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Pathophysiology of the Hematologic System > Pathophysiology

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Anemia

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Question 1:

A nurse is assessing a client with iron-deficiency anemia.
Which statement by the client is indicative of their condition?

A. "I've been experiencing frequent nosebleeds lately.” B. "I've been eating a lot of leafy greens in my diet.” C. "I've had a fever for the past week.” D. "I've been feeling more energetic than usual.”

Answer and Explanation

Choice A:

The client's statement, "I've been experiencing frequent nosebleeds lately," is indicative of iron-deficiency anemia. Iron is essential for the formation of hemoglobin, which carries oxygen in red blood cells. When there is a deficiency of iron, the blood vessels in the nose can become fragile, leading to frequent nosebleeds. This is a common symptom of iron-deficiency anemia.

Choice B:

The client's statement, "I've been eating a lot of leafy greens in my diet," is not indicative of iron-deficiency anemia. In fact, consuming leafy greens is a good dietary source of iron, which can help prevent iron deficiency.

Choice C:

The client's statement, "I've had a fever for the past week," is not indicative of iron-deficiency anemia. Fever is typically associated with infections or inflammatory conditions, not anemia.

Choice D:

The client's statement, "I've been feeling more energetic than usual," is not indicative of iron-deficiency anemia. In fact, one of the hallmark symptoms of iron-deficiency anemia is fatigue and a lack of energy due to reduced oxygen-carrying capacity in the blood.

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Question 2:

A nurse is educating a client about the etiology of iron-deficiency anemia.
Which statement by the nurse is accurate regarding iron absorption?

A. "Iron absorption can be impaired by consuming green leafy vegetables.” B. "Inadequate iron intake is usually caused by chronic diseases.” C. "Iron is primarily obtained from recycling old red blood cells.” D. "Excessive iron loss can occur due to pregnancy and lactation.”

Answer and Explanation

Choice A:

The nurse's statement, "Iron absorption can be impaired by consuming green leafy vegetables," is not accurate. Green leafy vegetables contain non-heme iron, which is less readily absorbed than heme iron found in animal products. However, they do not impair iron absorption.

Choice B:

The nurse's statement, "Inadequate iron intake is usually caused by chronic diseases," is not accurate. Inadequate iron intake is typically caused by dietary factors, such as a lack of iron-rich foods in the diet. Chronic diseases can lead to anemia, but they do so by affecting the body's utilization of iron, not by causing inadequate intake.

Choice D:

The nurse's statement, "Excessive iron loss can occur due to pregnancy and lactation," is partially accurate. Pregnancy and lactation can lead to increased iron requirements, but they do not directly cause excessive iron loss. Iron loss through menstruation is a more common cause of iron deficiency in women.

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Question 3:

A nurse is teaching a group of clients about different types of anemia.
Select all the types of anemia that are characterized by RBCs that are smaller than normal.

A. Microcytic anemia. B. Normocytic anemia. C. Macrocytic anemia. D. Anisocytosis. E. Poikilocytosis.

Answer and Explanation

Choice A:

Microcytic anemia is characterized by red blood cells (RBCs) that are smaller than normal. This can occur in conditions like iron-deficiency anemia and thalassemia, where there is impaired hemoglobin production or insufficient iron for RBC formation.

Choice B:

Normocytic anemia is characterized by RBCs that are of normal size. This can occur in various conditions, including chronic diseases like chronic kidney disease and some types of anemia of chronic inflammation.

Choice C:

Macrocytic anemia is characterized by RBCs that are larger than normal. This can be seen in conditions like megaloblastic anemia, which is often caused by vitamin B12 or folate deficiency.

Choice D:

Anisocytosis refers to a condition where RBCs are of unequal sizes. While it is not a specific type of anemia, anisocytosis can be seen in various types of anemia, including iron-deficiency anemia, as RBCs may vary in size due to different stages of development.

Choice E:

Poikilocytosis refers to a condition where RBCs have abnormal shapes. Like anisocytosis, poikilocytosis is not a specific type of anemia but can be observed in various anemias, including sickle cell anemia, where RBCs take on a characteristic crescent shape.

