Choice A rationale:

Following a strict vegan diet can lead to vitamin B12 deficiency as it is primarily found in animal products.

However, the patient's recent gastrectomy is a more likely cause of their condition.

Choice B rationale:

This is the correct answer.

A gastrectomy can interfere with the absorption of vitamin B12 in the stomach, leading to a deficiency.

Choice C rationale:

Regular use of acid-suppressing drugs may affect the absorption of some nutrients, including vitamin B12, but it is not as direct a cause as a gastrectomy.

Choice D rationale:

Family history of pernicious anemia indicates a genetic predisposition, but it may not be the direct cause in this case.

The gastrectomy is a more likely cause.

Choice A rationale:

Pale skin (pallor) is a common symptom of anemia, but it is not specific to vitamin B12 deficiency anemia.

Many types of anemia can lead to paler skin.

Choice B rationale:

Joint pain and stiffness are not typically associated with vitamin B12 deficiency anemia.

This symptom is more characteristic of other conditions, such as arthritis.

Choice C rationale:

This is the correct answer.

Feeling lightheaded and dizzy when standing up quickly is a common symptom of anemia, including vitamin B12 deficiency anemia.

Anemia can lead to decreased oxygen delivery to the brain, resulting in dizziness upon sudden position changes.

Choice D rationale:

Higher energy levels are not a typical symptom of vitamin B12 deficiency anemia.

Fatigue and weakness are more common symptoms of this condition.

Choice A rationale:

Jaundice is not a typical manifestation of vitamin B12 deficiency anemia.

It is more commonly associated with liver dysfunction or hemolytic anemias.

Choice B rationale:

This is a correct answer.

Glossitis, which is inflammation of the tongue, can be a clinical manifestation of vitamin B12 deficiency anemia.

The tongue may appear red and swollen.

Choice C rationale:

This is a correct answer.

Peripheral neuropathy, characterized by tingling, numbness, and weakness in the extremities, can result from long-term vitamin B12 deficiency.

Choice D rationale:

Increased platelet count (thrombocytosis) is not a typical manifestation of vitamin B12 deficiency anemia.

It may occur in other conditions, such as inflammation or reactive thrombocytosis.

Choice E rationale:

This is a correct answer.

Oval-shaped red blood cells (macro-ovalocytes) can be observed in the blood smear of individuals with vitamin B12 deficiency anemia.

These abnormally shaped red blood cells are a characteristic finding.

Choice A rationale:

Oral supplements are less effective in raising vitamin B12 levels.

Rationale: Vitamin B12 deficiency anemia often results from malabsorption issues in the gastrointestinal tract, where the body cannot adequately absorb vitamin B12 from the digestive system.

In such cases, oral supplements may not be effective because they rely on the digestive system for absorption.

In contrast, vitamin B12 injections bypass the gastrointestinal tract, delivering the vitamin directly into the bloodstream, ensuring absorption, and increasing the effectiveness of treatment.

Choice B rationale:

Injections are less painful for the client.

Rationale: While the pain associated with injections can vary from person to person, it is not the primary reason for choosing injections over oral supplements in the treatment of vitamin B12 deficiency anemia.

The primary consideration is the effectiveness of absorption, as discussed in Choice A's rationale.

Choice C rationale:

Injections have fewer side effects.

Rationale: Both oral supplements and vitamin B12 injections have their own set of potential side effects, but the choice between the two primarily depends on the underlying cause of the deficiency and the ability to absorb vitamin B12.

Therefore, the assertion that injections have fewer side effects is not the primary reason for choosing them.

Choice D rationale:

Oral supplements may cause gastrointestinal distress.

Rationale: This is the correct answer.

Oral supplements of vitamin B12 may cause gastrointestinal distress, particularly in individuals with gastrointestinal issues.

These supplements can be hard for some individuals to tolerate, leading to discomfort, gas, or other gastrointestinal symptoms.

This is a significant consideration when choosing the route of administration for vitamin B12 treatment.

Choice A rationale:

"Include more leafy green vegetables in your diet." Rationale: This statement is incorrect because leafy green vegetables are not a significant source of vitamin B12.

Vitamin B12 is primarily found in animal products such as meat, poultry, fish, and dairy.

Leafy green vegetables are sources of other essential nutrients like folate, but they do not contain vitamin B12.

Choice B rationale:

"Increase your consumption of red meat and poultry." Rationale: This is the correct answer.

Red meat and poultry are excellent dietary sources of vitamin B12.

Consuming these foods can help individuals increase their vitamin B12 intake, which is crucial for addressing vitamin B12 deficiency anemia.

