Cardiology Study Material: Heart Function, Valves, and Anemia, Exams of Nursing

Download Cardiology Study Material: Heart Function, Valves, and Anemia and more Exams Nursing in PDF only on Docsity! Pathophysiology II: Exam 1 The pericardium is: a. the outer muscular layer of the heart. b. the innermost layer of the heart chambers. c. a membranous sac that encloses the heart. d. the heart's fibrous skeleton. - ANS: C The pericardium is the membranous sac that surrounds the heart. The outer layer that acts as the fibrous skeleton of the heart is the myocardium. The innermost layer of the heart is the endocardium. A function of the pericardium is to: a. provide a barrier against extracardial infections. b. improve blood flow through the heart. c. play a role in cardiac conduction. d. assist in cardiac contraction. - ANS: A A function of the pericardium is to provide a barrier against extracardial infections. The pericardium does not improve blood flow through the heart as it is on the outside. The inner portions of the heart control cardiac conduction. The muscular layers assist with cardiac contraction. As a result of blockage in the pulmonary artery, blood would first back up into the: a. aorta. b. left ventricle. c. pulmonary veins. d. right ventricle. - ANS: D Blockage in the pulmonary artery would cause blood to back up into the right ventricle, not the aorta since these two vessels do not communicate. The pulmonary artery and left ventricle do not communicate. Blockage in the pulmonary artery would not cause blood to back up into the pulmonary vein since the pulmonary vein takes blood to the left atrium. Which chamber of the heart generates the highest pressure? a. Right atrium b. Left atrium c. Left ventricle d. Right ventricle - ANS: C The left ventricle generates the highest pressure of all the heart's chambers. The internal lining of the cardiovascular system is formed by what tissue? a. Tunica adventitia b. Connective c. Mesothelium d. Endothelium - ANS: D The endothelium, not the tunica adventitia, is the lining of blood vessels. Connective tissues help make up arterial walls but are not the lining of blood vessels. The mesothelium is a part of the pericardial cavity. A 20 year old underwent an echocardiogram to assess chest pain. Results revealed a congenital defect in the papillary muscles. Which of the following would the nurse expect to occur? a. Closure of the semilunar valve b. Backward expulsion of the atrioventricular valves c. Closure of the atrioventricular valve d. Backward expulsion of the semilunar valves - ANS: B The papillary muscles are extensions of the myocardium that pull the cusps together and downward at the onset of ventricular contraction, thus preventing their backward expulsion into the atria. Defects in the papillary muscles would not affect either the semilunar or atrioventricular valves. What is the nurse monitoring when observing the QRS complex on the electrocardiogram? a. Ventricular activity b. Pulmonary artery closure c. Mitral valve opening d. Aortic valve closing - ANS: A The QRS complex represents the sum of all ventricular muscle cell depolarizations, not the closure of the pulmonary artery. The QRS complex does not reflect activity of either the mitral or aortic valves. What term is used to identify the period that follows depolarization of the myocardium and represents a period during which no new cardiac potential can be propagated? a. Absolute refractory b. Hyperpolarization c. Resting d. Threshold - ANS: A A refractory period is the time during which no new cardiac action potential can be initiated by a stimulus. It follows depolarization. Neither hyperpolarization nor resting correctly identifies this period. Threshold is related to depolarization. The PR interval viewed on a normal electrocardiogram represents: a. atrial depolarization. b. ventricular depolarization. c. onset of atrial activation to onset of ventricular activity. d. "electrical systole" of the ventricles. - ANS: C The PR interval represents the onset of atrial activation to the onset of ventricular activity. The P wave represents atrial depolarization. The QRS complex represents ventricular depolarization. The QT interval represents "electrical systole" of the ventricles. What represents the sum of all ventricular muscle cell depolarization? a. PR interval b. QRS complex c. QT interval d. P wave - ANS: B The QRS complex represents the sum of all ventricular muscle cell depolarizations. The PR interval represents the onset of atrial activation to the onset of