FNP REVIEW - ANEMIA/HEMATOLOGY EXAM
QUESTIONS AND ANSWERS UPDATED
(2026/2027) (VERIFIED ANSWERS)
1. What does MCV (mean corpuscular volume) measure?
A. The amount of hemoglobin in each red blood cell
B. The average volume and size of each erythrocyte
C. The variability in red blood cell size
D. The percentage of red blood cells in whole blood
Correct Answer: B
Rationale: MCV expresses the average volume and size of each erythrocyte. "Cytic"
refers to size: microcytic ≤80 fL, normocytic 80-100 fL, and macrocytic ≥100 fL .
2. A patient's CBC shows an MCV of 72 fL. The red blood cells are described as:
A. Normocytic
B. Macrocytic
C. Microcytic
D. Hyperchromic
Correct Answer: C
Rationale: Microcytic anemia is defined by an MCV ≤80 fL. This is characteristic of iron
deficiency anemia, thalassemia, and anemia of chronic disease (sometimes) .
3. What does MCHC (mean corpuscular hemoglobin concentration) measure?
A. The size of the red blood cell
B. The average hemoglobin concentration or proportion of each RBC by hemoglobin
percentage
C. The variability in red blood cell size
D. The number of new red blood cells
Correct Answer: B
Rationale: MCHC is an expression of the average hemoglobin concentration or
,proportion of each RBC by hemoglobin percentage. "Chromic" refers to color:
hypochromic <32%, normochromic 32-36%, hyperchromic >36% .
4. Which of the following is associated with a low MCV?
A. Vitamin B12 deficiency
B. Folate deficiency
C. Iron deficiency anemia
D. Liver failure
Correct Answer: C
Rationale: Low MCV (microcytic) is associated with iron deficiency anemia and
thalassemia. High MCV (macrocytic) is associated with B12 or folate deficiency,
alcoholism, and liver failure .
5. A patient has anemia with an elevated MCV (>100 fL). Which tests should the
NP order next?
A. Serum iron and TIBC
B. Vitamin B12 and folate levels
C. Hemoglobin electrophoresis
D. Reticulocyte count
Correct Answer: B
Rationale: When a patient has an MCV greater than 100, the next step is to order
vitamin B12 and folate levels to evaluate for macrocytic anemia due to deficiency of
these nutrients .
6. What does an increased reticulocyte count indicate?
A. Decreased red blood cell production
B. Increased red blood cell production
C. Iron deficiency
D. Bone marrow failure
Correct Answer: B
Rationale: Reticulocyte count measures the number of new, young RBCs in circulation.
An increased count indicates that RBC production is increased, which can be seen after
acute blood loss or hemolysis .
,7. Which lab finding is most consistent with anemia of chronic disease?
A. Low serum iron, low TIBC, high ferritin, low reticulocyte count
B. Low serum iron, high TIBC, low ferritin, high reticulocyte count
C. High MCV, low B12, positive anti-IF antibodies
D. Low MCV, low MCHC, elevated RDW
Correct Answer: A
Rationale: Anemia of chronic disease typically presents with low serum iron, low TIBC,
normal to high ferritin, and low reticulocyte count. The MCV and MCHC are usually
normal (normocytic, normochromic) .
8. Which of the following is an example of a microcytic, hypochromic anemia?
A. Pernicious anemia
B. Folate deficiency
C. Iron deficiency anemia
D. Anemia of chronic disease
Correct Answer: C
Rationale: Iron deficiency anemia is microcytic (low MCV) and hypochromic (low
MCHC). Pernicious anemia and folate deficiency are macrocytic, and anemia of chronic
disease is typically normocytic .
9. An elderly patient of Mediterranean descent has a routine CBC showing
hemoglobin 12.0 g/dL, MCV 72 fL. What is the most appropriate next step?
A. Order serum iron, ferritin, TIBC, and RDW
B. Order vitamin B12 and folate levels
C. Reassure the patient this is normal
D. Order hemoglobin electrophoresis
Correct Answer: A
Rationale: The patient has anemia with a low MCV, which requires evaluation for iron
deficiency vs. thalassemia trait. The appropriate first step is to order serum iron, serum
ferritin, TIBC, and RDW. If serum iron/ferritin is low, the patient has iron deficiency. If iron
and ferritin are normal, thalassemia trait is likely .
10. Low ferritin levels indicate:
, A. Iron deficiency anemia
B. Anemia of chronic disease
C. Thalassemia trait
D. Hemolytic anemia
Correct Answer: A
Rationale: Low ferritin is a sensitive and specific indicator of iron deficiency anemia.
Normal or high ferritin levels in a patient with microcytic anemia suggest thalassemia
minor/trait .
SECTION 2: IRON DEFICIENCY ANEMIA (Questions 11-30)
11. What is the most common cause of anemia worldwide?
A. Thalassemia
B. Sickle cell disease
C. Iron deficiency anemia
D. Vitamin B12 deficiency
Correct Answer: C
Rationale: Iron deficiency anemia is the most common cause of anemia worldwide.
Causes include blood loss, inadequate iron intake, and impaired absorption of iron .
12. Which of the following is a common cause of iron deficiency anemia in adults?
A. Increased dietary iron
B. Blood loss (menstrual or gastrointestinal)
C. Decreased need for iron
D. Iron supplementation
Correct Answer: B
Rationale: Iron deficiency anemia is most commonly caused by blood loss, such as may
occur during menses or gastrointestinal hemorrhage .
