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?

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

Explanation

Vitamin B12 is essential for neurological function, DNA synthesis, and the formation of red blood cells.
Natural dietary sources of Vitamin B12 are almost exclusively from animal products, such as meat, fish, eggs, and dairy.
A strict vegan diet, which excludes all animal products, places an individual at a high risk for Vitamin B12 deficiency if they do not consume fortified foods or take supplements.
Adolescence is a period of rapid growth, increasing the demand for essential nutrients, which elevates the risk of deficiency in a malnourished state.

Option A: Vitamin A is incorrect because its precursor, beta-carotene, is widely available in many colorful plant-based foods like carrots, sweet potatoes, and leafy greens. A varied vegan diet can typically provide sufficient amounts.
Option C: Vitamin C is incorrect as it is abundant in many fruits and vegetables (e.g., citrus fruits, berries, bell peppers), which are staples of most vegan diets. Deficiency is extremely rare in this population.
Option D: Vitamin K is incorrect. It is found in high amounts in green leafy vegetables like kale, spinach, and broccoli. It is also synthesized by beneficial bacteria in the human gut. A vegan diet is typically rich in sources of Vitamin K.

Visual 1: Infographic: A chart showing common nutrient deficiencies in various diets (vegan, vegetarian, omnivore) and listing plant-based vs. animal-based sources for each nutrient.
Visual 2: Diagram: Illustration of megaloblastic anemia, showing large, immature red blood cells, a hallmark of Vitamin B12 deficiency.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nutritional deficiencies associated with a vegan diet to guide bedside assessment, documentation, and the next nursing action.
Nurses must educate clients on vegan diets about the critical need for Vitamin B12 supplementation or consumption of B12-fortified foods (like nutritional yeast, plant milks, and cereals) to prevent irreversible neurological damage and anemia.
When assessing a client with a vegan diet, the nurse should specifically ask about their intake of fortified foods and supplements, not just their general dietary pattern.
What if the client was an ovo-lacto-vegetarian (eats eggs and dairy)? The risk of B12 deficiency would be significantly lower, as eggs and dairy are good sources of Vitamin B12. However, intake should still be monitored to ensure it is adequate.

How to Approach the Question

First, identify the key elements of the question: the client is a 'malnourished adolescent' on a 'vegan diet'. The question asks for the most specific vitamin deficiency to assess.
Recall the definition of a vegan diet: it excludes all animal products (meat, dairy, eggs, fish).
Systematically review the dietary sources of each vitamin listed in the options.
Analyze Vitamin A, C, and K: Recognize that these are all readily available from plant sources (fruits and vegetables).
Analyze Vitamin B12: Recall that Vitamin B12 is unique because its natural, bioavailable sources are almost exclusively animal-based.
Conclude that the exclusion of all animal products in a vegan diet creates a direct and high risk for Vitamin B12 deficiency, making it the most important and specific deficiency to assess for in this scenario.

Concept Tested & Keywords

Concept Tested: Nutritional deficiencies associated with a vegan diet
Stem keywords: malnourished adolescent, vegan diet, vitamin deficiency
Lead-in keywords: specific vitamin deficiency
Clinical cues: The combination of 'malnourished' and 'vegan diet' strongly points towards a deficiency of a nutrient not found in plants.
Negative lead-in flag: false

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Practise the full NORCET 5 Prelims - Sept 2023 (Shift-2)

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