ventricular activity. The QT interval represents "electrical systole" of the ventricles. The P wave represents atrial depolarization. A 13 year old took a weight loss drug that activated the sympathetic nervous system. Which of the following assessment findings would the nurse expect? a. Decreased myocardial contraction b. Decreased heart rate c. Increased cardiac conduction d. Increased intranodal conduction time - ANS: C Stimulation of the SA node by the sympathetic nervous system rapidly increases cardiac conduction. Stimulation of the sympathetic nervous system would increase myocardial contraction and heart rate. Such simulation would not affect conduction time within the node. These are inherent rates. A 50-year old received trauma to the chest that caused severe impairment of the primary pacemaker cells of the heart. Which of the following areas received the greatest damage? a. Atrioventricular (AV) node b. Sinoatrial (SA) node c. Bundle of His d. Ventricles - ANS: B The SA node, not the AV node, is considered the pacemaker of the heart. Neither the bundle of His nor the ventricles are involved. A 28 year old with seizure disorder has a vagus nerve stimulator implanted to help control seizure activity. Which result will the nurse expect to occur? a. Increased speed of cardiac cycle b. Increased cardiac contractility c. Decreased vasodilation d. Decreased cardiac conduction - ANS: D The vagus nerve releases acetylcholine. Acetylcholine causes decreased heart rate and slows conduction through the AV node, thus decreasing the speed of the cardiac cycle. This reaction also decreases contractility but does not cause decreased vasodilation. A nurse assesses the heart after acetylcholine because the effect of acetylcholine on the heart is to: a. decrease the refractory period. b. increase calcium influx. c. increase the strength of myocardial contraction. d. decrease the heart rate. - ANS: D Acetylcholine causes decreased heart rate and slows conduction through the AV node; it does not decrease the refractory period nor does it increase calcium influx. It does not increase the strength of myocardial contraction. One difference between cardiac muscle and skeletal muscle is that: a. cardiac muscle cells are arranged in branching networks. b. skeletal muscle cells have only one nucleus. c. cardiac muscle cells appear striped. d. skeletal muscle cells contain sarcomeres. - ANS: A Cardiac cells are arranged in branching networks throughout the myocardium, whereas skeletal muscle cells tend to be arranged in parallel units throughout the length of the muscle. Cardiac muscle cells have only one nucleus, whereas skeletal muscle cells have many nuclei. Both cardiac and muscle cells appear striped and contain sarcomeres. The molecule that aids in bonding of the troponin complex to actin and tropomyosin is troponin: a. blood viscosity. b. blood vessel diameter. c. blood pressure. d. blood vessel length. e. blood composition. - ANS: A, B, C, D Resistance to flow is generally greater in longer tubes because resistance increases with length but decreases with a wider diameter. Blood flow varies inversely with the viscosity of the fluid. Thick fluids move more slowly and experience greater resistance to flow than thin fluids. Increased blood pressure decreases blood flow because resistance is increased. Blood volume, not composition, plays a role in blood flow. A nurse is evaluating stroke volume. Which of the following factors affect stroke volume? (Select all that apply.) a. Preload b. Peripheral vascular resistance c. Afterload d. Ejection fraction e. Contractility - ANS: A, C, E Preload, afterload, and contractility affect stroke volume. A 75-year-old obese female presents to her primary care provider reporting edema in the lower extremities. Physical exam reveals that she has varicose veins. Upon performing the history, which of the following is a possible cause for the varicose veins? a. Extreme exercise b. Long periods of standing c. Trauma to the deep veins d. Ischemia - ANS: B The probable cause of the patient's varicose veins is gradual venous distention caused by the action of gravity on blood in the legs due to long periods of standing. Varicose veins are most likely due to long periods of standing leading to the action of gravity promoting venous distention. Exercise would help prevent this. Trauma can occur, but usually this affects the more superficial veins. Ischemia affects arteries, not veins. When a patient is diagnosed with coronary artery disease, the nurse assesses for