83Qw/exp *YAS* Ch54: Anemia Drugs

A pregnant patient is diagnosed with folic acid deficiency anemia. The primary health care provider prescribes oral folic acid. What other instructions will the nurse give the patient to promote health?

"Include fruits and green vegetables in your diet." The nurse advises the patient to eat green leafy vegetables and fruits. Consuming a diet rich in folic acid will help the patient to recover quickly.

A patient with hyperacidity is diagnosed with iron-deficiency anemia. The prescription contains oral antacid preparations and oral iron supplements. What is the most important advice the nurse gives to the patient?

"Take the iron supplements at least 2 hours after taking antacids." Oral iron supplements should be taken at least 2 hours after taking antacids, because the presence of antacids decreases the absorption of iron.

What instructions are given to a patient who is prescribed oral iron tablets?

"Take the iron tablets with plenty of fluids." Adequate fluid intake with iron tablets decreases the chances of stomach upset and increases drug absorption.

Which type of anemia is caused by a genetic defect? 1 Sickle cell anemia 2 Pernicious anemia 3 Megaloblastic anemia 4 Iron-deficiency anemia

1 A genetic defect can cause abnormalities in the structure of red blood cells. Sickle cell anemia is the only type of anemia that is caused by a genetic defect. Pernicious anemia is caused by a deficiency of cyanocobalamin (vitamin B12). Megaloblastic anemia is caused by a deficiency of folic acid. Iron-deficiency anemia is caused by a deficiency of dietary iron.

What instructions are given to a patient who is prescribed oral iron tablets? 1 "Take the iron tablets with plenty of fluids." 2 "Take the iron tablets in a powdered form." 3 "Take an iron tablet just before going to bed." 4 "Take the iron tablet after dissolving it in water using a straw."

1 Adequate fluid intake with iron tablets decreases the chances of stomach upset and increases drug absorption. The oral tablets are consumed in the correct prescribed dosage; therefore, they are not to be crushed and consumed in a powdered form. The patient needs to maintain a sitting position at least for 30 minutes after taking the oral dose to prevent esophageal irritation. Liquid solutions of iron need to be diluted with fluids according to the manufacturer's instructions and consumed using a straw to prevent discoloration of the teeth.

For what disease should the nurse assess in a patient before administering ferrous fumarate? 1 Cirrhosis 2 Heart attack 3 Renal failure 4 Ovarian cancer

1 Ferrous fumarate is contraindicated in patients with cirrhosis of the liver. The liver is the storage site for iron. During cirrhosis, the liver lacks the ability to store iron, and all the iron taken as ferrous fumarate accumulates in the blood, leading to toxicity. Heart attack is an adverse event if epoetin alfa is administered in patients with hemoglobin levels above 12 g/dL. Renal failure is associated with a decrease in the hormone erythropoietin. In this case, iron supplements are given along with epoetin alfa. Anemia caused by ovarian cancer can be treated with epoetin alfa along with iron supplements.

Iron dextran is prescribed for a patient with severe iron-deficiency anemia. How will the nurse administer the drug? 1 Administer a test dose by the intravenous route. 2 Administer a test dose by the subcutaneous route. 3 Administer the full dose by the intravenous route. 4 Administer the full dose by the subcutaneous route.

1 Iron dextran is a colloidal solution of iron and dextran that can be administered by the intravenous or intramuscular route. It has the potential to cause anaphylactic reactions in some patients. Because of this, a test dose of the drug is initially administered by the intravenous route before administering the full dose. It is not administered by the subcutaneous route because of limited effectiveness. Administration of the full dose may lead to an anaphylactic reaction in the patient.

Which drug requires a test dose to ensure safe medication administration? 1 Iron dextran 2 Iron sucrose 3 Ferric gluconate 4 Ferrous fumarate

1 Iron dextran is an injectable iron formulation that may cause an anaphylactic reaction in the patient. Therefore, a test dose of iron dextran is injected, and the patient is monitored for any adverse reactions. The risk of precipitating an anaphylactic reaction is much lower with iron sucrose. Therefore, a test dose is not required for this iron formulation. Ferric gluconate injectable formulations have fewer adverse effects; hence, the complete prescribed dose can be administered. Ferrous fumarate is an oral formulation that is 33% elemental iron. This oral drug is not known to cause anaphylactic reactions.

