemia): 10 g/dl
❖Grade 2 (Moderate Anemia): 7-10 g/dl
❖Grade 3 (Severe Anemia): below 7 g/dl
Classification of anemia - ANSWERClassification
❑On The Basis of Cause
A. Hypo proliferative (Resulting From Defective RBC Production)
B. Haemorrhagic (Resulting from RBC Loss)
C. Haemolytic Anaemia (Resulting From RBC Destruction)
❑ On the Basis of Morphology
A. Microcytic Anemia (Cells are smaller than normal under 80 fl)
B. Macrocytic Anaemia (cells are larger than normal over 100 fl)
C. Normocytic Anaemia (Cells are normal size 80-100 fl)
1.Microcytic Anaemia - ANSWERIt Occurs in Iron Deficiency Anemia and Ineffective
RBC Production a result of Hemoglobin synthesis failure/insufficiency.
,▪Cells are smaller than normal under 80 fl Heme synthesis defect
- Iron Deficiency Anaemia
▪Globin Deficiency Defect
- Thalassemia
2. Macrocytic Anaemia - ANSWERAn Abnormally Large RBC, cells are larger than
normal over 100 fl
▪ It Occurs as Nutritional Deficiency. E.g.Vit.B12 , Folates and Protein
▪It's also occurs due to Drug toxicity (phenytoin), Liver Disease, Alcolism,
Hypothyrodism,
Chronic Haemolytic Anaemia , Leukemia &Gastric Bypass surgery
3. Normocytic Anaemia - ANSWER▪Overall Haemoglobin levels are decreased but the
red blood cell size(MCV)
remains normal.
▪Cells are normal size 80-100 fl'
Causes
➢Acute blood loss
➢ Haemolytic Anaemia
➢ Aplastic Anaemia
CAUSES OF ANEMIA - ANSWER-increased requirements
menstruating females
pregnancy
lactation
growing infants and children
erythropoietin treatment
-increased loss
GI bleeding
menorrhagia persistent hematuria
intravascular hemolytic anemias
regular blood donors
parasitic infections
-decreased intake
vegetarian diet
socioeconomic factors
-decreased absorption
upper GI pathology(celiac disease and Crohn disease )gastrectomy medications
( antacids, zantac )
, causes continue.....anemia - ANSWERimpaired rbc production ( deficiency of
nutrition e.g., iron, vitamin B12 , vitamin B6, decreased erythropoietin production
increased destruction of RBC z9 hemolytic ( abnormal hemoglobin synthesis
( thalassemia )
enzymatic defect ( glucose- 6 phosphate deficiency
infection ( malaria)
antibody reaction ( RH or ABO iso immunizations
poisoning ( lead poisoning )
burns
splenomegaly
idiopathic
hereditary spherocytosis
•Due to Increased Blood Loss(Haemorrhagic) -Acute
(Trauma,Epistaxis,Scurvy,Hemophilia etc.) -Chronic(Chronic Dysentry,Bleeding
Piles,Haemorrhage etc.)
•Decreased RBC Production(Bone Marrow Depression)
- Hypoplasia ,Chronic Illness (Leukaemia & Nephritis)
- TB , Neoplastic Disease , Liver Disease
- Hypothyrodism
PATHOPHYSIOLOGY OF ANEMIA ( DDHS) - ANSWERdecrease in RBCs, HB, or HCT
diminished o2 carrying capacity
hypoxia and hypoxia induced effects on organ function
signs and symptoms of anemia
''Anemia occurs when there is a decrease in red blood cells (RBCs), hemoglobin (Hb),
or hematocrit (Hct), leading to a reduced oxygen-carrying capacity in the blood. This
diminished oxygen supply causes tissue hypoxia, which can impair the function of
various organs. A reduction in RBCs, hemoglobin, or hematocrit can result from
factors such as blood loss, destruction of RBCs (hemolysis), or decreased production
in the bone marrow. As oxygen delivery to tissues declines, symptoms like fatigue,
weakness, dizziness, and shortness of breath arise. Organs struggle to function
properly without sufficient oxygen, contributing to further symptoms like pallor,
increased heart rate, and difficulty breathing ''.
INVESTIGATIONS - ANSWERCBC ( Hb, hematocrit, rbc, mcv)
stool hemoglobin test
peripheral blood smear
iron levels
ferritin
folate
vitamin B12
bilirubin
lead level
hemoglobin
reticulocyte count