myocardial: a. hypertrophy. b. ischemia. c. necrosis. d. inflammation. - ANS: B Coronary artery disease leads to myocardial ischemia. Coronary artery disease would not lead to hypertrophy but not to ischemia, necrosis, or inflammation. A nurse takes an adult patient's blood pressure and determines it to be normal. What reading did the nurse obtain? a. Systolic pressure between 140 and 150 mm Hg b. Systolic pressure less than 120 mm Hg and diastolic pressure less than 80 mm Hg c. Systolic pressure less than 100 mm Hg regardless of diastolic pressure d. Systolic pressure greater than 140 mm Hg and a diastolic pressure of 100 mm Hg - ANS: B Normal blood pressure has a systolic pressure less than 120 mm Hg and diastolic pressure less than 80 mm Hg. A systolic pressure of 140 mm Hg or more would indicate stage I hypertension. A systolic pressure of less than 100 mm Hg would indicate low blood pressure. A diastolic pressure greater than 90 mm Hg would indicate hypertension. Most cases of combined systolic and diastolic hypertension have no known cause and are documented on the chart as _____ hypertension. a. primary b. secondary c. congenital d. acquired - ANS: A Most cases of hypertension are diagnosed as primary hypertension, not secondary, which is due to a known cause. Most cases of hypertension are not a result of congenital or acquired causes. A patient presents to the emergency department reporting difficulty swallowing and shortness of breath. A CT scan would most likely reveal an aneurysm in the: a. cerebral vessels. b. renal arteries. c. inferior vena cava. d. thoracic aorta. - ANS: D Thoracic aortic aneurysms can cause dysphagia (difficulty swallowing) and dyspnea (breathlessness). Aneurysms in cerebral vessels will produce a headache. Aneurysms in the renal arteries will produce flank pain. Aneurysms in the inferior vena cava may produce chest pain. An older adult is diagnosed with cerebral aneurysm. Where does the nurse suspect the cerebral aneurysm is located? a. Vertebral arteries b. Basilar artery c. Circle of Willis d. Carotid arteries - ANS: C Cerebral aneurysms often occur in the circle of Willis. Such an aneurysm is not associated with the vertebral arteries, the basilar artery, or the carotid arteries. A patient is diagnosed with coronary artery disease. Which of the following modifiable risk factors would the nurse suggest the patient change? a. Eating meat b. Living arrangements c. Drinking tomato juice d. Smoking cigarettes - ANS: D a. Administer a diuretic to decrease volume. b. Apply oxygen to increase myocardial oxygen supply. c. Encourage exercise to increase heart rate. d. Give an antibiotic to decrease infection. - ANS: B Increasing the myocardial oxygen supply is indicated to treat ischemia. A decrease in fluid volume is not appropriate. Heart rate should be decreased to decrease cardiac workload. Antibiotics are not the most beneficial; oxygen is. A 68-year-old male presents to the ER reporting chest pain. He has a history of stable angina that now appears to be unstable. He most likely has: a. mild to moderate atherosclerosis. b. impending myocardial infarction (MI). c. electrical conduction problems in the heart. d. decreased myocardial oxygen demand. - ANS: B Unstable angina is an indication of impending MI. Unstable angina could be caused by moderate atherosclerosis, altered electrical conduction, or a decrease in myocardial oxygen, but it is an indication of impending MI. A 55-year-old male died of a myocardial infarction. Autopsy would most likely reveal: a. embolization of plaque from the aorta. b. decreased ventricular diastolic filling time. c. platelet aggregation within the atherosclerotic coronary artery. d. smooth muscle dysplasia in the coronary artery. - ANS: C The autopsy would reveal platelet aggregation within an atherosclerotic coronary artery. The cause of death is most likely occlusion of the coronary artery, not emboli from the aorta, decreased filling time, or dysplasia in the artery. A 75-year-old male has severe chest pain and dials 911. Based upon the lab findings indicating a patient has elevated levels of cardiac troponins I and T, the nurse suspects which of the following has occurred? a. Raynaud disease b. Myocardial infarction (MI) c. Orthostatic hypotension d. Angina - ANS: B The diagnosis of acute MI is made on the basis of serial cardiac biomarker alterations. The cardiac troponins (troponins I and T) are the most specific indicators of MI. Elevated troponins I and T are indicative of MI, not Raynaud disease, orthostatic