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.
Rationale: Regularly staying out all night is the behavior of someone younger who is seeking intimacy.
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.
Rationale: Regularly staying out all night is the behavior of someone younger who is seeking intimacy.
