FNP Anemia Evaluation Practice Questions

The earliest indicator of bone marrow response to iron therapy is an increase in reticulocytes, which typically peaks at 5 to 10 days. Therefore, checking a reticulocyte count at one week is the best way to confirm medication adherence and absorption. Hemoglobin takes about four weeks to show a significant rise of 1 g/dL, making one week too early for a hemoglobin check. Waiting four weeks to check reticulocytes misses the peak response window.

Before treating anemia of chronic disease with erythropoiesis-stimulating agents, you must evaluate iron stores. Option A is correct because assessing ferritin and TSAT identifies absolute or functional iron deficiency, which must be corrected first. Option B is premature without knowing iron status. Option C inappropriately assumes iron deficiency without confirming labs. Option D is excessive for a stable hemoglobin of 9.2 g/dL without acute bleeding or severe cardiopulmonary symptoms.

First-trimester anemia is defined as a hemoglobin of 10.2 g/dL (less than 11.0 g/dL). The low mean corpuscular volume of 72 fL indicates a microcytic anemia, which is most commonly caused by iron deficiency or thalassemia. Ordering a serum ferritin and hemoglobin electrophoresis is the correct next step to differentiate these conditions. Option A is incorrect because physiologic hemodilution typically causes a normocytic anemia and rarely drops hemoglobin below 11.0 g/dL in the first trimester. Option B is incorrect because folic acid deficiency causes macrocytic, not microcytic, anemia. Option D is incorrect because oral iron is first-line for iron deficiency, and the underlying cause must be diagnosed before initiating intravenous therapy.

Liquid iron supplements frequently cause temporary, harmless dental staining. Option D correctly addresses this by advising the parent to bypass the front teeth, which prevents further staining while maintaining the necessary therapy. Option A is inappropriate because chewable tablets pose a choking hazard for a 15-month-old. Option B incorrectly reduces a needed therapeutic dose for a cosmetic issue. Option C is an extreme overreaction, as intravenous iron is reserved for severe, refractory cases or malabsorption issues.

This patient has iron deficiency anemia, which is common in the second trimester due to expanded maternal blood volume. Ferrous sulfate absorption is significantly enhanced by an acidic environment and concurrent intake of vitamin C, making orange juice the optimal choice. Option A is incorrect because the calcium in milk binds to iron, inhibiting its absorption. Option B is incorrect because the tannins and polyphenols in black tea also severely decrease iron uptake. Option D is a neutral choice but misses the opportunity to actively enhance iron absorption through dietary synergy.

In a SOAP note, diagnostic tests that have already been completed and resulted, such as the CBC from yesterday, are documented in the Objective section because they are factual, measurable data. Conversely, tests that the clinician is ordering for the future, like the ferritin level today, belong in the Plan section. Option D is correct. Option A is incorrect because it places a future order in the Objective section. Option B is incorrect as it places resulted labs in the Assessment, which is reserved for diagnoses. Option C is incorrect because resulted labs are not subjective patient reports, and future orders do not belong in the Assessment.

The patient's burning foot pain combined with macrocytosis and elevated GGT points toward alcoholic neuropathy. Alcohol toxicity and associated nutritional deficits (like folate deficiency) cause a painful, length-dependent small fiber neuropathy, while directly elevating GGT and mean corpuscular volume. Diabetic neuropathy causes similar burning pain but is ruled out by normal glucose levels. Idiopathic small fiber neuropathy is a diagnosis of exclusion and does not explain the macrocytosis or liver enzyme elevation. Uremic neuropathy is associated with severe chronic kidney disease, not isolated GGT elevations.

The patient demonstrates a partial response to the iron trial, evidenced by the normalization of the RDW (decreasing to 13%). However, the persistent microcytosis (MCV 64 fL) alongside a high RBC count (5.2 million/mcL) yields a Mentzer index of 12.3. This pattern indicates that while a concurrent iron deficiency was treated and resolved, an underlying thalassemia trait is the primary cause of the persistent microcytosis. Concluding the patient needs a higher iron dosage is incorrect and potentially harmful, as iron stores are likely replete now. Suspecting poor iron compliance is illogical because the RDW improved, proving the medication was taken and absorbed. Assuming the patient has concurrent lead toxicity is incorrect, as lead poisoning would not typically present with this specific post-treatment index pattern and high RBC count.

The presence of gnawing epigastric pain alongside alarm features—specifically microcytic anemia, positive fecal occult blood, and a concerning family history—strongly points to a bleeding or malignant lesion, making complicated peptic ulceration the most critical diagnosis to investigate. Gastroesophageal reflux disease typically presents with heartburn and regurgitation, not isolated gnawing pain with lower GI bleeding indicators. Nonulcer functional dyspepsia is a benign condition that does not cause gastrointestinal bleeding or anemia. Eosinophilic esophagitis typically presents with solid food dysphagia and food impaction, not occult bleeding and gnawing epigastric pain.

Older adults who are maintained on long-term metformin therapy are at a significantly increased risk for vitamin B12 malabsorption in the terminal ileum. This can lead to a macrocytic anemia even before classic neurological symptoms, such as numbness or tingling, begin to appear. Establishing this primary diagnosis early is crucial for patients with diabetes to prevent irreversible peripheral neuropathy. Option B is incorrect because, while poor nutrition certainly causes folate deficiency, the specific medication history strongly points to B12 as the culprit. Option C is incorrect because iron deficiency typically presents as a microcytic, hypochromic anemia with a low MCV, rather than an elevated one. Option D is incorrect because the anemia associated with chronic kidney disease is generally normocytic and normochromic.