AGNP BOARD EXAM Hematology Assessment (24 Questions with Answers and Explanations)
AGNP BOARD EXAM Hematology Assessment (24 Questions with Answers and Ex
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Question:
If a newborn develops a cephalohematoma, the newborn is at an increased risk for:
infection.
jaundice. Correct
caput succedaneum.
erythema toxicum.
Explanation:
Cephalohematomas are characterized by bleeding between the bone and the periosteum. Because of breakdown of the red blood cells within a hematoma, the infants are at greater risk for jaundice. They do not increase the risk for infections. Caput succedaneum is an edematous area on the head from pressure against the cervix. Erythema toxicum is a benign rash of unknown cause that consists of blotchy red areas.
Question:
A twelve-month-old was recently diagnosed with Acquired Immunodeficiency Syndrome (AIDS). The mother asks the nurse practitioner: "How could my child have acquired AIDS?" The best response from the nurse practitioner should be that: "Children under two years of age usually acquire AIDS:
by sharing car seats with an HIV infected toddler."
because the child may have been sexually abused by someone who was HIV positive."
perinatally through an HIV infected mother." Correct
through casual contact with an HIV infected individual in a day care center."
Explanation:
Perinatally is the acquired mode for infants. Children usually over five years of age acquire AIDS through sexual abuse. HIV does not survive in the environment and there is no evidence to date to support the fact That AIDS is acquired through casual contact or by sharing car seats with HIV infected seats.
Question:
Which ethnicity is associated with glucose-6-phosphate-dehydrogenase (G-6-PD) deficiency?
American Indian
black Correct
Asian
Hispanic
Explanation:
Glucose-6-phosphate-dehydrogenase (G-6-PD) deficiency is a condition in which red blood cells break down when the body is exposed to certain drugs (aspirin, antimalaria drugs) or the stress of infection. G-6-PD is most prevalent in people of Mediterranean and African descent, and specifically common in Saudi Arabian, African, and black patients.
Question:
The blood lead level that requires further testing and monitoring in children is:
3 mcg/dL.
5 mcg/dL. Correct
7 mcg/dL.
9 mcg/dL.
Explanation:
In children, a blood lead level of 5 mcg/dL or 0.24 µmol/L or greater requires further testing and monitoring. The source of lead must be found and removed. A lead level greater than 45 mcg/dL or 2.17 µmol/L in a child's blood usually indicates the need for chelation.
Question:
Which of the following foods contains the LEAST amount of folic acid?
Dairy Correct
Green leafy vegetables
Liver
Fruits
Explanation:
Dairy foods such as cheese, milk and yogurt do not contain folic acid unless they have been specifically fortified to include this vitamin. Foods high in folic acid include green leafy vegetables, meat from animal sources, fruits, nuts, liver, and foods containing yeast.
Question:
Which assessment finding is consistent with pernicious anemia?
Facial palsy
Nuchal rigidity
Priapism
Peripheral neuropathy Correct
Explanation:
Pernicious anemia is associated with B12 deficiency. Vitamin B12 deficiency may lead to nerve damage attributable to pathology in the peripheral and optic nerves, posterior and lateral columns of the spinal cord (subacute combined degeneration), and in the brain. This can cause tingling and numbness in the hands and feet, muscle weakness, and loss of reflexes. Patients may feel unsteady and experience equilibrium problems and ataxia. Vitamin B12 deficiency can cause weakened bones and may lead to hip fractures. Vitamin B 12 deficiency does not cause facial palsy; however, vitamin B12 has been used in the treatment of Bell's Palsy. Nuchal rigidity and priapism are not associated with vitamin B12 deficiency.
Question:
The infant with the lowest risk of developing elevated levels of bilirubin is the one who:
is feeding poorly or whose feedings are delayed for several hours.
has developed a cephalhematoma.
is the second birth to an Rh negative mother.
breast feeds within the first hour of life. Correct
Explanation:
The infant who is fed early will be less likely to retain meconium and reabsorb bilirubin from the intestines back into the circulation. Additionally, lack of adequate intestinal flora hinders excretion of conjugated bilirubin so by feeding soon after birth, this speeds up the development of bacteria and creation of good intestinal flora. The other choices are all examples of situations that increase the risk for jaundice in the newborn.
Question:
Patients who develop pica have a deficiency in:
folic acid.
lead.
magnesium.
iron. Correct
Explanation:
Pica is characterized by an appetite for substances that are nonnutritive, such as ice, starch, or clay. This finding is associated with iron deficiency anemia. Note: Pica is considered an eating disorder in the DSM-5 criteria.
Question:
Which of the following symptoms is associated with iron deficiency anemia?
