hematology

Question 1

The most important role of plasma albumin is to regulate the passage of solutes and water through the capillaries. What is the effect of having low levels of plasma albumin?
A. third spacing of fluid
B. Hemophilia
C. Protein C Deficiency
D. Immune thombocytopenis

Answer 1

Third spacing- low levels of plasma albumin result in decreased plasma oncotic pressure, leading to movement of water and solutes into the interstitial space (p 892)

Question 2

Which clinical scenario describes a patient for whom immunosuppression is the primary treatment of choice for Aplastic Anemia?
A. No suitable donor is available
B. The patient will relieve peripheral blood stem cell transplantation from their sibling
C. the cause of aplastic anemia is idiopathic
D. The condition is progressing rapidly

Answer 2

No suitable donor is available-
In cases where a patient can’t undergo bone marrow transplant and/or there isn’t a suitable donor, immunosuppressant drugs like antithymocyte globulin (STG) and cyclosporine are the treatment of choice. Prior to transplantation, the recipient will typically receive radiation or chemotherapy to prevent graft vs. host disease (Rogers, p. 936, 2022).

Question 3

Which of the following anemias is a disorder of increased red blood cell destruction from an inherited trait?

A.Pernicious anemia

B. Aplastic anemia

C. Sickle cell anemia

D. Autoimmune hemolytic anemia

Answer 3

Sickle cell anemia is a disease of abnormal hemoglobin synthesis that is caused by a genetic inheritance. HbS is inherited from one or both parents causing different levels of severity of the anemia. The sickled cells die prematurely and the body is not able to create sufficient normal red blood cells. Pernicious anemia is the decreased production of red blood cells from a deficiency of b12. Aplastic anemia is a decrease of red blood cell production from multiple factors and autoimmune hemolytic anemia is the destruction of red blood cells that is acquired. (McCance & Huethers, 2023, pp. 925,997)

Question 4

Which statement accurately implies the (believed) correlation between malaria and susceptibility to lymphoma?
A. Malaria is believed to decrease resistance to EBV
B. Malaria is believed to decreased resistance to sick cell disease
C Malaria is believed to decreased resistance to thalaseemias
D. Malaria is believed to decrease resistance to G^PD deficiency

Answer 4

Malaria is believed to decrease resistance to EBV-Most cases of Burkitt Lymphoma occur in areas of the world where malaria is prevalent. Burkitt Lymphoma is often associated with latent Epstein Barr Virus (EBV) infection. EBV, HIV and other immunodeficiency conditions increase the risk of Burkitt Lymphoma (Rogers, p. 1013, 2022).

Question 5

A patient in clinic who has a past medical history of Hereditary Hemochromatosis receives education regarding their disease process. You know more education is needed when the patient states.

A. I need to reduce my alcohol intake

B. I need to start taking iron supplements to maintain my iron levels

C. Therapeutic phlebotomy every few months helps keep my iron level normal

D. I should be vaccinated against hepatitis A and B

Answer 5

B. Hereditary Hemochromatosis is an inherited hyper absorption of iron. The excessive iron is stored in the liver, pancreas, heart, joints and soft tissue. This causes damage in all the affected organs like cirrhosis. Patient with this disorder should limit their iron intake so taking iron supplements requires more education. Due to issues with cirrhosis and liver impairment alcohol should be avoided and hepatitis immunizations are recommended. Therapeutic phlebotomy is a common treatment for reducing iron levels.

Question 6

Which newborn is at highest risk of developing erythroblastosis fetalis?

A. A+ newborn with A+ mother

B. A+ newborn with O- mother

C. B- newborn with B+ mother

D. O- newborn with O- mother

Answer 6

B- This can occur due to ABO incompatibility and/or if the mother is Rh-negative and the child is Rh-positive.

