Answer:
Neovascularization of the retina
Explanation:
A client with diabetes mellitus complains of difficulty seeing. The nurse concludes that the causative factor is neovascularization of the retina.
Neovascularization is a process in which new blood vessels form in your body. This may happen in a variety of sites in the eye, including the retina or cornea. These new vessels have the potential to leak and cause vision loss. Diabetes mellitus is becoming increasingly common. This condition is distinguished by hyperglycemia. Diabetes is classified into two types: type 1 diabetes mellitus or type 2 diabetes mellitus, having type 2 diabetes accounting about 90% of all occurrences.
Diabetes mellitus is caused by a combination of circumstances. Belonging to a specific ethnic group, increasing age, being overweight or obese, a family history of diabetes, a history of heart disease or hypertension, hyperlipidemia, and a history of gestational diabetes are all risk factors for type 2 diabetes mellitus. Excessive appetite, unintentional weight loss, exhaustion and weakness, impaired vision, anger, as well as other mood changes are all possible. If you or your kid exhibits any of these symptoms, user should consult your doctor. A blood test is the most accurate technique to establish the existence of type 1 diabetes.
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the home health nurse is developing a treatment care plan for an elderly retired client with Medicare insurance. What factor will the nurse take into
The home health nurse is developing a treatment care plan for an elderly retired client with Medicare insurance. The nurse will under take the factor that the treatments are often covered by publicly financed health care plans if the practitioner orders them.
Initiated in 1965 by the Social Security Administration and currently run by the Centers for Medicare and Medicaid Services, Medicare is a government-sponsored universal health insurance programme in the United States.
In most cases, you only need to register for Parts A and B once. You have a choice every year regarding how you obtain health insurance (and add or switch drug coverage). Medicare is distinct from private insurance because it doesn't provide couples' or family plans.
As determined by Money Geek's scoring methodology, the best Medicare Advantage plans are Blue Cross Blue Shield for preferred provider organisations and United Healthcare for health maintenance organisations.
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a patient with ulcers in the mouth is compalining of pain. How would the nurse most likely classify this pain
The nurse would most likely classify this pain as Deep pain.
Pain is a distressing sensory and emotional experience caused by either real or potential tissue injury. The skin and mucous membranes are the source of superficial discomfort. Deep discomfort originates in tissues under the skin. Skeletal muscles, ligaments, and joints cause somatic discomfort. Organs and smooth muscles cause visceral discomfort.
Pain pushes people to avoid dangerous circumstances, safeguard a wounded bodily part while it heals, and avoid similar experiences in the future. Most pain goes away once the noxious stimulus is withdrawn and the body heals, but it can last even after the stimulus is gone and the body appears to be healed. Pain can occur in the absence of any apparent stimuli, injury, or disease.
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As a nurse manager, you embrace the usefulness of resources such as Smart Bed. This behavior is important to:
This behavior is important to encouragement of staff utilization of technology.
Informatics, such as Smart Bed, improves care efficacy and efficiency. Early use of technology encourages staff members, particularly senior personnel who may be less familiar with technology, to appreciate its use in care delivery and administration.
Nurse managers are in charge of managing human and financial resources, as well as assuring patient and staff satisfaction, providing a safe environment for employees, patients, and visitors, maintaining standards and quality of care, and aligning the unit's goals with hospital's strategic goals. Nurse case managers advocate for solutions and services that will fulfil the requirements of the patient and family while encouraging excellent, cost-effective results for the assigned case types. They also plan employee training, promote professional growth, and create budgets. Quality-of-Care Requirements. Nurse leaders supervise nursing units, ensuring that nurses adhere to established rules and procedures that ensure patient safety and excellent care.
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When discussing infection prevention with a group of prenatal women, which interventions should the nurse emphasize to prevent toxoplasmosis in this population
Before eating, thoroughly cook the meat.
Throughout the pregnancy, have your significant other change the litter box. interventions should the nurse emphasize to prevent toxoplasmosis in this population
The protozoan infection toxoplasmosis is most frequently transferred via contact with raw meat, though it can also be acquired by handling cat feces in soil or cat litter. Mosquitoes primarily infect people with malaria in Africa and South America. Malaria is reduced with the use of insect repellent. By using condoms, sexually transmitted illnesses can be avoided. Keeping away from large gatherings of young children in childcare centers helps reduce exposure to CMV.
