NR 661 Hematology 1 to 60

12 August 2024

NR 661 Hematology 1 to 60

  1. An African American male complains of pain in his back and trunk. He is diagnosed with multiple myeloma. He is probably:
    • Correct Answer: About 65 years old (correct answer in bracket).
    • Explanation: Multiple myeloma is most common in older adults, typically around the age of 65.
  2. Which statement is true about vitamin B12?
    • Correct Answer: Inadequate amounts can produce cognitive changes (correct answer in bracket).
    • Explanation: Vitamin B12 deficiency can lead to neurological issues, including cognitive impairments.
  3. A patient has had an allergic reaction to seafood with anaphylaxis 48 hours ago. Which white cell will probably be abnormal?
    • Correct Answer: Eosinophils (correct answer in bracket).
    • Explanation: Eosinophils are often elevated in allergic reactions, especially those involving anaphylaxis.
  4. What statement is true about anemia in older adults?
    • Correct Answer: Anemia may have more than one origin and co-exist in older adults (correct answer in bracket).
    • Explanation: Anemia in older adults often has multiple causes, such as chronic disease and nutritional deficiencies.
  5. Thalassemia minor can be recognized by:
    • Correct Answer: Microcytic, hypochromic red cells (correct answer in bracket).
    • Explanation: Thalassemia minor typically presents with small (microcytic) and pale (hypochromic) red blood cells.
  6. Lead toxicity can be associated with:
    • Correct Answer: Sideroblastic anemia (correct answer in bracket).
    • Explanation: Lead toxicity can interfere with hemoglobin production, leading to sideroblastic anemia.
  7. A 28-year-old female patient reports fatigue for the past 4-6 weeks. Based on her most likely diagnosis, she will receive an oral supplement as treatment for her anemia. For best absorption, it should be taken:
    • Correct Answer: On an empty stomach (correct answer in bracket).
    • Explanation: Iron supplements are best absorbed when taken on an empty stomach, as food can inhibit absorption.
  8. An older adult has suspected vitamin B12 deficiency. Which of the following lab indices is more indicative of a vitamin B12 deficiency?
    • Correct Answer: Macrocytosis (correct answer in bracket).
    • Explanation: Macrocytosis (enlarged red blood cells) is a common sign of vitamin B12 deficiency.
  9. A patient with pernicious anemia may be observed to have:
    • Correct Answer: Glossitis (correct answer in bracket).
    • Explanation: Pernicious anemia often presents with glossitis, an inflammation of the tongue.
  10. What diagnosis is likely based on this patient’s laboratory values?
    • Correct Answer: Pernicious anemia (correct answer in bracket).
    • Explanation: Pernicious anemia is characterized by specific lab findings, including low vitamin B12 levels and macrocytosis
  11. A patient is found to have anemia. What term is used to describe the patient’s MCH in this CBC?
    • Correct Answer: Normochromic (correct answer in bracket).
    • Explanation: Normochromic refers to red blood cells that have a normal concentration of hemoglobin, which is typical in certain types of anemia.
  12. A 20-year-old student has an MMR titer that demonstrates an unprotective titer for rubella. She is HIV positive. Her CD4 cell count is unknown. Which statement is true?
    • Correct Answer: She is at risk for MMR but should not be immunized (correct answer in bracket).
    • Explanation: Immunization with live vaccines like MMR is contraindicated in individuals with compromised immune systems, such as those with low CD4 counts.
  13. The following lab values most likely indicate what type of anemia?
    • Correct Answer: Iron deficiency anemia (correct answer in bracket).
    • Explanation: Iron deficiency anemia typically presents with low hemoglobin, hematocrit, and ferritin levels, along with microcytosis and hypochromia.
  14. A 26-year-old female has thalassemia minor. What should be limited in her diet to avoid hepatotoxicity?
    • Correct Answer: Multivitamin with iron (correct answer in bracket).
    • Explanation: Iron overload can be harmful in individuals with thalassemia minor, leading to liver damage, so iron supplementation should be avoided.
  15. A measure of the degree of variation in red cell size is indicated by:
    • Correct Answer: RDW (correct answer in bracket).
    • Explanation: Red cell distribution width (RDW) is a measurement of the variability in the size of red blood cells.
  16. A serum ferritin level:
    • Correct Answer: Demonstrates the amount of iron in storage (correct answer in bracket).
    • Explanation: Ferritin is a protein that stores iron, and its levels in the blood indicate the amount of iron stored in the body.