Question 7

While working as the school nurse, Billy comes in complaining of a nose bleed. This is the third time this week he’s come in for a minor nosebleed, and he states he gets them frequently. You notice that he has small patches of bruising over his arms but he denies any recent falls, and small spots in his gums. Based on these findings, which other statement would raise the most alarm for further examination?
A. Reports the flu from 3 weeks ago
B. Decreased appetite
C. Soreness in his legs after gym class
D. Difficulty sleeping at night after playing video games

Answer 7

A

Billy is exhibiting common signs of Primary immune thrombocytopenia, including frequent nosebleeds, spots on his gums and spots of unusual bruising despite any trauma, which tend to develop 1 to 3 weeks after a viral illness (Rogers & Brashers, 2023, p. 1008),

Question 8

Janice visits your clinic with complaints of fatigue, shortness of breath and dizziness. Bloodwork shows that the patient is anemic, with their MCV levels above 100. What would be an appropriate follow-up question after receiving these results?
A. Are you on any heart medications?
B. How often do you exercise?
C. Are you sleeping okay at night?
D. Describe to me what your typical diet is.

Answer 8

D. Janice is experiencing folic deficiency anemia, as evident by her MCV above the normal threshold (90), which means her RBCs are large and is a common finding with folic deficiency anemia. Therefore, it is important to assess her dietary intake to see if it can be modified to increase folic acid intake, or if added supplements will benefit her as well (Rogers & Brashers, 2023, p. 932). The other questions would not be pertinent to folic deficiency anemia.

Question 9

While looking at an X-ray of a patient’s femur, you notice round, punched-out areas throughout the bone, and bloodwork showed the patient is hypercalcemic. What disease is associated typically with these findings?
A Burkitt lymphoma
B Hodgkin’s lymphoma
C Multiple myeloma
D Osteoporosis

Answer 9

C
A hallmark sign of multiple myeloma (MM) is lytic bone lesions, which are plasma cells that proliferate in bone marrow that appear as round, punched out areas on scans, as well as hypercalcemia due to osteoclasts attempting to break down areas where the cancer cells have infiltrated in an attempt to make space for new bone, but is taken over by those cancer cells (Rogers & Brashers, 2023, p. 965).

Question 10

Which of the following statements about anemia is false?

A There is a reduced oxygen carrying capacity of blood, resulting in tissue hypoxia
B. The body compensates by shifting interstitial fluid into the blood causing the consistency of blood to be more viscous
C. The compensation for loss of red blood cells causes a hyper-dynamic state
D. Cardiac dilation and heart valve insufficiency may result from the faster flowing blood

Answer 10

The body compensates by shifting interstitial fluid into the blood causing the consistency of blood to be more viscous

Question 11

Which of the following lymphoid neoplasms in being described in the following sentence: Slowly progressing disease with increased numbers of maturing granulocytic precursors in bone marrow.

A. Acute lymphocytic leukemia
B. Acute myelogenous leukemia
C. Chronic lymphocytic leukemia
D. Chronic myelogenous leukemia

Answer 11

CML is a slowly progressing disease that is classified as a myeloproliferative neoplasm

Question 12

Katherine is a nurse practitioner student who is in a clinical rotation at the local hematological clinic. She is preparing to meeting with a 25 year old who has been previously diagnosed with sickle cell disease. Which of the following statements indicate that Katherine is prepared to care for this patient?

A. Sickle cell disease involves mutated hemoglobin molecules (Hbs) that causes the erythrocyte to distort into a sickle shape
B. The sickling process is an intermitted phenomenon that that can be trigger by stressors, including hypoxemia, acidosis, hypothermia
C. Sickle cell disease can be cured
D. a and b

Answer 12

D. Sickle cell disease is characterized by the production of an atypical type of hemoglobin (hemoglobin s) within the erythrocytes. The sickling process is an occasional, intermitted phenomenon that can be triggered by decreased oxygen tension of the blood, decreased pH, increased plasma osmolality, decreased plasma volume and low temperature.

Question 13

A 45-year-old patient presents to the emergency room with fatigue, paresthesia of the feet and fingers, difficulty walking, abdominal pain, and a sore tongue that is smooth and beefy red. The patient’s skin is lemon yellow. The patient’s hemoglobin level is 7g/dL. What diagnosis would you consider for this patient?

A. Iron deficiency anemia

B. Pernicious anemia

C. Aplastic anemia

D. Hemolytic anemia

Answer 13

pernicious anemia
is a type of megaloblastic anemia and is caused by vitamin B12 deficiency due to intestinal malabsorption. PA develops slowly over 20-30 years; hemoglobin levels may decrease to 7-8g/dL; other symptoms are weakness, fatigue, paresthesia of feet and fingers, difficulty walking, loss of appetite, abdominal pain, weight loss, and a sore tongue that is smooth and beefy red, the skin may also become lemon yellow caused by a combination of pallor and jaundice

Question 14

A 65-year-old patient presents to his primary care physician with symptoms that include lymphadenopathy in the cervical and axillary region; the nodes are painless and have drastically grown within the last month. Per the patient the patient also states night sweats and weight loss. With non-Hodgkin’s lymphoma being the suspected diagnosis, which diagnostic treatment would be conducted first to determine lymphoma?

