FNP Mastery Hematology | 100% Correct
Answers | Verified | Latest 2024 Version
When treating a patient for iron deficiency anemia, she complains that the iron supplements have been
causing constipation. What solutions might you suggest to help the patient increase her iron absorption
as well as her tolerance for the supplement?
Select all that apply.
Consume adequate dietary fiber
Consume more nuts and berries
Take iron tablets with vitamin C
Avoid taking antacids - ✔✔Increasing dietary intake of iron-rich foods alone is not generally
recommeded to treat iron deficiency anemia. Advice about intake should center around either eating
foods that enhance absorption and/or avoiding foods at the same time as the iron dose-especially foods
or medicines that decrease absorption (antacids and calcium-dairy). In addition, taking iron along with
vitamin C may increase absorption.
Eating adequate fiber and staying hydrated serves to decrease constipation that may result from iron
supplements.
Incorrect option: Nuts are high in magnesium, not iron. Berries are not good sources of either. Foods
high in iron include liver, red meat, and legumes.
Common side effect of iron supplements? - ✔✔Constipation
How can you increase iron supplementation absorption without getting constipation - ✔✔Consume
adequate dietary fiber
,Taking with Vitamin C increases absorption of iron
Antacids decrease iron absorption
Which supplemental nutrient is important for your vegan patient to take?
Folic acid
Vitamin B12
Iron
Amino acids - ✔✔Since vegans do not eat animal-based foods that have natural B12, they are often low
in vitamin B12 and may need to take supplements.
Incorrect options: Iron, amino acids, and folic acid can be found in a plant-based diet.
When the NP is educating a patient on the best way to take oral iron supplementation for maximum
absorption, the NP should instruct the patient to take the medication as prescribed:
immediately after a large meal
on an empty stomach
with an over-the-counter antacid
with a glass of whole milk - ✔✔Milk, antacids, calcium supplements, and caffeine may lower the amount
of iron that is absorbed if taken at the same time.
,• Iron supplements work best if taken on an empty stomach but some patients may have upset stomach
when taking iron so they may be advised to take the iron with a small amount of food.
• A large meal or a large amount of food may lower the amount of iron that is absorbed.
The NP is seeing a 3-day-old infant for the first clinic visit after birth. The infant is alert and vigorous with
a normal physical exam with the notable exception of extensive petechiae to the face and trunk; there is
no active bleeding. The infant's CBC is normal except for low platelet count of 6,000. There is no
maternal history of ITP or lupus and maternal platelet count is within normal range. The infant was born
at term with an uneventful delivery and hospital stay and was discharged home yesterday. What is the
next best course of action for the NP?
Contact a hematologist for urgent inpatient referral and follow their recommendations
Prepare a referral for an outpatient hematology clinic
Reassure the parents that the petechiae may be a rash and recheck at next visit
Repeat the CBC in 24 hours - ✔✔Contact a hematologist for urgent inpatient referral and follow their
recommendations
These findings are concerning for neonatal alloimmune thrombocytopenia (NAIT) due to low platelets in
an otherwise healthy infant and no maternal history of thrombocytopenia; this can result in severe
bleeding and requires prompt treatment.
• There are variations in neonatal thrombocytopenia causes and these should be managed by a
hematologist.
A patient has iron deficiency anemia. The serum iron level is expected to be low. Which other laboratory
results are expected to also be low?
, Select all that apply.
Hemoglobin (Hgb)
Red cell distribution width (RDW)
Mean corpuscular volume (MCV)
Total iron binding capacity (TIBC) - ✔✔Iron deficiency anemia is a microcytic, hypochromic anemia. MCV
is a reflection of the size of the RBC so it is expected to be low. Anemia by definition is low Hgb so that is
also expected to be low.
TIBC is a test that measures the blood's capacity to bind with iron; it will be high due to low levels of
circulating iron.
RDW measures the variability in red blood cell size; it will be high because more, smaller RBCs will be in
circulation.
An African American infant patient recently transferred to your practice with sudden onset severe pain in
his back and extremities, leg ulcers, and dyspnea? Of the following differential, what would be the most
likely diagnosis?
Osgood-Schlatter disease
Metastatic cancer
Sickle cell anemia
Rheumatoid arthritis - ✔✔In a sickle-cell crisis, an infant with sickle cell anemia may have sudden severe
pain. Because red blood cells are sickle-shaped and get lodged in the smaller capillaries, they cannot
Answers | Verified | Latest 2024 Version
When treating a patient for iron deficiency anemia, she complains that the iron supplements have been
causing constipation. What solutions might you suggest to help the patient increase her iron absorption
as well as her tolerance for the supplement?
