FNP BOARD REVIEW ANEMIA AND HEMATOLOGY COMPREHENSIVE EXAM MASTER KEY GRADE A+ MATERIAL DETAILED CORRECT ANSWERS WITH RATIONALES INCLUDED | 100% PASS GUARANTEE | INSTANT DOWNLOAD

FNP BOARD REVIEW ANEMIA AND
HEMATOLOGY COMPREHENSIVE EXAM
MASTER KEY GRADE A+ MATERIAL
DETAILED CORRECT ANSWERS WITH
RATIONALES INCLUDED | 100% PASS
GUARANTEE | INSTANT DOWNLOAD



FNP Review: Anemia & Hematology Comprehensive
Exam
Question 1
A 32-year-old female presents to the primary care clinic
complaining of progressive fatigue, generalized weakness, and
exertional dyspnea over the past four months. She reports
heavy menstrual periods lasting 7 to 8 days, requiring the use of
double pads. A complete blood count (CBC) reveals a
hemoglobin of 9.2 g/dL, hematocrit of 28%, and a Mean
Corpuscular Volume (MCV) of 72 fL. Which of the following
laboratory panels is most appropriate to confirm the primary
diagnosis? [1, 2]
• Option A: Serum B12, folate levels, and a reticulocyte
count. Rationale: InCorrect. These labs evaluate
macrocytic anemias, whereas this patient exhibits
microcytic anemia with a low MCV. [1, 2, 3, 4]
• Option B: Serum ferritin, iron, total iron-binding
capacity (TIBC), and transferrin saturation.
Rationale: Correct. The patient has a microcytic
anemia secondary to menorrhagia, making iron
deficiency anemia the most likely diagnosis. A low serum
ferritin is the most sensitive indicator of iron deficiency.
[1, 2]

, • Option C: Hemoglobin electrophoresis and a peripheral
blood smear. Rationale: InCorrect. While these can
assess for thalassemia, iron deficiency must be ruled out
or confirmed first, especially given the history of
menorrhagia. [1]
• Option D: Bone marrow aspirate and biopsy with
cytogenetic analysis. Rationale: InCorrect. This is an
invasive procedure reserved for suspected bone marrow
failure or malignancies, not initial microcytic anemia
evaluations. [1, 2]
Question 2
A 68-year-old male with a history of chronic alcoholism and
poor dietary intake presents with a two-month history of
progressive paresthesias in his lower extremities, loss of
balance, and memory lapses. Physical examination reveals
decreased vibratory sensation and loss of proprioception in
both feet. A CBC demonstrates a hemoglobin of 10.1 g/dL and
an MCV of 114 fL. Which diagnostic finding would definitively
differentiate Vitamin B12 deficiency from folate deficiency in
this patient?
• Option A: An elevated serum homocysteine level.
Rationale: InCorrect. Homocysteine is elevated in
both Vitamin B12 and folate deficiencies, so it cannot
differentiate between them. [1, 2, 3]
• Option B: A low reticulocyte percentage on a peripheral
smear. Rationale: InCorrect. Both nutritional
deficiencies result in a low reticulocyte count due to
impaired production.
• Option C: An elevated serum methylmalonic acid
(MMA) level. Rationale: Correct. Methylmalonic
acid is elevated exclusively in Vitamin B12 deficiency,

, whereas folate deficiency presents with a normal MMA
level. [1]
• Option D: The presence of hypersegmented neutrophils on
a peripheral blood smear. Rationale: InCorrect.
Hypersegmented neutrophils are a hallmark feature of
megaloblastic anemia seen in both B12 and folate
deficiencies. [1, 2, 3]
Question 3
A 26-year-old pregnant female at 28 weeks gestation presents
for a routine prenatal visit. Her CBC reveals a hemoglobin of
10.5 g/dL and a hematocrit of 32%. Her baseline pre-pregnancy
hemoglobin was 12.8 g/dL. She denies fatigue, pica, shortness
of breath, or bleeding. Her MCV, MCH, and serum ferritin
levels are entirely within normal limits. What is the most likely
pathophysiological mechanism behind these findings? [1]
• Option A: Occult gastrointestinal bleeding from increased
abdominal pressure. Rationale: InCorrect.
Gastrointestinal bleeding would lead to iron deficiency,
which is ruled out by her normal ferritin and indices.
• Option B: Impaired erythropoietin production by the
maternal kidneys. Rationale: InCorrect.
Erythropoietin production normally increases during
pregnancy to stimulate red blood cell production.
• Option C: Physiological hydremia of pregnancy
causing relative hemodilution. Rationale:
Correct. During pregnancy, plasma volume expands
by approximately 50%, while red blood cell mass
increases by only 20-30%, resulting in a physiological
decline in hemoglobin concentration.
• Option D: Increased fetal utilization of maternal Vitamin
B12 stores. Rationale: InCorrect. B12 deficiency

, would cause macrocytosis, which is absent as her MCV is
normal. [1, 2, 3]
Question 4
A 45-year-old female of Mediterranean descent presents for a
routine physical. Her CBC reveals a mild anemia with a
hemoglobin of 11.2 g/dL, an extremely low MCV of 64 fL, and a
normal Red Cell Distribution Width (RDW). An iron panel
reveals a normal serum ferritin and normal transferrin
saturation. What is the most appropriate next step in the
clinical management of this patient?
• Option A: Initiate empirical therapy with oral ferrous
sulfate 325 mg three times daily. Rationale:
InCorrect. Giving iron to a patient with normal
ferritin levels who likely has thalassemia trait can lead to
dangerous iron overload.
• Option B: Order a quantitative hemoglobin
electrophoresis to screen for thalassemia.
Rationale: Correct. The presentation of microcytic
anemia with a normal RDW and normal iron stores in a
patient of Mediterranean descent is highly suggestive of
thalassemia minor. Electrophoresis confirms the
diagnosis.
• Option C: Schedule a colonoscopy to evaluate for an occult
lower gastrointestinal malignancy. Rationale:
InCorrect. There is no evidence of iron deficiency or
gastrointestinal symptoms to warrant a colonoscopy at
this time.
• Option D: Prescribe daily oral folate and Vitamin B12
supplements for three months. Rationale: InCorrect.
Megaloblastic supplements will not correct a microcytic
genetic globin chain synthesis defect.