NURS 8022 EXAM 2 QUESTIONS WITH CORRECT ANSWERS VERIFIED BY EXPERTS NEW GENERATION 2024
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NURS 8022
Institution
NURS 8022
NURS 8022 EXAM 2 QUESTIONS WITH CORRECT ANSWERS VERIFIED BY EXPERTS NEW GENERATION 2024 NURS 8022 EXAM 2 QUESTIONS WITH CORRECT ANSWERS VERIFIED BY EXPERTS NEW GENERATION 2024 NURS 8022 EXAM 2 QUESTIONS WITH CORRECT ANSWERS VERIFIED BY EXPERTS NEW GENERATION 2024 NURS 8022 EXAM 2 QUESTIONS WITH COR...
NURS 8022 EXAM 2 QUESTIONS
WITH CORRECT ANSWERS
VERIFIED BY EXPERTS NEW
GENERATION 2024
Hematopoiesis - CORRECT ANSWER>>>>Process of blood cell production in adult
bone marrow or the liver and/or spleen of the fetus
Two stages
▪ Mitosis (proliferation)
▪ Maturation (differentiation)
Primary site of hematopoietic stem cells - CORRECT ANSWER>>>>Bone marrow
("myeloid tissue")
Difference between red and yellow bone marrow - CORRECT ANSWER>>>>Red
marrow produces RBCs, yellow marrow does not produce RBCs
Active bone marrow sites - CORRECT ANSWER>>>>pelvic bones
vertebrae
cranium
mandible
sternum
ribs
humerus
femur
Factors that increase hematopoiesis - CORRECT ANSWER>>>>(1) conversion of
yellow bone marrow, which does not produce blood cells, to hematopoietic red marrow
by the actions of erythropoietin (a hormone that stimulates erythrocyte production)
(2) faster differentiation of progenitor cells
(3) faster proliferation of stem cells into progenitor cells
Erythropoiesis - CORRECT ANSWER>>>>production of RBCs
Sequence of erythropoiesis - CORRECT ANSWER>>>>Pluripotent hematopoietic stem
cell --> committed Proerythroblast/Pronormoblast --> Erythroblast/Normoblast (Hgb
synthesis begins) --> Reticulocyte (nucleus is lost; 3 days spent in bone marrow, about
1 day in blood) --> Erythrocyte
** aprox. 1% of RBCs are reticulocytes **
In each step the quantity of hemoglobin increases and the nucleus decreases in size
,Erythropoietin - CORRECT ANSWER>>>>A hormone produced and released by the
kidney that stimulates the production of red blood cells by the bone marrow
Always present in plasma
Released in response to low renal oxygenation
- NOT the # of RBCs but rather oxygen delivery
- e RBC production increases within 24 hours; life span 4-12 hours; increased RBC # in
5 days
- Given to dialysis and chemo patients
Reticulocytes - CORRECT ANSWER>>>>▪ Last immature form of erythroblast
▪ Contains polyribosomes (globin synthesis) and mitochondria (heme synthesis)
▪ 24-48 hours after leaving bone marrow for circulation, matures into erythrocyte
- Loses polyribosomes and mitochondria
-Make up 1-2% of RBCs
- Last about 2 days in bone marrow and 1 day in blood continuing to mature
- During time of low HCT time in marrow decreased to as little as 1 day
▪ Reticulocyte count -- Indicates whether new RBCs are being produced; good indicator
of erythropoiesis
Hemoglobin and its structure - CORRECT ANSWER>>>>Oxygen-carrying protein of
the erythrocyte --> may carry up to 300 hgb molecules
Reversible deformity to be abvle to squeeze through the tiniest of capillaries
Each Hgb molecule has 2 pairs of different globin chains and 4 complexes of iron +
heme
▪ Heme: large, flat, iron-protoporphyrin disk that is synthesized in the mitochondria and
can carry one molecule of oxygen
▪ Each Hgb can carry 4 molecules of oxygen
Heme vs Globin - CORRECT ANSWER>>>>Heme: Synthesized in mitochondria of
reticulocyte
- Carries Oxygen
Globin: Polyribosomes in reticulocytes
- 2 pairs of globin chains on each Hgb molecule
- Combo of pair determines type of globin chain
,▪ Most common hgb A: 2 alpha chains and 2 beta chains - hgb F (fetal): 2 alpha, 2
gamma
Red blood cell structure - CORRECT ANSWER>>>>Sac of Hgb, no nucleus or
mitochondria, only hemoglobin & enzymes surrounded by membrane
-Lack mitochondria, rely on glycolysis for energy --> "aerobic metabolism"
▪ Deficiencies of 2 enzymes result in anemia
• Pyruvate kinase - necessary for glycolysis - no glycolysis results in RBC damage and
death
• G6PD - involved in protecting the RBC against oxidative stress
Anisocytosis
Poikilocytosis - CORRECT ANSWER>>>>Variation in RBC size
Variation in RBC shape
MCV: 78-100 (related to size)
MCH: 27-34 (related to hgb content)
Reticulocytes: new RBC formation - low suggest issues in production
Microcytic-Hypochromic Anemias - CORRECT ANSWER>>>>Characterized by red
cells that are abnormally small and contain reduced amounts of hemoglobin
Iron Deficiency Anemia (IDA)
Sideroblastic
Thalassemia
Iron Deficiency Anemia (IDA) - CORRECT ANSWER>>>>Type of Microcytic-
Hypochromic Anemia
- Most common type of anemia
- Highest risk: older adults, women, infants, poverty
- Associated with cognitive impairment in children
, - Causes: inadequate dietary intake; excessive blood loss (GI bleed most common
pathophysiologic cause); chronic parasite infestations; metabolic or functional iron
deficiency; menorrhagia (most common physiologic cause)
** Good sign of malignancy for postmenopausal women and men **
IDA Diagnostic Manifestations - CORRECT ANSWER>>>>▪ Low MCV, low MCH
▪ High RDW
▪ Low initial reticulocyte count - elevated once treatment and iron supplementation begin
▪ Ferritin low - #1 test for IDA
▪ Low serum iron; TIBC high - not enough iron to bind transferrin
IDA Clinical Manifestations - CORRECT ANSWER>>>>▪ Mild (hgb 10-12): likely no
symptoms
▪ Moderate (hgb 7-11): palpitations, dyspnea, exercise intolerance, angular stomatitis,
glossitis, pallor, koilonychia (pitting nails), pica (eating disorder in which a person eats
things not usually considered food)
Sideroblastic Anemia - CORRECT ANSWER>>>>Type of Microcytic-Hypochromic
Anemia
Caused by a defect in mitochondrial heme synthesis
▪ Altered mitochondrial metabolism causes ineffective iron uptake and results in
dysfunctional hemoglobin synthesis --> intracellular iron accumulates
- Can be due to alcohol abuse, lead poisoning
Sideroblastic Anemia Diagnostic Manifestations - CORRECT ANSWER>>>>- Presence
of ringed sideroblasts in the bone marrow are diagnostic (erythroblasts contain iron
granules that have not been synthesized into hemoglobin)
- Hct 20-30%
- MCV usually normal
- Elevated serum iron ** iron overload** Enlarged spleen and liver
- High transferrin saturation = Low TIBC
Thalassemia - CORRECT ANSWER>>>>Type of Microcytic-Hypochromic Anemia
Characterized by abnormal formation of hemoglobin resulting from mutation that causes
loss of one or both alpha globin chains or one or both of beta globin chains
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