A nurse is caring for a patient with vitamin B12 deficiency anemia.
Which statement by the patient indicates a possible cause of their condition?
"I have been following a strict vegan diet for the past year.”
"I recently had a gastrectomy to treat my stomach ulcer.”
"I take acid-suppressing drugs regularly for my heartburn.”
"I have a family history of pernicious anemia.”
The Correct Answer is B
Choice A rationale:
Following a strict vegan diet can lead to vitamin B12 deficiency as it is primarily found in animal products.
However, the patient's recent gastrectomy is a more likely cause of their condition.
Choice B rationale:
This is the correct answer.
A gastrectomy can interfere with the absorption of vitamin B12 in the stomach, leading to a deficiency.
Choice C rationale:
Regular use of acid-suppressing drugs may affect the absorption of some nutrients, including vitamin B12, but it is not as direct a cause as a gastrectomy.
Choice D rationale:
Family history of pernicious anemia indicates a genetic predisposition, but it may not be the direct cause in this case.
The gastrectomy is a more likely cause.
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Correct Answer is B
Explanation
Serum vitamin B12 level.
Choice A rationale:
Serum folate level does not confirm vitamin B12 deficiency anemia.
While both vitamin B12 and folate deficiencies can lead to similar types of anemia (macrocytic and hypochromic), measuring serum folate levels alone will not confirm the diagnosis of vitamin B12 deficiency anemia.
Choice B rationale:
The correct answer is choice B.
A serum vitamin B12 level test is a crucial diagnostic tool for confirming vitamin B12 deficiency anemia.
In this case, where the client presents with macrocytic (large) and hypochromic (pale) RBCs with low hemoglobin (Hgb) and hematocrit (Hct) levels and an elevated mean corpuscular volume (MCV) above 100 fL, a low serum vitamin B12 level would confirm the diagnosis.
Choice C rationale:
Serum homocysteine level can be elevated in cases of vitamin B12 deficiency, but it is not a specific test for confirming the diagnosis of vitamin B12 deficiency anemia.
It may be used as an additional marker, but it should not be the primary test for confirmation.
Choice D rationale:
Reticulocyte count measures the percentage of young, immature red blood cells in the blood and is not a specific test for confirming vitamin B12 deficiency anemia.
While anemia is present in this case, it does not provide direct information about the underlying cause, which is best confirmed by measuring serum vitamin B12 levels.
Correct Answer is D
Explanation
Choice A rationale:
Assessing vital signs is important for overall patient assessment, but it is not the most crucial aspect when identifying signs of pallor or jaundice.
Vital signs help in evaluating the patient's general condition and stability.
Choice B rationale:
Heart sounds are important for assessing cardiac function and may provide information on the patient's cardiovascular status, but they are not the most crucial aspect when identifying signs of pallor or jaundice.
Choice C rationale:
Lung sounds are essential for evaluating the respiratory status of the patient, but they do not directly help in identifying signs of pallor or jaundice.
Choice D rationale:
The correct choice is D.
When assessing a patient with suspected vitamin B12 deficiency anemia, it is crucial to examine the skin, mucous membranes, and eyes.
Pallor (pale skin) and jaundice (yellowing of the skin and eyes) are common signs of anemia, and these can be detected through the inspection of the skin, mucous membranes (such as the inside of the mouth), and the whites of the eyes (sclera)
These signs are indicative of an underlying health issue, and identifying them is essential for the diagnosis and management of anemia.
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