PRIMARY CARE THE ART AND SCIENCE OF
ADVANCED PRACTICE NURSING
CERTIFICATION EVALUATION EXAMS 2026
◉ What indicates the need for referral to a specialist in normocytic
anemia? Answer: High WBC and platelets.
◉ What are some symptoms of normocytic anemia related to skin
findings? Answer: Pallor, sallow-colored skin, and cold hands and
feet.
◉ What might be seen in the extremities of a patient with
normocytic anemia? Answer: Spoon-shaped nails (koilonychia), pale
palmar creases, and brittle nails.
◉ What is the significance of the history regarding inflammatory
conditions in normocytic anemia? Answer: It helps identify potential
underlying causes such as infectious, neoplastic, or autoimmune
diseases.
◉ What is the Mean Corpuscular Volume (MCV) threshold for
macrocytic anemia? Answer: MCV is equal to or greater than 100 fL.
,◉ What are the typical characteristics of macrocytic anemia?
Answer: Typically normochromic, could be normoblastic or
megaloblastic.
◉ Which age group is most affected by macrocytic anemia? Answer:
All age groups are affected, but it increases past 60 years old.
◉ What is the most common cause of macrocytic anemia? Answer:
Pernicious anemia resulting in Vitamin B12 deficiency.
◉ What is pernicious anemia? Answer: An autoimmune disorder
that results in B12 malabsorption due to lack of gastric intrinsic
factor, usually from atrophic gastritis.
◉ What are some conditions associated with pernicious anemia?
Answer: Chronic alcoholism, Helicobacter pylori infection, long-term
use of antacids, H2 receptor antagonists, proton pump inhibitors,
and biguanides (metformin).
◉ How does metformin affect Vitamin B12 absorption? Answer: It
decreases Vitamin B12 absorption by one-third in patients taking it.
◉ Is dietary deficiency of Vitamin B12 common? Answer: Dietary
deficiency is rare except in vegetarians.
,◉ What is the role of folic acid in relation to Vitamin B12? Answer:
Folic acid works with B12 to further nuclear maturation in
erythrocytes.
◉ What is the most common cause of folic acid deficiency? Answer:
Inadequate dietary intake.
◉ Which patient populations are at risk for folic acid deficiency?
Answer: Alcoholic and anorectic patients.
◉ Name some drugs that may interfere with folic acid absorption.
Answer: Phenytoin (Dilantin), methotrexate, sulfa drugs (Bactrim),
and oral contraceptives.
◉ When are folic acid requirements elevated? Answer: During
pregnancy and certain other conditions.
◉ What is recommended for women before and during pregnancy to
reduce neural tube defects? Answer: Folate supplements should be
given.
◉ What are the typical serum levels in folic acid deficiency? Answer:
Low serum folate levels with a normal level of Vitamin B12.
, ◉ What is the relationship between folic acid and neural tube
defects? Answer: Folate supplements reduce the incidence of neural
tube defects when taken before and during pregnancy.
◉ What are common clinical presentations of Vitamin B12 and
Folate deficiency? Answer: Patients may experience stomatitis,
glossitis, nausea, anorexia, diarrhea, gastritis, fatigue, malaise, mild
jaundice, weakness, lightheadedness, pallor, and peripheral
neuropathies (not in folate deficiency).
◉ What medication history should be considered in patients with
suspected Vitamin B12 or Folate deficiency? Answer: Long-term use
of antacids, H2 receptor antagonists, proton pump inhibitors, and
Metformin.
◉ What past medical history factors may contribute to Vitamin B12
or Folate deficiency? Answer: Gastric or ileal surgery, Crohn's
disease, Whipple disease, celiac disease, chronic infections,
hypofertility, repeated miscarriages, venous thromboembolic
disease, and angina.
◉ What social history factors increase the risk of Vitamin B12 or
Folate deficiency? Answer: Dietary habits (especially strict
vegetarianism) and alcohol intake.