hypotension, or angina. A 28 year old presents to the ER reporting severe chest pain that worsens with respirations or lying down. Other signs include a fever, tachycardia, and a friction rub. Assessment findings support which medical diagnosis? a. Acute pericarditis b. Myocardial infarction (MI) c. Stable angina d. Pericardial effusion - ANS: A Severe chest pain that worsens with respirations or lying down in a patient with fever, tachycardia, and a friction rub is characteristic of acute pericarditis. MI pain does not worsen with respirations. Stable angina does not worsen with respiration or lying down. Pericardial effusion is not manifested by these symptoms. A 56 year old presents to his primary care provider for a checkup. Physical exam reveals edema, hepatomegaly, and muffled heart sounds. Which of the following is of greatest concern to the nurse? a. Tamponade b. Exudate c. Aneurysm d. Pulsus paradoxus - ANS: A Muffled heart sounds are an indication of tamponade, and with tamponade the blood backs up into the venous system, leading to hepatomegaly. Muffled heart sounds with hepatomegaly are symptoms of tamponade, not exudates. An aneurysm would present without symptoms. Pulsus paradoxus is manifested by a change in blood pressure during inspiration and expiration. A 42 year old is diagnosed with constrictive pericarditis. The nurse assesses the blood pressure for decreased cardiac output because of: a. pericardial effusions. b. fibrosis and calcification of the pericardial layers. c. cardiomyopathy. d. hemorrhage in the pericardial cavity. - ANS: B In constrictive pericarditis, fibrous scarring compresses the heart and eventually reduces cardiac output. Pericardial effusion is manifested by chest pain. Cardiomyopathy is a general term for pathophysiologic changes in the heart. Hemorrhage in the pericardial cavity will lead to tamponade. A 60-year-old female has survived a myocardial infarction. The nurse is providing care for impaired ventricular function because: a. there is a temporary alteration in electrolyte balance. b. there is too much stress on the heart. c. the cells become hypertrophic. d. the resulting ischemia leads to hypoxic injury and myocardial cell death. - ANS: D The patient has impaired ventricular functioning because a portion of the myocardium has died due to ischemia. Impaired ventricular function is due to damage to the myocardium; it is not due to electrolyte imbalance. There was stress on the heart, but the impaired functioning is due to myocardial damage secondary to ischemia. The impaired ventricular dysfunction is due to myocardial cell death, not hypertrophy. Many valvular stenosis and regurgitation disorders in adults have a common etiology. Which of the following conditions should alert the nurse that the patient may have both types of valve dysfunctions? a. Heart failure b. Connective tissue disorders c. Rheumatic fever or heart disease d. Syphilis infection - ANS: C b. pulmonary stenosis. c. tricuspid valve prolapse. d. aortic stenosis. - ANS: A Mitral valve prolapse is the most common valve disorder in the United States. Neither pulmonary stenosis, tricuspid valve prolapse, nor aortic stenosis is the most common valve disorder in the United States. A 30-year-old female presents to her primary care provider with fever, cardiac murmur, and petechial skin lesions and is diagnosed with infective endocarditis. The most likely cause of the disease is: a. bacteria. b. viruses. c. fungi. d. parasites. - ANS: A Infective endocarditis is due to a bacterial infection, not a viral, fungal, or parasitic infection. Inflammatory cells have difficulty limiting the colonization of microorganisms in infective endocarditis because the: a. microorganisms are resistant. b. valves are avascular. c. microorganisms are sequestered in a fibrin clot. d. colonies overwhelm the phagocytes. - ANS: C In endocarditis, bacterial colonies are inaccessible to host defenses because they are embedded in the protective fibrin clots; it is not because the microorganisms are resistant, that the valves are avascular, or that the colonies overwhelm the phagocytes. Which characteristic changes should the nurse keep in mind while caring for a patient with left heart failure? As left heart failure progresses: a. left ventricular preload increases. b. systemic vascular resistance decreases. c. left end-diastolic volume decreases. d. pulmonary vascular resistance decreases. - ANS: A Left ventricular preload increases in left heart failure because less blood is ejected from the left