SAS #7

1. In a severely anemic patient, you expect to

find
A. dyspnea and tachycardia.
B. cyanosis and pulmonary edema.
C. cardiomegaly and pulmonary fibrosis.
D. ventricular dysrhythmias and wheezing.
Patients with severe anemia (hemoglobin <6 g/dL) exhibit the
followingcardiovascular and pulmonary manifestations: tachycardia,
increased pulse pressure,systolic murmurs, intermittent claudication, angina,
heart failure, myocardial infarction;tachypnea, orthopnea, dyspnea at rest.

2. You are caring for a patient with a diagnosis

of iron-deficiency anemia. Which clinical
manifestations are you most likely to observe
when assessing this patient?
A. Convex nails, bright red gums, and alopecia
B. Brittle nails; smooth, shiny tongue; and
cheilosis
C. Tenting of the skin, sunken eyes, and
complaints of diarrhea
D. Pale pink tongue; dull, brittle hair; and blue
mucous membranes
Specific clinical manifestations may be related to iron-deficiency anemia.
Pallor is the most common finding, and glossitis (inflammation of the tongue)
is the second most common; another finding is cheilitis (inflammation of the
lips).

3.When providing teaching for the patient with

iron-deficiency anemia who has been
prescribed iron supplements, you should
include taking the iron with which beverage?
A. Milk
B. Ginger ale
C. Orange juice
D. Water and
Taking iron with vitamin C (ascorbic acid) or orange juice, which contains
ascorbic acid, also enhances iron absorption. Milk may interfere with iron
absorption. Ginger ale and water do not facilitate iron absorption.

4.The primary pathophysiology underlying

thalassemia is
A. erythropoietin deficiency.
B. abnormal hemoglobin synthesis.
C. autoimmunity.
D. S-shaped hemoglobin.
Thalassemia is a group of autosomal recessive diseases that involve
inadequate production of normal hemoglobin. 

5. Which individual is at high risk for a

cobalamin (vitamin B12) deficiency anemia?
A. A 47-year-old man who had a gastrectomy
(removal of the stomach) bowel disease and ulcerative colitis
C. A 26-year-old woman who complains of
heavy menstrual periods
D. A 15-year-old girl who is a vegetarian
There are many causes of cobalamin deficiency. The most common cause is
pernicious anemia, a disease in which the gastric mucosa is not secreting
intrinsic factor (IF) because of antibodies being directed against the gastric
parietal cells or IF itself. 

6. You encourage the patient with cobalamin

deficiency to seek treatment because
untreated pernicious anemia may result in
A. death.
B. liver failure.
C. heart failure.
D. gastrectomy.
Regardless of how much cobalamin is ingested, the patient is not able to
absorb it if intrinsic factor is lacking or if there is impaired absorption in the
ileum. For this reason, increasing dietary cobalamin does not correct the
anemia. 

7. The Schilling test for pernicious anemia

involves
A. administration of radioactive cobalamin and
measuring its excretion in the urine.
B. blood cultures for organism identification.
C. the measurement of serum iron.
D. the administration of iron and blood
assessment of total iron binding in 24 hours.
Parietal cell function can be assssed with a Schilling test. After radioactive
cobalamin is administered to the patient, the amount of cobalamin excreted in
the urine is measured. An individual who cannot absorb cobalamin excretes
only a small amount of this radioactive form.

8. Which finding allows you to identify the

patient's anemia as folic acid deficiency rather
than cobalamin deficiency?
A. Loss of appetite
B. Lack of neuromuscular symptoms
C. Red tongue
D. Change in nail shape
The absence of neurologic problems is an important diagnostic finding and
differentiates folic acid deficiency from cobalamin deficiency.

9. Which foods should you encourage patients

with folic acid deficiency to include in their
daily food intake (select all that apply)?
A. Ready-to-eat cereal
B. Wheat tortillas
C. Lentils
D. Strawberries
E. Potatoes
Whole-grain foods and beans are high in folic acid.

10. You are evaluating the laboratory data of

the patient with suspected aplastic anemia.
Which findings support this diagnosis?
A. Reduced RBCs, reduced white blood cells
(WBCs), and reduced platelets
B. Reduced RBCs, normal WBCs, and normal
platelets
C. Normal RBCs, reduced WBCs, and reduced
platelets
D. Elevated RBCs, increased WBCs, and
increased platelets
Because all marrow elements are affected, hemoglobin, WBC, and platelet
values are decreased in aplastic anemia. Other RBC indices usually are
normal.