NUR 6121 Advanced Nursing II
2024 – 2025 NUR 612 Adv Nursing
2 Exam 1 Practice Test with
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MCH – Mean Corpuscular Hgb
• Amount of Hgb in RBC
• 27 – 34 pg
• Hypochromic and hyperchromic
MCV – Mean Corpuscular Volume; normal range 80 – 100
• Size of average RBC
• MICROCYTICS <80
o Iron deficiency
o Thalassemia
o Anemia of Chronic Disease (ACD)
• NORMOCYTIC 80 – 100
o Acute Blood loss
o ACD – Renal Failure
• MACROCYTIC >100
o B12 or Folate deficiency
RDW – Red Cell Distribution Width
• Measure of the variability of the RBC size
• Normal – homogenous RBC size
o ACD, renal insufficiency, liver disease, ETOH
• Increased – heterogeneous RBC size
o IDA (11.5 – 15)
Microcytic Anemia
IRON DEFICIENCY ANEMIA
• Most common presentation: fatigue, mild dyspnea and mild exercise intolerance
• Mod – severe anemia: pallor, tachycardiac, marked dyspnea, activity intolerance
o Craving ice (pagophagia) ***most common s/s***
• Elderly pts present with exacerbation of comorbidities – dementia, cp, HF
• Most common cause of anemia
• Most common cause if chronic blood loss:
o Menorrhagia, GI bleed – NSAID/ASA
o In women: menorrhagia or pregnancy?
• Also caused by inadequate diet, malabsorption – celiac, H. pylori, gastric bypass, pregnancy,
extreme athletes
• Blood work:
o Ferritin
▪ Iron stores
▪ Earliest lab abnormality; Most accurate test
▪ Women 12 – 150 ng
▪ Men 15 – 300 ng
▪ Decreased – IDA
▪ Increased – ACD, sideroblastic anemia
▪ In chronic states od inflammation - <50ng is considered IDA
o Serum Iron – circulation iron
▪ Decreased
o TIBC – Total Iron Binding Capacity
▪ Serum Transferring
▪ Increased; this transfer iron to bind with Hgb.
o TSat – Transferring Sat
▪ Ration between serum Iron and TIBC
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▪ Decreased
o Other test: reticulocyte count (new immature RBC) – decreased, peripheral smear – count
and morphology, bone marrow, FOV, Hcg (women)
THALASSEMIA, beta/alpha
• Genetic disorder which normal ration of alpha globin to beta globin production is disrupted r/t a
disease- causing variant
• Africa (beta), asia, and the Mediterranean region
• Non – anemia diff dx: hypothyroid, pregnancy, uterine fibroid
• Blood work:
o Hgb electrophoresis – standard dx
o Globin gen – dx confirmation
o Retic count – increased
o RDW and ferritin – normal
o Non – anemia diff dx:
▪ Hypothyroid
▪ Pregnancy
▪ Uterine fibroid
MANAGEMENT
• Orla replacements – 180 mg
o FeSO4 325 mg tid, Fe Fumarate 325mg, Ferrous flucconate
▪ Side effects – GI – metallic taste, n/v/d, constipation – CHECK TOLERANCE
o Calcium/dairy lowers absorption
o Vit C aka OJ helps absorption
• F/U
o Repeat CBC, ferritin – expected improvement in 4 weeks
o Ferritin takes 4 – 6 months to replenish
o C/w supplements for 3 months after hgb/ferritin normalize
Macrocytic Anemia
VIT B 12 DEFICIENCY
• Pernicious anemia (most common) – absence/decreased intrinsic factor (IF)
• Inadequate dietary intake – vegetarians/vegans
• Malabsorption – sprue, post gastrectomy
• Meds – PPI, H2 receptor blockers, metformin
• Takes several years (~10) to develop
• S/s in severe cases:
o Smooth red shiny tongue, sore mouth, loss of taste
o Neurologic symptoms – early s/s: decrease vibratory sense, decrease proprioception,
peripheral neuropathy, ataxia
▪ Later: Romberg’s sign, spasticity, hyperactive reflexes
o May not resolve with treatment if symptoms >6 months
• Dx
o Vit B12 (<300 ng/ml)
o Folate (<3 ng/dl), RBC folate (<150 mg/ml)
o Homocysteine level (MCH) – increased in both
o Methylmalonic acid (MMA) – increased; used to confirm
o Anti – IF antibodies or Schilling test
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