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A new look at vitamin B12 deficiency

doi: 10.1097/01.NPR.0000363589.59740.26
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INSTRUCTIONS A new look at vitamin B12 deficiency

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PROVIDER ACCREDITATION

Lippincott Williams & Wilkins, publisher of The Nurse Practitioner journal, will award 2.5 contact hours for this continuing nursing education activity.

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A new look at vitamin B12 deficiency

General Purpose: To familiarize the NP with the recognition and treatment of vitamin B12 deficiency. Learning Objectives: After reading the preceding article and completing the following test, the you will be able to: 1. Discuss the pathophysiology, signs, and symptoms of vitamin B12 deficiency. 2. Explain the diagnostic process and treatment options for vitamin B12 deficiency.

1. Vitamin B12 deficiency occurs in what percentage of the elderly?

a. 5% to 20%

b. 25% to 40%

c. 45% to 60%

d. 65% to 80%

2. The most common cause of vitamin B12 deficiency is

a. pernicious anemia.

b. food malabsorption.

c. alcohol abuse.

d. insufficient dietary intake.

3. Vitamin B12 and which additional substance are both required for DNA synthesis?

a. folic acid

b. homocysteine

c. MMA

d. intrinsic factor

4. Vitamin B12 is derived from

a. green leafy vegetables.

b. fresh or canned fruits.

c. whole wheat products.

d. meat and dairy products.

5. Vitamin B12 deficiency due to decreased absorption can be the result of

a. a strict vegetarian diet.

b. chronic malnutrition.

c. Crohn's disease.

d. chronic pancreatitis.

6. Gastric bypass surgery may lead to vitamin B12 deficiency due to

a. limited oral intake.

b. autoimmune gastric binding.

c. reduced vitamin B12 stores in the liver.

d. lack of intrinsic factor.

7. The most common feature of vitamin B12 deficiency is

a. pernicious anemia.

b. megaloblastic anemia.

c. malnutrition.

d. chronic fatigue syndrome.

8. Signs and symptoms of anemia include

a. fatigue, dyspnea, and pallor.

b. fever, palpitations, and pallor.

c. hypertension, listlessness, and anorexia.

d. fatigue, palpitations, and hypoventilation.

9. Neurologic manifestations of vitamin B12 deficiency include

a. blurred vision.

b. paralysis of the upper extremities.

c. numbness of the lower extremities.

d. hypersensitivity to cold.

10. GI manifestations of vitamin B12 deficiency include

a. weight gain.

b. bad breath.

c. anorexia.

d. sore tongue.

11. Because of potential for irreversible neurologic symptoms, patients with megaloblastic anemia should be tested for both vitamin B12 and

a. MMA.

b. intrinsic factor.

c. homocysteine.

d. folate.

12. A sensitive and early indicator of vitamin B12 deficiency is

a. elevated MMA level.

b. decreased homocysteine level.

c. deficiency of intrinsic factor.

d. elevated folate level.

13. The intrinsic factor blocking antibody test is used to identify

a. antibodies that prevent vitamin B12 from binding with intrinsic factor.

b. malabsorption of vitamin B12 in the ileum.

c. deficiency of intrinsic factor.

d. lack of vitamin B12 intake.

14. The intrinsic factor blocking antibody test is

a. not specific but has a sensitivity of 50%.

b. fairly specific and has a sensitivity of 50%.

c. fairly specificand has a sensitivity of 75%.

d. highly specific and has a sensitivity of 75%.

15. Serum vitamin B12 level screening isleastlikely to be needed by persons

a. living in a psychiatric facility.

b. who have had small bowel surgery.

c. who eat fortified cereal daily.

d. committed to a vegan diet.

16. Factors that may cause false vitamin B12 deficiency include allexcept

a. myeloma.

b. anticonvulsant therapy.

c. oral contraceptives.

d. long-term proton pump inhibitor therapy.

17. Which statement is true about pernicious anemia therapy?

a. It requires I.M. vitamin B12 injections.

b. Vitamin B12 therapy via nasal gel is now available.

c. Oral supplements do not provide sufficient vitamin B12.

d. The appropriate initial vitamin B12 dose is 1,500 mcg/day I.M. for 1 week.

18. The potential for vitamin B12 toxicity is

a. high in pregnant women but low in other populations.

b. low in the elderly but high in children.

c. high in all populations.

d. low in all populations.

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