FNP Certification FINAL EXAM Questions
and Answers (2024/2025) (Verified
Answers) Graded A+
In the person with reactive thrombocytosis, clotting risk is typically absent until a
platelet count of:
a. ≥400,000 mm3
b. ≥800,000 mm3.
c. ≥1 million mm3.
d. ≥2 million mm3.
C. ≥1 million mm3.
Reactive thrombocytosis is an increase in platelet count in response to a stimulus.
There are several causes of reactive thrombocytosis, including acute bleeding and
blood loss, allergic reactions, cancer, infections, some types of anemia, major surgery,
splenectomy, and some types of medications. Treatment of reactive thrombocytosis is
directed at the underlying cause and platelet counts usually return to normal once the
underlying condition is brought under control. An increased risk of blood clots can occur
once the platelet count is ≥1 million mm3 (NL = 150,000-450,000 mm3). Topic:
Assessment and Intervention in Select Hematologic Disorders
Antibodies are primarily formed by:
a. T-cell lymphocytes.
b. B-cell lymphocytes.
c. Mast cells.
d. Eosinophils.
B. B-cell lymphocytes.
B cells are involved in antibody formation. Delaying the hypersensitivity response is a
primary function of T-cell lymphocytes. Granulocytes and monocytes are involved in the
phagocytosis of circulating debris and pathogens, such as bacteria or fungi. Topic:
Assessment and Intervention in Select Hematologic Disorders
Constitutional neutropenia is most often found in:
a. Those of African ancestry.
b. Sepsis recovery.
c. Post transfusion states.
d. Patients who have undergone splenectomy.
A. Those of African ancestry.
Constitutional neutropenia (also called benign ethnic neutropenia or benign familial
neutropenia) is a condition more often observed in people with African and Middle
Eastern ancestry. The condition is potentially caused by a defect in the release of
mature WBCs from the bone marrow to peripheral circulation. Despite a consistently
lower than normal ANC in people with constitutional neutropenia, many do not show
increased susceptibility to infection or any other adverse effect. Topic: Assessment and
Intervention in Select Hematologic Disorders
Agranulocytosis is characterized by:
,a. Total WBC ≤8000 mm3.
b. Total WBC ≤5000 mm3.
c. ANC < 2000 mm3
d. ANC < 500 mm3
D. ANC < 500 mm3.
Neutropenia is characterized by an absolute neutrophil count (ANC) of <2000 mm3.
Several factors can result in the development of neutropenia, including a drug-induced
reaction, nutritional deficiencies (e.g., vitamin B12, folate, or copper), and hormone
disorders (e.g., thyrotoxicosis, Addison disease, and acromegaly). Severe neutropenia,
or agranulocytosis, is defined as an ANC <500 mm3 and places the patient at increased
susceptibility to serious bacterial infections. Topic: Assessment and Intervention in
Select Hematologic Disorders.
Eosinophilia is often seen in infections caused by:
a. Viruses.
b. Encapsulated bacteria.
c. Mycobacterium.
d. Protozoans.
D. Protozoans.
Eosinophils exhibit weak phagocytic action in the presence of foreign substances and
can ingest antigen-antibody complexes. These cells are active against parasitic
infections, such as protozoans, and if the parasite is too large for ingestion, the cells can
release substances directly onto the parasite's surface. Neutrophils are active against
bacteria while lymphocytes are active against viral infections. Topic: Assessment and
Intervention in Select Hematologic Disorders
A WBC morphology report relates toxic granulation. This is most often seen in:
a. Pathogenic conditions are caused by intracellular organisms.
b. Viral illness.
c. Recovery stage from protozoan infestation.
d. Serious bacterial infection.
D. Serious bacterial infection.
Toxic granulation refers to a morphology observed in granulocytes, such as neutrophils,
that is characterized by the presence of dark, coarse granules. This condition is
commonly observed in patients during inflammation or acute infection. Granulocytes are
involved in the phagocytosis of bacterial or fungal pathogens and, thus, toxic
granulation is most likely a result of a serious bacterial infection. Topic: Assessment and
Intervention in Select Hematologic Disorders
Which of the following is consistent with neutrophilia?
a. TWBC=8,000 mm3, 45% neuts
b. TWBC=13,500 mm3, 35% neuts
c. TWBC=10,100 mm3, 81% neuts
d. TWBC=12,000 mm3, 40% neuts
C. TWBC=10,100 mm3, 81% neuts.
,Neutrophils are involved in the degradation of pathogens, generation of oxidants, and
tissue degradation. Neutrophilia can occur from acute infections and is characterized by
an elevated number of neutrophils (>70% TWBC [NL=50%-70% TWBC in adults]).