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Question 4:

A nurse is caring for a client with anemia due to increased RBC destruction.
What condition might have caused this type of anemia in the client?

A. Iron deficiency. B. Vitamin B12 deficiency. C. Autoimmune disease. D. Bone marrow disorder.

Answer and Explanation

Choice A:

Iron deficiency Iron deficiency anemia is characterized by a decrease in the body's iron stores, which results in reduced hemoglobin synthesis and decreased oxygen-carrying capacity of red blood cells (RBCs) This condition is typically caused by insufficient dietary iron intake, malabsorption of iron, or blood loss, but it does not involve increased RBC destruction. Therefore, iron deficiency is not the correct choice for the cause of anemia in this client.

Choice B:

Vitamin B12 deficiency Vitamin B12 deficiency can lead to a type of anemia known as megaloblastic anemia, which is characterized by larger-than-normal RBCs and inadequate hemoglobin production. However, this condition is not typically associated with increased RBC destruction. Vitamin B12 deficiency anemia is usually caused by inadequate dietary intake, malabsorption, or certain medical conditions affecting vitamin B12 absorption, but it does not fit the scenario described in the question. Therefore, vitamin B12 deficiency is not the correct choice for the cause of anemia in this client.

Choice C:

Autoimmune disease (Correct Choice) Autoimmune diseases can lead to hemolytic anemias, a group of disorders characterized by the premature destruction of RBCs by the immune system. In these conditions, the immune system mistakenly recognizes RBCs as foreign invaders and targets them for destruction. This process results in anemia due to increased RBC destruction. Conditions such as autoimmune hemolytic anemia (AIHA) and autoimmune thrombocytopenic purpura (ITP) are examples of autoimmune diseases that can cause hemolytic anemia. Therefore, autoimmune disease is the correct choice for the cause of anemia in this client.

Choice D:

Bone marrow disorder Bone marrow disorders, such as aplastic anemia or myelodysplastic syndrome, can lead to anemia by affecting the production of RBCs in the bone marrow. However, these disorders do not typically involve increased RBC destruction. Instead, they result in a decreased production of RBCs, leading to anemia. Therefore, a bone marrow disorder is not the correct choice for the cause of anemia in this client.

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Question 5:

A client with anemia presents with symptoms of fatigue, shortness of breath, and headache.
What is the most likely reason for these symptoms in the client?

A. Increased oxygen-carrying capacity of the blood. B. Tissue hypoxia. C. Excessive iron intake. D. Enhanced immune function.

Answer and Explanation

Choice A:

Increased oxygen-carrying capacity of the blood Increased oxygen-carrying capacity of the blood would not result in symptoms of fatigue, shortness of breath, and headache. In fact, having more oxygen-carrying capacity would be expected to improve oxygen delivery to tissues, which would not cause these symptoms. Therefore, this choice is not the correct reason for the client's symptoms.

Choice B:

Tissue hypoxia (Correct Choice) Anemia is characterized by a decreased concentration of hemoglobin in the blood, which leads to reduced oxygen-carrying capacity. As a result, tissues and organs may not receive an adequate supply of oxygen, leading to symptoms such as fatigue, shortness of breath, and headache. Tissue hypoxia is the most likely reason for these symptoms in a client with anemia, as the body struggles to meet its oxygen demands due to the decreased hemoglobin levels.

Choice C:

Excessive iron intake Excessive iron intake would not typically cause the symptoms of fatigue, shortness of breath, and headache. Instead, excessive iron intake can lead to iron overload, which may result in gastrointestinal symptoms, liver damage, and other complications. It is not a likely cause of anemia-related symptoms in this context.

Choice D:

Enhanced immune function Enhanced immune function would not be a direct cause of symptoms like fatigue, shortness of breath, and headache in a client with anemia. While anemia can weaken the immune system to some extent, it does not lead to enhanced immune function that would result in these particular symptoms. Therefore, this choice is not the correct reason for the client's symptoms.

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Question 6:

A nurse is assessing a client with suspected iron-deficiency anemia.
The client reports feeling fatigued and weak.
Which of the following clinical manifestations are consistent with iron-deficiency anemia in this client?

