A client has been diagnosed with pernicious anemia. In planning care for the client, a nurse anticipates that the client will be treated with?

Appeared in: AIIMS Bhatinda NO - 2019

Explanation

Pernicious anemia is a type of megaloblastic anemia caused by the body's inability to absorb vitamin B12 from the diet.
This absorption failure is due to a lack of intrinsic factor, a protein secreted by the stomach that is necessary to bind and transport vitamin B12 for absorption in the ileum.
Because the problem is with absorption and not dietary intake, treatment requires bypassing the gastrointestinal tract.
The standard of care is lifelong replacement with vitamin B12, typically administered via intramuscular injection to ensure it enters the bloodstream directly.

Option A: Thiamine (vitamin B1) is not used to treat pernicious anemia. Its deficiency is associated with conditions like beriberi and Wernicke-Korsakoff syndrome, often seen in individuals with chronic alcoholism.
Option B: Iron supplements are used to treat iron-deficiency anemia, which results from inadequate dietary iron or chronic blood loss. Pernicious anemia is a vitamin B12 absorption problem, not an iron problem.
Option D: Administering folic acid alone to a patient with pernicious anemia is dangerous. While it can temporarily correct the megaloblastic anemia (the blood cell abnormalities), it does not address the underlying vitamin B12 deficiency. This masks the problem and allows irreversible neurological damage to progress.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pathophysiology and treatment of pernicious anemia to guide bedside assessment, documentation, and the next nursing action.
The cornerstone of nursing care for pernicious anemia is patient education about the necessity of lifelong vitamin B12 replacement therapy to prevent both anemia and permanent neurological damage.
Nurses must monitor for improvement in hematologic parameters and resolution of neurologic symptoms (e.g., paresthesia, ataxia) after initiating treatment.
What if? If a patient with an unconfirmed megaloblastic anemia is given folic acid, their anemia might improve, but if the underlying cause was B12 deficiency, they would be at high risk for developing severe, permanent nerve damage. This underscores the critical need for a correct differential diagnosis.

How to Approach the Question

First, identify the key diagnosis in the question stem: 'pernicious anemia'.
Recall the specific pathophysiology of this condition. The term 'pernicious' implies a harmful, insidious process, which is the autoimmune destruction of gastric parietal cells.
Connect this pathophysiology to its direct consequence: a lack of intrinsic factor, which is essential for absorbing vitamin B12.
Determine the logical treatment based on this defect. The therapy must replace the deficient substance (vitamin B12) and bypass the faulty absorption mechanism (e.g., via injection).
Evaluate the options. Thiamine and iron treat different deficiencies. Folic acid is a dangerous choice as it can mask the B12 deficiency while allowing neurological damage to worsen. This leaves vitamin B12 as the only correct answer.

Concept Tested & Keywords

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 139-141

Practise the full AIIMS Bhatinda NO - 2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.