  17. A patient is being treated for iron deficiency anemia. Iron is better absorbed:
    • Correct Answer: On an empty stomach (correct answer in bracket).
    • Explanation: Taking iron supplements on an empty stomach enhances absorption, though it may cause gastrointestinal discomfort in some patients.
  18. A patient had a splenectomy after an automobile accident 3 months ago. Patients who are asplenic are:
    • Correct Answer: More susceptible to bacterial infection (correct answer in bracket).
    • Explanation: The spleen plays a crucial role in fighting bacterial infections, and its absence increases the risk of infection.
  19. A patient is found to have an anemia. What term is used to describe this patient’s MCV?
    • Correct Answer: Normocytic (correct answer in bracket).
    • Explanation: Normocytic anemia refers to anemia with normal-sized red blood cells, which can occur in chronic diseases.
  20. A 75-year-old adult asks for the pneumonia vaccine. His immunization record indicates that he had one at age 65 and another a year later. What is the recommendation of the CDC about how the NP should handle his request?
    • Correct Answer: Do not revaccinate this patient at this time (correct answer in bracket).
    • Explanation: The CDC recommends not revaccinating older adults if they have already received the appropriate pneumonia vaccines unless specific conditions warrant it.
  21. A 75-year-old male patient has been in poor health for a decade. Which type of anemia is LEAST likely in this patient?
    • Correct Answer: Sideroblastic anemia (correct answer in bracket).
    • Explanation: Sideroblastic anemia is less common in older adults and usually arises from congenital or acquired causes, often unrelated to general poor health.
  22. A 50-year-old female presents to your clinic with symptoms of fatigue over the past 1-2 months. Preliminary labs have been performed. What should the NP do next?
    • Correct Answer: Prescribe an iron supplement (correct answer in bracket).
    • Explanation: If iron deficiency anemia is suspected based on preliminary labs, starting iron supplementation is a typical next step.
  23. A healthy appearing 3-year-old female child presents with lymphadenopathy, nonblanchable redness over both knees and elbows, and a low-grade fever. During the exam, she is found to have normal growth and development and interacts appropriately with the nurse practitioner. She had an upper respiratory infection about 4 weeks ago. Her CBC demonstrates thrombocytopenia. Urinalysis demonstrates hematuria. The most likely diagnosis is:
    • Correct Answer: Idiopathic thrombocytopenic purpura (correct answer in bracket).
    • Explanation: Idiopathic thrombocytopenic purpura (ITP) is a condition characterized by a low platelet count following a viral infection, often presenting with symptoms like bruising and petechiae.
  24. What is true regarding the shingles vaccine given to adults at or after age 50?
    • Correct Answer: It contains significantly more virus than the chickenpox vaccine (correct answer in bracket).
    • Explanation: The shingles vaccine contains a higher dose of the varicella-zoster virus to boost immunity in older adults.
  25. Leukemia may have varied clinical presentations. Which characteristic would be unusual to find in a patient with leukemia?
    • Correct Answer: Sickle-shaped cells (correct answer in bracket).
    • Explanation: Sickle-shaped cells are characteristic of sickle cell anemia, not leukemia, which typically presents with abnormal white blood cells.
  26. A 34-year-old female has been recently diagnosed with rheumatoid arthritis and is being cared for by a rheumatologist. Her current medication list includes methotrexate, levothyroxine, and Depo-Provera contraceptive. She presents to your primary care clinic for her annual examination. What diagnosis is likely?
    • Correct Answer: Folic acid deficiency anemia (correct answer in bracket).
    • Explanation: Methotrexate, a common treatment for rheumatoid arthritis, can lead to folic acid deficiency, causing anemia.
  27. A female patient has been diagnosed with Glucose-6-phosphate dehydrogenase deficiency (G6PD). What should be done to prevent lysis of red cells in this patient?
    • Correct Answer: Avoid aspirin and sulfa drugs (correct answer in bracket).
    • Explanation: G6PD deficiency can cause hemolysis when patients are exposed to certain drugs, such as aspirin and sulfa drugs.
  28. Besides inadequate intake of vitamin D in older adults, which other factor contributes to deficiencies?
    • Correct Answer: Impaired synthesis of previtamin D (correct answer in bracket).
    • Explanation: Older adults often have impaired skin synthesis of vitamin D, leading to deficiencies.
