The nurse is reviewing the past medical history of a group of clients. Which client would the nurse suspect as having folic acid deficiency? The:

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.

Choice A reason: This is the correct answer. Tremors and twitching are signs of hypomagnesemia, which is a low level of magnesium in the blood. Magnesium is a mineral that is involved in many enzymatic reactions and neuromuscular functions. A low magnesium level can cause hyperexcitability of the nerves and muscles, leading to involuntary movements and spasms. Alcoholism can cause hypomagnesemia by reducing the absorption and increasing the excretion of magnesium.

Choice B reason: Positive Chvostek's sign is not a sign of hypomagnesemia, but of hypocalcemia, which is a low level of calcium in the blood. Calcium is another mineral that is important for the function of nerves and muscles. A low calcium level can cause tetany, which is a condition of sustained muscle contraction. Chvostek's sign is a test that involves tapping the facial nerve in front of the ear and observing for a twitching of the facial muscles. A positive Chvostek's sign indicates hypocalcemia, not hypomagnesemia.

Choice C reason: Decreased deep tendon reflexes are not a sign of hypomagnesemia, but of hypermagnesemia, which is a high level of magnesium in the blood. A high magnesium level can cause hyporeflexia, which is a reduced or absent response to stimuli. Magnesium has a sedative effect on the nerves and muscles, and can inhibit the transmission of impulses. Hypermagnesemia can be caused by excessive intake or impaired excretion of magnesium.

Choice D reason: Polyuria and flank pain are not signs of hypomagnesemia, but of kidney problems, such as infection, stones, or failure. Polyuria is the production of abnormally large amounts of urine, and flank pain is the pain in the side or back below the ribs. These symptoms can indicate damage or inflammation of the kidneys, which can affect the balance of fluids and electrolytes in the body. Hypomagnesemia does not directly cause polyuria or flank pain, but it can be a result of kidney dysfunction.