ch 26 patho

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The neurologic symptoms in vitamin B12 deficiency anemia are not reversed even with appropriate treatment.

T

Considering oral iron therapy, the ferric form is preferred to the ferrous form because ferric is more readily absorbed

F - ferrous form versus ferric form

In hemolytic anemia, the bone marrow is capable of increasing red cell production because of elevated levels of erythropoietin

T

Anemia of chronic disease (ACD) is initially a normochromic and normocytic anemia, but as the condition progresses, it becomes hypochromic and microcytic.

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Anemia of chronic disease (ACD) is initially a normochromic and normocytic anemia, but as the condition progresses, it becomes hypochromic and microcytic.

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1. In some anemias the erythrocytes are present in various sizes, which is referred to as:
a.
poikilocytosis.
b.
isocytosis.
c.
anisocytosis.
d.
microcytosis.

anisocytosis.

2. The major physiologic manifestation of anemia is:
a.
hypotension.
b.
hyperesthesia.
c.
hypoxia.
d.
ischemia

hypoxia

3. The paresthesia that occurs in vitamin B12
a. deficiency anemia is a result of a(n):
reduction in acetylcholine receptors in the postsynaptic nerves.
b.
myelin degeneration in the spinal cord.
c.
destruction of myelin in peripheral nerves.
d.
altered function of neurons in the parietal lobe.

myelin degeneration in the spinal cord.
c.

4. The body compensates for anemia by:
a.
increasing rate and depth of breathing.
b.
capillary vasoconstriction.
c.
hemoglobin holds on to oxygen more firmly.
d.
kidneys release more erythropoietin.

increasing rate and depth of breathing.
b.

5. Which of the following is classified as a macrocytic-normochromic anemia?
a.
Iron deficiency
b.
Pernicious
c.
Sideroblastic
d.
Hemolytic

Pernicious

6. Deficiencies in folate and vitamin B12
a. alter the synthesis of:
RNA.
b.
cell membrane.
c.
DNA.
d.
mitochondria

DNA

7. The underlying disorder of _____ anemia is defective secretion of intrinsic factor, which is essential for the absorption of vitamin B
a.
12.
microcytic
b.
pernicious
c.
hypochromic
d.
hemolytic

pernicious

8. After a person has a subtotal gastrectomy for chronic gastritis, what type of anemia would result?
a.
Iron deficiency
b.
Pernicious
c.
Folic acid
d.
Vitamin B
12

Pernicious

9. Atrophy of gastric mucosal cells results in pernicious anemia because of:
a.
erythrocyte destruction.
b.
folic acid malabsorption.
c.
vitamin B12
d. malabsorption.
poor nutritional intake

vitamin B12
d. malabsorption.

10. A woman complains of chronic gastritis, fatigue, weight loss, and tingling in her fingers. Laboratory findings show low hemoglobin and hematocrit levels, and a high mean corpuscular volume. These findings are consistent with _____ anemia.
a.
folate deficiency
b.
pernicious
c.
iron deficiency
d.
aplastic

pernicious

11. The Schilling test is described as the:
a.
administration of radioactive cobalamin and the measurement of its excretion in the urine to test for vitamin B12
b. deficiency.
measurement of antigen-antibody immune complexes in the blood to test for hemolytic anemia.
c.
measurement of serum ferritin and total iron-binding capacity in the blood to test for iron deficiency anemia.
d.
administration of folate and measurement in 2 hours of its level in a blood sample to test for folic acid deficiency anemia

administration of radioactive cobalamin and the measurement of its excretion in the urine to test for vitamin B12

12. Pernicious anemia is treated with:
a.
vitamin B12
b. by oral intake.
cyanocobalamin by intramuscular injection.
c.
ferrous fumarate by intramuscular injection, Z track.
d.
folate by oral intake.

cyanocobalamin by intramuscular injection

13. Untreated pernicious anemia is fatal, usually because of:
a.
brain hypoxia.
b.
liver hypoxia.
c.
heart failure.
d.
renal failure.

heart failure.

14. How is the effectiveness of vitamin B12
a. therapy measured?
Reticulocyte count
b.
Serum transferring
c.
Hemoglobin
d.
Serum vitamin B
12

Reticulocyte count

15. Which statement about folic acid is false?
a.
Folic acid absorption is dependent on the enzyme folacin.
b.
Folic acid is stored in the liver.
c.
Folic acid is essential for RNA and DNA synthesis within erythrocytes.
d.
Folic acid is absorbed in the upper small intestine

Folic acid absorption is dependent on the enzyme folacin.
b.

