Advanced NURS 5315 Hematology Multiple
Choice Questions (MCQs) with Answers and
Explanations for Graduate Nursing and
Master's Degree Exams
1. A 62-year-old patient presents with fatigue, glossitis, and paresthesias. Laboratory studies
reveal macrocytic anemia and elevated methylmalonic acid levels. Which mechanism
best explains these findings?
A. Iron sequestration by macrophages
B. Defective globin chain synthesis
C. Impaired DNA synthesis secondary to vitamin B12 deficiency
D. Excessive destruction of mature erythrocytes
Explanation: Vitamin B12 deficiency causes ineffective DNA synthesis, leading to
megaloblastic anemia and neurologic manifestations such as paresthesias. Elevated
methylmalonic acid further supports the diagnosis.
2. A patient with chronic kidney disease develops normocytic normochromic anemia.
Which pathophysiological process is primarily responsible?
A. Increased iron losses
B. Reduced folate absorption
C. Excessive hemolysis
D. Decreased erythropoietin production by the kidneys
Explanation: Chronic kidney disease impairs erythropoietin synthesis, resulting in reduced red
blood cell production and normocytic anemia.
3. Which laboratory profile is most consistent with iron deficiency anemia?
A. Elevated ferritin and decreased total iron-binding capacity
B. Normal ferritin and increased reticulocyte count
C. Low ferritin, low serum iron, and elevated total iron-binding capacity
, D. Increased serum iron and low transferrin
Explanation: Iron deficiency anemia is characterized by depleted iron stores, resulting in low
ferritin and serum iron with compensatory elevation of total iron-binding capacity.
4. A patient with hereditary spherocytosis is at increased risk for hemolysis because of:
A. Defective hemoglobin polymerization
B. Autoimmune destruction of platelets
C. Bone marrow suppression
D. Abnormal erythrocyte membrane proteins causing splenic sequestration
Explanation: Defects in membrane proteins produce spherical erythrocytes that are less
deformable and susceptible to splenic destruction.
5. A patient with acute blood loss initially demonstrates normal hemoglobin levels. Which
explanation best accounts for this finding?
A. Increased iron absorption
B. Immediate reticulocytosis
C. Simultaneous loss of plasma and red blood cells before hemodilution occurs
D. Increased erythropoietin production
Explanation: Acute hemorrhage causes proportional loss of plasma and red blood cells, so
hemoglobin concentration may initially remain unchanged until fluid shifts occur.
6. Which finding most strongly supports intravascular hemolysis?
A. Elevated ferritin levels
B. Increased platelet count
C. Decreased bilirubin concentration
D. Reduced haptoglobin with elevated lactate dehydrogenase
Explanation: Haptoglobin binds free hemoglobin released during intravascular hemolysis,
leading to decreased serum levels and elevated LDH.
7. A patient with sickle cell disease develops severe chest pain, hypoxemia, and pulmonary
infiltrates. Which complication should be suspected?
Choice Questions (MCQs) with Answers and
Explanations for Graduate Nursing and
Master's Degree Exams
1. A 62-year-old patient presents with fatigue, glossitis, and paresthesias. Laboratory studies
reveal macrocytic anemia and elevated methylmalonic acid levels. Which mechanism
best explains these findings?
A. Iron sequestration by macrophages
B. Defective globin chain synthesis
C. Impaired DNA synthesis secondary to vitamin B12 deficiency
D. Excessive destruction of mature erythrocytes
Explanation: Vitamin B12 deficiency causes ineffective DNA synthesis, leading to
megaloblastic anemia and neurologic manifestations such as paresthesias. Elevated
methylmalonic acid further supports the diagnosis.
2. A patient with chronic kidney disease develops normocytic normochromic anemia.
Which pathophysiological process is primarily responsible?
A. Increased iron losses
B. Reduced folate absorption
C. Excessive hemolysis
D. Decreased erythropoietin production by the kidneys
Explanation: Chronic kidney disease impairs erythropoietin synthesis, resulting in reduced red
blood cell production and normocytic anemia.
3. Which laboratory profile is most consistent with iron deficiency anemia?
A. Elevated ferritin and decreased total iron-binding capacity
B. Normal ferritin and increased reticulocyte count
C. Low ferritin, low serum iron, and elevated total iron-binding capacity
, D. Increased serum iron and low transferrin
Explanation: Iron deficiency anemia is characterized by depleted iron stores, resulting in low
ferritin and serum iron with compensatory elevation of total iron-binding capacity.
4. A patient with hereditary spherocytosis is at increased risk for hemolysis because of:
A. Defective hemoglobin polymerization
B. Autoimmune destruction of platelets
C. Bone marrow suppression
D. Abnormal erythrocyte membrane proteins causing splenic sequestration
Explanation: Defects in membrane proteins produce spherical erythrocytes that are less
deformable and susceptible to splenic destruction.
5. A patient with acute blood loss initially demonstrates normal hemoglobin levels. Which
explanation best accounts for this finding?
A. Increased iron absorption
B. Immediate reticulocytosis
C. Simultaneous loss of plasma and red blood cells before hemodilution occurs
D. Increased erythropoietin production
Explanation: Acute hemorrhage causes proportional loss of plasma and red blood cells, so
hemoglobin concentration may initially remain unchanged until fluid shifts occur.
6. Which finding most strongly supports intravascular hemolysis?
A. Elevated ferritin levels
B. Increased platelet count
C. Decreased bilirubin concentration
D. Reduced haptoglobin with elevated lactate dehydrogenase
Explanation: Haptoglobin binds free hemoglobin released during intravascular hemolysis,
leading to decreased serum levels and elevated LDH.
7. A patient with sickle cell disease develops severe chest pain, hypoxemia, and pulmonary
infiltrates. Which complication should be suspected?
