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?

Choice A rationale

A low sodium, high-calorie diet may improve overall health but does not address immediate severe pain from renal colic. Dietary modifications can have long-term benefits but are not first-line interventions for acute pain caused by kidney stones. Immediate pain relief is prioritized over dietary adjustments in this scenario.

Choice B rationale

Increasing fluid intake helps flush out kidney stones and prevent their formation. However, fluid intake does not provide immediate pain relief for renal colic. It is crucial in long-term management, but acute management prioritizes analgesics to address the client’s severe pain.

Choice C rationale

Tamsulosin relaxes the smooth muscles in the urinary tract, facilitating stone passage and reducing obstruction-related discomfort. While beneficial, it takes time to work and does not immediately relieve severe pain. It is not the first prescription to implement for acute pain management in renal colic.

Choice D rationale

Morphine sulfate is an opioid analgesic that provides rapid relief for severe pain associated with renal colic. Administering morphine addresses the acute issue and allows for further interventions to manage the underlying cause. Pain control is the priority in renal colic cases with severe pain.

Choice A rationale

Referring the client to see an optometrist is inappropriate because visual disturbances can be a sign of digoxin toxicity, which requires immediate medical attention rather than routine visual examination. Toxicity manifests due to elevated serum digoxin levels, with symptoms including blurred vision and yellow-green halos. Normal digoxin range is 0.5-2.0 ng/mL.

Choice B rationale

Asking if the client wears glasses or contact lenses does not address the root cause of visual disturbances, which is likely linked to digoxin toxicity. Such queries delay prompt medical intervention needed to evaluate and manage the client’s condition. Ocular aids are unrelated to pharmacological adverse effects.

Choice C rationale

Obtaining a prescription for stat laboratory tests is essential for assessing serum digoxin levels and electrolytes, particularly potassium, as hypokalemia increases sensitivity to digoxin toxicity. Prompt identification of toxicity allows timely interventions, including discontinuation of digoxin or administration of antidotes like Digibind.

Choice D rationale

Obtaining the client’s blood pressure is irrelevant in this scenario, as visual disturbances are not indicative of blood pressure abnormalities but rather digoxin toxicity. Immediate focus should be on confirming and managing toxicity through laboratory evaluation and clinical assessment.