16. Which anemia produces small, pale erythrocytes?
a.
Folic acid
b.
Hemolytic
c.
Iron deficiency
d.
Pernicious

Iron deficiency

17. A man has fatigue, weakness, and dyspnea. His conjunctiva and palms are pale. His nails appear brittle, thin, and concave, and he has sores at the corners of his mouth. Considering this information, the nurse suspects that this patient probably has _____ anemia.
a.
pernicious
b.
iron deficiency
c.
aplastic
d.
hemolytic

iron deficiency

18. The most common cause of iron deficiency anemia is:
a.
decreased dietary intake.
b.
chronic blood loss.
c.
vitamin deficiency.
d.
autoimmune disease

chronic blood loss

19. Pernicious anemia generally requires continued therapy lasting:
a.
6 to 8 weeks.
b.
8 to 12 months.
c.
until the iron level is normal.
d.
the rest of one's life.

the rest of one's life.

20. A man has cheilosis, stomatitis, and painful ulceration of the buccal mucosa and mouth. He complains of dysphagia and watery diarrhea. These clinical manifestations are indicative of:
a.
PA.
b.
folate deficiency anemia.
c.
anemia of chronic disease.
d.
IDA.

folate deficiency anemia.

21. If a man has inherited the gene for sideroblastic anemia, he received it from his:
a.
mother.
b.
father.
c.
grandfather.
d.
grandmother

mother.

22. Clinical manifestations of mild to moderate splenomegaly and hepatomegaly, bronze-colored skin, and cardiac dysrhythmias are indicative of which anemia?
a.
Iron deficiency
b.
Pernicious
c.
Sideroblastic
d.
Aplastic

Sideroblastic

v23. A person with sideroblastic anemia would be likely to have _____ plasma levels of iron.
a.
high
b.
low
c.
normal
d.
absent

high

24. In a plastic anemia, pancytopenia develops as a result of the:
a.
suppression of erythropoietin to produce adequate amounts of erythrocytes.
b.
suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes.
c.
lack of DNA to form sufficient quantities of erythrocytes, leukocytes, and thrombocytes.
d.
lack of stem cells to form sufficient quantities of leukocytes.

suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes.
c.

25. What is the pathophysiologic process of aplastic anemia?
a.
Autoimmune disease against hematopoiesis by activated cytotoxic T cells
b.
Malignancy of the bone marrow in which unregulated proliferation of erythrocytes crowd out other blood cells
c.
Autoimmune disease against hematopoiesis by activated immunoglobulins
d.
Inherited genetic disorder with recessive X-linked transmission

Autoimmune disease against hematopoiesis by activated cytotoxic T cells

26. An allogenic bone marrow transplantation remains the preferred and most successful method for treating which anemia?
a.
Polycythemia vera
b.
Aplastic anemia
c.
Sideroblastic anemia
d.
Anemia of chronic disease

Aplastic anemia

27. Which is a characteristic of warm antibody immunohemolytic anemia?
a.
It occurs primarily in men.
b.
It is self-limiting and rarely produces hemolysis.
c.
Erythrocytes are bound to macrophages and sequestered in the spleen.
d.
IgM coats erythrocytes and binds them to receptors on monocytes.

Erythrocytes are bound to macrophages and sequestered in the spleen.
d.

28. In hemolytic anemia, jaundice occurs only when:
a.
erythrocytes are destroyed in the spleen.
b.
heme destruction exceeds the liver's ability to conjugate and excrete bilirubin.
c.
the patient has elevations in aspartate transaminase (AST) and alanine transaminase (ALT).
d.
the erythrocytes are coated with an immunoglobulin.

heme destruction exceeds the liver's ability to conjugate and excrete bilirubin.
c.

29. Erythrocyte life span less than 120 days, ineffective bone marrow response to erythropoietin, and altered iron metabolism describe the pathophysiology of:
a.
aplastic anemia.
b.
sideroblastic anemia.
c.
anemia of chronic disease.
d.
IDA.
30.

anemia of chronic disease

30. Anemia of chronic disease is a mild to moderate anemia associated with chronic infections, chronic noninfectious inflammatory diseases, and malignancies. Chronic diseases commonly associated with this anemia include all of the following except:
a.
rheumatoid arthritis.
b.
AIDS.
c.
polycythemia vera.
d.
systemic lupus erythematosus

.
polycythemia vera.

31. Symptoms of polycythemia vera are mainly the result of:
a.
a decreased erythrocyte count.
b.
destruction of erythrocytes.
c.
increased blood viscosity.
d.
neurologic involvement

increased blood viscosity

32. Treatment for polycythemia vera involves:
a.
therapeutic phlebotomy and radioactive phosphorus.
b.
restoration of blood volume by plasma expanders.
c.
the administration of cyanocobalamin.
d.
blood transfusions

therapeutic phlebotomy and radioactive phosphorus.
b.

1. Pernicious anemia

c.
Macrocytic-normochromic anemia

2. Sideroblastic anemia

b.
Microcytic-hypochromic anemia

3. Aplastic anemia

a.
Normocytic-normochromic anemia

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