A. "My tongue has been inflamed lately.” B. "I have a craving for ice all the time.” C. "I've been experiencing chest pain.” D. "I often faint when I stand up.”

Answer and Explanation

Choice A:

"My tongue has been inflamed lately." Inflammation of the tongue, a condition known as glossitis, can be a clinical manifestation of iron-deficiency anemia. When the body lacks sufficient iron, it may not produce enough hemoglobin, which can lead to changes in the appearance and texture of the tongue. Glossitis can cause the tongue to become red, swollen, and sore. This symptom is consistent with iron-deficiency anemia.

Choice B:

"I have a craving for ice all the time." Pica, which involves cravings for non-nutritive substances like ice, is a classic symptom of iron-deficiency anemia. While the exact cause of pica in iron deficiency is not fully understood, it is considered a manifestation of the body's attempt to obtain more iron. This unusual craving for ice or other non-food items is a significant indicator of iron-deficiency anemia.

Choice C:

"I've been experiencing chest pain." Chest pain is not a typical manifestation of iron-deficiency anemia. Instead, it may be associated with other cardiovascular or respiratory conditions. Iron-deficiency anemia primarily affects the blood's oxygen-carrying capacity and may lead to symptoms such as fatigue, pallor, weakness, and shortness of breath, but chest pain is not a direct consequence of this type of anemia.

Choice D:

"I often faint when I stand up." Fainting upon standing up may be indicative of orthostatic hypotension, which can occur in various medical conditions but is not a specific symptom of iron-deficiency anemia. Iron-deficiency anemia can lead to weakness and dizziness, but fainting when changing positions may suggest other factors, such as blood pressure regulation issues.

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Question 7:

A nurse is caring for a client diagnosed with iron-deficiency anemia.
The client's laboratory results show a low hemoglobin level and microcytic, hypochromic red blood cells on the peripheral blood smear.
What other laboratory findings are consistent with iron-deficiency anemia in this client?

A. "My serum iron levels are within the normal range.” B. "My transferrin saturation is above 20%.” C. "My serum ferritin is significantly elevated.” D. "My MCV and MCHC are both within the normal range.”

Answer and Explanation

Choice A:

Elevated serum iron levels are not consistent with iron-deficiency anemia. Iron-deficiency anemia is characterized by low serum iron levels, as the body lacks sufficient iron to produce hemoglobin. In this case, the client mentions that their serum iron levels are within the normal range, which does not align with the typical findings of iron-deficiency anemia.

Choice B:

Transferrin saturation measures the amount of iron bound to transferrin in the blood. In iron-deficiency anemia, transferrin saturation is typically below 20% because there is insufficient iron available for binding to transferrin. Therefore, the statement that "My transferrin saturation is above 20%" is inconsistent with the diagnosis of iron-deficiency anemia.

Choice C:

Serum ferritin is a key indicator of iron stores in the body. In iron-deficiency anemia, serum ferritin levels are significantly decreased because the body has depleted its iron stores to maintain essential functions like hemoglobin synthesis. Therefore, the statement "My serum ferritin is significantly elevated" contradicts the typical laboratory findings of iron-deficiency anemia.

Choice D:

The mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC) are both red blood cell indices. In iron-deficiency anemia, these indices are often decreased, resulting in microcytic (small) and hypochromic (pale) red blood cells. Therefore, the statement "My MCV and MCHC are both within the normal range" does not align with the characteristic findings of iron-deficiency anemia.

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Question 8:

A nurse is educating a group of clients about iron-deficiency anemia.
Which of the following factors should the nurse include as potential causes of iron-deficiency anemia? (Select all that apply.)

A. Chronic gastrointestinal bleeding. B. High serum iron levels. C. Inadequate dietary intake of iron. D. Elevated serum ferritin levels. E. Increased erythropoietic activity.

Answer and Explanation

Choice A:

Chronic gastrointestinal bleeding is a common cause of iron-deficiency anemia. Blood loss from the gastrointestinal tract leads to the loss of iron, ultimately depleting iron stores in the body and impairing hemoglobin synthesis.

