The nurse is assessing four clients at the neighborhood clinic.
Which of these clients should the nurse identify to be at risk for the development of pernicious anemia?

35-year-old male recently diagnosed with chronic renal failure.

26-year-old woman in her second trimester of pregnancy.

50-year-old male who is following a high-fat and high-protein diet.

43-year-old male who had gastric bypass surgery one year ago.

Answer and Explanation

The Correct Answer is D

Choice A rationale

Chronic renal failure results in decreased erythropoietin production, leading to anemia due to poor red blood cell production, not the vitamin B12 deficiency seen in pernicious anemia. Pernicious anemia specifically results from the lack of intrinsic factor causing B12 deficiency.

Choice B rationale

Pregnancy may cause iron-deficiency anemia due to increased iron demands, not pernicious anemia. Pernicious anemia stems from intrinsic factor deficiency, unrelated to pregnancy physiology. Iron supplementation is required in pregnancy-induced anemia, not B12.

Choice C rationale

A high-fat, high-protein diet does not inherently affect vitamin B12 absorption. Pernicious anemia results from the deficiency of intrinsic factor or issues with B12 absorption, not dietary composition. This individual is not at increased risk based on diet alone.

Choice D rationale

Gastric bypass surgery can disrupt intrinsic factor secretion due to altered gastric mucosa. Intrinsic factor is essential for vitamin B12 absorption in the ileum, and its deficiency directly contributes to the development of pernicious anemia in post-gastric bypass patients. .

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Correct Answer is C

Explanation

Choice A rationale

Metal catheters with prostatic curves are used in challenging cases of urinary retention caused by BPH. However, these catheters are not the first-line intervention due to their specialized nature and the risk of injury. Less invasive measures should be tried first.

Choice B rationale

Cystostomy, a surgical procedure that creates a suprapubic urinary drainage site, is reserved for severe cases of urinary retention where catheterization fails. It is not the initial step due to its invasive nature and requirement for surgical expertise.

Choice C rationale

Inserting an indwelling urethral catheter is the first-line action for managing acute urinary retention associated with BPH. It provides immediate bladder decompression, relieves discomfort, and reduces risks of complications like hydronephrosis or bladder rupture.

Choice D rationale

Discussing surgical options addresses the long-term management of BPH but does not resolve acute urinary retention. Interventions like catheterization should first alleviate symptoms before evaluating the need for definitive surgical treatment. .

A. Venison stew and ice cream. B. Poached salmon and green beans. C. Spinach salad and rhubarb pie. D. Sautéed mushrooms and fried rice.

Correct Answer is C

Explanation

Choice A rationale

Venison stew and ice cream are low in oxalate content. Oxalate kidney stones are formed due to high urinary oxalate levels, often from consuming oxalate-rich foods. Venison provides protein but does not contribute significantly to oxalate levels, while dairy products like ice cream have calcium which binds oxalate, reducing absorption in the gut.

Choice B rationale

Poached salmon and green beans are suitable choices as they have low oxalate content. Salmon provides omega-3 fatty acids, which can reduce kidney stone risk, and green beans are a low-oxalate vegetable, making this meal appropriate for oxalate management.

Choice C rationale

Spinach and rhubarb are high in oxalates. Spinach contains around 750 mg oxalates per 100 grams, and rhubarb contains 860 mg per 100 grams. Consuming these increases urinary oxalate excretion, elevating the risk of stone formation, indicating a need for further dietary education.

Choice D rationale

Sautéed mushrooms and fried rice are acceptable as both are low in oxalates. Mushrooms provide nutrients like selenium and vitamin D, while rice is a carbohydrate source free from oxalate, making this option suitable for oxalate kidney stone prevention.

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The nurse is assessing four clients at the neighborhood clinic.Which of these clients should the nurse identify to be at risk for the development of pernicious anemia?

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The nurse is assessing four clients at the neighborhood clinic.
Which of these clients should the nurse identify to be at risk for the development of pernicious anemia?