Atrophic glossitis Correct
Oral candida
Melanoglossia
Transient lingual papillitis
Explanation:
Atrophic glossitis occurs when a large number of papillae are lost, resulting in changes to the tongue’s color and texture. This type of glossitis typically turns the tongue dark red and is a symptom of iron deficiency anemia. Oral candida is a white paste on the tongue. The most common type of oral candida is Candida albicans fungus. Melanoglossia is a medical condition in which the tongue becomes blackened. This is usually caused by a bacterial infection or allergic reaction. Transient lingual papillitis is a common painful inflammatory condition affecting one or several fungiform papillae on the tongue.
Question:
Folic acid deficiency is an example of which type of anemia?
Normocytic
Macrocytic Correct
Microcytic
Hemolytic
Explanation:
Macrocytic anemia is characterized by larger than normal red blood cells. Vitamin B12 and folate deficiencies are examples of macrocytic anemias. Normocytic anemia is caused by acute blood loss, chronic disease, or failure to produce adequate red blood cells. Chronic renal failure (decreased production of erythropoietin) or liver failure causes normocytic anemia. Microcytic anemia usually occurs in iron deficiency anemia. Hemolytic anemia can be autoimmune, hereditary or mechanical. It can result (because of cell fragmentation) in a microcytic anemia, a normochromic anemia, or (because of premature release of immature red blood cells from the bone marrow), a macrocytic anemia.
Question:
Which situation would put the patient at the LEAST risk for developing lead toxicity?
Being a plumber
Residing in a home built before 1988 Correct
Having a history of gout
Living near a busy highway.
Explanation:
Risks for lead toxicity may include an occupation as a plumber, having a history of gout, living near a busy highway or hazardous waste dump, and residing in a home built before 1978.
Question:
Which patient is most likely to carry the alpha thalassemia anemia trait?
A 45-year-old black man
A 32-year-old Filipino man Correct
A 24-year-old Italian woman
A 19-year-old Greek woman
Explanation:
Alpha thalassemia minor is a disease that occurs among the Asian population. Beta thalassemia is commonly found in patients of Mediterranean descent (Italian, Greek).
Question:
Hemophilia type A is a deficiency of factor:
VIII. Correct
IX.
XI.
IV.
Explanation:
Hemophilia is an inherited disorder in which a person lacks adequate clotting factors. Type A is a lack of clotting factor VIII (90% of cases). Type B is a lack of clotting factor IX. Type C is a lack of clotting factor XI.
Question:
A child with sickle cell anemia presents with a history of sudden onset of rapid breathing with left upper quadrant (LUQ) tenderness upon palpation. The child is most likely experiencing a (an):
aplastic crisis.
sequestration crisis. Correct
vaso-occlusive crisis.
hemarthrosis crisis.
Explanation:
Sequestration occurs when RBC's are trapped or sequestered in the spleen causing it to enlarge; therefore, there would be tenderness in the LUQ and the child may have tachypnea as well. Aplastic crisis occurs when RBC production is decreased. Symptoms include pallor, decreased hemoglobin and decreased RBCs. Vaso-occlusion usually involves pain but no increase in spleen size. Hemarthrosis is usually seen in hemophilia and where there is joint involvement, but not spleen involvement.
Question:
The nurse practitioner differentiates physiologic jaundice from pathologic jaundice by assessment of the:
degree of jaundice of the skin.
timing of the onset of the jaundice. Correct
maternal history of drugs/medications.
level of bilirubin in the blood.
Explanation:
Physiologic jaundice is identified after 24 hours. Pathologic jaundice is identified before the infant is 24 hours of age. The fetus produces more red blood cells (RBCs) than the normal adult or child has, with a hematocrit of up to 60% being normal. At birth, structural and functional changes take place which enable the fetus to breathe room air, bringing the baby's paO2 up to the normal child-adult range. Thus, the excess RBCs are no longer needed for O2 carrying capacity, and they begin to break down. This is a normal, physiologic change that occurs at birth. The breakdown of these RBCs releases bilirubin into the blood stream. So, a rise in bilirubin within 24-48 hours of life is normal. If something causes an excessive number of RBCs to break down (such as ABO or Rh incompatibility, birth trauma or infection) or impairs the baby's ability to excrete bilirubin out of the GI tract (NPO status, delayed stooling, meconium ileus), the bilirubin level can rise to dangerous levels, requiring treatment to prevent buildup in the brain, (kernicterus) which can cause brain damage and death. The other choices are not specific to either type.