ADVANCED PRACTICE NURSING
CERTIFICATION EVALUATION EXAMS 2026
◉ What indicates the need for referral to a specialist in normocytic
anemia? Answer: High WBC and platelets.
◉ What are some symptoms of normocytic anemia related to skin
findings? Answer: Pallor, sallow-colored skin, and cold hands and
feet.
◉ What might be seen in the extremities of a patient with
normocytic anemia? Answer: Spoon-shaped nails (koilonychia), pale
palmar creases, and brittle nails.
◉ What is the significance of the history regarding inflammatory
conditions in normocytic anemia? Answer: It helps identify potential
underlying causes such as infectious, neoplastic, or autoimmune
diseases.
◉ What is the Mean Corpuscular Volume (MCV) threshold for
macrocytic anemia? Answer: MCV is equal to or greater than 100 fL.
,◉ What are the typical characteristics of macrocytic anemia?
Answer: Typically normochromic, could be normoblastic or
megaloblastic.
◉ Which age group is most affected by macrocytic anemia? Answer:
All age groups are affected, but it increases past 60 years old.
◉ What is the most common cause of macrocytic anemia? Answer:
Pernicious anemia resulting in Vitamin B12 deficiency.
◉ What is pernicious anemia? Answer: An autoimmune disorder
that results in B12 malabsorption due to lack of gastric intrinsic
factor, usually from atrophic gastritis.
◉ What are some conditions associated with pernicious anemia?
Answer: Chronic alcoholism, Helicobacter pylori infection, long-term
use of antacids, H2 receptor antagonists, proton pump inhibitors,
and biguanides (metformin).
◉ How does metformin affect Vitamin B12 absorption? Answer: It
decreases Vitamin B12 absorption by one-third in patients taking it.
◉ Is dietary deficiency of Vitamin B12 common? Answer: Dietary
deficiency is rare except in vegetarians.
,◉ What is the role of folic acid in relation to Vitamin B12? Answer:
Folic acid works with B12 to further nuclear maturation in
erythrocytes.
◉ What is the most common cause of folic acid deficiency? Answer:
Inadequate dietary intake.
◉ Which patient populations are at risk for folic acid deficiency?
Answer: Alcoholic and anorectic patients.
◉ Name some drugs that may interfere with folic acid absorption.
Answer: Phenytoin (Dilantin), methotrexate, sulfa drugs (Bactrim),
and oral contraceptives.
◉ When are folic acid requirements elevated? Answer: During
pregnancy and certain other conditions.
◉ What is recommended for women before and during pregnancy to
reduce neural tube defects? Answer: Folate supplements should be
given.
◉ What are the typical serum levels in folic acid deficiency? Answer:
Low serum folate levels with a normal level of Vitamin B12.
, ◉ What is the relationship between folic acid and neural tube
defects? Answer: Folate supplements reduce the incidence of neural
tube defects when taken before and during pregnancy.
◉ What are common clinical presentations of Vitamin B12 and
Folate deficiency? Answer: Patients may experience stomatitis,
glossitis, nausea, anorexia, diarrhea, gastritis, fatigue, malaise, mild
jaundice, weakness, lightheadedness, pallor, and peripheral
neuropathies (not in folate deficiency).
◉ What medication history should be considered in patients with
suspected Vitamin B12 or Folate deficiency? Answer: Long-term use
of antacids, H2 receptor antagonists, proton pump inhibitors, and
Metformin.
◉ What past medical history factors may contribute to Vitamin B12
or Folate deficiency? Answer: Gastric or ileal surgery, Crohn's
disease, Whipple disease, celiac disease, chronic infections,
hypofertility, repeated miscarriages, venous thromboembolic
disease, and angina.
◉ What social history factors increase the risk of Vitamin B12 or
Folate deficiency? Answer: Dietary habits (especially strict
vegetarianism) and alcohol intake.
