HESI RN EXIT CASE STUDY: PERNICIOUS ANEMIA
COMPLETE WITH 2024 NGN QUESTIONS AND
ANSWERS VERIFIED / A+ GRADE
pernicious anemia case study
John Baker is a 45-year-old Caucasian male who was admitted to the medical-
surgical unit 6 hours ago from the Emergency Department due to nausea,
vomiting, shortness of breath, pallor, weakness, and severe fatigue. John is
divorced with no children and has been practicing law for 15 years. He also has
had a medical history of chronic gastric ulcers.
The nurse receives shift report and proceeds to Mr. Baker's room, bringing the
vital sign measurement equipment. Which vital sign should concern the nurse the
most?
Blood pressure is 142/80 mmHg.
Rationale: This elevated blood pressure indicates an underlying issue that must be
addressed.
The nurse asks Mr. Baker how he is feeling today. He reports that he does not
have time for this hospitalization. The nurse notes that he seems annoyed. He
coughs as he tries to sit up. He turns on the television, focuses on a news
station, and ignores the nurse.
Which type of assessment should the nurse perform on Mr. Baker?
A focused assessment.
Rationale: This assessment is for evaluating the status of specific previously identified
problems and any symptoms of new problems developing
Rationale:
The nurse performs a focused assessment. Which systems should the nurse
evaluate? (Select all that apply.)
Cardiovascular system.
Rationale: The client has hypertension and an elevated heart rate.
Respiratory system.
Rationale: The client has a cough.
The nurse finds that Mr. Baker has a weak, irregular, and rapid pulse and his
tongue is inflamed. The nurse decides to perform a neurological assessment
because of mild tremoring. His unexpected neurological findings included
hyperactive deep tendon reflexes and mild burning and prickling sensations on
his feet and hands. He also appears to startle easily, and he has lost about 15% of
his weight as compared to his last visit, which was four months ago.
During the assessment, the nurse suspects that the client may have pernicious
anemia. Which pathophysiological process promotes this condition?
Destruction of gastric parietal cells.
, Rationale:
Pernicious anemia is often associated with chronic gastritis. This is because destruction
of gastric parietal cells due to inflammation and cellular hypoxia causes gradual gastric
atrophy and a reduction of available intrinsic factor, which is a transporter molecule that
is required to promote the bioavailability of vitamin B12.
The nurse finished documenting the client interview and notices that new
laboratory results have been posted in the electronic health record. The nurse
notes that the serum magnesium level is 1.0 mEq/L (0.50 mmol/L), and the normal
range is 1.3 to 2.1 mEq/L (0.65 to 1.05 mmol/L). Which other result will need
intervention?
Potassium of 2.9 mEq/L (mmol/L).
Rationale:
This is a low serum potassium level; normal range is 3.5 to 5 mEq/L (mmol/L).
Which action is most important for the nurse to perform before calling the
healthcare provider to report the lab values?
Initiate telemetry.
Rationale: Although telemetry does require a healthcare provider's prescription, most
hospitals have a standing order in place for situations such as this one. Telemetry
placement is essential to protect the client from potential decompensation due to
cardiac dysrhythmias.
Which sign or diagnostic result should the nurse expect to observe in a client due
to hypokalemia?
A dampened or flattened T-wave on an ECG.
Rationale: A dampened or flattened T-wave on an ECG is an expected finding due to
hypokalemia. This is also the reason that the client must be placed on telemetry until
the hypokalemia is resolved.
Morning laboratory results have begun appearing in Mr. Baker's electronic health
record. Which electrolyte deficiency would make the nurse suspect that this
client may be suffering from chronic alcoholism?
Magnesium. .
Rationale: A magnesium deficit is consistent with the client's assessment findings, and it
is commonly associated with chronic alcoholism
The nurse assesses Mr. Baker's lifestyle choices to explore what resources he
has for health promotion. Which lifestyle choice may concern the nurse about a
client with possible chronic alcoholism?
He enjoys staying out all night at his favorite local bar.
Rationale: While the bar may provide social stimulation, it also provides access to
alcohol.
Mr. Baker is 45-years-old. Which life style choice is surprising given his
psychosocial developmental stage?