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Identify and describe practice barriers for all four APNs roles in Indiana and discuss these barriers on a state and national level. The four roles include the nurse midwife, nurse anesthetist, nurse practitioner and clinical nurse specialist.
Practice barriers for APNs in Indiana include lack of full practice authority, limited reimbursement, and lack of recognition by insurance companies.
These barriers can prevent APNs from providing care to patients to the fullest extent of their education and training. On a state level, Indiana has some restrictions on the practice of APNs, such as the requirement for collaboration or supervision by a physician. This can limit the ability of APNs to provide care in certain settings or to certain populations. Nationally, there is a lack of consistency in state regulations regarding APN practice, which can make it difficult for APNs to practice across state lines or for patients to access care when they travel. Additionally, reimbursement for APN services is often lower than that for physician services, which can discourage the use of APNs in healthcare settings. These barriers can make it more difficult for APNs to provide care to patients and make it harder for patients to access the care that they need.
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the severe form of erythema multiform, which involves widespread lesions that may appear in the oral cavity and on the eyes, genitalia, thoracic and abdominal regions is known as
Answer: The answer to this question is Stevens-Johnson syndrome.
Explanation: Stevens–Johnson syndrome (SJS) is a type of severe skin reaction. Together with toxic epidermal necrolysis (TEN) and Stevens–Johnson/toxic epidermal necrolysis (SJS/TEN), it forms a spectrum of disease, with SJS being less severe. Erythema multiforme (EM) is generally considered a separate condition. Early symptoms of SJS include fever and flu-like symptoms. Stevens-Johnson syndrome (SJS) is a rare, serious disorder of the skin and mucous membranes.
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Quick, large changes in weight are most likely the result of all of the following except:
A. changes in fat stores.
B. changes in body fluid content.
C. changes in electrolytes and fluid balance.
D. changes in lean tissues such as muscles.
E. changes in bone minerals.
Quick, large changes in weight are most likely the result of all of the following except changes in the bone's minerals. Connective tissue constitutes bones with the reinforcement of calcium. Bones are the structural constituents of the body.
On them, muscles are attached which makes the body work and move. They have a whole cavity which is known as bone marrow. The bone marrow is the hub for the maturation of the blood cells. Minerals such as calcium present in the bones cannot be depleted by losing weight. along with calcium phosphorus is also present.
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A nurse in the pediatric clinic is taking the health history of a toddler with an exacerbation of eczema. What are the nurse's priority assessments of the child
a toddler with an exacerbation of eczema priority are
Wearing cotton clothes
Tolerance of new foods are the nurse's priority assessments of the child
Children's eczema, a common symptom of allergies, frequently has connections to meals and clothing. Cotton clothing is a sign that the parents are aware of their child's allergy and are making an effort to lessen it. The ability to tolerate new foods is a sign that a youngster has outgrown some food sensitivities. Eczema does not develop due to a lack of appetite. Eczema is a sign of allergies; it is not communicable.Dry, itchy, and irritated skin are symptoms of atopic dermatitis (eczema). Despite being age-neutral, it is frequently seen in young children. The chronic condition known as atopic dermatitis occasionally flares up. Although it may irritate you, it is not contagious.
The full question was :
A nurse in the pediatric clinic is taking the health history of a toddler with an exacerbation of eczema. What are the nurse's priority assessments of the child?
Increase in appetite
Wearing cotton clothes
Tolerance of new foods
Exposure to a viral infection
Recent contact with someone with eczema
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A client is admitted to the ambulatory care unit for an endoscopic procedure. The gastroenterologist administers midazolam 1 mg intravenously for sedation and titrates the dosage upward to 3.5 mg. The client becomes hypotensive (86/60 mm Hg), develops severe respiratory depression (SpO2 86%), and has periods of apnea. The nurse anticipates the administration of which antidote drug?
1.
Benztropine (10%)
2.
Flumazenil (36%)
3.
Naloxone (46%)
4.
Phentolamine (7%)
OmittedCorrect answer 2
36%Answered correctly
The nurse anticipates the administration of flumazenil antidote drug. Thus, the correct option is 2.
What is Antidote drug?Antidote drug are the agents which negate the effect of a poison or a toxin. Antidotes are used to mediate its effect either through preventing the absorption of the toxin, by binding and neutralizing the poison effect, antagonizing its end-organ effect, or by the inhibition of conversion of the toxin to more toxic metabolites.
