A client has been placed on corticosteroid therapy for Addison's disease. The nurse should be aware of which of the following side effects associated with this type of therapy? (Select all that apply)

Reasoning:

Choice A reason: Strict vegetarians are at risk for megaloblastic anemia due to vitamin B12 deficiency, as B12 is primarily found in animal products. B12 deficiency impairs DNA synthesis, causing macrocytic anemia and symptoms like fatigue and neurological issues, a significant concern in vegan diets without supplementation.

Choice B reason: Sickle cell anemia is an inherited disorder caused by a hemoglobin S mutation, not dietary factors like vegetarianism. It leads to hemolytic anemia and vaso-occlusive crises, unrelated to nutritional deficiencies, making it an unlikely risk for a vegetarian client without genetic predisposition.

Choice C reason: Iron deficiency anemia is possible in vegetarians due to lower bioavailability of non-heme iron from plant sources, but B12 deficiency is a more specific risk in strict vegetarians, as animal products are the primary B12 source. Iron supplements or fortified foods can mitigate this risk.

Choice D reason: Aplastic anemia results from bone marrow failure, not dietary deficiencies. It causes pancytopenia and is unrelated to vegetarianism, which primarily risks nutritional anemias like B12 or iron deficiency. The client’s diet suggests a nutrient-specific issue, not bone marrow suppression.

Reasoning:

Choice A reason: Sickle cell disease is a hemolytic anemia caused by a hemoglobin mutation, not low iron. Laboratory findings show normal or elevated iron due to hemolysis, not low serum iron, transferrin saturation, or ferritin, which are specific to iron deficiency, ruling out sickle cell anemia.

Choice B reason: Pernicious anemia results from vitamin B12 deficiency, impairing DNA synthesis and red blood cell maturation. It is not associated with low serum iron, transferrin saturation, or ferritin, which reflect iron stores. Pernicious anemia typically shows megaloblastic changes, not microcytic anemia, unlike iron deficiency.

Choice C reason: Hemolytic anemia involves red blood cell destruction, often increasing iron levels due to hemoglobin breakdown. Low serum iron, transferrin saturation, and ferritin are not typical, as hemolysis does not deplete iron stores. These findings point to iron deficiency, not hemolytic processes.

Choice D reason: Iron deficiency anemia is characterized by low serum iron, transferrin saturation, and ferritin, reflecting depleted iron stores. Iron is essential for hemoglobin synthesis, and its deficiency causes microcytic, hypochromic anemia, leading to fatigue, matching the client’s laboratory findings and clinical presentation accurately.