NURS 5315 HEMATOLOGY EXAM STUDY
GUIDE 2026 | COMPREHENSIVE PRACTICE
QUESTIONS & ANSWERS | VERIFIED
RATIONALES & GRADUATE NURSING
REVIEW
• This 200-question practice guide covers the full breadth of graduate-level
hematology nursing content tested in NURS 5315, featuring verified correct
answers with bold highlighting and detailed clinical EXPERT RATIONALE to
reinforce pathophysiology and treatment reasoning.
• Work through each question independently before checking the correct answer
and EXPERT RATIONALE — use missed questions to identify weak areas and return
to those sections for targeted review before your exam.
Question 1: A patient presents with fatigue, pallor, and a hemoglobin of 7.2
g/dL. The MCV is 70 fL and serum ferritin is 6 ng/mL. Which of the following is
the most appropriate first-line treatment?
A. Vitamin B12 intramuscular injection
B. Folic acid supplementation
C. Blood transfusion
D. Erythropoiesis-stimulating agent
E. Oral iron supplementation
E. Oral iron supplementation
EXPERT RATIONALE: The clinical picture — low hemoglobin, low MCV (microcytic),
and critically low ferritin — is diagnostic of iron deficiency anemia. First-line
treatment in non-emergent cases is oral iron supplementation (ferrous sulfate 325
mg TID). Blood transfusion is reserved for hemodynamic instability or Hgb < 7 with
symptoms. B12 and folate treat macrocytic anemias, which this is not.
,Question 2: Which laboratory finding is most consistent with hemolytic
anemia?
A. Decreased reticulocyte count
B. Elevated serum ferritin
C. Decreased indirect bilirubin
D. Low MCV
E. Elevated lactate dehydrogenase (LDH)
E. Elevated lactate dehydrogenase (LDH)
EXPERT RATIONALE: Hemolytic anemia is characterized by increased RBC
destruction, which releases intracellular contents including LDH. Other markers
include elevated indirect bilirubin, decreased haptoglobin, and elevated reticulocyte
count (compensatory erythropoiesis). MCV is typically normal unless there is
concurrent nutritional deficiency.
Question 3: A 28-year-old woman with sickle cell disease presents with severe
bone pain, fever, and chest infiltrates. What is the priority nursing
intervention?
A. Administer hydroxyurea
B. Initiate exchange transfusion
C. Provide supplemental oxygen and IV hydration
D. Administer deferoxamine
E. Obtain bone marrow biopsy
C. Provide supplemental oxygen and IV hydration
EXPERT RATIONALE: This presentation is consistent with acute chest syndrome
(ACS), a life-threatening complication of sickle cell disease. Priority management
includes supplemental oxygen to correct hypoxia, IV hydration to reduce sickling,
pain management, and close monitoring. Exchange transfusion may be needed if
,the condition deteriorates, but initial nursing intervention is oxygenation and
hydration.
Question 4: Which type of anemia is associated with hypersegmented
neutrophils on peripheral blood smear?
A. Iron deficiency anemia
B. Anemia of chronic disease
C. Aplastic anemia
D. Megaloblastic anemia
E. Hemolytic anemia
D. Megaloblastic anemia
EXPERT RATIONALE: Hypersegmented neutrophils (>5 lobes) are a hallmark finding
in megaloblastic anemia, caused by vitamin B12 or folate deficiency. Impaired DNA
synthesis leads to abnormal nuclear maturation in all rapidly dividing cells,
including neutrophils. Iron deficiency produces microcytic, hypochromic cells.
Aplastic anemia shows pancytopenia without hypersegmentation.
Question 5: A patient is diagnosed with pernicious anemia. Which of the
following best explains the pathophysiology?
A. Decreased dietary intake of iron
B. Autoimmune destruction of parietal cells leading to intrinsic factor deficiency
C. Hemolysis due to complement activation
D. Chronic blood loss from the gastrointestinal tract
E. Folate malabsorption in the jejunum
B. Autoimmune destruction of parietal cells leading to intrinsic factor
deficiency
, EXPERT RATIONALE: Pernicious anemia is an autoimmune condition where
antibodies destroy gastric parietal cells, eliminating intrinsic factor (IF) production.
Without IF, vitamin B12 cannot be absorbed in the terminal ileum. This leads to B12
deficiency, impaired DNA synthesis, and megaloblastic anemia. Treatment is
lifelong intramuscular B12 injections.
Question 6: Which of the following is the most common inherited bleeding
disorder?
A. Hemophilia A
B. Hemophilia B
C. Von Willebrand disease
D. Bernard-Soulier syndrome
E. Glanzmann thrombasthenia
C. Von Willebrand disease
EXPERT RATIONALE: Von Willebrand disease (vWD) is the most common inherited
bleeding disorder, affecting approximately 1% of the population. It results from
deficiency or dysfunction of von Willebrand factor (vWF), which is necessary for
platelet adhesion and acts as a carrier protein for factor VIII. It presents with
mucocutaneous bleeding such as epistaxis, gum bleeding, and menorrhagia.
Question 7: A patient with hemophilia A requires surgery. Which factor
replacement is indicated?