Midazolam (Versed) is a benzodiazepine which is commonly used to induce conscious sedation in the clients undergoing endoscopic procedures. The initial dose of the drug is 1 mg and it is titrated up slowly until speech becomes slurred.
Generally no more than 3.5 mg is necessary to induce conscious sedation in the clients. It is commonly administered with an opioid analgesic because of their synergistic effects. Side effects of the drug can include airway occlusion, apnea, hypotension, and oxygen desaturation with resultant respiratory arrest.
Flumazenil (Romazicon) is an antidote drug which is used to reverse the sedative effects of benzodiazepines. Flumazenil is a drug which is used to reverse the sedative effects of benzodiazepines such as midazolam.
Therefore, the correct option is 2.
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How does a nurse determine which strategy would best enable the targeted individuals to gain more control over, and improve, their health
By evaluating available resources and the needs of the targeted individuals, a nurse can determine which strategy will be the best to enable the targeted individuals to gain more control over and improve their health.
What are the health promotion strategies?The basic health promotion strategies identified in the Ottawa Charter were: advocate (to increase the factors that promote health), enable (to allow all people to achieve health equity), and mediate (through collaboration across all sectors).Some well-known Health Promotion Strategies include: developing a healthy public policy.
Creating a welcoming environment.Increasing community cooperation.Developing and encouraging skill.Reorienting health-care delivery.Premature deaths are reduced through health promotion. Health promotion, by focusing on prevention, reduces the costs (both financial and human) that individuals, employers, families, insurance companies, medical facilities, communities, states, and nations would incur for medical treatment.Strategic planning in health care organizations entails outlining the specific steps required to achieve specific goals.To learn more about health promotion strategy refer to :
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if you are studying, using this type of memory, you would be replicating all of the content that is around you. which form of memory is being used?
Which disease is almost certain to cause death if infected patients do not receive postexposure prophylaxis
Rabies disease is almost certain to cause death if infected patients do not receive post-exposure prophylaxis.
Rabies is a preventable viral illness that is most commonly spread via a rabid animal's bite. The rabies virus attacks mammals' central nervous systems, resulting in brain illness and death. When clinical symptoms of rabies arise, the condition is almost invariably deadly, and treatment is usually supportive. There have been less than 20 reported examples of human survival from clinical rabies. Only a few individuals had no prior or post-exposure prophylactic history.
Lyssaviruses, such as the rabies virus and the Australian bat lyssavirus, cause rabies. When an infected animal bites or scratches a human or another animal, the disease spreads. If saliva from an infected animal comes into contact with the eyes, mouth, or nose, it can transmit rabies.
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nurse discovers her clients bed smoldering from a lit cigarette. describe the race mnemonic to guide the order of the nurses actions
The nurse should use the mnemonic RACE (Remove the client-Activate the alarm-Contain the fire - Extinguish the fire) to prioritize actions.
Fire safety refers to a collection of measures designed to limit the devastation caused by fire. Fire safety procedures include those used to prevent the initiation of an uncontrolled fire as well as those used to minimise the growth and impact of a fire after it has begun.
Fire safety measures include those that are designed during building construction or implemented in existing buildings, as well as those that are taught to building inhabitants.
Fire risks are widely used to describe threats to fire safety. A fire hazard is anything that raises the chance of a fire or makes escape difficult in the case of a fire.
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If phenobarbital has a four day half-life, and a client accidentally took 200 mg of the drug on Tuesday morning, and no intervention occurred, how much medication will remain in the bloodstream of that client on Thursday morning?
Assuming client's metabolism and the other variables remain the constant, approximately 100 mg of the medication that will remain in the bloodstream on the Thursday morning.
Metabolism is the process by which the body converts food and drink into energy. During this process, calories from food and drink mix with oxygen to create the energy your body needs. Even at rest, your body needs energy to do anything. Metabolism is the totality of chemical reactions that sustain life in living organisms. The three main functions of metabolism are: Converting energy in food into energy that cellular processes can carry out. Metabolism has two categories for her:Catabolic and anabolic. Catabolism is the breakdown of organic matter, and anabolism uses energy to build cellular components such as proteins and nucleic acids.
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After a person experiences a closure of the epiphyses, which statement is true?
