img-download-app
img-download-app

The nurse administers vitamin B12 to a patient with pernicious anemia. This patient has the inability to absorb vitamin B12 because of a deficiency in

Explanation

• Intrinsic factor, released by parietal cells of the stomach, binds to B12 to facilitate absorption in the small bowel. A deficiency of intrinsic factor leads to pernicious anemia.

• Gastrin is a peptide hormone that stimulates gastric acid secretion.

• Folic acid is important in DNA synthesis and the production and maintenance of new cells. A deficiency would cause anemia, but this is unrelated to B12.

• Pernicious anemia is a macrocytic anemia that results when vitamin B12 cannot be absorbed in the distal small intestine because there is a lack of the required intrinsic factor (which is normally produced by parietal cells in the stomach) for this absorption to occur. Pernicious anemia may result after surgical removal of parts of the stomach or from chronic gastritis causing decreased secretion of intrinsic factor. Autoimmune conditions may also produce antibodies against gastric parietal cells. When the production of intrinsic factor declines gradually, symptoms may progress over 20+ years, from mild GI effects and mood swings to weakness and fatigue, paresthesias of feet and fingers, and even cognitive effects and memory deficits, as well as difficulty walking. In later stages, these patients may have a beefy, red tongue and an enlarged liver that can lead to right-sided heart failure. The HGB can be 7–8 g/dL. Treatment requires monthly B12 injections for life.

• Folate (folic acid) deficiency is another macrocytic anemia. Folate deficiency is dangerous for unborn infants because folic acid prevents neural tube defects. Pregnant women are recommended to have at least 400 ug/day. Folate is absorbed in the small intestine and stored in the liver. Alcoholism or a diet low in vegetables can lead to folate deficiency. Patients with folate deficiency may develop stomatitis and ulcerations on the tongue. They may have dysphagia, flatulence, and watery diarrhea. 

• Iron deficiency anemia is a microcytic anemia often caused by chronic blood loss from minor gastrointestinal bleeding or colon cancer. Over time, the demands for iron exceed intake. Even blood loss of 10–20 milliliters of red cells per day is more iron a person can absorb in the diet. Manifestations of iron deficiency anemia include fatigue, pallor, fissures at the corners of the mouth, spooning of fingernails, and reduced exercise tolerance. Anemia is defined as HGB <13 g/dL for men and <12 g/dL for women.

• Thalassemia major or Cooley's anemia is a disorder caused by defects in both beta-chains of the hemoglobin molecule, result in a severe microcytic anemia. These patients develop facial deformities from expansion of the marrow of the facial bones, including maxillary hyperplasia and frontal bossing. Thalassemia is found most often in Black, Mediterranean, and Southeast Asian ethnic groups.

• Aplastic anemia is a normocytic anemia resulting from a decline in blood cell production related to bone marrow depression. (Pancytopenia is often also be seen with this type of anemia, resulting in the decline of all three types of blood cells.) RBC production declines gradually than WBCs or PLTs, so this anemia appears with a chronic pattern. Aplastic anemia can be either hereditary or acquired after birth. If the onset is sudden, symptoms include hypoxia, pallor, weakness, fever, and dyspnea. The slower onset produces progressive weakness, infections, low-grade fever, cellulitis in the neck, nosebleeds, or waxy and pale skin tones. Aplastic anemia can cause an extremely low HGB of 7 g/dL. 

Visit our website for other NCLEX topics now!
Related questions

A patient with a recent myocardial infarction (MI) has asked if he can talk to the nurse about sex. What should the nurse do?

The nurse is performing an admission assessment on a patient with a history of myocardial infarction. Which signs and symptoms of left-sided heart failure should the nurse look for?

A patient is scheduled to undergo an upper GI endoscopy for the diagnosis of esophageal varices. The nurse explains to the patient that esophageal varices:

The nurse is caring for a patient complaining of chest pain related to pericarditis. To help relieve the pain, the nurse should instruct the patient to

The nurse is reviewing the lab results of a patient with osteoporosis. The nurse would most likely note abnormalities in:

A patient with hyperaldosteronism is having trouble controlling his hypertension. The nurse explains that his hypertension is caused by excessive aldosterone secretion from the

Lower abdominal pain is a common complaint of patients diagnosed with urinary tract infections. Burning pain is experienced, especially upon urination. To help these patients prevent and relieve urinary discomfort, which of the following should be taught?

A nurse is caring for a patient suspected of having acute respiratory distress syndrome (ARDS). Which of the following assessment data would support the suspected diagnosis?

The nurse is interviewing a patient suspected of having systemic lupus erythematosus (SLE). Which of the following features of SLE is correct?

The nurse is caring for a patient suspected of having lung cancer. The physician performs a bronchoscopy to obtain a biopsy. Which of the following should be reported to the physician?

The nurse reviews a patient's lab results, noting a blood glucose level of 495 mg/dl. The patient is most likely experiencing which acid-base imbalance?

Which consultation is the priority for a patient admitted with a sickle cell crisis?

A patient with chronic renal failure will have lab work to evaluate his kidney function. The nurse knows that which of the following are most accurate in predicting kidney function? 

A patient with a recent cerebrovascular accident (CVA) is on a dysphagia diet. What should the nurse do to ensure patient safety while eating?

The nurse is discharging a patient who recently underwent surgery for an above-the-knee amputation (AKA) of the left lower extremity. The patient requires additional education if he states:

The nurse is caring for a client receiving chemotherapy for lung cancer. Laboratory results show a platelet count of 18,000/mm³ and WBC of 5,000/mm³. Which of the following measures should the nurse implement based on these results?

A hospital patient is complaining of increased shortness of breath. The nurse observes a respiratory rate of 24 on 3 liters per minute (LPM) of oxygen via nasal cannula. Which of the following actions should be done initially?

The nurse is reviewing the complete blood count with differential of a patient with cytomegalovirus. The nurse should expect an elevation of

Which of these tests are used to detect or diagnose breast cancer?

The nurse is initiating continuous bladder irrigation on a patient that just underwent a prostatectomy. The nurse understands that the flow rate is adequate if:

The nurse is caring for a patient with a Miller-Abbott tube used to decompress the small bowel. Which of the following would confirm the tube is located in the small intestine?

A patient with diabetes mellitus is seen in the clinic for acute sinusitis. The patient is taught this infection will have which effect on his insulin needs?

While inserting a urinary catheter, the nurse should have the patient:

After surgery on a left femur fracture, the patient is ordered partial weight bearing. Which of the following is correct about partial weight bearing?

The nurse is caring for a patient with pleurisy. When the nurse auscultates the patient's lungs, a friction rub is heard.  This friction rub is the result of

A patient is admitted for gastric bypass surgery. Which of the following patient statements indicates a need for further patient teaching?

Older adults are at risk for excessive fluid loss for several reasons. The nurse is correct by giving which of the following reasons when asked by an elderly client? 

Which of the following are normally fluid-filled spaces?

A patient undergoing peritoneal dialysis is being assessed by the nurse for signs of peritonitis. Which of the following would indicate peritonitis?