Choice C rationale:

"Avoid dairy products to prevent exacerbating the deficiency." Rationale: This statement is incorrect.

Dairy products are a good source of vitamin B12, and avoiding them may worsen a vitamin B12 deficiency.

It is important to include dairy products in the diet, especially for individuals with vitamin B12 deficiency anemia.

Choice D rationale:

"Consume more citrus fruits for their vitamin B12 content." Rationale: This statement is incorrect.

Citrus fruits are not a source of vitamin B12.

They are known for their vitamin C content, but vitamin B12 is primarily found in animal-based foods.

Choice A rationale:

Dyspnea.

Rationale: Dyspnea refers to difficulty breathing and is not a characteristic symptom of vitamin B12 deficiency anemia.

Symptoms of vitamin B12 deficiency anemia are primarily related to the blood and nervous system.

Choice B rationale:

Numbness and tingling of extremities.

Rationale: Numbness and tingling of extremities (peripheral neuropathy) can be a symptom of vitamin B12 deficiency anemia, but it is not related to the specific complaint of soreness, redness, and smoothness of the tongue mentioned in the question.

Choice C rationale:

Glossitis.

Rationale: This is the correct answer.

Glossitis refers to inflammation of the tongue, which can result in soreness, redness, and a smooth appearance of the tongue.

It is a distinctive feature of vitamin B12 deficiency anemia, as vitamin B12 plays a role in maintaining the health of the oral mucosa and nerves.

Choice D rationale:

Memory loss.

Rationale: Memory loss is not a typical symptom of vitamin B12 deficiency anemia.

Symptoms related to the nervous system, such as numbness and tingling, are more common neurological manifestations of the condition.

They are neuropsychiatric symptoms associated with vitamin B12 deficiency anemia.

Choice A rationale:

These neuropsychiatric symptoms are actually related to vitamin B12 deficiency anemia.

Vitamin B12 deficiency can lead to neurological symptoms, including confusion, irritability, and depression.

It is not unrelated to the condition.

Choice B rationale:

Gastrointestinal symptoms are not the primary manifestation of vitamin B12 deficiency anemia.

Choice C rationale:

Glossitis is a common sign of vitamin B12 deficiency anemia, but it primarily involves inflammation and changes in the tongue.

While glossitis is associated with vitamin B12 deficiency, it does not fully explain the neuropsychiatric symptoms mentioned in the question.

Choice D rationale:

The correct answer is choice D.

Neuropsychiatric symptoms such as confusion, irritability, and depression are indeed associated with vitamin B12 deficiency anemia.

Schilling test.

Choice A rationale:

A complete blood count (CBC) is a common blood test that provides information about the number and types of blood cells but does not directly measure the absorption of vitamin B12 in the urine.

It is not the test used to differentiate between pernicious anemia and other causes of malabsorption.

Choice B rationale:

Serum vitamin B12 level measures the amount of vitamin B12 in the blood but does not directly assess its absorption in the urine.

While it is a valuable test for diagnosing vitamin B12 deficiency, it does not differentiate between pernicious anemia and other causes of malabsorption.

Choice C rationale:

Serum folate level measures the amount of folate (a different B vitamin) in the blood and is not specific to vitamin B12 deficiency or malabsorption of vitamin B12.

It does not help differentiate between pernicious anemia and other causes of malabsorption.

Choice D rationale:

Serum homocysteine level can be elevated in cases of vitamin B12 deficiency, but it is not a direct test of vitamin B12 absorption in the urine.

It also does not differentiate between pernicious anemia and other causes of malabsorption.

Choice E rationale:

The correct answer is choice E.

The Schilling test measures the absorption of radioactive vitamin B12 in the urine and is specifically designed to differentiate between pernicious anemia (a type of B12 deficiency caused by impaired absorption) and other causes of malabsorption.

This test helps identify the underlying cause of vitamin B12 deficiency.

Serum vitamin B12 level.

Choice A rationale:

Serum folate level does not confirm vitamin B12 deficiency anemia.

While both vitamin B12 and folate deficiencies can lead to similar types of anemia (macrocytic and hypochromic), measuring serum folate levels alone will not confirm the diagnosis of vitamin B12 deficiency anemia.

Choice B rationale:

The correct answer is choice B.

A serum vitamin B12 level test is a crucial diagnostic tool for confirming vitamin B12 deficiency anemia.

In this case, where the client presents with macrocytic (large) and hypochromic (pale) RBCs with low hemoglobin (Hgb) and hematocrit (Hct) levels and an elevated mean corpuscular volume (MCV) above 100 fL, a low serum vitamin B12 level would confirm the diagnosis.