After a person experiences a closure of epiphyses, true statement is No further increase in bone length occurred. After the ends of the bones closure, the bone length cannot be increased any further.
What is the cause of premature closure of the epiphyseal plate?Premature closure of the ends is usually due to cartilage injury. Rarely, vitamin A derivatives are known to cause premature bone closure
What happens when epiphyseal plates close?As children grow, the growth plates turn into strong bones. A solid growth plate entirely made of solid bone is a self-contained growth plate. After the growth plate closes, the bone stops growing. Hormone Estrogen accelerates bone head fusion and suppresses longitudinal bone growth.
What factors affect bone end closure?Important predisposing factors include the ability to differentiate chondrocytes, multiple molecular pathways operating in the growth plate, and axis I activation of insulin-like growth hormone-like growth factor and expression fusion. tissues by estrogen and its receptors.
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The staff development coordinator plans to teach use of physical management techniques for use when patients become assaultive. Which topic should the coordinator emphasize
When patients become aggressive, the staff development coordinator should emphasize practice and teamwork to improve management techniques.
The use of manual intervention to control and limit undesirable behavior is known as physical management. In a crisis, using sound techniques can help to reduce injury and liability. Physical management training has numerous advantages for your company. If done correctly, it can produce competent and confident staff capable of handling crisis situations, as well as reduce staff fear by relieving anxiety caused by confusion and indecision. Physical management is an important tool for creating and maintaining a safe work environment.
In general, physical management is part of a use-of-force continuum. According to the organizations involved, these can range from verbal or nonverbal techniques to, eventually, lethal force.
For example, most security organizations consider the first technique to be officer presence, with lethal force as a last resort.
The staff development coordinator plans to teach use of physical management techniques for use when patients become assaultive. Which topic should the coordinator emphasize?
a. Practice and teamwork
b. Spontaneity and surprise
c. Caution and superior size
d. Diversion and physical outlets
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A nurse manager has been employed in the same facility for 20 years and has held the same position. This career style is known as:
Holding the same position for 20 years implies that the nurse is stable and working as a Manager in the same facility. This type of career style is called a steady state. This high retention strategy is very effective for long-term employment.
A job that you anticipate staying employed for long in is one that is considered steady. The majority of jobs provide stable employment, but in the "global marketplace," more individuals are searching for project work, contract work, or temporary agency work.
When someone is said to "not be able to obtain permanent employment," the term is typically taken to be a criticism of the worker's or the economy's poor condition.
A "steady job" is one that is regularly scheduled and offers a respectable but not excessive wage. It is safe to work as well.
Similar labor is done in a "stable job," with the added benefit of continual employment. There aren't any unforeseen layoffs or labor disputes.
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A client is treated for increased intracranial pressure (ICP). It is important for the client to avoid hypothermia because
The client must avoid hypothermia because shivering in hypothermia can raise intracranial pressure.
What is hypothermia?Frostbite and hypothermia (abnormally low body temperature) are both dangerous conditions that can occur when a person is exposed to extremely cold temperatures.
Hypothermia in patients with traumatic brain injury (TBI) reduces cerebral metabolism and blood flow, lowering intracranial pressure (ICP). There have been numerous debates about the clinical effectiveness of prophylactic hypothermia.
What is the course of action for elevated ICP?Sedation, CSF draining, and osmotherapy with either mannitol or hypertonic saline should all be used in the medical management of elevated ICP. Barbiturate coma, hypothermia, or decompressive craniectomy should be taken into consideration for intracranial hypertension that is resistant to initial medical therapy.
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The complete question is -
A client is treated for increased intracranial pressure (ICP). It is important for the client to avoid hypothermia because:
Which health literacy factors will the nurse consider when developing a teaching plan for a 69-year-old homeless man with a grade school education diagnosed with prostate cancer
Homelessness, elementary school education, and patient age are the literacy factors related to health that the nurse should consider when designing a teaching plan who is suffering from prostate cancer.
Since the old man is homeless, he will have a difficult time understanding complex topics, so the nurse should try to simplify the teachings to make them easily understandable. The patient is also 69 years old and older people are less self capable and so the teaching plan should be such that there is less pressure on the patient for self-care. Also, if the patient is well educated or has recieved an elementary school education, then there will be a better understanding of prostate cancer and its effect and the patient will be able to manage his symtpoms more effectively. The nurse should provide maximum details in the simplest way possible for an effective teaching plan.