Leukocytosis with neutrophilia is characterized by elevated levels of WBCs (NL = 6,000-
10,000 per mm3 in adults). Topic: Assessment and Intervention in Select Hematologic
Disorders
The use of which of the following medications is a common cause of drug-
induced thrombocytopenia?
a. Warfarin
b. Aspirin
c. Ibuprofen
d. Unfractionated heparin
D. Unfractionated heparin.
Drug-induced thrombocytopenia is commonly caused by accelerated platelet
destruction by drug-dependent, platelet-reactive antibodies. Medications associated
with drug-induced thrombocytopenia include UF heparin, sulfonamides, thiazide
diuretics, cimetidine, quinine, vancomycin, phenytoin, carbamazepine, beta-lactams,
digoxin, and valproic acid. Upon discontinuation of the agent, an increase in platelet
count typically occurs within 2-7 days. Topic: Assessment and Intervention in Select
Hematologic Disorders
Which of the following is most consistent with a hemogram finding in vitamin B12
deficiency that can occasionally be found with long-term metformin use?
a. Low MCV, elevated MCHC
b. Elevated MCV, normal MCHC
c. Low MCV, low MCHC
d. Normal MCV, elevated MCHC
B. Elevated MCV, normal MCHC.
Pernicious anemia is caused by a deficiency in vitamin B12 which is needed for RBC
production. The most common cause of pernicious anemia is an inability to absorb
vitamin B12 from food due to reduced production of intrinsic factors in the stomach but
has also been attributed to long-term metformin use in a dose-dependent manner. The
characteristics of vitamin B12 deficiency are an elevated MCV with a normal MCHC.
Treatment of pernicious anemia involves vitamin B12 replacement therapy. Topic:
Assessment and Intervention in Select Hematologic Disorders
You see a 64-year-old man with chronic kidney disease with a chief complaint of
fatigue. A hemogram reveals a hemoglobin level of 8.6 g/dL and hematocrit of
28%. The most appropriate intervention for this patient includes:
a. Vitamin B12 injection.
b. Treatment of the underlying cause.
c. Transfusion.
d. Oral iron.
B Treatment of the underlying cause.
Anemia of chronic disease (ACD) is found in persons with long-term medical conditions
, such as autoimmune disorders, cancer, chronic kidney disease, liver cirrhosis,
hypothyroidism, and long-term infections (e.g., endocarditis, osteomyelitis, HIV/AIDS,
hepatitis B or C). The primary intervention is to treat the underlying cause of anemia.
Once the underlying cause has been addressed, epoetin alpha is often used to boost
red blood cell production. ACD is not necessarily attributed to a nutrient deficiency, such
as vitamin B12 or iron. Topic: Assessment and Intervention in Select Hematologic
Disorders
Which of the following is usually associated with a low reticulocyte percentage?
a. Hemorrhage
b. Hemolytic anemia
c. Anemia of chronic disease
d. Folate therapy Feedback
C. Anemia of chronic disease.
A low reticulocyte percentage indicates fewer red blood cells are being produced in the
bone marrow. Anemia of chronic disease is associated with reduced production of
erythropoietin in the kidneys and, thus, reduced production of red blood cells and a low
reticulocyte percentage. Hemolytic anemia or a loss of blood would cause an increase
in red blood cell production and a higher reticulocyte percentage. Similarly, folate
therapy used to treat folic acid deficiency anemia is accompanied by reticulocytosis 7-
10 days after initiation of therapy. Topic: Assessment and Intervention in Select
Hematologic Disorders
Which of the following statements about epoetin alpha is false?
a. Induces the release of reticulocytes from bone marrow
b. Has the same biological activity as the endogenous hormone
c. Induces erythropoiesis
d. Available in oral and parenteral formulations
D. available in oral and parenteral formulations.
Epoetin alpha is an alpha glycoprotein that contains an identical amino acid sequence
and confers the same biological activity as endogenous human erythropoietin. Epoetin
alpha induces erythropoiesis by stimulating the proliferation and differentiation of
committed erythroid progenitor cells and induces the release of reticulocytes from bone
marrow. The agent is administered via subcutaneous injection or infusion; an oral
formulation is not available. Topic: Assessment and Intervention in Select Hematologic
Disorders
The most common cause of pernicious anemia is:
a. Occult blood loss.
b. Intestinal malabsorption.
c. Dietary deficiency of vitamin B12.
d. Reduced intrinsic factor production.
D. Reduced intrinsic factor production.
Pernicious anemia is caused by a deficiency in vitamin B12, which is needed for RBC
production. The most common cause of pernicious anemia is an inability to absorb
vitamin B12 from food due to the reduced production of intrinsic factors in the stomach.