Choice B:

High serum iron levels are not a potential cause of iron-deficiency anemia. Iron-deficiency anemia is characterized by low serum iron levels, as the body lacks sufficient iron to produce hemoglobin.

Choice C:

Inadequate dietary intake of iron can lead to iron-deficiency anemia, especially in individuals who do not consume enough iron-rich foods. A lack of dietary iron can result in reduced iron absorption and insufficient iron stores in the body.

Choice D:

Elevated serum ferritin levels are not a potential cause of iron-deficiency anemia. In fact, elevated serum ferritin levels are more indicative of iron overload conditions rather than iron deficiency.

Choice E:

Increased erythropoietic activity can be a compensatory response to iron-deficiency anemia. When the body senses low oxygen-carrying capacity due to reduced hemoglobin levels, it may increase erythropoietin production, leading to the production of more red blood cells (erythropoiesis) in an attempt to improve oxygen delivery to tissues.

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Question 9:

A nurse is reviewing the laboratory results of a client suspected to have iron-deficiency anemia.
Which of the following findings would confirm the diagnosis of iron-deficiency anemia?

A. High serum iron levels and low TIBC. B. High MCV and MCH. C. Low hemoglobin and low hematocrit. D. Elevated MCHC and low RDW.

Answer and Explanation

Choice A:

High serum iron levels and low total iron-binding capacity (TIBC) are not indicative of iron-deficiency anemia. In this scenario, elevated serum iron levels contradict the typical finding of low serum iron levels in iron-deficiency anemia.

Choice B:

High mean corpuscular volume (MCV) and high mean corpuscular hemoglobin (MCH) are not consistent with the characteristic findings of iron-deficiency anemia. Iron-deficiency anemia typically results in microcytic (small) and hypochromic (pale) red blood cells, leading to low MCV and low MCH.

Choice C:

Low hemoglobin and low hematocrit are consistent with the diagnosis of iron-deficiency anemia. In this condition, there is insufficient iron available to produce hemoglobin, leading to decreased hemoglobin levels and reduced hematocrit.

Choice D:

Elevated mean corpuscular hemoglobin concentration (MCHC) and low red cell distribution width (RDW) are not typical findings of iron-deficiency anemia. Iron-deficiency anemia is characterized by hypochromic (pale) red blood cells and often results in increased RDW due to variability in red cell size (anisocytosis) Elevated MCHC is not expected in iron-deficiency anemia.

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Question 10:

A client with suspected iron-deficiency anemia is undergoing diagnostic evaluation.
The nurse observes that the client has pallor and spoon-shaped nails.
Which additional clinical manifestation should the nurse expect to assess in this client?

A. Restless legs syndrome. B. High transferrin saturation. C. Normal white blood cell count. D. Elevated serum iron levels.

Answer and Explanation

Choice A:

Restless legs syndrome is not typically associated with iron-deficiency anemia. The hallmark clinical manifestations of iron-deficiency anemia include pallor, spoon-shaped nails (koilonychia), fatigue, weakness, and cold intolerance. Restless legs syndrome is characterized by uncomfortable sensations in the legs and an irresistible urge to move them, which is unrelated to iron-deficiency anemia.

Choice B:

High transferrin saturation is not an expected clinical manifestation of iron-deficiency anemia. In fact, iron-deficiency anemia is characterized by a decrease in transferrin saturation. Transferrin saturation is a measure of the iron-carrying capacity of transferrin in the blood. In iron-deficiency anemia, the body struggles to adequately transport iron, leading to low transferrin saturation.

Choice C:

Normal white blood cell count is not a typical clinical manifestation of iron-deficiency anemia. Iron-deficiency anemia primarily affects red blood cells and their ability to carry oxygen. While anemia may lead to fatigue and weakness, it does not directly impact white blood cell counts.

Choice D:

Elevated serum iron levels are not expected in iron-deficiency anemia. In fact, iron-deficiency anemia is characterized by low serum iron levels due to insufficient iron stores in the body. Elevated serum iron levels may be seen in other types of anemia or conditions, but they are not a hallmark of iron-deficiency anemia.

