A client with pernicious anemia takes supplemental folate and self-administers monthly vitamin B12 injections. The client reports feeling increasingly fatigued. Which laboratory value should the nurse review?

Choice A reason: Liver enzymes are not directly related to pernicious anemia. While liver disease can cause fatigue, the client’s history of pernicious anemia makes hematologic evaluation more relevant. Choice B reason: A complete blood count (CBC) is the most appropriate laboratory test. Pernicious anemia is caused by vitamin B12 deficiency, leading to megaloblastic anemia. Even with folate supplementation, inadequate B12 can result in persistent anemia and fatigue. Reviewing the CBC will reveal hemoglobin, hematocrit, and red blood cell indices, confirming whether anemia is present. Choice C reason: Serum electrolytes are important for overall health but do not directly explain fatigue in the context of pernicious anemia. Electrolyte imbalances may cause weakness, but they are not the primary concern here. Choice D reason: Platelet count is part of hematologic evaluation but does not specifically explain fatigue. Fatigue in pernicious anemia is due to reduced oxygen-carrying capacity from anemia, not platelet abnormalities.