A nurse is assessing a patient with suspected vitamin B12 deficiency anemia.
The patient complains of soreness, redness, and smoothness of the tongue.
What distinctive feature of vitamin B12 deficiency anemia does this symptom indicate?

Choice A rationale:

Administering 500 mcg of cyanocobalamin intramuscularly daily for a week, then monthly for life is the appropriate route and dosage for a patient with pernicious anemia or severe malabsorption.

Intramuscular injection is the preferred route for patients with impaired absorption of vitamin B12, as it ensures direct absorption into the bloodstream.

The initial daily dose helps replenish depleted stores, and the monthly maintenance dose is required to prevent recurrence.

Choice B rationale:

Administering 1000 mcg of cyanocobalamin orally daily for a week, then weekly for a month, then monthly for life is not the best choice for patients with pernicious anemia or severe malabsorption.

Oral vitamin B12 is not effective in these cases because the underlying issue is the inability to absorb vitamin B12 from the gastrointestinal tract.

Intramuscular administration bypasses this problem.

Choice C rationale:

Administering 1000 mcg of cyanocobalamin intramuscularly daily for a week, then monthly for life is a reasonable option, but it is not as effective as the regimen described in choice A.

The initial daily dose is lower, and there is no weekly dosing phase to replenish stores quickly.

Choice D rationale:

Administering 2000 mcg of cyanocobalamin subcutaneously daily for a week, then monthly for life is not the preferred route for vitamin B12 supplementation in patients with pernicious anemia or severe malabsorption.

Intramuscular injection is the preferred route as it ensures better absorption, and subcutaneous injection may not be as effective.

Choice A rationale:

Oral supplements are less effective in raising vitamin B12 levels.

Rationale: Vitamin B12 deficiency anemia often results from malabsorption issues in the gastrointestinal tract, where the body cannot adequately absorb vitamin B12 from the digestive system.

In such cases, oral supplements may not be effective because they rely on the digestive system for absorption.

In contrast, vitamin B12 injections bypass the gastrointestinal tract, delivering the vitamin directly into the bloodstream, ensuring absorption, and increasing the effectiveness of treatment.

Choice B rationale:

Injections are less painful for the client.

Rationale: While the pain associated with injections can vary from person to person, it is not the primary reason for choosing injections over oral supplements in the treatment of vitamin B12 deficiency anemia.

The primary consideration is the effectiveness of absorption, as discussed in Choice A's rationale.

Choice C rationale:

Injections have fewer side effects.

Rationale: Both oral supplements and vitamin B12 injections have their own set of potential side effects, but the choice between the two primarily depends on the underlying cause of the deficiency and the ability to absorb vitamin B12.

Therefore, the assertion that injections have fewer side effects is not the primary reason for choosing them.

Choice D rationale:

Oral supplements may cause gastrointestinal distress.

Rationale: This is the correct answer.

Oral supplements of vitamin B12 may cause gastrointestinal distress, particularly in individuals with gastrointestinal issues.

These supplements can be hard for some individuals to tolerate, leading to discomfort, gas, or other gastrointestinal symptoms.

This is a significant consideration when choosing the route of administration for vitamin B12 treatment.