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During an interview, tears appear in the patient's eyes and his voice becomes shaky. Initially, you should:
What is an overriding concern for patients with diabetes who need to acquire a blood glucose monitor
The cost of test strips and disposable supplies is a major worry for diabetic individuals who need to purchase a blood glucose monitor.
Diabetes is a chronic condition that arises when the pancreas does not create enough or when the body does not utilise the insulin that is produced adequately. Insulin is the hormone that controls blood glucose levels. The most essential thing you can do to control type 1 or type 2 diabetes is to monitor your blood sugar levels on a regular basis. You'll be able to observe what causes your numbers to rise or fall, such as eating various meals, taking your medication, or exercising.
With this information, one can collaborate with ones healthcare team to determine the optimal diabetes treatment strategy for you. Diabetes consequences such as heart attack, stroke, renal disease, blindness, or amputation can be delayed or avoided by making these choices.
Your doctor will advise you on when and how frequently users should monitor one's blood sugar levels. Checking the blood sugars is an important component of living with diabetes if you use certain medications, such as insulin or sulphonylureas. It can assist you in working out when you have to take additional medication, eat something, or get out and move about more.
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Mrs. Webb is a 38-year-old patient who has been changing her lifestyle to eat in a healthy way and lose weight. During your health promotion education regarding her nutritional status, you explain the function of dietary protein as:
Protein is an essential nutrient that is necessary for a number of bodily functions. It is necessary for building and maintaining tissues, such as muscles, organs, bones, skin, and blood.
Protein is composed of smaller molecules called amino acids, which are the building blocks of life. Amino acids are responsible for a number of bodily functions, including development, growth, repair, and maintenance.
When dietary protein is consumed, it is broken down in the stomach and small intestine into individual amino acids. After that, the bloodstream carries these amino acids to the body's cells for use. The body then uses the amino acids to create new proteins, which are used to build and maintain tissues.
Protein also plays an important role in other bodily functions, such as metabolism, energy production, and hormone regulation. In addition, proteins are necessary for the production of enzymes, hormones, and other substances, which are important for the proper functioning of the body.
By consuming a diet high in protein, Mrs. Webb can ensure that her body is receiving the necessary building blocks for the creation and maintenance of healthy tissues. Eating a diet rich in protein can also help her body to maintain its energy levels, regulate hormones, and carry out other important functions.
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Places where there is an elevated chance of being the victim of crime are known as: A. Hot targets B. Hot spots C. Suitable targets D. Chronic spots
The places where there is an elevated chance of being the victim of crime are known as hotspots, which means option B is the right answer.
Crime refers to the intentional act of doing something which is against the law. Major criminals are born between the age of 15 to 20 years because of the hormonal rush which are undergoing as a result of natural process and the unlawful environment to which they are exposed. Hot spot analysis helps police identify high-crime areas, types of crime being committed, and the best way to respond. Hotspots of crime are the areas where there are high chances of multiple criminal acts. It is necessary to identify them so as to control such activities and protect the citizens.
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Nutrition, caregiver responsiveness, and learning opportunities are all __________ influences on maturation.
Nutrition, caregiver responsiveness, and learning opportunities are all environmental influences on maturation.
Nutrition, caregiver responsiveness, and learning opportunities are all examples of environmental factors that can influence a child's physical and cognitive development. They are not genetic or innate factors, but rather the external conditions and experiences that can shape a child's growth and maturation. Adequate nutrition, responsive caregiving and sufficient learning opportunities can facilitate child's growth, while the lack of them can hinder it.
b. A 24 year old newly diagnosed with seizures is prescribed phenytoin. The client asks the nurse if she will still be able to take her oral contraceptive medication. How should the nurse respond?
The nurse must respond to the query of the women on oral contraceptive by responding that she must use a different form of birth control while taking phenytoin, which means option B is the right answer.
Oral Contraceptives are the pills which are taken by the women before and after intercourse to prevent the egg from fertilizing. It is one of the most commonly used method to avoid unwanted pregnancy. Phenytoin is the anti-seizure drug which is used to decreasing abnormal electrical activity in the brain. It has some side effects like flu, rashes etc. Phenytoin can reduce the effects of oral contraceptive pills (OCPs) and so the women will have to extra dosage of contraceptives which can be harmful for the body and so she is advised to use another method of birth control.