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Question 11:

A nurse is assessing a patient with iron-deficiency anemia.
Which components should be included in the nursing assessment for this patient?

A. Review of the results of the CBC with differential and peripheral blood smear. B. Monitoring the patient's vital signs and oxygen saturation. C. Administering iron supplements as prescribed. D. Providing emotional support and counseling to the patient and family members.

Answer and Explanation

Choice A:

Review of the results of the CBC (Complete Blood Count) with differential and peripheral blood smear is essential in assessing a patient with iron-deficiency anemia. The CBC provides information about hemoglobin levels, hematocrit, mean corpuscular volume (MCV), and red blood cell indices, which are crucial in diagnosing and monitoring anemia. A peripheral blood smear can help identify the characteristic microcytic and hypochromic red blood cells seen in iron-deficiency anemia.

Choice B:

Monitoring the patient's vital signs and oxygen saturation is essential in the assessment of a patient with iron-deficiency anemia. Anemia can lead to reduced oxygen-carrying capacity in the blood, potentially causing symptoms such as shortness of breath and tachycardia. Monitoring vital signs and oxygen saturation helps assess the patient's response to anemia and the need for oxygen supplementation.

Choice C:

Administering iron supplements as prescribed is a nursing intervention rather than a component of the nursing assessment. While it is important for the management of iron-deficiency anemia, the assessment phase involves gathering data about the patient's condition, not implementing interventions.

Choice D:

Providing emotional support and counseling to the patient and family members is a crucial component of nursing care for patients with iron-deficiency anemia. Anemia can have a significant impact on a patient's quality of life, causing fatigue, weakness, and emotional distress. Offering emotional support and education to the patient and family members helps them cope with the condition and its management.

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Question 12:

A client with iron-deficiency anemia is prescribed iron supplements.
What should the nurse teach the client about taking iron supplements correctly?

A. "You should take iron supplements with dairy products to enhance absorption.” B. "It's best to take iron supplements on an empty stomach.” C. "You can take iron supplements with antacids to reduce gastrointestinal side effects.” D. "Iron supplements should be taken with a large meal to improve effectiveness.”

Answer and Explanation

Choice A:

Taking iron supplements with dairy products is not recommended for optimal iron absorption. Calcium, present in dairy products, can inhibit the absorption of iron. Therefore, it is best to take iron supplements separately from dairy products.

Choice B:

Taking iron supplements on an empty stomach is the correct recommendation. Iron absorption is enhanced when the supplements are taken on an empty stomach. However, some individuals may experience gastrointestinal discomfort when taking iron on an empty stomach. In such cases, it can be taken with a small amount of food that does not contain dairy products or high in calcium.

Choice C:

Taking iron supplements with antacids is not recommended to reduce gastrointestinal side effects. Antacids containing calcium can interfere with iron absorption, potentially worsening the anemia. Therefore, it is best to avoid taking iron supplements with antacids.

Choice D:

Taking iron supplements with a large meal is not the most effective way to improve their effectiveness. In fact, taking iron supplements with a large meal can decrease iron absorption due to competition with other nutrients. It is generally recommended to take iron supplements on an empty stomach or with a small, iron-friendly snack if gastrointestinal discomfort occurs.

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Question 13:

(Select all that apply):
A nurse is caring for a patient with iron-deficiency anemia.
Which nursing interventions are appropriate for this patient? Select all that apply.

A. Administering blood transfusions as prescribed. B. Monitoring the patient's response to erythropoiesis-stimulating agents (ESAs) C. Educating the patient about the causes, symptoms, and complications of sickle cell anemia. D. Encouraging the patient to eat a balanced diet rich in iron. E. Providing emotional support and counseling to the patient and family members.

Answer and Explanation

Choice A:

Administering blood transfusions as prescribed. Administering blood transfusions is not typically the first-line treatment for iron-deficiency anemia. Blood transfusions are usually reserved for severe cases of anemia or when other treatments have failed. Iron replacement therapy is the primary treatment for iron-deficiency anemia.