A. Factor IX concentrate
B. Fresh frozen plasma only
C. Factor VIII concentrate
D. Platelet transfusion
E. Cryoprecipitate alone
GUIDE 2026 | COMPREHENSIVE PRACTICE
QUESTIONS & ANSWERS | VERIFIED
RATIONALES & GRADUATE NURSING
REVIEW
• This 200-question practice guide covers the full breadth of graduate-level
hematology nursing content tested in NURS 5315, featuring verified correct
answers with bold highlighting and detailed clinical EXPERT RATIONALE to
reinforce pathophysiology and treatment reasoning.
• Work through each question independently before checking the correct answer
and EXPERT RATIONALE — use missed questions to identify weak areas and return
to those sections for targeted review before your exam.
Question 1: A patient presents with fatigue, pallor, and a hemoglobin of 7.2
g/dL. The MCV is 70 fL and serum ferritin is 6 ng/mL. Which of the following is
the most appropriate first-line treatment?
A. Vitamin B12 intramuscular injection
B. Folic acid supplementation
C. Blood transfusion
D. Erythropoiesis-stimulating agent
E. Oral iron supplementation
E. Oral iron supplementation
EXPERT RATIONALE: The clinical picture — low hemoglobin, low MCV (microcytic),
and critically low ferritin — is diagnostic of iron deficiency anemia. First-line
treatment in non-emergent cases is oral iron supplementation (ferrous sulfate 325
mg TID). Blood transfusion is reserved for hemodynamic instability or Hgb < 7 with
symptoms. B12 and folate treat macrocytic anemias, which this is not.
,Question 2: Which laboratory finding is most consistent with hemolytic
anemia?
A. Decreased reticulocyte count
B. Elevated serum ferritin
C. Decreased indirect bilirubin
D. Low MCV
E. Elevated lactate dehydrogenase (LDH)
E. Elevated lactate dehydrogenase (LDH)
EXPERT RATIONALE: Hemolytic anemia is characterized by increased RBC
destruction, which releases intracellular contents including LDH. Other markers
include elevated indirect bilirubin, decreased haptoglobin, and elevated reticulocyte
count (compensatory erythropoiesis). MCV is typically normal unless there is
concurrent nutritional deficiency.
Question 3: A 28-year-old woman with sickle cell disease presents with severe
bone pain, fever, and chest infiltrates. What is the priority nursing
intervention?
A. Administer hydroxyurea
B. Initiate exchange transfusion
C. Provide supplemental oxygen and IV hydration
D. Administer deferoxamine
E. Obtain bone marrow biopsy
C. Provide supplemental oxygen and IV hydration
EXPERT RATIONALE: This presentation is consistent with acute chest syndrome
(ACS), a life-threatening complication of sickle cell disease. Priority management
includes supplemental oxygen to correct hypoxia, IV hydration to reduce sickling,
pain management, and close monitoring. Exchange transfusion may be needed if
,the condition deteriorates, but initial nursing intervention is oxygenation and
hydration.
Question 4: Which type of anemia is associated with hypersegmented
neutrophils on peripheral blood smear?
A. Iron deficiency anemia
B. Anemia of chronic disease
C. Aplastic anemia
D. Megaloblastic anemia
E. Hemolytic anemia
D. Megaloblastic anemia
EXPERT RATIONALE: Hypersegmented neutrophils (>5 lobes) are a hallmark finding
in megaloblastic anemia, caused by vitamin B12 or folate deficiency. Impaired DNA
synthesis leads to abnormal nuclear maturation in all rapidly dividing cells,
including neutrophils. Iron deficiency produces microcytic, hypochromic cells.
Aplastic anemia shows pancytopenia without hypersegmentation.
Question 5: A patient is diagnosed with pernicious anemia. Which of the
following best explains the pathophysiology?
A. Decreased dietary intake of iron
B. Autoimmune destruction of parietal cells leading to intrinsic factor deficiency
C. Hemolysis due to complement activation
D. Chronic blood loss from the gastrointestinal tract
E. Folate malabsorption in the jejunum
B. Autoimmune destruction of parietal cells leading to intrinsic factor
deficiency
, EXPERT RATIONALE: Pernicious anemia is an autoimmune condition where
antibodies destroy gastric parietal cells, eliminating intrinsic factor (IF) production.
Without IF, vitamin B12 cannot be absorbed in the terminal ileum. This leads to B12
deficiency, impaired DNA synthesis, and megaloblastic anemia. Treatment is
lifelong intramuscular B12 injections.
Question 6: Which of the following is the most common inherited bleeding
disorder?
A. Hemophilia A
B. Hemophilia B
C. Von Willebrand disease
D. Bernard-Soulier syndrome
E. Glanzmann thrombasthenia
C. Von Willebrand disease
EXPERT RATIONALE: Von Willebrand disease (vWD) is the most common inherited
bleeding disorder, affecting approximately 1% of the population. It results from
deficiency or dysfunction of von Willebrand factor (vWF), which is necessary for
platelet adhesion and acts as a carrier protein for factor VIII. It presents with
mucocutaneous bleeding such as epistaxis, gum bleeding, and menorrhagia.
Question 7: A patient with hemophilia A requires surgery. Which factor
replacement is indicated?
A. Factor IX concentrate
B. Fresh frozen plasma only
C. Factor VIII concentrate
D. Platelet transfusion
E. Cryoprecipitate alone