A. Pet scan

B. CT scan

C. Biopsy

D. Bone marrow aspiration

Answer 14

C. Biopsy

biopsy is the primary means for diagnosis of NHL

Question 15

An infant presents to the emergency room with these symptoms: difficulty feeding, circumoral pallor, tachycardia, nasal flaring, and lethargy; labs show that the patient has hemolytic anemia and hyperbilirubinemia. Which condition do you suspect this patient may have?

A. Glucose 6 phosphate dehydrogenase deficiency
B. Sickle cell anemia

C. Aplastic crisis

D. Hereditary spherocytosis

Answer 15

hereditary spherocytosis
s an inherited disorder caused by defects in the membrane skeleton of RBCs; symptoms of this condition include anemia, jaundice, splenomegaly, hemolytic anemia, hyperbilirubinemia, difficulty feeding, circumoral pallor, tachycardia, nasal flaring, and lethargy

Question 16

Which of the following is not a cause of intravascular hemolytic anemia?

A Snake venom

B. Mechanical injury

C. Bone marrow phagocytosis

D. Lead poisoning

Answer 16

Bone marrow phagocytosis

phagocytosis of erythrocytes often takes place in bone marrow, spleen and liver. This is part of extravascular hemolysis.

Question 17

A 9 year old female presents to your clinic 2 weeks after fever, and upper respiratory tract infection. Patient is complaining of spots and swelling around her ankles. On examination you find petechial rash to bilateral lower extremities with swelling and bruising. Based on the recent viral diagnosis you know this rash is related to:

A. Immune Thrombocytopenic Purpura

B. Primary Thrombocythemia

C. Dissemination Intravascular Coagulation

D. Alloimmune thrombocytopenia purpura

Answer 17

immune thrombocytopenia

immune thrombocytopenia purpura is also known as idiopathic thrombocytopenic purpura and is the most common thrombocytopenic purpura in children. “Approximately 70% of cases of ITP are preceded by a viral illness,” with 1-3 weeks between infection onset and purpura

Question 18

Which statement regarding thrombus formation is true:

A. A moving clot is called a thrombus

B. Venous thrombi form under areas of high blood flow

C. Thromboembolism are not life threatening

D. Blood clots can happen to anyone and can be preventable

Answer 18

D. according to Rogers (2023) “blood clots can happen to anyone and are often preventable” (p. 978). Early diagnosis is critical!

Question 19

A 30-year-old woman presents to the clinic with the symptoms of nosebleeds, petechiae, and mucosal bleeding. Labs are drawn, and the following are the critical results:
Platelet count: 12,000/ul (low)
The patient is diagnosed as having idiopathic thrombocytopenic purpura (ITP). Further evaluation determines that there is no major organ damage in the patient. What would be the best first treatment option?

A. Splenectomy
b. Monitor for now and schedule the patient for follow-up
c. Treat with therapeutic plasma exchange (TPE) and
d. corticosteroids
Platelet transfusion

Answer 19

D

Administration of corticosteroids and TPE has been shown to have a response rate in 70% to 85% of patients, aiding their recovery (Rogers & Brashers, 2023, p. 972). When there is no major organ damage detected, this treatment option can lead to a full recovery with no lasting complications.

Question 20

Anemia is classified as a reduction in erythrocytes in the circulating bloodstream, or a decrease in the quality or quantity of hemoglobin. One type of anemia typically presents with low hemoglobin, low mean corpuscular volume (MCV), low mean corpuscular hemoglobin concentration (MCHC), a normal reticulocyte count as well as a low level of ferritin in the blood. Which type of anemia is most likely the cause, based on these findings?
A Vitamin B12 deficiency anemia
B Anemia of chronic disease
C Iron-deficiency anemia
D Hemolytic anemia

Answer 20

iron defeciency anemia

A microcytic anemia is indicated due to the low levels of MCV and MCHC, and with the concurrent findings of low ferritin, there is an indication of low iron stores, so iron-deficiency anemia would be the most likely cause