  29. Which disease listed below can be associated with lymphocytosis?
    • Correct Answer: Mononucleosis (correct answer in bracket).
    • Explanation: Infectious mononucleosis, caused by the Epstein-Barr virus, is characterized by an increase in lymphocytes.
  30. Which white cell should be present in the greatest number in a patient who is healthy today?
    • Correct Answer: Neutrophils (correct answer in bracket).
    • Explanation: Neutrophils are the most abundant type of white blood cells in a healthy individual and are the first line of defense against infection.
  31. Which hallmark finding is associated with both B12 and folate deficiencies?
    • Correct Answer: Macrocytosis (correct answer in bracket).
    • Explanation: Both B12 and folate deficiencies cause macrocytosis, which is characterized by larger than normal red blood cells.
  32. A patient has the following CBC. The most likely interpretation is that he:
    • Correct Answer: Has an infection of unknown etiology (correct answer in bracket).
    • Explanation: A complete blood count (CBC) with elevated white blood cells often indicates an infection of unknown cause.
  33. A patient demonstrates leukocytosis. This means:
    • Correct Answer: He has an infection of unknown origin (correct answer in bracket).
    • Explanation: Leukocytosis is an increase in white blood cells, commonly due to infection.
  34. A patient complains of numbness and tingling in both hands. He has the following lab values. The nurse practitioner should suspect:
    • Correct Answer: Iron deficiency anemia (correct answer in bracket).
    • Explanation: Numbness and tingling, along with specific lab findings, can indicate iron deficiency anemia.
  35. A 70-year-old male who is a smoker has lymph nodes in his axillary and inguinal areas that are palpable but nontender. He states that he feels well today. However, he has had a nonproductive cough for the past 4 weeks. What should be included in a differential diagnosis for this patient?
    • Correct Answer: Lymphoma (correct answer in bracket).
    • Explanation: Persistent cough and nontender lymphadenopathy in a smoker should raise concern for lymphoma.
  36. A contraindication to giving MMR vaccination is:
    • Correct Answer: Encephalopathy within 7 days after immunization (correct answer in bracket).
    • Explanation: A history of encephalopathy following immunization is a contraindication to receiving further doses of MMR.
  37. A definitive diagnosis of sickle cell anemia can be made:
    • Correct Answer: By a hemoglobin electrophoresis (correct answer in bracket).
    • Explanation: Hemoglobin electrophoresis is the test used to confirm sickle cell anemia by identifying abnormal hemoglobin types.
  38. A 7-year-old boy who was previously unimmunized received his first tetanus, diphtheria, and acellular pertussis (TDaP), Hepatitis A, Hepatitis B, inactivated polio (IPV), measles, mumps, and rubella (MMR), and Varicella vaccinations one month ago. He returns today for his second series of immunizations. He should receive:
    • Correct Answer: Hepatitis B, TDaP, IPV, MMR, and Varicella (correct answer in bracket).
    • Explanation: The child should continue with the next series of the recommended vaccines for full immunization coverage.
  39. An older adult has suspected B12 deficiency. Which of the following lab indices is more indicative of a B12 deficiency?
    • Correct Answer: Macrocytosis (correct answer in bracket).
    • Explanation: Macrocytosis is a key indicator of B12 deficiency, often leading to anemia.
  40. The nurse practitioner sees a child who reports fatigue and presents with purpura on his lower extremities. His temperature is normal. The differential includes:
    • Correct Answer: Acute leukemia (correct answer in bracket).
    • Explanation: Purpura and fatigue in a child could be signs of acute leukemia, which should be included in the differential diagnosis.
  41. The best way to evaluate jaundice associated with liver disease is to observe:
    • Correct Answer: The sclera, skin, and lips (correct answer in bracket).
    • Explanation: Jaundice is most easily seen in the sclera (whites of the eyes), skin, and mucous membranes like the lips.
  42. A 12-month-old was screened for iron deficiency anemia and found to be anemic. The nurse practitioner ordered oral iron. In 1 month, the child’s hemoglobin was reassessed. It increased greatly. Which answer might account for this?
    • Correct Answer: The bone marrow is responding appropriately (correct answer in bracket).
    • Explanation: An increase in hemoglobin after iron supplementation indicates that the bone marrow is producing red blood cells effectively.
  43. What choice below can be attributed to the two most common causes of iron deficiency anemia in adults?
    • Correct Answer: Gynecologic losses and bleeding in the gastrointestinal tract (correct answer in bracket).