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To refer to complete question, see below:
A patient is to begin taking phenytoin [Dilantin] for seizures. The patient tells the nurse that she is taking oral contraceptives. What will the nurse tell the patient?
a. She may need to increase her dose of phenytoin while taking oral contraceptives.
b. She should consider a different form of birth control while taking phenytoin.
c. She should remain on oral contraceptives, because phenytoin causes birth defects.
d. She should stop taking oral contraceptives, because they reduce the effectiveness of phenytoin.
A community health nurse is assigned to work in a different area of the city. Which assessment techniques could be used to develop an overview of the community
A windshield survey and review of demographic assessment techniques could be used to develop an overview of the community
Which elements make up a windshield survey?
Survey elements for walking and using windshields
1) Bounds, include neighborhood, political, and administrative boundaries. 2) Housing structure and zones: Home designs, dwelling types, and neighborhood divisions.Which aspect of the neighborhood would the nurse evaluate while doing a windshield survey?
The nurse will be able to see if people are walking or otherwise exercising using a windshield survey. It will also assist the nurse in locating single- or multi-family private and public housing units, social services agency availability, and other crucial neighborhood characteristics.
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in january, a 57-year-old man with life-threatening heart disease received the first successful transplant of a ’s heart into a human being, a groundbreaking procedure that offers hope to hundreds of thousands of patients with failing organs.
This groundbreaking procedure offers hope to many people with life-threatening heart disease, as the first successful human heart transplant was performed in January.
How to transplant the organs successfully?To transplant organs successfully, it is important to carefully match the donor and recipient to ensure the best match. The donor must be healthy and free of any diseases that could be passed on to the recipient.
The organs should be transported quickly after removal and handled properly to preserve their quality. The recipient must be prepared for the transplant with a careful evaluation of their medical history, lifestyle, and health condition to ensure the transplant is successful. The transplant surgery should be performed by a team of experienced and skilled surgeons.
The team should also monitor the patient closely after the surgery to ensure that the body is accepting the new organ.
Medications may be prescribed to reduce the risk of rejection. Finally, the patient should be given comprehensive follow-up care to ensure a successful transplant.
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During the newborn examination, the nurse notes that an infant who is appropriate for gestational age by birth weight has a head circumference below the 10th percentile and the fontanels (fontanelles) are not palpable. What action would the nurse take
The nurse take action ;Report the findings to the pediatric provider.
What is the newborn's inspection like?
Within 72 hours of giving birth, all parents are entitled to a full physical checkup for their newborn. The checkup involves screening tests to see whether your infant has any eye, heart, hip, or, in boys, testicular issues (testes).
What is a newborn's transitional assessment?4 to 6 hours after delivery is the newborn's transition phase, during which time they should begin to acclimate to life outside the womb. The infant should be checked for temperature, respiration rate, heart rate, color, and tone every 30 to 60 minutes throughout this period (Overview, 2020).
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Which statements would be considered appropriate interventions for a client with an endotracheal tube
The statements which would be considered appropriate interventions for a client with an endotracheal tube are the cuff is deflated before the tube is removed, and cuff pressures should be checked every 6 to 8 hours.
The cuff of the endotracheal tube( ETT) is designed to give a seal within the airway, allowing tailwind through the ETT but precluding passage of air or fluids around the ETT. Deliberate or unintentional movement of the ETT may affect cuff pressure or shift crowds in the cuff, marshaling pooled concealment.
The cuff is inflated to shut the airway to deliver instrumental ventilation. A cuff pressure between 20 and 30 cm H2O is recommended to give an acceptable seal and reduce the threat of complications.
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Mrs. Grace is a 58-year-old patient who has a diagnosis of pernicious anemia. Which B vitamin is deficient in patients with pernicious anemia
In patients with pernicious anemia, the B vitamin that is deficient is vitamin B12. Pernicious anemia is a type of megaloblastic anemia, which is caused by the body's inability to properly absorb vitamin B12. This can be due to a lack of intrinsic factor, which is a protein that is necessary for the absorption of vitamin B12 in the gastrointestinal tract. Without enough intrinsic factor, the body cannot absorb vitamin B12 from food, leading to a deficiency of this vitamin and the development of pernicious anemia.