The nurse notes that a patient has a smooth and shiny tongue surface.
The nurse would attribute these findings to which condition?

Choice A rationale:

Increased bilirubin levels can occur in thalassemia major due to the destruction of red blood cells, leading to elevated bilirubin, which is a breakdown product of hemoglobin. This elevation can contribute to jaundice and other symptoms.

Choice B rationale:

Thalassemia major leads to the destruction of red blood cells, causing the bone marrow to release more reticulocytes (immature red blood cells) into the bloodstream. Therefore, an increased reticulocyte level is expected in thalassemia major.

Choice C rationale:

Increased mean corpuscular volume (MCV) is not a typical finding in thalassemia major. Thalassemia major is characterized by microcytic (smaller than normal) red blood cells, leading to a decreased MCV.

Choice D rationale:

Thalassemia major causes increased iron absorption by the intestines, leading to elevated total iron-binding capacity (TIBC) TIBC measures the body's capacity to bind and transport iron in the blood, and elevated levels are seen in conditions with increased iron demand, such as thalassemia major.

Choice A rationale:

Neutropenia is a condition characterized by a low number of neutrophils, a type of white blood cell. Neutropenic patients are at increased risk of infections, but neutropenia does not cause specific changes in the tongue surface. The smooth and shiny tongue surface described in the question is not indicative of neutropenia.

Choice B rationale:

Polycythemia is a condition characterized by an abnormally high concentration of hemoglobin in the blood. It can cause the skin to appear reddish or flushed, but it does not directly cause changes in the tongue surface such as smoothness and shininess.

Choice C rationale:

Pernicious anemia is a type of anemia caused by a deficiency of vitamin B12, which is essential for the formation of red blood cells and the maintenance of the nervous system. One of the characteristic signs of pernicious anemia is glossitis, which is inflammation of the tongue that can make the tongue appear smooth and shiny. This finding aligns with the description provided in the question.

Choice D rationale:

Elevated estrogen levels can cause changes in the skin, such as increased pigmentation or the development of spider veins, but they do not directly cause changes in the tongue surface as described in the question.