Question 21

An 11-year-old child comes with their parents to see their pediatrician due to feeling ill the past few days. The child has a diagnosis of sickle cell disease, and is presenting today with complaints of fatigue, pain, and pallor. Which of the following treatment options would be most beneficial to prevent a future vaso-occlusive crisis for this child?
A. Hydroxyurea
B. Transfusion therapy
C. Aspirin (
D. IV fluids and antibiotics

Answer 21

hydroxyurea

Hydroxyurea is the most common treatment option for patients suffering from sickle cell disease, as it works to increase HbF concentration in the blood (Rogers & Brashers, 2023, p. 1003). Due to the increased level of HbF, an anti-inflammatory effect is created, as the HbF will not sickle.

Question 22

Myelogenous leukemias arise from myeloid stem cells. Myeloid stem cells are the precursors to all of the following except:
A. B lymphocytes
B. Platelets
C. Red blood cells
D. Neutrophils

Answer 22

B lymphocytes are produced by lymphoid stem cells. (McCance & Huether, 2019, p 952).

Question 23

Heparin-induced thrombocytopenia (HIT) happens in about 4% of people who take heparin. The following statements about HIT are true, except:
A. A downward trend in platelets usually starts 5-10 days in to therapy
B. HIT increases the risk of thrombosis
C. HIT is the result of an IgG immune-mediated response
D. Patients with HIT are at high risk of spontaneous hemorrhage

Answer 23

D. HIT creates a pro-thrombotic state because of IgG antibodies binding to platelets and causing aggregation, increasing risk of both venous and arterial thrombotic events. Generally, platelet counts trend down to 60,000, which is not sufficient to cause spontaneous bleeds (McCance & Huether, 2019, p 970).

Question 24

Primary care measures for children with sickle cell anemia include all of the following, except:
A. Annual transcranial doppler screening
B. Hydroxyurea therapy
C. PCN prophylaxis until age 5
D. Dilated vision exams starting at age 18

Answer 24

The NHLBI has evidenced- based treatment guidelines for patients with sickle cell that addresses HTN, retinopathy, pain mgmt, etc. These include standards as identified as above; except dilated vision exams are recommended starting at age 10.

Question 25

A 45-year-old patient presents with a platelet count of 18,000/mm³. The nurse practitioner is assessing the patient’s condition. What is the most important information for the nurse practitioner to communicate to the patient regarding their condition?

A. “Your platelet count is low, but spontaneous bleeding is unlikely to occur as long as it stays above 50,000/mm³.”
B. “Since your platelet count is below 20,000/mm³, there is a risk of spontaneous major bleeding, and you should be closely monitored.” (Correct answer)
C. “You should increase your intake of iron-rich foods to help raise your platelet count.
D. “As long as your clotting times remain normal, there is no need for concern about bleeding.”

Answer 25

B A platelet count below 20,000/mm³ increases the risk of spontaneous major bleeding, so the nurse practitioner must inform the patient about this risk and the need for close monitoring.

Question 26

A patient presents to the clinic with symptoms of fatigue, pallor, and shortness of breath. Upon further examination, the nurse practitioner suspects anemia. What is the most likely cause of anemia in this patient based on common etiologies?

A. Impaired erythrocyte production
B. Acute blood loss
C. Decreased fluid intake.
D. Chronic heart disease

Answer 26

A. Anemias typically result from blood loss (acute or chronic), impaired erythrocyte production, increased erythrocyte destruction, or a combination of these factors (McCance & Huether, 2014, p. 925). In this case, the most likely cause based on the patient’s presentation (fatigue, pallor, shortness of breath) and the common causes of anemia would be impaired erythrocyte production.

Question 27

An adolescent patient has been diagnosed with acute leukemia. The nurse practitioner is explaining the types of leukemia most common in children. What is the most common type of acute leukemia found in children and adolescents?
A. Acute Lymphoblastic Leukemia (ALL)
B. Acute Myeloid Leukemia (AML)
C. Chronic Lymphocytic Leukemia (CLL)
D. Chronic Myeloid Leukemia (CML)

Answer 27

A Acute Lymphoblastic Leukemia (ALL), which accounts for 75% to 80% of childhood leukemias.