A patient with chronic renal disease is prescribed an iron supplement along with erythropoiesis-stimulating agents. What is the reason for prescribing an iron supplement with erythropoiesis-stimulating agents? 1 To improve the efficacy of erythropoiesis-stimulating agents 2 To decrease the absorption of erythropoiesis-stimulating agents 3 To increase the elimination of erythropoiesis-stimulating agents 4 To reduce the adverse effects of erythropoiesis-stimulating agents

1 Iron supplements increase the efficacy of erythropoiesis-stimulating agents by promoting the maturation of erythrocytes. Iron supplements enhance the absorption of erythropoiesis-stimulating agents. Erythropoiesis-stimulating agents work effectively when iron stores in the body are adequate. Iron does not affect the elimination of erythropoiesis-stimulating agents from the body but helps in their absorption. Adverse effects of erythropoiesis-stimulating agents include hypertension, fever, and headache, which are not prevented by iron supplements.

A patient informs the nurse she must take her iron with a meal to prevent stomach upset. To increase the uptake of oral iron, which food group will the nurse instruct the patient to avoid? 1 Dairy 2 Fruits 3 Proteins 4 Vegetables

1 Many individuals find that they need to take oral iron products with meals or food because of the commonly encountered adverse effect of gastrointestinal upset, even though altered absorption occurs. However, the patient should avoid taking iron with dairy products; antacids or milk products should be consumed at least 1 to 2 hours before or after the oral dosage of iron. Fruits, proteins, and vegetables all can alter the absorption of iron, but not to the extent of milk or antacids.

What are the common causes of iron-deficiency anemia? Select all that apply. 1 Childbirth 2 Blood loss 3 Genetic defect 4 Vitamin B12 deficiency 5 Drug-induced antibodies

1, 2 Iron-deficiency anemia is a type of cytoplasmic maturation anemia resulting in abnormal hemoglobin synthesis that is caused by blood loss and childbirth. Red blood cell (RBC) abnormalities caused by intrinsic factors are usually a result of a genetic defect such as sickle cell anemia, hereditary spherocytosis, and others. Pernicious anemia occurs as a result of B12 deficiency, which is used in the formation of new RBCs. Excessive RBC destruction that occurs as a result of extrinsic factors is caused by drug-induced antibodies.

A patient with chronic renal failure who eats a well-balanced diet reports fatigue and lightheadedness. What is the most likely reason for fatigue in the patient? 1 The patient has been exercising. 2 The patient lacks erythropoietin. 3 The patient lacks folic acid in the diet. 4 The patient has iron-deficiency anemia.

2 Erythropoiesis is the process of maturation of red blood cells. It is facilitated by erythropoietin, which is secreted by the kidneys. The secretion of erythropoietin decreases in chronic renal failure, leading to anemia, which manifests as fatigue. Exercise may cause temporary fatigue that subsides after rest. Because the patient eats a well-balanced diet, folic acid deficiency is unlikely. The anemia is probably not caused by a deficiency of iron, because the patient has a well-balanced diet.

What is the genetic disorder that is associated with excessive red blood cell (RBC) destruction? 1 Pernicious anemia 2 Sickle cell anemia 3 Megaloblastic anemia 4 Iron-deficiency anemia

2 Sickle cell anemia is a genetic disorder associated with excessive RBC destruction. It results from defects in the intrinsic factors of RBCs that cause excessive RBC destruction. Pernicious anemia is caused by a deficiency of folic acid. Megaloblastic anemia is caused by a deficiency of vitamin B12 or folic acid. Iron-deficiency anemia is caused by blood loss, childbirth, or a deficiency of dietary iron. Topics

What is a side effect associated with oral iron therapy? 1 Fatigue 2 Tarry stools 3 Yellow urine 4 Hypertension

2 Tarry stools, vomiting, and epigastric pain are the side effects associated with oral iron supplements. The nurse instructs the patient to expect these adverse effects so that the patient does not panic. Fatigue is a symptom of anemia. It is relieved upon administration of oral iron supplements. Yellow urine is an adverse effect associated with folic acid therapy. Hypertension is a side effect associated with the administration of epoetin alfa

A pregnant patient is diagnosed with folic acid deficiency anemia. The primary health care provider prescribes oral folic acid. What other instructions will the nurse give the patient to promote health? 1 "Take the drug along with antacid medications." 2 "Include fruits and green vegetables in your diet." 3 "Sit upright for at least 1 hour after taking the drug." 4 "Report immediately if your stools are tarry and black."