    • Explanation: In adults, iron deficiency anemia is most commonly caused by menstrual blood loss or gastrointestinal bleeding.
  44. A 6-month-old child comes into the clinic for immunizations. Which item below allows a delay in his getting immunizations today?
    • Correct Answer: Child has otitis media with temperature of 103°F (correct answer in bracket).
    • Explanation: A high fever due to otitis media may warrant delaying immunizations until the child recovers.
  45. A 72-year-old male has been diagnosed with anemia. Which of the following statements is true?
    • Correct Answer: He may have a GI bleed (correct answer in bracket).
    • Explanation: Gastrointestinal bleeding is a common cause of anemia in older adults and should be investigated.
  46. A side effect of DTaP that should be reported is:
    • Correct Answer: Nonstop crying (3h or more) within 48 hours of receiving the immunization (correct answer in bracket).
    • Explanation: Prolonged crying after DTaP immunization may indicate a serious reaction and should be reported.
  47. A 2-year-old with sickle cell anemia (SCA) should receive which immunizations?
    • Correct Answer: All routine childhood immunizations at the usual time (correct answer in bracket).
    • Explanation: Children with sickle cell anemia should follow the standard immunization schedule to protect against infections.
  48. A 6-year-old complains that his legs hurt. His mother states that he has complained for the past 2 weeks, and she thought it was from “playing outside too much”. When asked to identify the painful areas, the child points to the midshaft of the femurs. He grimaces slightly when asked to walk. What should be part of the differential diagnosis?
    • Correct Answer: Acute lymphocytic leukemia (ALL) (correct answer in bracket).
    • Explanation: Bone pain, particularly in the long bones like the femurs, can be an early sign of acute lymphocytic leukemia.
  49. Which suggestion below is the standard for treating iron deficiency anemia in infants and children?
    • Correct Answer: Iron supplementation in divided doses between meals with orange juice (correct answer in bracket).
    • Explanation: Iron is best absorbed when taken with vitamin C (like orange juice) between meals.
  50. An older adult has suspected B12 deficiency. Which of the following lab indices is most indicative of a B12 deficiency?
    • Correct Answer: Increased MCV (correct answer in bracket).
    • Explanation: Increased mean corpuscular volume (MCV) is a common finding in B12 deficiency anemia
  51. An African American male complains of pain in his back and trunk. He is diagnosed with multiple myeloma. He is probably:
    • Correct Answer: About 65 years old (correct answer in bracket).
    • Explanation: Multiple myeloma is most common in older adults, typically around the age of 65.
  52. Which statement is true about vitamin B12?
    • Correct Answer: Inadequate amounts can produce cognitive changes (correct answer in bracket).
    • Explanation: Vitamin B12 deficiency can lead to neurological issues, including cognitive impairments.
  53. A patient has had an allergic reaction to seafood with anaphylaxis 48 hours ago. Which white cell will probably be abnormal?
    • Correct Answer: Eosinophils (correct answer in bracket).
    • Explanation: Eosinophils are often elevated in allergic reactions, especially those involving anaphylaxis.
  54. What statement is true about anemia in older adults?
    • Correct Answer: Anemia may have more than one origin and co-exist in older adults (correct answer in bracket).
    • Explanation: Anemia in older adults often has multiple causes, such as chronic disease and nutritional deficiencies.
  55. Thalassemia minor can be recognized by:
    • Correct Answer: Microcytic, hypochromic red cells (correct answer in bracket).
    • Explanation: Thalassemia minor typically presents with small (microcytic) and pale (hypochromic) red blood cells.
  56. Lead toxicity can be associated with:
    • Correct Answer: Sideroblastic anemia (correct answer in bracket).
    • Explanation: Lead toxicity can interfere with hemoglobin production, leading to sideroblastic anemia.
  57. A 28-year-old female patient reports fatigue for the past 4-6 weeks. Based on her most likely diagnosis, she will receive an oral supplement as treatment for her anemia. For best absorption, it should be taken:
    • Correct Answer: On an empty stomach (correct answer in bracket).
    • Explanation: Iron supplements are best absorbed when taken on an empty stomach, as food can inhibit absorption.
  58. An older adult has suspected vitamin B12 deficiency. Which of the following lab indices is more indicative of a vitamin B12 deficiency?
    • Correct Answer: Macrocytosis (correct answer in bracket).
    • Explanation: Macrocytosis (enlarged red blood cells) is a common sign of vitamin B12 deficiency.
