NUR 6121 Advanced Practice Nursing II
Comprehensive Practice Exam: Exams
1-3
EXAM 1: Hematological &
Immunological Disorders, Mental
Health, and Common Infections
Question 1
A 56-year-old male presents with fatigue and pallor. Laboratory results
show: Hgb 10.5 g/dL, Hct 32%, MCV 72 fL. What additional tests would be
most appropriate to support your most likely diagnosis?
A. Serum B12 and folate levels
B. Ferritin level and stool occult blood testing
C. Reticulocyte count only
D. Coagulation profile
Correct Answer: B. Ferritin level and stool occult blood testing
Rationale:
,This patient presents with microcytic anemia (MCV < 80 fL), which in an
older adult male is most concerning for iron deficiency anemia (IDA)
secondary to chronic gastrointestinal blood loss.
Why B is correct:
● Ferritin is the most sensitive and specific test for evaluating iron
stores. A low ferritin (< 30 ng/mL) confirms iron deficiency.
● Stool occult blood testing screens for occult GI bleeding, the most
common cause of IDA in older adults. Colorectal cancer, peptic ulcer
disease, and angiodysplasia must be ruled out.
Why other options are incorrect:
● A. B12 and folate levels – These assess macrocytic anemias (MCV >
100 fL). This patient has microcytosis, making megaloblastic causes
unlikely.
● C. Reticulocyte count only – While helpful in evaluating bone marrow
response, reticulocyte count alone does not identify the etiology of
anemia.
● D. Coagulation profile – Not indicated unless there is suspicion of
bleeding disorder, which is not suggested by this presentation.
Clinical Pearl: In older men with iron deficiency anemia, gastrointestinal
malignancy must be ruled out. Referral for colonoscopy is indicated.
Question 2
A 22-year-old college student presents with fatigue, low-grade fever, and
sore throat for 2 weeks. Physical exam reveals posterior cervical
lymphadenopathy and splenomegaly. What CBC findings would support
your suspected diagnosis?
,A. Low WBC with neutropenia
B. Normal Hgb/HCT, elevated WBC, and atypical lymphocytes
C. Severe thrombocytopenia with normal WBC
D. Elevated Hgb with decreased platelets
Correct Answer: B. Normal Hgb/HCT, elevated WBC, and atypical
lymphocytes
Rationale:
This presentation is classic for infectious mononucleosis caused by
Epstein-Barr virus (EBV). The classic tetrad includes fever, pharyngitis,
lymphadenopathy (especially posterior cervical), and fatigue.
Why B is correct:
● Atypical lymphocytes (>10%) are the hallmark of EBV infection,
representing reactive T-cells responding to B-cell infection.
● Elevated WBC with lymphocytosis is characteristic.
● Normal hemoglobin and hematocrit – EBV does not typically cause
significant anemia.
Why other options are incorrect:
● A. Low WBC with neutropenia – This pattern is seen in viral infections
like influenza early in the course, not mononucleosis.
● C. Severe thrombocytopenia – While mild thrombocytopenia can
occur, it is not the primary diagnostic finding.
● D. Elevated Hgb with decreased platelets – Not consistent with
mononucleosis.
Clinical Pearl: Diagnosis is confirmed with heterophile antibody test
(Monospot) or EBV-specific serology (IgM to viral capsid antigen). Patients
should avoid contact sports due to splenomegaly and risk of splenic
rupture.
, Question 3
A 45-year-old avid hunter presents with 2 weeks of fatigue, body aches, and
arthralgias. No erythema migrans rash is noted. ELISA testing for Lyme
disease is positive. According to CDC two-tier testing guidelines, what is
the next step?
A. Repeat ELISA in 48 hours
B. Order IgM and IgG Western blot
C. Start long-term steroids
D. No further testing is required; initiate treatment
Correct Answer: B. Order IgM and IgG Western blot
Rationale:
The CDC recommends a two-tier testing algorithm for Lyme disease.
Why B is correct:
● Step 1: ELISA or immunofluorescence assay (sensitive screening
test)
● Step 2: If ELISA is positive or equivocal, Western blot (IgM and/or
IgG) is performed for confirmation.
● Western blot increases specificity and helps confirm the diagnosis
before initiating antibiotic therapy.
Why other options are incorrect:
● A. Repeat ELISA – Repeating a positive ELISA is not recommended;
confirmatory testing is needed.
● C. Start long-term steroids – Steroids are not indicated; they may
suppress immune response and worsen infection.
