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 D

Explanation

Choice A rationale

A low-sodium, high-calorie diet is not the priority for immediate management of renal colic. Nutritional changes are addressed as part of long-term care but do not alleviate acute pain and discomfort caused by obstruction or irritation in the urinary tract.

Choice B rationale

Increasing fluid intake of 3 to 4 L/day is beneficial for preventing stone formation and enhancing urinary output, but fluid intake changes alone do not address acute renal colic. The urgency lies in alleviating the pain and promoting ureteral relaxation.

Choice C rationale

Tamsulosin (Flomax) 0.4 mg p.o. daily relaxes smooth muscles in the ureter, aiding stone passage, but does not provide immediate pain relief. It is a supportive measure rather than a first-line intervention during acute renal colic.

Choice D rationale

Morphine sulfate (Morphine) 2 mg IV every 4 hours PRN is the correct choice, as it addresses severe pain due to renal colic by acting directly on opioid receptors to block pain transmission. Pain relief improves the client’s comfort and allows further management strategies.

A. Serum electrolytes. B. Complete blood count. C. Blood urea nitrogen. D. Brain natriuretic peptide.

Correct Answer is D

Explanation

Choice A rationale

Serum electrolyte analysis provides insights into fluid and electrolyte balance but does not specifically diagnose heart failure. Electrolyte changes may occur secondary to heart failure but are not definitive markers for the condition.

Choice B rationale

Complete blood count evaluates for anemia or infection, which may contribute to symptomatology but is not diagnostic for heart failure. Heart failure diagnosis focuses on cardiac-specific markers rather than hematologic parameters.

Choice C rationale

Blood urea nitrogen assesses renal function and reflects perfusion status but lacks specificity for heart failure. Although renal dysfunction may occur in advanced heart failure, BNP measurement is more definitive for cardiac assessment.

Choice D rationale

Brain natriuretic peptide (BNP) is a key diagnostic marker for heart failure. Elevated BNP levels occur due to ventricular stretch and strain associated with fluid overload, a hallmark of heart failure. Normal BNP levels are typically <100 pg/mL, with elevated levels strongly suggesting cardiac dysfunction. .

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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?