[Fan Favorite] Anemia Assessment

As we step away for a holiday break, we’re excited to revisit some of the most popular episodes of the FNP Certification Q & A Podcast. These listener favorites have informed, inspired, and empowered aspiring NPs on their journey to certification success. Enjoy some of our favorites. We'll catch you in 2025 with fresh questions from Dr. Fitzgerald!

The NP sees a 34-year-old woman with a chief complaint of 6-month history of increasing fatigue despite adequate opportunity to sleep and rest. Laboratory results reveal a microcytic, hypochromic anemia with elevated RDW. You expect to find which of the following upon review of the patient’s health history?

A. Report that she has been eaten a plant-based diet since age 18

B. History of prolonged menses with the need for =8 pads per day

C. Report of drinking 5 or more 5 oz glasses of wine daily

D. A prior diagnosis of rheumatoid arthritis
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Transcript

Welcome to NP Certification Q&A presented by Fitzgerald Health Education Associates. This podcast is for NP students studying to pass their NP certification exam. Getting to the correct test answers means breaking down the exam questions themselves. Leading NP expert Dr. Margaret Fitzgerald shares her knowledge and experience to help you dissect the anatomy of a test question so you can better understand how to arrive at the correct test answer. So, if you're ready, let's jump right in. 

The nurse practitioner sees a 34-year-old woman with a chief complaint of a six-month history of increasing fatigue, despite adequate opportunity 

to rest and sleep. Laboratory results reveal a microcytic, hypochromic anemia with elevated RDW. You expect to find which of the following upon review of the patient's health history,  

A. A report that she has eaten a plant-based diet since age 18. Or another way of putting that, a vegan diet. 

B. History of prolonged menses with the need for eight plus pads per day.  

C. Report of drinking five or more five-ounce glasses of wine daily. 

D. A prior diagnosis of rheumatoid arthritis. 

Where do you start with a question like this? It's a fairly deep, complex question, which is the kind you should expect to find on the NP boards. 

 A great place to start is to determine what kind of question this is. This is actually an assessment question as we're given a fair amount of data about the patient. But at the same time, this is focused on the analysis and synthesis of the subjective and objective data presented.  

 So, the subjective data, her six-month history of fatigue, also her report that she does have adequate opportunity to rest, but she's still tired.  

Objective data. What's given there? The results of a microscopic hypochromic anemia.  

But now with the question is saying to us, you actually don't have enough information yet to proceed. So, what do you need to do? You need more information. Next step should be determine the probabilities. 

 This is going to work for you regardless of what kind of question it. And based on his patient's symptoms, history, and risk category, what is the most likely for a particular diagnosis that this woman has? She's a woman of reproductive age, relatively new onset of fatigue, even with adequate rest. We're given that information about the microcytic hypochromic anemia with elevated RDW. Every word in the exam question in the stem, the story of that question is important. Anemia, of course, leads to decrease oxygen carrying capability of the blood, and that can contribute to fatigue.  

 But let's break it down even some more. Small red blood cells, which is what we see in a microcytic anemia, are always pale red blood cells because they don't have a normal amount of hemoglobin in them. And think of the two components of hemoglobin: heme - iron, globin - protein. The RDW is elevated. That means the new red blood cells are even smaller and paler than the old red blood cells. That implies it's an ongoing anemia. What's the most common reason in all age groups to have a microcytic hypochromic anemia? That's going to be iron deficiency. And what's the most common reason for iron deficiency anemia in a woman of reproductive age, particularly reporting heavy menses with resulting fatigue and microcytic hypochromic anemia? 

 The best answer is going to be option B, but let's break this down. So looking at option A: reports that she's been eating a plant based diet 

since age 18, well, a well-balanced plant-based diet poses very little anemia risk very little. So I would eliminate that. History of the prolonged menses with the need for eight plus pads per day. That's our correct answer, option B, because that is a common history in a person with an iron deficiency anemia. And where does the iron deficiency come from? The excessive menstrual blood loss. 

 Now, how about option C, the report of drinking five or more glasses of wine per day? And you'll notice in this a glass of wine is quantified at five ounces, and that is considered to be the standard, if you will, dose of wine, a standard drink is considered to be 12 ounces of beer, five ounces of wine or one and a half ounces of hard liquor like rum, vodka, something along those lines. And all three of those have the equivalent amount of alcohol in them. Well, the report of drinking heavily does increase risk for folic acid deficiency anemia, but I can eliminate that immediately from this because folic acid deficiency anemia presents as a macrocytic, not a microcytic anemia. 

And then risk for option D with a history of rheumatoid arthritis that poses a risk for anemia, chronic disease. Chronic anemia of chronic disease presents with a normocytic normochromic anemia with a normal limit RDW. Plus, we would no doubt be given more data about this anemia of chronic disease. Like her, rheumatoid arthritis is not in good control. Something along those lines. What's the key takeaway when assessing a person with anemia? Keep in mind the most common risk factors for each anemia, coupled with the clinical presentation.  

Thank you for listening to NP Certification Q&A presented by Fitzgerald Health Education Associates. Please rate, review, and subscribe to this podcast and for more NP resources, visit FHEA.com.