Which finding most concerns the nurse that the client has pernicious anemia?
1. The client takes a daily antacid tablet.
2. Report of tingling and hand clumsiness
3. B12 level 300 pg/mL
4. Bowel movement frequency is every three days.
2. Report of tingling and hand clumsiness
Explanation: 1. Acid-blocking medications can contribute to pernicious anemia, particularly in the older client who has a decrease in hydrochloric acid and intrinsic factor production. The nurse would carefully assess based on this.
2. Symptoms of B12 (cobalamin) deficiency include neuropathies, paresthesias, and cognitive impairment. MCV will be greater than 100 fL and B12 level will be less than 150 pg/mL for most clients with pernicious anemia.
3. Pernicious anemia results when an older person lacks the needed intrinsic factor to absorb vitamin B12. A more common cause of low serum vitamin B12 results from the inability to split vitamin B12 from proteins in food. This inability may be the result of a deficiency of hydrochloric acid. Levels lower than 150 pg/mL are diagnostic for pernicious anemia.
4. Decreased peristalsis in the gastrointestinal tract is not related to the older client's developing of pernicious anemia.
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