Comprehensive Practice Exam: Exams
1-3
EXAM 1: Hematological &
Immunological Disorders, Mental
Health, and Common Infections
Question 1
A 56-year-old male presents with fatigue and pallor. Laboratory results
show: Hgb 10.5 g/dL, Hct 32%, MCV 72 fL. What additional tests would be
most appropriate to support your most likely diagnosis?
A. Serum B12 and folate levels
B. Ferritin level and stool occult blood testing
C. Reticulocyte count only
D. Coagulation profile
Correct Answer: B. Ferritin level and stool occult blood testing
Rationale:
,This patient presents with microcytic anemia (MCV < 80 fL), which in an
older adult male is most concerning for iron deficiency anemia (IDA)
secondary to chronic gastrointestinal blood loss.
Why B is correct:
● Ferritin is the most sensitive and specific test for evaluating iron
stores. A low ferritin (< 30 ng/mL) confirms iron deficiency.
● Stool occult blood testing screens for occult GI bleeding, the most
common cause of IDA in older adults. Colorectal cancer, peptic ulcer
disease, and angiodysplasia must be ruled out.
Why other options are incorrect:
● A. B12 and folate levels – These assess macrocytic anemias (MCV >
100 fL). This patient has microcytosis, making megaloblastic causes
unlikely.
● C. Reticulocyte count only – While helpful in evaluating bone marrow
response, reticulocyte count alone does not identify the etiology of
anemia.
● D. Coagulation profile – Not indicated unless there is suspicion of
bleeding disorder, which is not suggested by this presentation.
Clinical Pearl: In older men with iron deficiency anemia, gastrointestinal
malignancy must be ruled out. Referral for colonoscopy is indicated.
Question 2
A 22-year-old college student presents with fatigue, low-grade fever, and
sore throat for 2 weeks. Physical exam reveals posterior cervical
lymphadenopathy and splenomegaly. What CBC findings would support
your suspected diagnosis?
,A. Low WBC with neutropenia
B. Normal Hgb/HCT, elevated WBC, and atypical lymphocytes
C. Severe thrombocytopenia with normal WBC
D. Elevated Hgb with decreased platelets
Correct Answer: B. Normal Hgb/HCT, elevated WBC, and atypical
lymphocytes
Rationale:
This presentation is classic for infectious mononucleosis caused by
Epstein-Barr virus (EBV). The classic tetrad includes fever, pharyngitis,
lymphadenopathy (especially posterior cervical), and fatigue.
Why B is correct:
● Atypical lymphocytes (>10%) are the hallmark of EBV infection,
representing reactive T-cells responding to B-cell infection.
● Elevated WBC with lymphocytosis is characteristic.
● Normal hemoglobin and hematocrit – EBV does not typically cause
significant anemia.
Why other options are incorrect:
● A. Low WBC with neutropenia – This pattern is seen in viral infections
like influenza early in the course, not mononucleosis.
● C. Severe thrombocytopenia – While mild thrombocytopenia can
occur, it is not the primary diagnostic finding.
● D. Elevated Hgb with decreased platelets – Not consistent with
mononucleosis.
Clinical Pearl: Diagnosis is confirmed with heterophile antibody test
(Monospot) or EBV-specific serology (IgM to viral capsid antigen). Patients
should avoid contact sports due to splenomegaly and risk of splenic
rupture.
, Question 3
A 45-year-old avid hunter presents with 2 weeks of fatigue, body aches, and
arthralgias. No erythema migrans rash is noted. ELISA testing for Lyme
disease is positive. According to CDC two-tier testing guidelines, what is
the next step?
A. Repeat ELISA in 48 hours
B. Order IgM and IgG Western blot
C. Start long-term steroids
D. No further testing is required; initiate treatment
Correct Answer: B. Order IgM and IgG Western blot
Rationale:
The CDC recommends a two-tier testing algorithm for Lyme disease.
Why B is correct:
● Step 1: ELISA or immunofluorescence assay (sensitive screening
test)
● Step 2: If ELISA is positive or equivocal, Western blot (IgM and/or
IgG) is performed for confirmation.
● Western blot increases specificity and helps confirm the diagnosis
before initiating antibiotic therapy.
Why other options are incorrect:
● A. Repeat ELISA – Repeating a positive ELISA is not recommended;
confirmatory testing is needed.
● C. Start long-term steroids – Steroids are not indicated; they may
suppress immune response and worsen infection.
