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NURS 8022 Exam 2 Study Guide Questions and Answers Top Rated 2024
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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") Difference betwe...

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  • September 29, 2024
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NURS 8022 Exam 2



NURS 8022 Exam 2 Study Guide
Questions and Answers Top Rated 2024
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")

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

Factors that increase hematopoiesis -Answer- ✔(1) conversion of yellow bone marrow,
which does not produce blood cells, to hematopoietic red marrow by the actions of
erythropoietin (a hormone that stimulates erythrocyte production)
(2) faster differentiation of progenitor cells
(3) faster proliferation of stem cells into progenitor cells

Erythropoiesis -Answer- ✔production of RBCs

Sequence of erythropoiesis -Answer- ✔Pluripotent hematopoietic stem cell -->
committed Proerythroblast/Pronormoblast --> Erythroblast/Normoblast (Hgb synthesis
begins) --> Reticulocyte (nucleus is lost; 3 days spent in bone marrow, about 1 day in
blood) --> Erythrocyte

** aprox. 1% of RBCs are reticulocytes **

In each step the quantity of hemoglobin increases and the nucleus decreases in size

Erythropoietin -Answer- ✔A hormone produced and released by the kidney that
stimulates the production of red blood cells by the bone marrow


NURS 8022 Exam 2

,NURS 8022 Exam 2



Always present in plasma

Released in response to low renal oxygenation
- NOT the # of RBCs but rather oxygen delivery
- e RBC production increases within 24 hours; life span 4-12 hours; increased RBC # in
5 days
- Given to dialysis and chemo patients

Reticulocytes -Answer- ✔▪ Last immature form of erythroblast

▪ Contains polyribosomes (globin synthesis) and mitochondria (heme synthesis)

▪ 24-48 hours after leaving bone marrow for circulation, matures into erythrocyte
- Loses polyribosomes and mitochondria
-Make up 1-2% of RBCs
- Last about 2 days in bone marrow and 1 day in blood continuing to mature
- During time of low HCT time in marrow decreased to as little as 1 day

▪ Reticulocyte count -- Indicates whether new RBCs are being produced; good indicator
of erythropoiesis

Renal oxygenation negative feedback loop -Answer- ✔

Hemoglobin and its structure -Answer- ✔Oxygen-carrying protein of the erythrocyte -->
may carry up to 300 hgb molecules

Reversible deformity to be abvle to squeeze through the tiniest of capillaries

Each Hgb molecule has 2 pairs of different globin chains and 4 complexes of iron +
heme
▪ Heme: large, flat, iron-protoporphyrin disk that is synthesized in the mitochondria and
can carry one molecule of oxygen
▪ Each Hgb can carry 4 molecules of oxygen

Heme vs Globin -Answer- ✔Heme: Synthesized in mitochondria of reticulocyte
- Carries Oxygen

Globin: Polyribosomes in reticulocytes
- 2 pairs of globin chains on each Hgb molecule
- Combo of pair determines type of globin chain
▪ Most common hgb A: 2 alpha chains and 2 beta chains - hgb F (fetal): 2 alpha, 2
gamma




NURS 8022 Exam 2

,NURS 8022 Exam 2


Red blood cell structure -Answer- ✔Sac of Hgb, no nucleus or mitochondria, only
hemoglobin & enzymes surrounded by membrane

-Lack mitochondria, rely on glycolysis for energy --> "aerobic metabolism"

▪ Deficiencies of 2 enzymes result in anemia
• Pyruvate kinase - necessary for glycolysis - no glycolysis results in RBC damage and
death
• G6PD - involved in protecting the RBC against oxidative stress

Anisocytosis
Poikilocytosis -Answer- ✔Variation in RBC size
Variation in RBC shape

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

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)


NURS 8022 Exam 2

, NURS 8022 Exam 2



** 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

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

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


NURS 8022 Exam 2

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