Question 28

A female presents for an annual physical exam. Past surgical history is remarkable for gastric bypass 8/2020. The patient reports tingling of hands and feet “for a while” worsening. On exam, the NP observed a pale conjunctiva, smooth, beefy red tongue, the patient having difficulty buttoning her shirt, and an unsteady gait. The NP will test the patient for:

A. Multiple myeloma
B. Polycythemia Vera
C. Pernicious Anemia
D. Sickle cell Anemia

Answer 28

C. Pernicious Anemia

Rationale: Pale conjunctiva, smooth, beefy red tongue, the patient having difficulty buttoning her shirt, and an unsteady gait are all signs of pernicious anemia (McCance & Huether, 2024, p. 932)

Question 29

A male presents to the ER and reports a new onset of fatigue, shortness of breath, and dark urine. Upon further assessment, the patient states he is on day 3 of Hydroxychloroquine (Plaquenil) for an upcoming trip.
On exam, the NP observes:

Yellow sclera
Pallor skin
BP- 124/78, T – 98.8, P- 112, R- 24
The NP will plan to order which testing after the patient is no longer symptomatic:

A. CBC and peripheral blood smear
B. Hemoglobin Electrophoresis
C. Serum B12 and Folate levels
D. Check serum folate levels only

Answer 29

CBC and peripheral blood smear

Rationale The clinical manifestation is common for glucose-6-phosphate dehydrogenase deficiency (G6PD). G6PD occurs after ingesting oxidative drugs like Plaquenil. Testing for glucose-6-phosphate dehydrogenase deficiency should not happen after an immediate crisis; it will cause a false negative (McCance & Huether, 2024, p. 994).

Question 30

A patient reports to the NP that they have had pelvic pain for the past three months. Pelvic ultrasound results are unremarkable. The patient has been diagnosed with multiple myeloma. The NP would expect to see an alteration in which result(s):
A. Elevated calcium and uric levels
B. Normal WBC
C. Decreased BUN
D. Decreased number of plasma cells in the bone marrow

Answer 30

Elevated calcium and uric levels

Rationale: Multiple myeloma is a plasma cell cancer. Bone pain is the primary symptom that the patient reports due to bone lysis, therefore causing hypercalcemia (McCance & Huether, 2024, p. 964)

Question 31

Krissy is caring for a 17-year-old male with infectious mononucleosis. Which of the following should not be included in the teaching for this patient?

A. Avoid contact sports
B. Rest and analgesics for symptom management
C. Antibiotics should be taken to stop infection
D. The infection is spread via saliva and sexual contact

Answer 31

C. Infectious mononucleosis is primarily caused by the Epstein-Barr virus, therefore antibiotic therapy should not be given

Question 32

Bethany is performing a physical examination on a patient with Hodgkin’s lymphoma. Which is the most likely finding when she palpates the patient’s lymph nodes?

A. The lymph nodes are enlarged and painless
B. The lymph nodes are swollen and tender
C. The lymph nodes are small and hard
D The lymph nodes are soft and moveable

Answer 32

Typically, Hodgkin’s lymphoma presents with enlarged and pain-free lymph nodes, which is often the first clinical manifestation

Question 33

A nurse practitioner is precepting a DNP student at a clinic in a community with a large African American population. Which statement below is correct for the nurse to include in her teaching regarding how sickle cell anemia is passed down to children?

A. The disease is more commonly environmentally caused
B. The disease is an autosomal dominate disease
C. The disease is an autosomal recessive disease
D. The disease is a chromosomal disorder

Answer 33

C. Sickle cell anemia is an autosomal recessive pattern in which each parent carries a copy of the mutated gene

Question 34

A 67-year-old African American male presents to your clinic complaining of body “bony” aches around his rib cage, along with fatigue and weakness. He reports unexpected weight loss and frequent infections. Suspecting multiple myeloma (MM), you order a Serum Protein Electrophoresis (SPEP) test, a complete blood count (CBC), and a CT scan. Which of the following findings is NOT expected in a patient with MM?

A. Lytic bone lesions on radiograph

B. Hypercalcemia

C. Increased immunoglobulin, M protein, Bence Jones protein

D. Enlarged cervical lymph node

Answer 34

D enlarged cervical lymph nodes, is not expected because the malignant cells primarily reside in the bone marrow rather than circulating in the blood, which typically does not affect lymph nodes.

