The primary care pediatric nurse practitioner sees a 12-month-old infant who is being fed goat's milk and a vegetarian diet. The child is pale and has a beefy-red, sore tongue and oral mucous membranes. Which tests will the nurse practitioner order to evaluate this child's condition?

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The child's presentation is consistent with a B vitamin deficiency, which may occur with a vegetarian diet lacking in certain nutrients, such as vitamin B12. The sore tongue and oral mucous membranes suggest a deficiency in folate and/or vitamin B12. Testing for RBC folate, iron, and B levels would help confirm this suspicion and guide treatment. Hemoglobin electrophoresis and reticulocyte levels would not be necessary in this case, as there is no indication of a hemoglobinopathy or anemia. Serum lead levels may be indicated if there is a suspicion of lead poisoning, but this is not the likely cause of the child's symptoms.

The Primary Care Pediatric Nurse Practitioner Sees a 12-Month-Old Infant