He enjoys staying out all night at his favorite local bar.
COMPLETE WITH 2024 NGN QUESTIONS AND
ANSWERS VERIFIED / A+ GRADE
pernicious anemia case study
John Baker is a 45-year-old Caucasian male who was admitted to the medical-
surgical unit 6 hours ago from the Emergency Department due to nausea,
vomiting, shortness of breath, pallor, weakness, and severe fatigue. John is
divorced with no children and has been practicing law for 15 years. He also has
had a medical history of chronic gastric ulcers.
The nurse receives shift report and proceeds to Mr. Baker's room, bringing the
vital sign measurement equipment. Which vital sign should concern the nurse the
most?
Blood pressure is 142/80 mmHg.
Rationale: This elevated blood pressure indicates an underlying issue that must be
addressed.
The nurse asks Mr. Baker how he is feeling today. He reports that he does not
have time for this hospitalization. The nurse notes that he seems annoyed. He
coughs as he tries to sit up. He turns on the television, focuses on a news
station, and ignores the nurse.
Which type of assessment should the nurse perform on Mr. Baker?
A focused assessment.
Rationale: This assessment is for evaluating the status of specific previously identified
problems and any symptoms of new problems developing
Rationale:
The nurse performs a focused assessment. Which systems should the nurse
evaluate? (Select all that apply.)
Cardiovascular system.
Rationale: The client has hypertension and an elevated heart rate.
Respiratory system.
Rationale: The client has a cough.
The nurse finds that Mr. Baker has a weak, irregular, and rapid pulse and his
tongue is inflamed. The nurse decides to perform a neurological assessment
because of mild tremoring. His unexpected neurological findings included
hyperactive deep tendon reflexes and mild burning and prickling sensations on
his feet and hands. He also appears to startle easily, and he has lost about 15% of
his weight as compared to his last visit, which was four months ago.
During the assessment, the nurse suspects that the client may have pernicious
anemia. Which pathophysiological process promotes this condition?
Destruction of gastric parietal cells.
, Rationale:
Pernicious anemia is often associated with chronic gastritis. This is because destruction
of gastric parietal cells due to inflammation and cellular hypoxia causes gradual gastric
atrophy and a reduction of available intrinsic factor, which is a transporter molecule that
is required to promote the bioavailability of vitamin B12.
The nurse finished documenting the client interview and notices that new
laboratory results have been posted in the electronic health record. The nurse
notes that the serum magnesium level is 1.0 mEq/L (0.50 mmol/L), and the normal
range is 1.3 to 2.1 mEq/L (0.65 to 1.05 mmol/L). Which other result will need
intervention?
Potassium of 2.9 mEq/L (mmol/L).
Rationale:
This is a low serum potassium level; normal range is 3.5 to 5 mEq/L (mmol/L).
Which action is most important for the nurse to perform before calling the
healthcare provider to report the lab values?
Initiate telemetry.
Rationale: Although telemetry does require a healthcare provider's prescription, most
hospitals have a standing order in place for situations such as this one. Telemetry
placement is essential to protect the client from potential decompensation due to
cardiac dysrhythmias.
Which sign or diagnostic result should the nurse expect to observe in a client due
to hypokalemia?
A dampened or flattened T-wave on an ECG.
Rationale: A dampened or flattened T-wave on an ECG is an expected finding due to
hypokalemia. This is also the reason that the client must be placed on telemetry until
the hypokalemia is resolved.
Morning laboratory results have begun appearing in Mr. Baker's electronic health
record. Which electrolyte deficiency would make the nurse suspect that this
client may be suffering from chronic alcoholism?
Magnesium. .
Rationale: A magnesium deficit is consistent with the client's assessment findings, and it
is commonly associated with chronic alcoholism
The nurse assesses Mr. Baker's lifestyle choices to explore what resources he
has for health promotion. Which lifestyle choice may concern the nurse about a
client with possible chronic alcoholism?
He enjoys staying out all night at his favorite local bar.
Rationale: While the bar may provide social stimulation, it also provides access to
alcohol.
Mr. Baker is 45-years-old. Which life style choice is surprising given his
psychosocial developmental stage?
He enjoys staying out all night at his favorite local bar.
