Page 1 of 56
NURS 8022 EXAM 2 PRACTICE QUESTIONS
WITH SOLUTIONS TESTED AND APPROVED
NEWLY MODIFIED!!!
Sideroblastic Anemia Diagnostic Manifestations -- ANSWER--- Presence of ringed sideroblasts in the
bone marrow are diagnostic (erythroblasts contain iron granules that have not been synthesized into
hemoglobin)
- Hct 20-30%
- MCV usually normal
- Elevated serum iron ** iron overload** Enlarged spleen and liver
- High transferrin saturation = Low TIBC
Thalassemia -- ANSWER--Type of Microcytic-Hypochromic Anemia
Characterized by abnormal formation of hemoglobin resulting from mutation that causes loss of one
or both alpha globin chains or one or both of beta globin chains
-- Abnormal hgb formed results in improper oxygen transport and destructing of RBCs results in
anemia
Autosomal recessive trait
Target cells may be seen
, Page 2 of 56
Hematopoiesis -- ANSWER--Process of blood cell production in adult bone marrow or the liver and/or
spleen of the fetus
Two stages
▪ Mitosis (proliferation)
▪ Maturation (differentiation)
Primary site of hematopoietic stem cells -- ANSWER--Bone marrow ("myeloid tissue")
Hereditary vs Acquired Hemolysis -- ANSWER--Hereditary hemolysis: sickle cell disease
Acquired hemolysis: immune mechanisms (transfusion reaction), infection (malaria), drugs
(penicillin), liver or kidney disease, toxins (chemicals, venoms)
Normal Labs (RBCs, Hgb, Hct, MCV, MCH) -- ANSWER--RBCs 4.2-6.1
Hgb 12-18
Hct 35-50%
MCV: 78-100 (related to size)
MCH: 27-34 (related to hgb content)
Reticulocytes: new RBC formation - low suggest issues in production
, Page 3 of 56
Microcytic-Hypochromic Anemias -- ANSWER--Characterized by red cells that are abnormally small
and contain reduced amounts of hemoglobin
Iron Deficiency Anemia (IDA)
Sideroblastic
Thalassemia
Iron Deficiency Anemia (IDA) -- ANSWER--Type of Microcytic-Hypochromic Anemia
- Most common type of anemia
- Highest risk: older adults, women, infants, poverty
- Associated with cognitive impairment in children
- Causes: inadequate dietary intake; excessive blood loss (GI bleed most common pathophysiologic
cause); chronic parasite infestations; metabolic or functional iron deficiency; menorrhagia (most
common physiologic cause)
** Good sign of malignancy for postmenopausal women and men **
IDA Diagnostic Manifestations -- ANSWER--▪ Low MCV, low MCH
▪ High RDW
▪ Low initial reticulocyte count - elevated once treatment and iron supplementation begin
▪ Ferritin low - #1 test for IDA
▪ Low serum iron; TIBC high - not enough iron to bind transferrin
, Page 4 of 56
IDA Clinical Manifestations -- ANSWER--▪ Mild (hgb 10-12): likely no symptoms
▪ Moderate (hgb 7-11): palpitations, dyspnea, exercise intolerance, angular stomatitis, glossitis,
pallor, koilonychia (pitting nails), pica (eating disorder in which a person eats things not usually
considered food)
▪ Severe (hgb <7): postural hypotension, dizziness, weakness, gastritis, paresthesias, lethargy
▪ Elderly: lethargy and confusion
Sideroblastic Anemia -- ANSWER--Type of Microcytic-Hypochromic Anemia
Caused by a defect in mitochondrial heme synthesis
▪ Altered mitochondrial metabolism causes ineffective iron uptake and results in dysfunctional
hemoglobin synthesis --> intracellular iron accumulates
- Can be due to alcohol abuse, lead poisoning
Difference between red and yellow bone marrow -- ANSWER--Red marrow produces RBCs, yellow
marrow does not produce RBCs
Active bone marrow sites -- ANSWER--pelvic bones
vertebrae
cranium mandible
sternum
ribs
humerus femur
NURS 8022 EXAM 2 PRACTICE QUESTIONS
WITH SOLUTIONS TESTED AND APPROVED
NEWLY MODIFIED!!!