ventricle. Left heart failure does not lead to a decrease in systemic resistance; it leads to an increase in resistance. Left end-diastolic volume will increase. Pulmonary vascular resistance will increase. A 65-year-old male with a history of untreated hypertension is now experiencing left heart failure. A nurse recalls his untreated hypertension led to: a. ventricular dilation and wall thinning. b. myocardial hypertrophy and ventricular remodeling. c. inhibition of renin and aldosterone. d. alterations in alpha and beta receptor function. - ANS: B With hypertension comes increased afterload and resistance to ventricular emptying and more workload for the ventricle, which responds with hypertrophy of the myocardium and ventricular remodeling. Ventricular dilation can occur, but the wall will thicken, not thin. Renin and aldosterone release are increased, not inhibited. Alterations in alpha and beta functioning may occur, but the response to hypertension is myocardial hypertrophy and ventricular remodeling. A patient with left heart failure starts to have a cough and dyspnea. Pulmonary symptoms common to left heart failure are a result of: a. inflammatory pulmonary edema. b. decreased cardiac output. c. pulmonary vascular congestion. d. bronchoconstriction. - ANS: C The clinical manifestations of left heart failure are the result of pulmonary vascular congestion and inadequate perfusion of the systemic circulation. Pulmonary edema does occur, but it is not due to inflammation. Decreased cardiac output does occur, but the pulmonary symptoms are related to pulmonary congestion. Pulmonary symptoms are not due to bronchoconstriction. A patient was admitted to the intensive care unit with a diagnosis of acute myocardial infarction (MI) and is being treated for shock. The primary cause of shock is most likely: a. rapid heart rate. b. decreased cardiac contractility. c. increased capillary permeability. d. decreased afterload due to vasodilation. - ANS: B MI leads to decreased cardiac contractility due to a damaged myocardium and would lead to shock. A rapid heart rate would not cause shock. Increased capillary permeability would not lead to shock. Decreased afterload will not lead to shock associated with MI. A 73 year old has increased pulmonary pressure resulting in right heart failure. A potential cause for the right heart to fail is: a. hypertension. b. left heart failure. c. acute pneumonia. d. pericarditis. - ANS: B Right-sided failure often follows left-sided failure when pulmonary congestion forces backward flow of blood into the left ventricle. It is not due to hypertension, pneumonia, or pericarditis. A 65-year-old male is diagnosed with chronic pulmonary disease and elevated pulmonary vascular resistance. Which of the following heart failures should the nurse assess for in this patient? a. Right heart b. Left heart c. Low-output d. High-output - ANS: A Right-sided failure occurs when the patient experiences chronic pulmonary disease and elevated pulmonary vascular resistance because the blood has difficulty overcoming the pressure and blood builds up in the right side of the heart. Pulmonary congestion leads to right-sided failure, not left, low- output failure, and high-output failure. b. lymphocyte. c. macrophage. d. neutrophil. - ANS: D Neutrophils are the chief phagocytes of early inflammation. Eosinophils ingest antigen-antibody complexes and are induced by IgE-mediated hypersensitivity reactions to attack parasites. Most lymphocytes transiently circulate in the blood and eventually reside in lymphoid tissues as mature T cells, B cells, or plasma cells. Macrophages migrate out of the vessels in response to infection or inflammation but are not the early responders. Which type of white blood cell contains preformed granules of vasoactive amines? a. Neutrophil b. Eosinophil c. Monocyte d. Basophil - ANS: D Basophils have cytoplasmic granules that contain vasoactive amines (e.g., histamine) and an anticoagulant (heparin). Their function is similar to tissue mast cells. Neutrophils are the chief phagocytes of early inflammation. Eosinophils ingest antigen-antibody complexes and are induced by IgE-mediated hypersensitivity reactions to attack parasites. Monocytes do not have amines, and their job is to help fight infection. Monocytes are blood cells that mature (differentiate) into: a. macrophages. b. neutrophils. c. eosinophils. d. mast cells. - ANS: A Monocytes mature into macrophages, not neutrophils, eosinophils, or mast cells. In addition to playing a role in hemostasis, platelets