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FNP Review – Anemia/Hematology (2026–2027) –
Hematology Exam Preparation With Complete
Questions And Correct Answers With Rationales
Already Graded A+Brand New Version!!
Question 1
A 68-year-old male presents with fatigue and pallor. His complete blood
count shows hemoglobin 9.2 g/dL, mean corpuscular volume 72 fL, red
cell distribution width 16.5%, and platelet count 450,000/microL. His
serum ferritin is 8 ng/mL. Which of the following is the most
appropriate next step in management?
A) Oral ferrous sulfate 325 mg daily
B) Intravenous iron dextran
C) Transfusion of packed red blood cells
D) Referral for bone marrow biopsy
Answer: A
Explanation: This patient presents with microcytic anemia (low MCV)
and a very low ferritin, which is pathognomonic for iron deficiency
anemia. The first-line treatment is oral iron replacement. Ferrous
sulfate 325 mg (65 mg elemental iron) daily or every other day is
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standard. Intravenous iron is reserved for those who cannot tolerate
oral iron, have malabsorption, or require rapid replenishment.
Transfusion is not indicated with a hemoglobin above 7 g/dL in a stable
patient. Bone marrow biopsy is unnecessary in straightforward iron
deficiency.
Question 2
A 45-year-old woman with a history of heavy menstrual bleeding is
found to have hemoglobin 10.1 g/dL, MCV 79 fL, serum ferritin 12
ng/mL, and serum iron 30 mcg/dL. Her total iron-binding capacity is 450
mcg/dL. What is the most likely diagnosis?
A) Anemia of chronic disease
B) Iron deficiency anemia
C) Thalassemia trait
D) Sideroblastic anemia
Answer: B
Explanation: Iron deficiency anemia is characterized by low ferritin, low
serum iron, and elevated total iron-binding capacity (TIBC). The
transferrin saturation (serum iron divided by TIBC) is low. In anemia of
chronic disease, ferritin is typically normal or elevated, and TIBC is low.
Thalassemia trait presents with microcytosis out of proportion to
anemia and a normal or elevated ferritin. Sideroblastic anemia often
has high iron stores and ringed sideroblasts on bone marrow.
Question 3
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An 82-year-old man with chronic kidney disease stage 4 has
hemoglobin 9.8 g/dL, MCV 98 fL, and serum ferritin 600 ng/mL. His
transferrin saturation is 22%. What is the most likely underlying cause
of his anemia?
A) Iron deficiency
B) Anemia of chronic disease
C) Vitamin B12 deficiency
D) Erythropoietin deficiency
Answer: D
Explanation: In chronic kidney disease, anemia is primarily due to
insufficient erythropoietin production by the diseased kidneys. The
normocytic normochromic picture with inappropriately low reticulocyte
count is classic. Ferritin may be elevated due to inflammation, but
transferrin saturation is often normal or low. Iron deficiency is unlikely
with elevated ferritin. Anemia of chronic disease can coexist but is not
the primary driver here. Vitamin B12 deficiency would more commonly
show macrocytosis, though MCV can be normal early on.
Question 4
A 30-year-old woman of Mediterranean descent presents with mild
fatigue. Her hemoglobin is 10.5 g/dL, MCV 65 fL, and RBC count 5.8
million/microL. Her ferritin is 60 ng/mL. Which of the following is the
most appropriate diagnostic test?
A) Serum iron and TIBC
B) Hemoglobin electrophoresis
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C) Reticulocyte count
D) Bone marrow aspiration
Answer: B
Explanation: The combination of microcytosis with a relatively high RBC
count and normal ferritin is highly suggestive of thalassemia trait,
particularly in a patient of Mediterranean descent. Hemoglobin
electrophoresis will confirm the diagnosis by showing elevated
hemoglobin A2 in beta-thalassemia trait. Iron studies are less useful
here because ferritin is normal. Reticulocyte count is typically normal or
slightly elevated. Bone marrow is unnecessary for this benign condition.
Question 5
A 55-year-old male with alcohol use disorder presents with macrocytic
anemia. His hemoglobin is 10.2 g/dL, MCV 106 fL. Serum vitamin B12 is
300 pg/mL (normal 200-900), and folate is 2.0 ng/mL (normal >4.0).
Which of the following is the most likely cause?
A) Pernicious anemia
B) Dietary folate deficiency
C) Thiamine deficiency
D) Myelodysplastic syndrome
Answer: B
Explanation: Folate deficiency is common in patients with poor
nutrition, especially those with alcohol use disorder. A low serum folate
FNP Review – Anemia/Hematology (2026–2027) –
Hematology Exam Preparation With Complete
Questions And Correct Answers With Rationales
Already Graded A+Brand New Version!!
