The client diagnosed with vitamin B12 deficiency presents to the outpatient department for the follow-up evaluation. Which nursing assessment finding indicates that the treatment has been effective? The client:

Choice A reason: You feel good because your medication is working properly is not the most appropriate statement by the nurse. This statement may imply that the client does not need to worry about their blood pressure or follow up with their doctor. The nurse should educate the client about the importance of regular monitoring and adherence to the prescribed treatment.

Choice B reason: Your blood pressure reflects how strong your heart muscle contracts is not the most appropriate statement by the nurse. This statement may confuse the client or give them a false sense of security. The nurse should explain that blood pressure is determined by the force and amount of blood pumped by the heart and the resistance of the blood vessels. The nurse should also inform the client about the normal and abnormal ranges of blood pressure and the risk factors for hypertension.

Choice C reason: Even if you are feeling good, damage can occur to your heart and kidneys is the most appropriate statement by the nurse. This statement conveys the seriousness of hypertension and its potential complications. The nurse should educate the client about the effects of high blood pressure on the vital organs and the need for preventive measures and lifestyle modifications.

Choice D reason: Have you told your doctor that you are feeling good is not the most appropriate statement by the nurse. This statement may suggest that the nurse is not interested in the client's condition or does not have the knowledge or authority to address their concerns. The nurse should communicate effectively with the client and the health care team and provide appropriate guidance and support.

Choice A reason: The 68-year-old male who smokes one pack of cigarettes per day is not likely to have folic acid deficiency. Smoking can increase the risk of many health problems, such as lung cancer, heart disease, and stroke, but it does not affect the absorption or metabolism of folic acid. ¹ Folic acid is a type of vitamin B that is essential for the production of red blood cells and DNA. ²

Choice B reason: The 47-year-old male construction foreman who takes atenolol is not likely to have folic acid deficiency. Atenolol is a drug that lowers blood pressure and heart rate by blocking the effects of adrenaline. ³ It does not interfere with the absorption or metabolism of folic acid.

Choice C reason: The 35-year-old female who drinks a glass of wine with dinner is not likely to have folic acid deficiency. Moderate alcohol consumption, defined as one drink per day for women and two drinks per day for men, does not affect the absorption or metabolism of folic acid. However, excessive alcohol intake can impair the absorption of folic acid from the intestine and increase its excretion from the urine, leading to folic acid deficiency.

Choice D reason: The 43-year-old female with Crohn's disease is the most likely to have folic acid deficiency. Crohn's disease is a chronic inflammatory condition that affects the digestive tract, causing symptoms such as diarrhea, abdominal pain, and weight loss. Crohn's disease can impair the absorption of folic acid from the intestine, especially if the disease affects the small intestine, where most of the folic acid is absorbed. Crohn's disease can also increase the demand for folic acid, as inflammation and tissue damage require more folic acid for repair and regeneration.