Question 35

Which of the following statements is correct regarding Heparin-induced thrombocytopenia (HIT)?

A. More than 50% of individuals treated with unfractionated heparin develop HIT.

B. A person who develops HIT antibodies reacts specifically against the PF4-heparin complex; the Fc (nonspecific) end of the antibodies binds to platelet Fc receptors, activating the platelets.

C. Due to thrombocytopenia, internal bleeding such as GI bleeding and hemorrhagic brain is a common side effect.

D. Arterial thrombosis is the most common clinical manifestation affecting the upper extremities, causing limb ischemia.

Answer 35

B. HIT is an immune-mediated, adverse drug reaction caused by IgG antibodies against the heparin-platelet factor 4 complex, leading to platelet activation through platelet FcγIIa receptors. The release of additional platelet factor 4 from activated platelets and activation of thrombin result in increased platelet consumption and a decrease in platelet counts beginning 5 to 10 days after heparin administration (p.970).

Question 36

Children who have inherited deficiencies of antithrombin III or proteins C or S have an increased risk of what clinical manifestations?

A. Thrombosis

B. Hemorrhage

C. Anemia

D. Infection

Answer 36

Inherited thrombophilic conditions are generally caused by defects in the clotting factors that inhibit clot formation, resulting in a shift toward the clotting aspects of hemostasis. Deficiencies in specific proteins (C and S) and antithrombin (AT), as well as resistance to activated protein C (APC) and hyperhomocysteinemia, are the main recognized causes of inherited thrombophilia. Proteins C and S inhibit coagulation and depend on vitamin K for synthesis in the liver. Deficiencies in proteins C and S predispose individuals to thrombosis, particularly venous thrombosis of the lower extremities.

Question 37

Albumin makes up about 57% of total plasma protein. What function does albumin serve in the blood?
A Albumin is a carrier molecule and regulates the passage of water and solutes through the capillaries.
B. Albumin is used to defend against infection.
C. Albumin provides gas transport to and from the cells and lungs.
D. Albumin controls inflammation and defense against parasites.

Answer 37

A.

Regulation of the passage of water and solutes through the capillaries is the most essential role of albumin. It is a carrier molecule, and due to its larger size, it does not diffuse freely through the vascular endothelium, resulting in maintaining the critical colloidal osmotic pressure

Question 38

John is a 45-year-old male who visits the primary care clinic complaining of fatigue, shortness of breath, dizziness, and slight jaundice. He has a history of being vegetarian for over a decade. After conducting a series of lab tests, the results are as follows:
Hemoglobin: 10 g/dL
MCV: 110 fL
Vitamin B12: 150 pg/mL
Folate: Normal
Given the lab results and his clinical symptoms, what type of anemia would the provider suspect John may have?

A Iron Deficiency Anemia
B. Pernicious Anemia
C. Aplastic Anemia
D. Anemia of Inflammation

Answer 38

Pernicous Anemia

Based on John’s low hemoglobin, increased MCV, and diminished Vitamin B12 levels, combined with his vegetarian diet, it appears he may be suffering from anemia related to a Vitamin B12 deficiency or Pernicious anemia. Pernicious anemia is a type of megaloblastic anemia that occurs due to Vitamin B12 deficiency resulting from malabsorption in the intestines

Question 39

A 6-year-old girl is taken to the pediatric clinic by her mother. The mother says her daughter has been more tired than usual and has developed a yellowish color in her skin and eyes over the past few days. She also mentions that her child recently had a cold and took a sulfa antibiotic about a week ago. During the check-up, the girl shows signs of paleness, jaundice, dark urine, and back pain. The mother recalls that her grandfather had similar symptoms, but she does not know the cause. Based on these findings, what condition might this child have?
A. Hereditary spherocytosis (HS)
B. Sickle Cell Disease
C. Thalassemia
D. Glucose-6-phosphate dehydrogenase Deficiency (G6PD)

Answer 39

The child shows consistent signs of hemolytic anemia, including jaundice, dark urine, and pallor. In G6PD, children can develop hemolytic anemia after exposure to certain medications like sulfa drugs as well, and a possible familial connection with similar symptoms in the grandfather raises the possibility of an X-link recessive disorder in which the mother carried the gene from her father to her child