have the ability to: a. stimulate bone marrow production of erythrocytes. b. release biochemical mediators of inflammation. c. undergo cell division in response to bleeding. d. activate a humoral response. - ANS: B Platelets contain cytoplasmic granules capable of releasing proinflammatory biochemical mediators when stimulated by injury to a blood vessel. Platelets assist with inflammation; they do not produce erythrocytes, undergo cell division in response to bleeding, or activate the humoral response. While planning care for a newborn, the pediatric nurse recalls that the site of hematopoiesis in the fetus is the: a. bone marrow. b. kidney. c. lymph nodes. d. spleen. - ANS: D Hematopoiesis is constantly ongoing, occurring in the liver and spleen of the fetus and only in bone marrow (medullary hematopoiesis) after birth. Fetal hematopoiesis does not occur in the bone marrow, kidney, or lymph nodes. Which of the following assessment findings is most likely to occur following a splenectomy? a. Leukocytosis b. Hypoglycemia c. Decreased red blood cell count d. Decreased platelets - ANS: A Leukocytosis often occurs after splenectomy. A splenectomy is not a trigger for hypoglycemia or decreased levels of either red blood cells or platelets. During an infection, lymph nodes enlarge and become tender because: a. lymphocytes are rapidly dividing. b. edema accumulates within the fibrous capsule. c. microorganisms are accumulating. d. the nodes are not functioning properly. - ANS: A During an infection, the rate of proliferation of lymphocytes within the nodes is so great that the nodes enlarge and become tender. Edema may be present, but the tenderness is due to proliferation of lymphocytes and is a normal function of the nodes. The tenderness is not due to the microorganisms. After birth, red blood cells are normally made only in the: a. liver. b. spleen. c. bone marrow. d. kidney. - ANS: C Red blood cells are produced in the bone marrow, not the liver, spleen, or kidney. Which cytokines participate in hematopoiesis? a. Stimulating factors (CSFs) b. Eosinophils c. Basophils d. Neutrophils - ANS: A Several cytokines participate in hematopoiesis, particularly CSFs (or hematopoietic growth factors). Neither eosinophils, basophils, nor neutrophils play a role in hematopoiesis. Erythropoietin is produced in the: a. liver. b. bone marrow. c. kidneys. d. spleen. - When a nurse is reviewing lab results and notices that the erythrocytes contain an abnormally low concentration of hemoglobin, the nurse calls these erythrocytes: a. hyperchromic. b. hypochromic. c. macrocytic. d. microcytic. - ANS: B Hypochromic erythrocytes have low concentrations of hemoglobin. Hyperchromic erythrocytes have high concentrations of hemoglobin. Macrocytic and microcytic refer to cell size. A 5 year old was diagnosed with normocytic-normochromic anemia. Which type of anemia does the nurse suspect the patient has? a. Sideroblastic b. Hemolytic c. Pernicious d. Iron deficiency - ANS: B Hemolytic anemia is an example of normocytic-normochromic anemia. Sideroblastic anemia is an example of microcytic hypochromic anemia. Pernicious anemia is an example of a macrocytic anemia. Iron deficiency anemia is an example of microcytic hypochromic anemia. After initial compensation, what hemodynamic change should the nurse monitor for in a patient who has a reduction in the number of circulating erythrocytes? a. Increased viscosity of blood b. Decreased cardiac output c. Altered coagulation d. Hyperdynamic circulatory state - ANS: D After initial compensation, the blood flows faster and more turbulently than normal blood, causing a hyperdynamic circulatory state. Blood viscosity decreases rather than increases. Cardiac output increases. Alteration in coagulation does not occur. A 25-year-old female has a heavy menses during which she loses a profuse amount of blood. Which of the following adaptations should the nurse expect? a. Movement of fluid into the cell b. Decreased cardiac output c. Decreased oxygen release from hemoglobin d. Peripheral vasoconstriction - ANS: D When the anemia is severe or acute in onset (e.g., hemorrhage), the initial compensatory mechanism is peripheral blood vessel constriction, diverting blood flow to essential vital organs. Fluid moves into the vascular space, not the cell. Blood volume increases; thus, cardiac output increases. There is an increase in hemoglobin release of oxygen. A 60-year-old patient diagnosed with emphysema experiences a rapid and pounding heart, dizziness, and fatigue with