Select all that apply.
Consume adequate dietary fiber
Consume more nuts and berries
Take iron tablets with vitamin C
Avoid taking antacids - ✔✔Increasing dietary intake of iron-rich foods alone is not generally
recommeded to treat iron deficiency anemia. Advice about intake should center around either eating
foods that enhance absorption and/or avoiding foods at the same time as the iron dose-especially foods
or medicines that decrease absorption (antacids and calcium-dairy). In addition, taking iron along with
vitamin C may increase absorption.
Eating adequate fiber and staying hydrated serves to decrease constipation that may result from iron
supplements.
Incorrect option: Nuts are high in magnesium, not iron. Berries are not good sources of either. Foods
high in iron include liver, red meat, and legumes.
Common side effect of iron supplements? - ✔✔Constipation
How can you increase iron supplementation absorption without getting constipation - ✔✔Consume
adequate dietary fiber
,Taking with Vitamin C increases absorption of iron
Antacids decrease iron absorption
Which supplemental nutrient is important for your vegan patient to take?
Folic acid
Vitamin B12
Iron
Amino acids - ✔✔Since vegans do not eat animal-based foods that have natural B12, they are often low
in vitamin B12 and may need to take supplements.
Incorrect options: Iron, amino acids, and folic acid can be found in a plant-based diet.
When the NP is educating a patient on the best way to take oral iron supplementation for maximum
absorption, the NP should instruct the patient to take the medication as prescribed:
immediately after a large meal
on an empty stomach
with an over-the-counter antacid
with a glass of whole milk - ✔✔Milk, antacids, calcium supplements, and caffeine may lower the amount
of iron that is absorbed if taken at the same time.
,• Iron supplements work best if taken on an empty stomach but some patients may have upset stomach
when taking iron so they may be advised to take the iron with a small amount of food.
• A large meal or a large amount of food may lower the amount of iron that is absorbed.
The NP is seeing a 3-day-old infant for the first clinic visit after birth. The infant is alert and vigorous with
a normal physical exam with the notable exception of extensive petechiae to the face and trunk; there is
no active bleeding. The infant's CBC is normal except for low platelet count of 6,000. There is no
maternal history of ITP or lupus and maternal platelet count is within normal range. The infant was born
at term with an uneventful delivery and hospital stay and was discharged home yesterday. What is the
next best course of action for the NP?
Contact a hematologist for urgent inpatient referral and follow their recommendations
Prepare a referral for an outpatient hematology clinic
Reassure the parents that the petechiae may be a rash and recheck at next visit
Repeat the CBC in 24 hours - ✔✔Contact a hematologist for urgent inpatient referral and follow their
recommendations
These findings are concerning for neonatal alloimmune thrombocytopenia (NAIT) due to low platelets in
an otherwise healthy infant and no maternal history of thrombocytopenia; this can result in severe
bleeding and requires prompt treatment.
• There are variations in neonatal thrombocytopenia causes and these should be managed by a
hematologist.
A patient has iron deficiency anemia. The serum iron level is expected to be low. Which other laboratory
results are expected to also be low?
, Select all that apply.
Hemoglobin (Hgb)
Red cell distribution width (RDW)
Mean corpuscular volume (MCV)
Total iron binding capacity (TIBC) - ✔✔Iron deficiency anemia is a microcytic, hypochromic anemia. MCV
is a reflection of the size of the RBC so it is expected to be low. Anemia by definition is low Hgb so that is
also expected to be low.
TIBC is a test that measures the blood's capacity to bind with iron; it will be high due to low levels of
circulating iron.
RDW measures the variability in red blood cell size; it will be high because more, smaller RBCs will be in
circulation.
An African American infant patient recently transferred to your practice with sudden onset severe pain in
his back and extremities, leg ulcers, and dyspnea? Of the following differential, what would be the most
likely diagnosis?
Osgood-Schlatter disease
Metastatic cancer
Sickle cell anemia
Rheumatoid arthritis - ✔✔In a sickle-cell crisis, an infant with sickle cell anemia may have sudden severe
pain. Because red blood cells are sickle-shaped and get lodged in the smaller capillaries, they cannot