Sideroblastic Anemia Diagnostic Manifestations -- ANSWER--- Presence of ringed sideroblasts in the
bone marrow are diagnostic (erythroblasts contain iron granules that have not been synthesized into
hemoglobin)
- Hct 20-30%
- MCV usually normal
- Elevated serum iron ** iron overload** Enlarged spleen and liver
- High transferrin saturation = Low TIBC
Thalassemia -- ANSWER--Type of Microcytic-Hypochromic Anemia
Characterized by abnormal formation of hemoglobin resulting from mutation that causes loss of one
or both alpha globin chains or one or both of beta globin chains
-- Abnormal hgb formed results in improper oxygen transport and destructing of RBCs results in
anemia
Autosomal recessive trait
Target cells may be seen
, Page 2 of 56
Hematopoiesis -- ANSWER--Process of blood cell production in adult bone marrow or the liver and/or
spleen of the fetus
Two stages
▪ Mitosis (proliferation)
▪ Maturation (differentiation)
Primary site of hematopoietic stem cells -- ANSWER--Bone marrow ("myeloid tissue")
Hereditary vs Acquired Hemolysis -- ANSWER--Hereditary hemolysis: sickle cell disease
Acquired hemolysis: immune mechanisms (transfusion reaction), infection (malaria), drugs
(penicillin), liver or kidney disease, toxins (chemicals, venoms)
Normal Labs (RBCs, Hgb, Hct, MCV, MCH) -- ANSWER--RBCs 4.2-6.1
Hgb 12-18
Hct 35-50%
MCV: 78-100 (related to size)
MCH: 27-34 (related to hgb content)
Reticulocytes: new RBC formation - low suggest issues in production
, Page 3 of 56
Microcytic-Hypochromic Anemias -- ANSWER--Characterized by red cells that are abnormally small
and contain reduced amounts of hemoglobin
Iron Deficiency Anemia (IDA)
Sideroblastic
Thalassemia
Iron Deficiency Anemia (IDA) -- ANSWER--Type of Microcytic-Hypochromic Anemia
- Most common type of anemia
- Highest risk: older adults, women, infants, poverty
- Associated with cognitive impairment in children
- Causes: inadequate dietary intake; excessive blood loss (GI bleed most common pathophysiologic
cause); chronic parasite infestations; metabolic or functional iron deficiency; menorrhagia (most
common physiologic cause)
** Good sign of malignancy for postmenopausal women and men **
IDA Diagnostic Manifestations -- ANSWER--▪ Low MCV, low MCH
▪ High RDW
▪ Low initial reticulocyte count - elevated once treatment and iron supplementation begin
▪ Ferritin low - #1 test for IDA
▪ Low serum iron; TIBC high - not enough iron to bind transferrin
, Page 4 of 56
IDA Clinical Manifestations -- ANSWER--▪ Mild (hgb 10-12): likely no symptoms
▪ Moderate (hgb 7-11): palpitations, dyspnea, exercise intolerance, angular stomatitis, glossitis,
pallor, koilonychia (pitting nails), pica (eating disorder in which a person eats things not usually
considered food)
▪ Severe (hgb <7): postural hypotension, dizziness, weakness, gastritis, paresthesias, lethargy
▪ Elderly: lethargy and confusion
Sideroblastic Anemia -- ANSWER--Type of Microcytic-Hypochromic Anemia
Caused by a defect in mitochondrial heme synthesis
▪ Altered mitochondrial metabolism causes ineffective iron uptake and results in dysfunctional
hemoglobin synthesis --> intracellular iron accumulates
- Can be due to alcohol abuse, lead poisoning
Difference between red and yellow bone marrow -- ANSWER--Red marrow produces RBCs, yellow
marrow does not produce RBCs
Active bone marrow sites -- ANSWER--pelvic bones
vertebrae
cranium mandible
sternum
ribs
humerus femur
