NUR 6121 Advanced Nursing II 2024 – 2025
William
NUR 612 Paterson
Adv Nursing University
2 Exam 1 Review
New Jersey
Study GuideNUR
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6121 ADVANCED NURSING II
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Course Title and Number: NUR 612 ADVANCED
NURSING II
Exam Title: NUR 612 Exam
Exam Date: Exam 2024- 2025
Instructor: [Insert Instructor’s Name]
Student Name: [Insert Student’s Name]
Student ID: [Insert Student ID]
Examination
180 minutes
Instructions:
1. Read each question carefully.
2. Answer all questions.
3. Use the provided answer sheet to mark your responses.
4. Ensure all answers are final before submitting the exam.
5. Please answer each question below and click Submit when you
have completed the Exam.
6. This test has a time limit, The test will save and submit
automatically when the time expires
7. This is Exam which will assess your knowledge on the course
Learning Resources.
Good Luck!
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Study Guide Exam #1
Hematology and Infectious Disorders
Anemia
• It is not a disease but a sign/symptom of an underlying disorder
• Low Hgb (<12 g/dl in women, 14 <14 g/dl in men)
• Decreased RBC production, increased RBC destruction, and blood loss
• It is important to identify underlying conditions or cause
• Hemoglobin: HGB is the protein molecule in red cells that carries oxygen
• Hematocrit: HCT is the proportion by volume of the blood that consists of RBCs
• Mean Corpuscular Hemoglobin MCH
o MCH is the amount of Hgb in RBCs
o 27-34 pg
o Hypochromic anemia
o Hyperchromic anemia
• Mean Corpuscular Volume MCV
o Size of average RBC, able to categorize anemia based on size
o Microcytic Anemia <80 (80-100 fl)
▪ Fe deficiency
▪ Thalassemia
▪ Anemia of Chronic Disease (ACD) - occasionally
o Normocytic < 80-100
▪ Acute blood loss
▪ ACD – including renal failure
o Macrocytic Anemia
▪ Megaloblastic anemia – b12 or folate deficiency
• Red Cell Distribution Width RDW
o Measures variability of the RBC size
o Normal: Homogenous RBC size
▪ ACD, renal insufficiency, liver disease, ETOH
o Increased: Heterogeneous RBC size
▪ IDA (11.5-15)
• Iron Deficiency Anemia IDA
o Most common cause of anemia
o Most common nutritional deficiency
o Most common cause is chronic blood loss
▪ Menorrhagia, GI bleed, NSAID/ASA
▪ In women, include menstrual hx – menorrhagia or pregnancy
o Also caused by
▪ Inadequate diet
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▪ Malabsorption: Celiac, H pylori, Gastric bypass
▪ Increase iron requirements (pregnancy)
▪ Extreme athletes
o May not show symptoms until anemia is severe (Hgb < 6 g/dl)
o IDA can cause symptoms with Hgb <11 g/dl
o Most common presentation: Fatigue, mild dyspnea and mild exercise intolerance
o Moderate to severe anemia: Marked dyspnea, activity intolerance, pallor, tachycardia
o Elderly patients may present with exacerbation of comorbidities: Dementia,
chest pain, HF
o Differential Dx
▪ Thalassemia, Beta/Alpha
• Genetic disorders in which the normal ratio of alpha globin to beta
globin production is disrupted due to a disease-causing variant in
one
or more of the globin genes
• Africa (beta), Asia and the Mediterranean region
• Types: Genotype (alpha/beta); phenotype (minor, intermedia or major)
• Labs
o RDW normal
o Retic count increased
o Ferritin normal
o High-performance liquid chromatography (HPLC)/
Hgb electrophoresis – diagnostic standard
o Globin gen – diagnostic confirmation
o Pre-conception and pre-natal testing and counseling
▪ Non-anemia diff dx
• Hypothyroidism
• Pregnancy
• Uterine fibroids
o Ferritin
▪ Iron stores
▪ Earliest lab abnormality
▪ Most accurate test to diagnose IDA
▪ Women 12-150 ng
▪ Men 15-300 ng
▪ Decreased: IDA
▪ Increased: ACD, sideroblastic anemia
▪ In chronic states of inflammation <50 ng is considered IDA
o Other iron studies
▪ Serum iron
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• Circulating iron
• Decreased
▪ TIBC- Total iron binding capacity
• Serum transferrin
• Increased
▪ TSat- Transferring Sat
• Ratio between serum Iron and TIBC
• Decreased
o Other tests (usually not necessary)
▪ Reticulocyte count: New immature RBCs (1%)
• Decreased
▪ Peripheral smear: Provides information of count and morphology
▪ Bone marrow (rare)
▪ Stool OB to r/o GI bleed
▪ HCG test r/o pregnancy
o Management
▪ Oral replacements 180 mg elemental iron (150-200)
▪ FeSO4 325 mg tid (65 mg elemental iron)
▪ Fe Fumarate 325 mg (106 mg elemental iron)
▪ Side effects
• GI: Metallic taste, n/v, diarrhea, constipation
• Check for tolerance
▪ Bioavailability affected by:
• Food- and calcium-containing foods
• pH – OJ
▪ Fe IV infusion: If intolerant to oral or severe, refer
▪ Identify the cause
• GI (+) guaiac
• GYN menorrhagia
o Patient Education
▪ Diet
▪ Fe replacement
o Follow up
▪ Repeat labs CBC ferritin; improvement expected in about 4 weeks
• Retic count expected to increase in 5 days
• Ferritin usually takes 4-6 months to replenish
▪ Continue supplement for 3 months once Hgb normalizes
▪ Monitor CBC periodically
▪ Refer depending on the underlying cause
▪ Refer to Gi for all men and post-menopausal women with IDA
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