  59. A patient with pernicious anemia may be observed to have:
    • Correct Answer: Glossitis (correct answer in bracket).
    • Explanation: Pernicious anemia often presents with glossitis, an inflammation of the tongue.
  60. What diagnosis is likely based on this patient’s laboratory values?
    • Correct Answer: Pernicious anemia (correct answer in bracket).
    • Explanation: Pernicious anemia is characterized by specific lab findings, including low vitamin B12 levels and macrocytosis.
  61. A patient is found to have anemia. What term is used to describe the patient’s MCH in this CBC?
    • Correct Answer: Normochromic (correct answer in bracket).
    • Explanation: Normochromic refers to red blood cells that have a normal concentration of hemoglobin, which is typical in certain types of anemia.
  62. A 20-year-old student has an MMR titer that demonstrates an unprotective titer for rubella. She is HIV positive. Her CD4 cell count is unknown. Which statement is true?
    • Correct Answer: She is at risk for MMR but should not be immunized (correct answer in bracket).
    • Explanation: Immunization with live vaccines like MMR is contraindicated in individuals with compromised immune systems, such as those with low CD4 counts.
  63. The following lab values most likely indicate what type of anemia?
    • Correct Answer: Iron deficiency anemia (correct answer in bracket).
    • Explanation: Iron deficiency anemia typically presents with low hemoglobin, hematocrit, and ferritin levels, along with microcytosis and hypochromia.
  64. A 26-year-old female has thalassemia minor. What should be limited in her diet to avoid hepatotoxicity?
    • Correct Answer: Multivitamin with iron (correct answer in bracket).
    • Explanation: Iron overload can be harmful in individuals with thalassemia minor, leading to liver damage, so iron supplementation should be avoided.
  65. A measure of the degree of variation in red cell size is indicated by:
    • Correct Answer: RDW (correct answer in bracket).
    • Explanation: Red cell distribution width (RDW) is a measurement of the variability in the size of red blood cells.
  66. A serum ferritin level:
    • Correct Answer: Demonstrates the amount of iron in storage (correct answer in bracket).
    • Explanation: Ferritin is a protein that stores iron, and its levels in the blood indicate the amount of iron stored in the body.
  67. A patient is being treated for iron deficiency anemia. Iron is better absorbed:
    • Correct Answer: On an empty stomach (correct answer in bracket).
    • Explanation: Taking iron supplements on an empty stomach enhances absorption, though it may cause gastrointestinal discomfort in some patients.
  68. A patient had a splenectomy after an automobile accident 3 months ago. Patients who are asplenic are:
    • Correct Answer: More susceptible to bacterial infection (correct answer in bracket).
    • Explanation: The spleen plays a crucial role in fighting bacterial infections, and its absence increases the risk of infection.
  69. A patient is found to have an anemia. What term is used to describe this patient’s MCV?
    • Correct Answer: Normocytic (correct answer in bracket).
    • Explanation: Normocytic anemia refers to anemia with normal-sized red blood cells, which can occur in chronic diseases.
  70. A 75-year-old adult asks for the pneumonia vaccine. His immunization record indicates that he had one at age 65 and another a year later. What is the recommendation of the CDC about how the NP should handle his request?
    • Correct Answer: Do not revaccinate this patient at this time (correct answer in bracket).
    • Explanation: The CDC recommends not revaccinating older adults if they have already received the appropriate pneumonia vaccines unless specific conditions warrant it.
  71. A 75-year-old male patient has been in poor health for a decade. Which type of anemia is LEAST likely in this patient?
    • Correct Answer: Sideroblastic anemia (correct answer in bracket).
    • Explanation: Sideroblastic anemia is less common in older adults and usually arises from congenital or acquired causes, often unrelated to general poor health.
  72. A 50-year-old female presents to your clinic with symptoms of fatigue over the past 1-2 months. Preliminary labs have been performed. What should the NP do next?
    • Correct Answer: Prescribe an iron supplement (correct answer in bracket).
    • Explanation: If iron deficiency anemia is suspected based on preliminary labs, starting iron supplementation is a typical next step.
  73. A healthy appearing 3-year-old female child presents with lymphadenopathy, nonblanchable redness over both knees and elbows, and a low-grade fever. During the exam, she is found to have normal growth and development and interacts appropriately with the nurse practitioner. She had an upper respiratory infection about 4 weeks ago. Her CBC demonstrates thrombocytopenia. Urinalysis demonstrates hematuria. The most likely diagnosis is:
    • Correct Answer: Idiopathic thrombocytopenic purpura (correct answer in bracket).