exertion. Which respiratory assessment findings indicate the respiratory system is compensating for the increased oxygen demand? a. Bronchoconstriction b. Increased rate and depth of breathing c. Dyspnea d. Activation of the renin-angiotensin response - ANS: B The rate and depth of breathing increase in an effort to increase oxygen availability accompanied by an increase in the release of oxygen from hemoglobin. Bronchodilation occurs, not constriction. Dyspnea is not a compensatory mechanism but a side effect of the body's attempt to increase oxygen. The respiratory system does not activate the renin-angiotensin response; the kidneys are involved. A 35-year-old female is diagnosed with vitamin B12 deficiency anemia (pernicious anemia). The most likely cause is a decrease in: a. ferritin. b. gastric enzymes. c. intrinsic factor. d. erythropoietin. - ANS: C The underlying alteration in pernicious anemia (PA) is the absence of intrinsic factor (IF), an enzyme required for gastric absorption of dietary vitamin B12, a vitamin essential for nuclear maturation, and DNA synthesis in red blood cells. PA is not due to a decrease in ferritin, gastric enzymes, or erythropoietin but to a lack of intrinsic factor. A 58-year-old female presents in the clinic with fatigue, weight loss, and tingling in her fingers. Laboratory findings show low hemoglobin and hematocrit, a high mean corpuscular volume, and normal plasma iron. These assessment findings are consistent with which type of anemia? a. Hemolytic anemia b. Pernicious anemia c. Iron deficiency anemia d. Aplastic anemia - ANS: B Pernicious anemia is manifested by tingling paresthesias of feet and fingers. The symptomology is not associated with hemolytic, iron deficiency, or aplastic anemias. Which individual should the nurse assess initially for a vitamin B12 deficiency anemia? a. A 3-year-old female who is a fussy eater b. A 26-year-old female in the second trimester of her first pregnancy c. A 47-year-old male who had a gastrectomy procedure d. A 64-year-old male with a history of duodenal ulcers - ANS: C With removal of the stomach, the intrinsic factor is also removed, leading to an inability to absorb B12; thus, the person with removal of the stomach is at greatest risk. Being a fussy eater, being pregnant, and having a history of duodenal ulcers are not risk factors for vitamin B12 deficiency anemia. A 65 year old experienced loss of appetite, weight loss, lemon-yellow skin, liver enlargement, and a beefy red tongue shortly before her death. Autopsy suggested pernicious anemia, and the cause of death would most likely reveal: a. brain hypoxia. b. liver hypoxia. A 50-year-old female was diagnosed with sideroblastic anemia. Which of the following assessment findings would most likely occur? a. Bronze-colored skin b. Decreased iron c. Normochromic erythrocytes d. Aplastic bone marrow - ANS: A The skin of the patient with sideroblastic anemia is bronze in color. The patient with sideroblastic anemia shows signs of iron overload. The erythrocytes of individuals with sideroblastic anemia are hypochromic. The bone marrow is not aplastic but contains ringed sideroblasts. Lab results showing high iron, bilirubin, and transferrin and low hemoglobin and hematocrit would support a diagnosis of which form of anemia? a. Pernicious b. Folate deficiency c. Iron deficiency d. Sideroblastic - ANS: D Individuals with sideroblastic anemia may show signs of iron overload (hemosiderosis), including mild to moderate enlargement of the liver (hepatomegaly) and spleen (splenomegaly). High levels of iron indicate sideroblastic anemia, not pernicious anemia, folate deficiency, or iron deficiency anemia. Considering anemia, what effect do vitamin B12 and folate deficiencies have on red blood cells? a. They are unable to differentiate into erythrocytes. b. They contain malformed hemoglobin molecules. c. O2-carrying capacity is decreased. d. Their life span is shorter. - ANS: D These deficiencies lead to defective erythrocytes that die prematurely, which decreases their numbers in the circulation, causing anemia. These deficiencies do not cause the RBCs to lack differentiation, contain malformed hemoglobin, or experience diminished O2-carrying capacity. Aplastic anemia is caused by: a. iron deficiency. b. excess levels of erythropoietin. c. hemolysis. d. stem cell deficiency. - ANS: D In aplastic anemia, erythrocyte stem cells are underdeveloped, defective, or absent; iron is not deficient, there are no excess levels of erythropoietin, nor do cells undergo hemolysis.