Choice B:

Monitoring the patient's response to erythropoiesis-stimulating agents (ESAs) Monitoring the patient's response to ESAs is appropriate because ESAs stimulate the production of red blood cells and can be used in the treatment of anemia, especially in chronic kidney disease patients. However, ESAs are not the primary treatment for iron-deficiency anemia, so this choice is not the only appropriate intervention.

Choice C:

Educating the patient about the causes, symptoms, and complications of sickle cell anemia. Educating the patient about sickle cell anemia is not relevant to the care of a patient with iron-deficiency anemia. Iron-deficiency anemia and sickle cell anemia are two distinct conditions with different causes, symptoms, and treatments.

Choice D:

Encouraging the patient to eat a balanced diet rich in iron. Encouraging the patient to eat a balanced diet rich in iron is an appropriate nursing intervention for a patient with iron-deficiency anemia. Iron-rich foods can help replenish the body's iron stores and support the treatment of anemia.

Choice E:

Providing emotional support and counseling to the patient and family members. Providing emotional support and counseling is an important aspect of nursing care for any patient, including those with iron-deficiency anemia. Dealing with a chronic condition can be emotionally challenging for patients and their families. Emotional support can help improve the patient's overall well-being and compliance with treatment.

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Question 14:

A nurse is caring for a patient with severe iron-deficiency anemia.
Which treatment option is typically reserved for cases of severe or symptomatic anemia that does not respond to iron supplements?

A. Administering iron supplements as prescribed. B. Administering erythropoiesis-stimulating agents (ESAs) C. Administering blood transfusions as prescribed. D. Encouraging the patient to eat a balanced diet rich in iron.

Answer and Explanation

Choice A:

Administering iron supplements as prescribed. Administering iron supplements is the primary treatment for iron-deficiency anemia. However, in severe cases of anemia where the patient is symptomatic or unresponsive to iron supplements, blood transfusions may be necessary.

Choice B:

Administering erythropoiesis-stimulating agents (ESAs) ESAs can be used in the treatment of anemia, especially in chronic kidney disease patients, but they are not typically the first-line treatment for iron-deficiency anemia. Iron replacement therapy is the primary approach to managing this condition.

Choice C:

Administering blood transfusions as prescribed. Administering blood transfusions is the correct choice for severe cases of iron-deficiency anemia that do not respond to iron supplements. Blood transfusions can quickly increase the patient's red blood cell count and alleviate symptoms.

Choice D:

Encouraging the patient to eat a balanced diet rich in iron. Encouraging a balanced diet is important for preventing and managing iron-deficiency anemia, but it is not typically reserved for severe or symptomatic cases that do not respond to iron supplements. In such cases, more immediate interventions like blood transfusions may be necessary.

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Question 15:

A client has been diagnosed with iron-deficiency anemia.
What is the primary goal of treatment and management for this client?

A. To correct the underlying cause of iron deficiency. B. To restore normal hemoglobin and iron levels. C. To prevent or treat complications of anemia. D. To provide immediate relief of anemia symptoms.

Answer and Explanation

Choice A:

To correct the underlying cause of iron deficiency. The primary goal of treatment and management for a client with iron-deficiency anemia is to correct the underlying cause of iron deficiency. This may involve addressing dietary deficiencies, identifying and treating gastrointestinal bleeding, or managing chronic conditions that contribute to iron loss. Correcting the underlying cause is essential for long-term management.

Choice B:

To restore normal hemoglobin and iron levels. Restoring normal hemoglobin and iron levels is certainly a goal of treatment for iron-deficiency anemia, but it is not the primary goal. Normalizing hemoglobin and iron levels is a means to an end, with the ultimate goal being to correct the underlying cause of the deficiency.

Choice C:

To prevent or treat complications of anemia. Preventing or treating complications of anemia is an important aspect of management, but it is not the primary goal. Complications such as fatigue, weakness, and impaired oxygen delivery are addressed through the correction of the underlying iron deficiency.

Choice D:

To provide immediate relief of anemia symptoms. Providing immediate relief of anemia symptoms is a short-term goal of treatment, but it is not the primary goal. The primary focus should be on addressing the root cause of iron deficiency to achieve long-term improvement in the patient's overall health and well-being.

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Anemia

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