Question 1
A 68-year-old male presents with fatigue and pallor. His complete blood
count shows hemoglobin 9.2 g/dL, mean corpuscular volume 72 fL, red
cell distribution width 16.5%, and platelet count 450,000/microL. His
serum ferritin is 8 ng/mL. Which of the following is the most
appropriate next step in management?
A) Oral ferrous sulfate 325 mg daily
B) Intravenous iron dextran
C) Transfusion of packed red blood cells
D) Referral for bone marrow biopsy
Answer: A
Explanation: This patient presents with microcytic anemia (low MCV)
and a very low ferritin, which is pathognomonic for iron deficiency
anemia. The first-line treatment is oral iron replacement. Ferrous
sulfate 325 mg (65 mg elemental iron) daily or every other day is
,2|Page
standard. Intravenous iron is reserved for those who cannot tolerate
oral iron, have malabsorption, or require rapid replenishment.
Transfusion is not indicated with a hemoglobin above 7 g/dL in a stable
patient. Bone marrow biopsy is unnecessary in straightforward iron
deficiency.
Question 2
A 45-year-old woman with a history of heavy menstrual bleeding is
found to have hemoglobin 10.1 g/dL, MCV 79 fL, serum ferritin 12
ng/mL, and serum iron 30 mcg/dL. Her total iron-binding capacity is 450
mcg/dL. What is the most likely diagnosis?
A) Anemia of chronic disease
B) Iron deficiency anemia
C) Thalassemia trait
D) Sideroblastic anemia
Answer: B
Explanation: Iron deficiency anemia is characterized by low ferritin, low
serum iron, and elevated total iron-binding capacity (TIBC). The
transferrin saturation (serum iron divided by TIBC) is low. In anemia of
chronic disease, ferritin is typically normal or elevated, and TIBC is low.
Thalassemia trait presents with microcytosis out of proportion to
anemia and a normal or elevated ferritin. Sideroblastic anemia often
has high iron stores and ringed sideroblasts on bone marrow.
Question 3
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An 82-year-old man with chronic kidney disease stage 4 has
hemoglobin 9.8 g/dL, MCV 98 fL, and serum ferritin 600 ng/mL. His
transferrin saturation is 22%. What is the most likely underlying cause
of his anemia?
A) Iron deficiency
B) Anemia of chronic disease
C) Vitamin B12 deficiency
D) Erythropoietin deficiency
Answer: D
Explanation: In chronic kidney disease, anemia is primarily due to
insufficient erythropoietin production by the diseased kidneys. The
normocytic normochromic picture with inappropriately low reticulocyte
count is classic. Ferritin may be elevated due to inflammation, but
transferrin saturation is often normal or low. Iron deficiency is unlikely
with elevated ferritin. Anemia of chronic disease can coexist but is not
the primary driver here. Vitamin B12 deficiency would more commonly
show macrocytosis, though MCV can be normal early on.
Question 4
A 30-year-old woman of Mediterranean descent presents with mild
fatigue. Her hemoglobin is 10.5 g/dL, MCV 65 fL, and RBC count 5.8
million/microL. Her ferritin is 60 ng/mL. Which of the following is the
most appropriate diagnostic test?
A) Serum iron and TIBC
B) Hemoglobin electrophoresis
, 4|Page
C) Reticulocyte count
D) Bone marrow aspiration
Answer: B
Explanation: The combination of microcytosis with a relatively high RBC
count and normal ferritin is highly suggestive of thalassemia trait,
particularly in a patient of Mediterranean descent. Hemoglobin
electrophoresis will confirm the diagnosis by showing elevated
hemoglobin A2 in beta-thalassemia trait. Iron studies are less useful
here because ferritin is normal. Reticulocyte count is typically normal or
slightly elevated. Bone marrow is unnecessary for this benign condition.
Question 5
A 55-year-old male with alcohol use disorder presents with macrocytic
anemia. His hemoglobin is 10.2 g/dL, MCV 106 fL. Serum vitamin B12 is
300 pg/mL (normal 200-900), and folate is 2.0 ng/mL (normal >4.0).
Which of the following is the most likely cause?
A) Pernicious anemia
B) Dietary folate deficiency
C) Thiamine deficiency
D) Myelodysplastic syndrome
Answer: B
Explanation: Folate deficiency is common in patients with poor
nutrition, especially those with alcohol use disorder. A low serum folate