Choice C rationale:

Serum homocysteine level can be elevated in cases of vitamin B12 deficiency, but it is not a specific test for confirming the diagnosis of vitamin B12 deficiency anemia.

It may be used as an additional marker, but it should not be the primary test for confirmation.

Choice D rationale:

Reticulocyte count measures the percentage of young, immature red blood cells in the blood and is not a specific test for confirming vitamin B12 deficiency anemia.

While anemia is present in this case, it does not provide direct information about the underlying cause, which is best confirmed by measuring serum vitamin B12 levels.

Choice A rationale:

Assessing vital signs is important for overall patient assessment, but it is not the most crucial aspect when identifying signs of pallor or jaundice.

Vital signs help in evaluating the patient's general condition and stability.

Choice B rationale:

Heart sounds are important for assessing cardiac function and may provide information on the patient's cardiovascular status, but they are not the most crucial aspect when identifying signs of pallor or jaundice.

Choice C rationale:

Lung sounds are essential for evaluating the respiratory status of the patient, but they do not directly help in identifying signs of pallor or jaundice.

Choice D rationale:

The correct choice is D.

When assessing a patient with suspected vitamin B12 deficiency anemia, it is crucial to examine the skin, mucous membranes, and eyes.

Pallor (pale skin) and jaundice (yellowing of the skin and eyes) are common signs of anemia, and these can be detected through the inspection of the skin, mucous membranes (such as the inside of the mouth), and the whites of the eyes (sclera)

These signs are indicative of an underlying health issue, and identifying them is essential for the diagnosis and management of anemia.

Choice A rationale:

Administering 500 mcg of cyanocobalamin intramuscularly daily for a week, then monthly for life is the appropriate route and dosage for a patient with pernicious anemia or severe malabsorption.

Intramuscular injection is the preferred route for patients with impaired absorption of vitamin B12, as it ensures direct absorption into the bloodstream.

The initial daily dose helps replenish depleted stores, and the monthly maintenance dose is required to prevent recurrence.

Choice B rationale:

Administering 1000 mcg of cyanocobalamin orally daily for a week, then weekly for a month, then monthly for life is not the best choice for patients with pernicious anemia or severe malabsorption.

Oral vitamin B12 is not effective in these cases because the underlying issue is the inability to absorb vitamin B12 from the gastrointestinal tract.

Intramuscular administration bypasses this problem.

Choice C rationale:

Administering 1000 mcg of cyanocobalamin intramuscularly daily for a week, then monthly for life is a reasonable option, but it is not as effective as the regimen described in choice A.

The initial daily dose is lower, and there is no weekly dosing phase to replenish stores quickly.

Choice D rationale:

Administering 2000 mcg of cyanocobalamin subcutaneously daily for a week, then monthly for life is not the preferred route for vitamin B12 supplementation in patients with pernicious anemia or severe malabsorption.

Intramuscular injection is the preferred route as it ensures better absorption, and subcutaneous injection may not be as effective.

Choice A rationale:

The nurse should encourage the client with vitamin B12 deficiency anemia to consume foods rich in vitamin B12.

Meat, poultry, fish, eggs, and fortified cereals are excellent sources of vitamin B12.

Including these foods in the diet can help increase vitamin B12 intake and support the treatment of the deficiency.

Choice B rationale:

Fruits and vegetables high in vitamin C are not directly related to increasing vitamin B12 intake.

Vitamin C is essential for iron absorption, but it does not provide vitamin B12.

Encouraging the consumption of vitamin C-rich foods is important for iron-deficiency anemia, not vitamin B12 deficiency anemia.

Choice C rationale:

Dairy products and nuts are not primary sources of vitamin B12.

While they offer other essential nutrients, they do not provide significant amounts of vitamin B12.

Therefore, they should not be the primary focus when trying to increase vitamin B12 intake.

Choice D rationale:

Foods high in iron and calcium, while important for overall health, are not the primary focus when addressing vitamin B12 deficiency anemia.

Iron and calcium-rich foods are more relevant to iron-deficiency anemia and bone health, respectively.

The primary focus for vitamin B12 deficiency anemia should be on foods rich in vitamin B12, as mentioned in choice A.

Choice A rationale:

Limit alcohol consumption is a crucial action to include in the client's self-care plan to prevent the recurrence of vitamin B12 deficiency anemia.

Excessive alcohol intake can interfere with the absorption of vitamin B12 in the body.