    • Explanation: Idiopathic thrombocytopenic purpura (ITP) is a condition characterized by a low platelet count following a viral infection, often presenting with symptoms like bruising and petechiae.
  74. What is true regarding the shingles vaccine given to adults at or after age 50?
    • Correct Answer: It contains significantly more virus than the chickenpox vaccine (correct answer in bracket).
    • Explanation: The shingles vaccine contains a higher dose of the varicella-zoster virus to boost immunity in older adults.
  75. Leukemia may have varied clinical presentations. Which characteristic would be unusual to find in a patient with leukemia?
    • Correct Answer: Sickle-shaped cells (correct answer in bracket).
    • Explanation: Sickle-shaped cells are characteristic of sickle cell anemia, not leukemia, which typically presents with abnormal white blood cells.
  76. A 34-year-old female has been recently diagnosed with rheumatoid arthritis and is being cared for by a rheumatologist. Her current medication list includes methotrexate, levothyroxine, and Depo-Provera contraceptive. She presents to your primary care clinic for her annual examination. What diagnosis is likely?
    • Correct Answer: Folic acid deficiency anemia (correct answer in bracket).
    • Explanation: Methotrexate, a common treatment for rheumatoid arthritis, can lead to folic acid deficiency, causing anemia.
  77. A female patient has been diagnosed with Glucose-6-phosphate dehydrogenase deficiency (G6PD). What should be done to prevent lysis of red cells in this patient?
    • Correct Answer: Avoid aspirin and sulfa drugs (correct answer in bracket).
    • Explanation: G6PD deficiency can cause hemolysis when patients are exposed to certain drugs, such as aspirin and sulfa drugs.
  78. Besides inadequate intake of vitamin D in older adults, which other factor contributes to deficiencies?
    • Correct Answer: Impaired synthesis of previtamin D (correct answer in bracket).
    • Explanation: Older adults often have impaired skin synthesis of vitamin D, leading to deficiencies.
  79. Which disease listed below can be associated with lymphocytosis?
    • Correct Answer: Mononucleosis (correct answer in bracket).
    • Explanation: Infectious mononucleosis, caused by the Epstein-Barr virus, is characterized by an increase in lymphocytes.
  80. Which white cell should be present in the greatest number in a patient who is healthy today?
    • Correct Answer: Neutrophils (correct answer in bracket).
    • Explanation: Neutrophils are the most abundant type of white blood cells in a healthy individual and are the first line of defense against infection.
  81. Which hallmark finding is associated with both B12 and folate deficiencies?
    • Correct Answer: Macrocytosis (correct answer in bracket).
    • Explanation: Both B12 and folate deficiencies cause macrocytosis, which is characterized by larger than normal red blood cells.
  82. A patient has the following CBC. The most likely interpretation is that he:
    • Correct Answer: Has an infection of unknown etiology (correct answer in bracket).
    • Explanation: A complete blood count (CBC) with elevated white blood cells often indicates an infection of unknown cause.
  83. A patient demonstrates leukocytosis. This means:
    • Correct Answer: He has an infection of unknown origin (correct answer in bracket).
    • Explanation: Leukocytosis is an increase in white blood cells, commonly due to infection.
  84. A patient complains of numbness and tingling in both hands. He has the following lab values. The nurse practitioner should suspect:
    • Correct Answer: Iron deficiency anemia (correct answer in bracket).
    • Explanation: Numbness and tingling, along with specific lab findings, can indicate iron deficiency anemia.
  85. A 70-year-old male who is a smoker has lymph nodes in his axillary and inguinal areas that are palpable but nontender. He states that he feels well today. However, he has had a nonproductive cough for the past 4 weeks. What should be included in a differential diagnosis for this patient?
    • Correct Answer: Lymphoma (correct answer in bracket).
    • Explanation: Persistent cough and nontender lymphadenopathy in a smoker should raise concern for lymphoma.
  86. A contraindication to giving MMR vaccination is:
    • Correct Answer: Encephalopathy within 7 days after immunization (correct answer in bracket).
    • Explanation: A history of encephalopathy following immunization is a contraindication to receiving further doses of MMR.
  87. A definitive diagnosis of sickle cell anemia can be made:
    • Correct Answer: By a hemoglobin electrophoresis (correct answer in bracket).
