1. B. Supplement with vitamin A. Vitamin A deficiency symptoms include night blindness that can lead to corneal ulceration. This deficiency can occur in patients with impaired liver storage or fat malabsorption. Dairy products, such as milk, are a good source of vitamin A. ยก-Carotene, a vitamin A precursor, is found in pigmented vegetables, such as carrots. When a deficiency is diagnosed, it is appropriate to treat the patient with a supplement rather than to rely on increased consumption of vitamin A-rich foods. A patient with pancreatic disease and malabsorption syndrome will need parenteral supplementation.

2. B. Pregnancy increases the need for vitamins and iron in general. Folic acid has been shown to decrease the risk of neural tube defects, such as spina bifida. It is important to assess the nutritional status of the patient to determine whether higher levels of folic acid are needed. Vitamin A is a teratogen and should not be given in high doses during pregnancy.

3. C. Early symptoms of vitamin C deficiency, or scurvy, include malaise. Hemorrhages, especially of the gums, may result from capillary fragility.

4. C. The only effective treatment of pernicious anemia is supplementation of vitamin B12.It is important to determine whether megaloblastic anemia is from a deficiency of folic acid or vitamin B12. Treatment of vitamin B12-deficient anemia with folic acid may result in neurological damage if vitamin B12 is not adequately supplemented.

5. E. Folic acid supplements should be given to all pregnant women. In addition, phenytoin use is associated with lowered folate levels.

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