13. A patient with iron deficiency anemia may present with which classic finding?
A. Pica
B. Glossitis with a beefy red tongue
QUESTIONS AND ANSWERS UPDATED
(2026/2027) (VERIFIED ANSWERS)
1. What does MCV (mean corpuscular volume) measure?
A. The amount of hemoglobin in each red blood cell
B. The average volume and size of each erythrocyte
C. The variability in red blood cell size
D. The percentage of red blood cells in whole blood
Correct Answer: B
Rationale: MCV expresses the average volume and size of each erythrocyte. "Cytic"
refers to size: microcytic ≤80 fL, normocytic 80-100 fL, and macrocytic ≥100 fL .
2. A patient's CBC shows an MCV of 72 fL. The red blood cells are described as:
A. Normocytic
B. Macrocytic
C. Microcytic
D. Hyperchromic
Correct Answer: C
Rationale: Microcytic anemia is defined by an MCV ≤80 fL. This is characteristic of iron
deficiency anemia, thalassemia, and anemia of chronic disease (sometimes) .
3. What does MCHC (mean corpuscular hemoglobin concentration) measure?
A. The size of the red blood cell
B. The average hemoglobin concentration or proportion of each RBC by hemoglobin
percentage
C. The variability in red blood cell size
D. The number of new red blood cells
Correct Answer: B
Rationale: MCHC is an expression of the average hemoglobin concentration or
,proportion of each RBC by hemoglobin percentage. "Chromic" refers to color:
hypochromic <32%, normochromic 32-36%, hyperchromic >36% .
4. Which of the following is associated with a low MCV?
A. Vitamin B12 deficiency
B. Folate deficiency
C. Iron deficiency anemia
D. Liver failure
Correct Answer: C
Rationale: Low MCV (microcytic) is associated with iron deficiency anemia and
thalassemia. High MCV (macrocytic) is associated with B12 or folate deficiency,
alcoholism, and liver failure .
5. A patient has anemia with an elevated MCV (>100 fL). Which tests should the
NP order next?
A. Serum iron and TIBC
B. Vitamin B12 and folate levels
C. Hemoglobin electrophoresis
D. Reticulocyte count
Correct Answer: B
Rationale: When a patient has an MCV greater than 100, the next step is to order
vitamin B12 and folate levels to evaluate for macrocytic anemia due to deficiency of
these nutrients .
6. What does an increased reticulocyte count indicate?
A. Decreased red blood cell production
B. Increased red blood cell production
C. Iron deficiency
D. Bone marrow failure
Correct Answer: B
Rationale: Reticulocyte count measures the number of new, young RBCs in circulation.
An increased count indicates that RBC production is increased, which can be seen after
acute blood loss or hemolysis .
,7. Which lab finding is most consistent with anemia of chronic disease?
A. Low serum iron, low TIBC, high ferritin, low reticulocyte count
B. Low serum iron, high TIBC, low ferritin, high reticulocyte count
C. High MCV, low B12, positive anti-IF antibodies
D. Low MCV, low MCHC, elevated RDW
Correct Answer: A
Rationale: Anemia of chronic disease typically presents with low serum iron, low TIBC,
normal to high ferritin, and low reticulocyte count. The MCV and MCHC are usually
normal (normocytic, normochromic) .
8. Which of the following is an example of a microcytic, hypochromic anemia?
A. Pernicious anemia
B. Folate deficiency
C. Iron deficiency anemia
D. Anemia of chronic disease
Correct Answer: C
Rationale: Iron deficiency anemia is microcytic (low MCV) and hypochromic (low
MCHC). Pernicious anemia and folate deficiency are macrocytic, and anemia of chronic
disease is typically normocytic .
9. An elderly patient of Mediterranean descent has a routine CBC showing
hemoglobin 12.0 g/dL, MCV 72 fL. What is the most appropriate next step?
A. Order serum iron, ferritin, TIBC, and RDW
B. Order vitamin B12 and folate levels
C. Reassure the patient this is normal
D. Order hemoglobin electrophoresis
Correct Answer: A
Rationale: The patient has anemia with a low MCV, which requires evaluation for iron
deficiency vs. thalassemia trait. The appropriate first step is to order serum iron, serum
ferritin, TIBC, and RDW. If serum iron/ferritin is low, the patient has iron deficiency. If iron
and ferritin are normal, thalassemia trait is likely .
10. Low ferritin levels indicate:
, A. Iron deficiency anemia
B. Anemia of chronic disease
C. Thalassemia trait
D. Hemolytic anemia
Correct Answer: A
Rationale: Low ferritin is a sensitive and specific indicator of iron deficiency anemia.
Normal or high ferritin levels in a patient with microcytic anemia suggest thalassemia
minor/trait .
SECTION 2: IRON DEFICIENCY ANEMIA (Questions 11-30)
11. What is the most common cause of anemia worldwide?
A. Thalassemia
B. Sickle cell disease
C. Iron deficiency anemia
D. Vitamin B12 deficiency
Correct Answer: C
Rationale: Iron deficiency anemia is the most common cause of anemia worldwide.
Causes include blood loss, inadequate iron intake, and impaired absorption of iron .
12. Which of the following is a common cause of iron deficiency anemia in adults?
A. Increased dietary iron
B. Blood loss (menstrual or gastrointestinal)
C. Decreased need for iron
D. Iron supplementation
Correct Answer: B
Rationale: Iron deficiency anemia is most commonly caused by blood loss, such as may
occur during menses or gastrointestinal hemorrhage .
13. A patient with iron deficiency anemia may present with which classic finding?
A. Pica
B. Glossitis with a beefy red tongue