    • Explanation: Hemoglobin electrophoresis is the test used to confirm sickle cell anemia by identifying abnormal hemoglobin types.
  88. A 7-year-old boy who was previously unimmunized received his first tetanus, diphtheria, and acellular pertussis (TDaP), Hepatitis A, Hepatitis B, inactivated polio (IPV), measles, mumps, and rubella (MMR), and Varicella vaccinations one month ago. He returns today for his second series of immunizations. He should receive:
    • Correct Answer: Hepatitis B, TDaP, IPV, MMR, and Varicella (correct answer in bracket).
    • Explanation: The child should continue with the next series of the recommended vaccines for full immunization coverage.
  89. An older adult has suspected B12 deficiency. Which of the following lab indices is more indicative of a B12 deficiency?
    • Correct Answer: Macrocytosis (correct answer in bracket).
    • Explanation: Macrocytosis is a key indicator of B12 deficiency, often leading to anemia.
  90. The nurse practitioner sees a child who reports fatigue and presents with purpura on his lower extremities. His temperature is normal. The differential includes:
    • Correct Answer: Acute leukemia (correct answer in bracket).
    • Explanation: Purpura and fatigue in a child could be signs of acute leukemia, which should be included in the differential diagnosis.
  91. The best way to evaluate jaundice associated with liver disease is to observe:
    • Correct Answer: The sclera, skin, and lips (correct answer in bracket).
    • Explanation: Jaundice is most easily seen in the sclera (whites of the eyes), skin, and mucous membranes like the lips.
  92. A 12-month-old was screened for iron deficiency anemia and found to be anemic. The nurse practitioner ordered oral iron. In 1 month, the child’s hemoglobin was reassessed. It increased greatly. Which answer might account for this?
    • Correct Answer: The bone marrow is responding appropriately (correct answer in bracket).
    • Explanation: An increase in hemoglobin after iron supplementation indicates that the bone marrow is producing red blood cells effectively.
  93. What choice below can be attributed to the two most common causes of iron deficiency anemia in adults?
    • Correct Answer: Gynecologic losses and bleeding in the gastrointestinal tract (correct answer in bracket).
    • Explanation: In adults, iron deficiency anemia is most commonly caused by menstrual blood loss or gastrointestinal bleeding.
  94. A 6-month-old child comes into the clinic for immunizations. Which item below allows a delay in his getting immunizations today?
    • Correct Answer: Child has otitis media with temperature of 103°F (correct answer in bracket).
    • Explanation: A high fever due to otitis media may warrant delaying immunizations until the child recovers.
  95. A 72-year-old male has been diagnosed with anemia. Which of the following statements is true?
    • Correct Answer: He may have a GI bleed (correct answer in bracket).
    • Explanation: Gastrointestinal bleeding is a common cause of anemia in older adults and should be investigated.
  96. A side effect of DTaP that should be reported is:
    • Correct Answer: Nonstop crying (3h or more) within 48 hours of receiving the immunization (correct answer in bracket).
    • Explanation: Prolonged crying after DTaP immunization may indicate a serious reaction and should be reported.
  97. A 2-year-old with sickle cell anemia (SCA) should receive which immunizations?
    • Correct Answer: All routine childhood immunizations at the usual time (correct answer in bracket).
    • Explanation: Children with sickle cell anemia should follow the standard immunization schedule to protect against infections.
  98. A 6-year-old complains that his legs hurt. His mother states that he has complained for the past 2 weeks, and she thought it was from “playing outside too much”. When asked to identify the painful areas, the child points to the midshaft of the femurs. He grimaces slightly when asked to walk. What should be part of the differential diagnosis?
    • Correct Answer: Acute lymphocytic leukemia (ALL) (correct answer in bracket).
    • Explanation: Bone pain, particularly in the long bones like the femurs, can be an early sign of acute lymphocytic leukemia.
  99. Which suggestion below is the standard for treating iron deficiency anemia in infants and children?
    • Correct Answer: Iron supplementation in divided doses between meals with orange juice (correct answer in bracket).
    • Explanation: Iron is best absorbed when taken with vitamin C (like orange juice) between meals.
  100. An older adult has suspected B12 deficiency. Which of the following lab indices is most indicative of a B12 deficiency?
    • Correct Answer: Increased MCV (correct answer in bracket).
    • Explanation: Increased mean corpuscular volume (MCV) is a common finding in B12 deficiency anemia.