Hematology

A 48-year-old woman developed iron-deficiency anemia after excessive perimenopausal 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

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

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

An increase in the normal variation of RBC size is known as: A. poikilocytosis. B. granulation. C. anisocytosis. D. basophilic stippling.

C

In health, the ratio of hemoglobin to hematocrit is usually: A. 1:1. B. 1:2. C. 1:3. D. 1:4.

C

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

Of the following medications, which is least likely to be implicated as a trigger for anaphylaxis? A. ibuprofen B. amoxicillin C. acetaminophen D. aspirin

C

Poikilocytosis refers to alterations in a red blood cell's: A. thickness. B. color. C. shape. D. size.

C

Results of hemogram in a person with anemia of chronic disease include: A. microcytosis. B. anisocytosis. C. reticulocytopenia. D. macrocytosis.

C

The most common clinical manifestation of systemic anaphylaxis typically is: A. dizziness. B. airway obstruction. C. urticaria. D. gastrointestinal upset.

C

Anemia in children is potentially associated with poorer school performance. _______ A. True B. False

A

Approximately 90% of the body's erythropoietin is produced by the kidney. _______ A. True B. False

A

During pregnancy, folic acid requirements increase twofold to fourfold. _______ A. True B. False

A

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

Second-line drug intervention in the presence of anaphylaxis should be: A. oral diphenhydramine. B. nebulized pentamidine. C. nebulized epinephrine. D. oral prednisone.

A

The red blood cell content is approximately 90% hemoglobin. _______ A. True B. False

A

The time to highest blood concentration (Cmax) of epinephrine is shorter when the medication is given: A. intramuscularly in the vastus lateralis. B. subcutaneously in the abdominal wall. C. intramuscularly in the deltoid. D. intramuscularly into the gluteus.

A

Which of the following plays an essential role in type 1 hypersensitivity? A. immunoglobulin E B. immunoglobulin A C. immunoglobulin G D. immunoglobulin F

A

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 gastrointestinal motility and results in enhanced ciprofloxacin absorption.

B

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 examination reveals conjunctiva pallor and a hemic murmur. Hemogram results are as follows: Hgb = 7.6 g Hct = 20.5% RBC = 2.1 million mm3 MCV = 76 fL MCHC = 28 g/dL RDW = 18.4% Reticulocytes = 1.8% The most likely cause of these finding is: A. poor nutrition. B. occult blood loss. C. malabsorption. D. chronic inflammation.

B

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

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

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

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

Risk factors for folate-deficiency anemia include: A. menorrhagia. B. chronic ingestion of overcooked foods. C. use of nonsteroidal anti-inflammatory drugs. D. gastric atrophy.

B

The body's normative response to anemia is reticulocytopenia. _______ A. True B. False

B

The use of a systemic corticosteroid in the treatment of anaphylaxis is primarily helpful for: A. treatment of the most acute symptoms. B. minimization of a protracted allergic response. C. prevention of future episodes. D. reducing the risk of fatality associated with the event.

B

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

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

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

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

Which of the following is 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

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 (normal 14 to 16 g) Hct = 45% (normal 42% to 48%) RBC = 4.8 million mm3 (normal 4.7 to 6.1 million mm3) MCV = 108 fL (normal 81 to 96 fL) MCHC = 33.2 g/dL (normal 31 to 37 g/dL) These values are most consistent with: A. pernicious anemia. B. alcohol abuse. C. thalassemia minor. D. Fanconi disease.

B

You examine a 57-year-old woman with rheumatoid arthritis who is on a disease-modifying antirheumatic drug (DMARD) 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

Your priority in caring for Tom, the aforementioned patient, is to: A. administer a rapidly acting oral antihistamine. B. administer parenteral epinephrine. C. initiate vasopressor therapy. D. administer a parenteral systemic corticosteroid.

B

Tom is a 19-year-old man who presents with sudden onset of edema of the lips and face and a sensation of "throat tightness and shortness of breath" after a bee sting. Physical examination reveals inspiratory and expiratory wheezing as well as pruritic wheals on his face and arms. Blood pressure is 78/44 mm Hg, heart rate is 102 bpm, and respiratory rate is 24/min. His clinical presentation is most consistent with the diagnosis of: A. vasculitis. B. angioedema. C. anaphylaxis. D. reactive airway disease.

C

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

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

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

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 43%) RBC = 5.6 million mm3 (normal 4.2 to 5.4 million mm3) MCV = 68 fL (normal 81 to 96 fL) MCHC = 33.2 g/dL (normal 31 to 37 g/dL) RBC distribution width (RDW) = 13% (normal ≤15%). Reticulocytes = 1.5% (normal 1% to 2%) This is most consistent with the laboratory assessment of: A. iron-deficiency anemia. B. Cooley anemia. C. alpha-thalassemia minor. D. hemoglobin Barts.

C

A person with latex allergy also often has a cross-allergy to all of the following except: A. banana. B. avocado. C. kiwi. D. romaine lettuce.

D

Erythropoietin is a glycoprotein that influences a stem cell to become a: A. lymphocyte. B. platelet. C. neutrophil. D. red blood cell.

D

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

In children younger than age 6 years, accidental overdose of iron-containing products is: A. easily treated. B. a source of significant gastrointestinal (GI) upset. C. worrisome but rarely causes significant harm. D. a leading cause of fatal poisoning in the age-group.

D

Increased risks for fatal reactions from anaphylaxis include all of the following except: A. personal history of asthma. B. delay in administering epinephrine. C. age in the teen years. D. delay in administering antihistamines.

D

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

Which of the following food-based allergies is likely to be found in adults and children? A. milk B. egg C. soy D. peanut

D

Which of the following is the best answer regarding anaphylaxis? A. Adults usually do not develop new anaphylaxis triggers such as food allergies. B. Peanuts are the primary food that can cause a severe allergic reaction. C. Future anaphylactic reactions will become increasingly more severe. D. Trace amounts of an allergen in a food can cause a severe anaphylactic reaction.

D

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

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 mm3 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