Alcohol can damage the lining of the stomach and the small intestine, where vitamin B12 is absorbed.

By limiting alcohol consumption, the client can improve their absorption of vitamin B12, reducing the risk of recurrence.

Choice C rationale:

Consuming foods high in vitamin C is another important action to prevent the recurrence of vitamin B12 deficiency anemia.

Vitamin C can enhance the absorption of vitamin B12 in the body.

Including vitamin C-rich foods in the diet can help improve the body's ability to absorb the vitamin B12 from dietary sources.

This is especially important for individuals who may have difficulty absorbing vitamin B12 due to underlying conditions.

Choice E rationale:

Monitoring for signs of infection is a relevant action in the self-care plan for preventing recurrence of vitamin B12 deficiency anemia.

Infections can lead to anemia by affecting the production of red blood cells.

By monitoring for signs of infection and promptly seeking medical treatment if any signs or symptoms arise, the client can reduce the risk of anemia caused or exacerbated by infections.

Choice B rationale:

Avoiding foods rich in vitamin B12 is not a recommended action for preventing the recurrence of vitamin B12 deficiency anemia.

In fact, it is counterproductive because the client with this deficiency should aim to increase their intake of vitamin B12-rich foods or supplements to correct the deficiency.

Choice D rationale:

Maintaining a diet low in iron is also not a recommended action for preventing the recurrence of vitamin B12 deficiency anemia.

Iron is essential for the production of red blood cells, and individuals with vitamin B12 deficiency anemia may have concurrent iron deficiency anemia.

Limiting iron intake can exacerbate the anemia and is not advisable.

Choice B rationale:

Treatment of underlying gastric disorders is an essential aspect of the client's treatment plan for vitamin B12 deficiency anemia when there are underlying gastric disorders contributing to the deficiency.

In such cases, the root cause of the deficiency is the impaired absorption of vitamin B12 due to gastric issues.

Simply providing vitamin B12 supplementation alone may not be effective because the absorption problem needs to be addressed.

Treating the underlying gastric disorders can improve the client's ability to absorb vitamin B12 from their diet or supplements, ultimately correcting the deficiency.

Choice A rationale:

Vitamin B12 supplementation alone may not be sufficient if there are underlying gastric disorders contributing to the deficiency.

While vitamin B12 supplementation is necessary to address the immediate deficiency, it does not address the root cause of the problem, which is the impaired absorption of vitamin B12 in the gastrointestinal tract.

Choice C rationale:

Intramuscular injections of iron are not indicated for the treatment of vitamin B12 deficiency anemia.

Iron is used to treat iron deficiency anemia, which is a separate condition from vitamin B12 deficiency anemia.

Using iron injections in a client with vitamin B12 deficiency anemia without iron deficiency could lead to iron overload and other complications.

Choice D rationale:

Folate supplementation is not the primary treatment for vitamin B12 deficiency anemia.

While folate (or folic acid) is essential for red blood cell production, it does not address the specific deficiency of vitamin B12.

Vitamin B12 and folate are related but distinct nutrients, and vitamin B12 supplementation is the primary treatment for vitamin B12 deficiency anemia.

Choice C rationale:

Regular blood tests to check hemoglobin and vitamin B12 levels should be prioritized to monitor the effectiveness of treatment for vitamin B12 deficiency anemia.

Monitoring hemoglobin levels can assess the improvement in anemia, while monitoring vitamin B12 levels can confirm that the deficiency is being adequately corrected.

Regular blood tests provide objective data on the client's response to treatment and help healthcare providers adjust the treatment plan if needed.

Choice A rationale:

Monitoring blood glucose levels is not a priority assessment for monitoring the effectiveness of treatment for vitamin B12 deficiency anemia.

While vitamin B12 deficiency can lead to neurological symptoms and affect glucose metabolism, the primary focus of monitoring in this context should be on anemia-related parameters, such as hemoglobin and vitamin B12 levels.

Choice B rationale:

Checking urine for protein is not a relevant assessment for monitoring the effectiveness of treatment for vitamin B12 deficiency anemia.

Proteinuria is a finding associated with kidney dysfunction and is not directly related to the evaluation of anemia or vitamin B12 deficiency.

Choice D rationale:

Measuring bone density is not a priority assessment for monitoring the effectiveness of treatment for vitamin B12 deficiency anemia.

Bone density assessment is typically used to evaluate bone health and the risk of osteoporosis, which is not a primary concern in the context of vitamin B12 deficiency anemia.

The focus should be on hematological parameters and neurological symptoms associated with the deficiency.