Question:
A symptom of severe hemorrhagic shock (Class IV) does NOT include:
tachycardia.
hypotension.
tachypnea.
hypertension. Correct
Explanation:
Severe hemorrhagic shock (Class IV) refers to a medical condition in which rapid fluid loss results in multiple organ failure due to inadequate circulating volume and subsequent inadequate perfusion. Symptoms of severe hemorrhagic shock include tachycardia, hypotension, decreased or no urinary output, loss of consciousness, cold and pale skin, and tachypnea.
Question:
An assessment finding in a patient diagnosed with von Willebrand disease is:
hypopigmentation.
café au lait spots.
ecchymosis. Correct
hyperpigmentation.
Explanation:
Von Willebrand disease is a group of congenital bleeding disorders caused by a deficiency of the protein von Willebrand factor (vWF). Defective vWF interaction between platelets and the vessel wall impairs primary hemostasis. Symptoms include: bruising (ecchymosis), menorrhagia, recurrent epistaxis, petechiae, and hemorrhage. Café au lait spots, hypopigmentation, and hyperpigmentation are not associated with von Willebrand.
Question:
The nurse practitioner should base a response to a parent's question about the prognosis of acute lymphoblastic leukemia (ALL) on which of the following statements?
Leukemia is a fatal disease even though chemotherapy provides increasingly longer periods of remission.
Research to find a cure for childhood cancers is very active.
A majority of children go into remission and remain symptom free when treatment is completed. Correct
It usually takes several months of chemotherapy to achieve a remission.
Explanation:
The majority of children diagnosed with the most common form of leukemia, acute lymphoblastic leukemia, go into remission and remain symptom free when treatment is complete and will have an 85% disease free survival rate. With the majority of children surviving 5 years or longer, it is inappropriate to refer to leukemia as a fatal disease. The research statement is true, but it does not address the parent's concern. About 95% of children achieve remission within the first month of chemotherapy.
Question:
The parents of a child with sickle cell anemia are asking for information about future pregnancies. The nurse practitioner should respond by telling them that with any future pregnancy they will have a:
1 in 4 chance of producing a child with sickle cell trait.
1 in 4 chance of producing a child with sickle cell anemia. Correct
1 in 2 chance of producing a child with neither sickle cell disease nor trait.
1 in 2 chance of producing a child with the sickle cell anemia.
Explanation:
Sickle cell anemia is an autosomal recessive condition, meaning since the parents do not have the disease then each must have the trait. Therefore, since both parents are carriers each pregnancy carries a 25% chance (1 in 4) that the child will have the disease.
Question:
Which one of the following does NOT produce anemia of chronic disease?
Systemic lupus
Rheumatoid arthritis
Osteomyelitis
Osteoporosis Correct
Explanation:
Mild to moderate normochromic, normocytic anemia is associated with chronic disease. Anemia has been identified as a risk factor for osteoporosis, however, osteoporosis does not cause anemia. Anemia of chronic disease is associated with diseases such as systemic lupus, rheumatoid arthritis, and osteomyelitis.
Question:
An example of a vaso-occlusive crisis of the pulmonary vasculature seen in patients with sickle cell anemia is:
acute chest syndrome. Correct
pulmonary embolism.
pneumonia.
pulmonary edema.
Explanation:
Acute chest syndrome is a vaso-occlusive crisis of the pulmonary vasculature commonly seen in patients with sickle cell anemia. It is often precipitated by a respiratory infection and symptoms include: fever, cough, excruciating pain, sputum production, shortness of breath, or low oxygen levels.
Question:
The most common malignancy diagnosed in children is:
chronic myelogenous leukemia (CML).
chronic lymphocytic leukemia (CLL).
acute lymphocytic leukemia (ALL). Correct
acute myeloid leukemia (AML).
Explanation:
Acute lymphocytic leukemia (ALL) is the most common type of malignancy in children. Thirteen percent of all leukemias and 75% of all pediatric cases affect children ages 2-10 years, with most cases diagnosed by 4 years of age.
Question:
When educating a patient about iron replacement, the provider advises to take the supplement:
with vitamin C. Correct
with a glass of milk.
on a full stomach.
on an empty stomach.
Explanation:
Taking iron supplements with vitamin C enhances absorption.
Question:
A possible assessment finding in patients taking oral iron supplements for anemia is:
steatorrhea.
hematochezia.
constipation. Correct
beeturia.
Explanation:
Constipation is a common side effect of iron supplements. Iron causes dysbiosis (microbes imbalance), which slows peristalsis. This results in longer bowel retention, which causes more water uptake and leads to dry feces, resulting in constipation. Steatorrhea is a greasy, foul-smelling stool associated with cystic fibrosis. Hematochezia is a passage of fresh blood through the anus and is commonly associated with lower gastrointestinal bleeding. Beeturia is red-colored feces after consuming beets. It occurs due to insufficient metabolism of a red pigment. [Show Less]