Anemias

One of the earliest laboratory markers in evolving macrocytic or microcytic anemia is: a. an increase in RBC distribution width (RDW). b. a reduction in measurable hemoglobin. c. a low MCH level. d. an increased platelet count.

a. an increase in RBC distribution width (RDW).

You examine a 47-year-old man who presents with difficulty initiating and maintaining sleep and chronic pharyngeal erythema with the following results on hemogram: Hemoglobin (Hgb) = 15 g Hct = 45% RBC = 4.2 million mm3 MCV = 108 fL MCHC=33.2 g/dL These values are most consistent with: a. pernicious anemia. b. alcohol abuse. c. thalassemia minor. d. Fanconi disease.

b. alcohol abuse.

A 40-year-old woman with pyelonephritis is taking two medications: ciprofloxacin and ferrous sulfate (for iron-deficiency anemia). She asks about taking both medications. You advise that: a. she should take the medications with a large glass of water. b. an inactive drug compound is potentially formed if the two medications are taken together. c. she can take the medications together to enhance adherence to therapy. d. the ferrous sulfate potentially slows GI motility and results in enhanced ciprofloxacin absorption.

b. an inactive drug compound is potentially formed if the two medications are taken together.

You examine a 57-year-old woman with rheumatoid arthritis who is on disease-modifying antirheumatic disease but continues to have poor disease control and find the following results on hemogram: Hgb = 10.5 g Hct = 33% RBC = 3.1 million mm3 MCV = 88 fL MCHC=32.8 g/dL RDW= 12.2% Reticulocytes = 0.8% The laboratory findings are most consistent with: a. pernicious anemia. b. anemia of chronic disease. c. beta-thalassemia minor. d. folate-deficiency anemia.

b. anemia of chronic disease.

Risk factors for folate-deficiency anemia include: a. menorrhagia. b. chronic ingestion of overcooked foods. c. use of NSAID's. d. gastric atrophy.

b. chronic ingestion of overcooked foods.

Two months into therapy for pernicious anemia, you wish to check the efficacy of the intervention. The best laboratory test to order at this point is a: a. Schilling test. b. hemoglobin measurement. c. reticulocyte count. d. serum Cobalamin.

b. hemoglobin measurement.

When counseling a patient about the neurological alterations often associated with vitamin B12 deficiency, the NP advises that: a. these usually resolve within days with appropriate therapy. b. if present for longer than 6 months, these changes are occasionally permanent. c. the use of parenteral vitamin B12 therapy is needed to ensure symptom resolution. d. cognitive changes associated with vitamin B12 deficiency are seldom reversible even with appropriate therapy.

b. if present for longer than 6 months, these changes are occasionally permanent.

Pernicious anemia is usually caused by: a. dietary deficiency of vitamin B12. b. lack of production of intrinsic factor by the gastric mucosa. c. RBC enzyme deficiency. d. a combination of micronutrient deficiencies caused by malabsorption.

b. lack of production of intrinsic factor by the gastric mucosa.

Which of the following is the most consistent with iron-deficiency anemia? a. low mean corpuscular volume (MCV), normal mean corpuscular hemoglobin (MCH). b. low MCV, low MCH. c. low MCV, elevated MCH. d. normal MCV, normal MCH.

b. low MCV, low MCH.

A 68-year-old man who is usually healthy presents with new onset of "huffing and puffing" with exercise for the past 3 weeks. Physical exam reveals conjunctiva pallor and a hemic murmur. Hemogram results are as follows: Hgb = 7.6 g Hct = 20.5% RBC = 2.1 million mm MCV = 76 fL MCHC=28 g/dL RBC distribution width (RDW) = 18.4% Reticulocytes = 1.8% The most likely cause of these findings is: a. poor nutrition. b. occult blood loss. c. malabsorption. d. chronic inflammation.

b. occult blood loss.

Which of the following conditions is unlikely to result in anemia of chronic disease? a. rheumatoid arthritis. b. peripheral vascular disease. c. chronic renal insufficiency. d. osteomyelitis.

b. peripheral vascular disease.

Most of the body's iron is obtained from: a. animal-based food sources. b. recycled iron content from aged red blood cells (RBCs). c. endoplasmic reticulum production. d. vegetable-based food sources.

b. recycled iron content from aged red blood cells (RBCs).

Common physical examination findings in patients with pernicious anemia include: a. hypoactive bowel sounds. b. stocking-glove neuropathy. c. thin, spoon-shaped nails. d. retinal hemorrhages.

b. stocking-glove neuropathy.

When prescribing erythropoietin supplementation, the nurse practitioner (NP) considers that: a. the adrenal glands are its endogenous source. b. the addition of micronutrient supplementation needed for erythropoiesis is advisable. c. its use is as an adjunct in treating thrombocytopenia. d. with its use, the RBC life span is prolonged.

b. the addition of micronutrient supplementation needed for erythropoiesis is advisable.

