A nurse is assessing a malnourished adolescent who has been consuming a vegan diet. For signs of which specific vitamin deficiency should the nurse assess this client?

1. A

   Vitamin A

2. B

   Vitamin B12

3. C

   Vitamin C

4. D

   Vitamin K

Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-2)

Explanation

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• Vitamin B12 is the correct answer because its natural sources are exclusively animal products like meat, dairy, and eggs.
• A vegan diet, which strictly excludes all animal products, provides no natural source of Vitamin B12.
• Adolescence is a period of rapid growth with high nutritional requirements, making a deficiency more likely and more impactful.
• Deficiency can lead to severe and irreversible neurological damage and megaloblastic anemia, making assessment critical.
• Unlike other vitamins, B12 must be obtained from fortified foods or supplements in a vegan diet.

Why Other Options Were Wrong

• Option A: Vitamin A deficiency is unlikely. The body can convert beta-carotene, found abundantly in many colorful fruits and vegetables (like carrots, sweet potatoes, and spinach) that are common in vegan diets, into Vitamin A.
• Option C: Vitamin C deficiency is highly improbable in a vegan. Vegan diets are typically rich in fruits and vegetables (like citrus fruits, berries, and bell peppers), which are the primary sources of Vitamin C.
• Option D: Vitamin K is readily available in a vegan diet. Its main sources are green leafy vegetables (like kale, spinach, and broccoli), and it is also synthesized by bacteria in the human gut.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Nutritional deficiencies associated with vegan diets to guide bedside assessment, documentation, and the next nursing action.
• Nurses play a vital role in dietary assessment and patient education. It is essential to ask about specific dietary practices like veganism, especially in vulnerable populations like adolescents.
• Patient education should include clear guidance on reliable sources of Vitamin B12 for vegans, such as fortified plant milks, fortified cereals, nutritional yeast, or direct supplementation.
• Monitoring for early signs of B12 deficiency, such as fatigue, weakness, pallor (from anemia), and neurological symptoms like tingling or numbness, is a key nursing responsibility.

How to Approach the Question

• First, identify the key elements of the clinical scenario: the patient is an 'adolescent', is 'malnourished', and follows a 'vegan diet'.
• Recall the fundamental principles of a vegan diet, which is the complete exclusion of all animal products.
• Consider the major nutrients that are primarily or exclusively derived from animal sources. Vitamin B12 should immediately come to mind.
• Evaluate each option based on its dietary sources. Ask yourself: 'Can a person get this vitamin from plants?'
• For Vitamin A, C, and K, the answer is 'yes' (from beta-carotene, fruits/veg, and leafy greens, respectively).
• For Vitamin B12, the answer is 'no'. This makes it the most likely deficiency in a strictly vegan diet.

Concept Tested & Keywords

• Concept Tested: Nutritional deficiencies associated with vegan diets
• Stem keywords: malnourished adolescent, vegan diet, vitamin deficiency
• Lead-in keywords: specific vitamin deficiency
• Clinical cues: The combination of 'adolescent' and 'malnourished' highlights a period of high nutritional demand coupled with inadequate intake, increasing the risk of deficiency.

Question ID

Q_x5VtOYL2QZ8CEydypIVa

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 463-465

E6 Medicine Davidson Principles Practice 24e p. 732-734