Intervention in anemia of chronic disease most often includes: a. oral vitamin B12. b. treatment of the underlying cause. c. transfusion. d. parenteral iron.

b. treatment of the underlying cause.

Which of the following is the best advice on taking ferrous sulfate to enhance iron absorption? a. "Take with other medications." b. "Take on a full stomach." c. "Take on an empty stomach." d. "Do not take with vitamin C."

c. "Take on an empty stomach."

In health, the ratio of hemoglobin to hematocrit is usually: a. 1:1. b. 1:2. c. 1:3. d. 1:4.

c. 1:3.

Which of the following is not consistent with anemia of chronic disease (ACD)? a. NL RDW. b. NL MCHC. c. Hct less than 24%. d. NL to slightly elevated serum ferritin.

c. Hct less than 24%.

You examine a 22-year-old woman of Asian ancestry. She has no presenting complaint. Hemogram results are as follows: Hgb = 9.1 g (normal 12 to 14 g) Hct = 28% (normal 36% to 42%) RBC = 5 million mm3 (normal 3.2 to 4.3 million mm3) MCV = 68 fL (normal 80 to 96 fL) MCHC=33.2 g/dL (normal 32-36 d/dL) RBC distribution width (RDW) = 13% (normal ≤15%). Reticulocytes = 1.5% This is most consistent with the laboratory assessment of: a. iron-deficiency anemia. b. Cooley anemia. c. alpha-thalassemia minor. d. hemoglobin Barts.

c. alpha-thalassemia minor.

An increase in the normal variation of RBC size is known as: a. poikilocytosis. b. granulation. c. anisocytosis. d. basophilic stippling.

c. anisocytosis.

A woman who is planning a pregnancy should increase her intake of which of the following to minimize the risk of neural tube defect in the fetus? a. iron b. niacin c. folic acid d. vitamin C

c. folic acid

In the first weeks of anemia therapy with parenteral vitamin B12 in a 68-year-old woman with hypertension who is taking a thiazide diuretic, the patient should be carefully monitored for: a. hypernatremia. b. dehydration. c. hypokalemia. d. acidemia.

c. hypokalemia.

When the cause of a macrocytic anemia is uncertain, the most commonly recommended additional testing includes which of the following? a. haptoglobin and reticulocyte count. b. Schilling test and gastric biopsy. c. methylmalonic acid and homocysteine. d. transferrin and prealbumin.

c. methylmalonic acid and homocysteine.

Results of hemogram in a person with anemia of chronic disease include: a. microcytosis. b. anisocytosis. c. reticulocytopenia. d. macrocytosis.

c. reticulocytopenia.

A 48-year-old woman developed iron-deficiency anemia after excessive peripmenopausal bleeding, successfully treated by endometrial ablation. Her hematocrit (Hct) level is 25%, and she is taking iron therapy. At 5 days into therapy, one possible observed change in laboratory parameters would include: a. a correction of mean cell volume. b. an 8% increase in Hct level. c. reticulocytosis. d. a correction in ferritin level.

c. reticulocytosis.

Poikilocytosis refers to alterations in a red blood cell's: a. thickness. b. color. c. shape. d. size.

c. shape.

A healthy 34-year-old man asks whether he should take an iron supplement. You respond that: a. this is a prudent measure to ensure health. b. iron-deficiency anemia is a common problem in men of his age. c. use of an iron supplement in the absence of a documented deficiency can lead to iatrogenic iron overload. d. excess iron is easily excreted.

c. use of an iron supplement in the absence of a documented deficiency can lead to iatrogenic iron overload.

In children younger than age 6 years, accidental over-dose of iron-containing products is: a. easily treated. b. a source of significant GI upset. c. worrisome but rarely causes significant harm. d. a leading cause of fatal poisoning in the age-group.

d. a leading cause of fatal poisoning in the age-group.

Worldwide, which of the following is the most common type of anemia? a. pernicious anemia. b. folate-deficiency anemia. c. anemia of chronic disease. d. iron-deficiency anemia.

d. iron-deficiency anemia.

Folate-deficiency anemia causes which of the following changes in the RBC indices? a. microcytic, normochromic. b. normocytic, normochromic. c. microcytic, hypochromic. d. macrocytic, normochromic.

d. macrocytic, normochromic.

Pernicious anemia causes which of the following changes in the RBC indices? a. microcytic, normochromic. b. normocytic, normochromic. c. microcytic, hypochromic. d. macrocytic, normochromic.

d. macrocytic, normochromic.

You examine a 27-year-old woman with menorrhagia who is otherwise well and note the following results on hemogram: Hgb = 10.1 g Hct = 32% RBC = 2.9 million mm 3 MCV = 72 fL MCHC=28.2 g/dL RDW = 18.9% Physical examination is likely to include: a. conjunctiva pallor. b. hemic murmur. c. tachycardia. d. no specific anemia-related findings.

d. no specific anemia-related findings.

Erythropoietin is a glycoprotein that influences a stem cell to become a: a. lymphocyte. b. platelet. c. neutrophil. d. red blood cell.

d. red blood cell.