2 The nurse advises the patient to eat green leafy vegetables and fruits. Consuming a diet rich in folic acid will help the patient to recover quickly. Antacids consumed with folic acid are known to decrease drug absorption. Maintaining a sitting position for about an hour is not needed with folic acid; however, a sitting position would relieve esophageal irritation in patients consuming iron supplements. Consuming folic acid would result in yellow discoloration of the urine but does not have any effect on the color of stools.

A patient who was diagnosed with anemia is prescribed folic acid supplements but shows no improvement in hemoglobin levels. The patient's blood smear shows normochromic and macrocytic red blood cells (RBCs). Which syndrome may be present in the patient? 1 Sickle cell anemia 2 Pernicious anemia 3 Megaloblastic anemia 4 Iron-deficiency anemia

2 The presence of normochromic and macrocytic RBCs in the blood smear indicates that the patient has RBC nuclear maturation defects. These defects are caused by a deficiency of folic acid or vitamin B12. Pernicious anemia is caused by a deficiency of vitamin B12. Hence, folic acid supplements are ineffective in patients with pernicious anemia. Sickle cell anemia is an RBC abnormality caused by a genetic disorder. Megaloblastic anemia is caused by folic acid deficiency. If the patient had megaloblastic anemia there would have been an improvement in the patient's condition with the use of folic acid supplements. Iron-deficiency anemia involves hypochromic and microcytic RBCs.

Which are known contraindications for use of erythropoiesis-stimulating agents in patients? Select all that apply. 1 Renal failure 2 Cancer of the neck 3 History of thrombosis 4 Uncontrolled hypertension 5 Hemoglobin level of 15 g/d

2, 3, 4, 5 Contraindications for erythropoiesis-stimulating agents (ESAs) include known drug allergy. Use in patients with head or neck cancers, or in patients at risk for thrombosis, is controversial because these medications increase tumor growth and risk for thrombosis. Use of epoetin and darbepoetin is contraindicated in cases of uncontrolled hypertension and when hemoglobin levels are above 10 g/dL for cancer patients and 12 g/dL for renal patients. Renal failure is not a contraindication of erythropoiesis-stimulating agents.

Where does the process of erythropoiesis take place in the human body? 1 Liver 2 Heart 3 Blood 4 Kidneys

3 Erythropoiesis involves the maturation of precursors of nucleated red blood cells (RBCs) into hemoglobin-filled, nucleus-free erythrocytes. It takes place in the circulation, where nucleated RBCs undergo a 24- to 36-hour maturation process to become mature, fully functional RBCs. The breakdown of RBCs takes place in the liver. The heart pumps the blood to all the organs; it has no role in erythropoiesis. The primary function of the kidneys is filtration. The kidneys are involved in the production of the hormone erythropoietin, which helps in the maturation of RBCs; however, they are not the site of erythropoiesis.

The nurse notices that a patient exhibits severe fatigue. The medication history shows that the patient has been taking a nonsteroidal antiinflammatory drug (NSAID) medication for 3 months. What type of anemia may be present in the patient? 1 Sickle cell anemia 2 Pernicious anemia 3 Iron-deficiency anemia 4 Folic acid deficiency anemia

3 Fatigue is one of the symptoms of anemia. Cytoplasmic defects in the red blood cells (RBCs) make them appear hypochromic (paler in color than normal). The patient is on NSAID therapy; therefore, the patient has a risk of developing gastrointestinal bleeding. This may lead to iron-deficiency anemia. Sickle cell anemia is a genetic disorder caused by a deficiency of glucose-6-phosphate dehydrogenase. Pernicious anemia is caused by a deficiency of vitamin B12. Folic acid deficiency anemia is caused by a deficiency of folic acid; however, it may not lead to fatigue.

What is the most common adverse effect of iron sucrose? 1 Dyspnea 2 Anaphylaxis 3 Hypotension 4 Yellow discoloration of urine

3 Hypotension is the most common adverse effect of iron sucrose. Dyspnea is associated with doses higher than 125 mg of ferric gluconate. Anaphylactic reactions are associated with iron dextran and have been reported in 0.3% of patients. Adverse effects associated with folic acid are rare, but yellow discoloration of urine is observed.

A patient had a total gastrectomy 12 months ago. The nurse learns that the patient has been eating a well-balanced diet rich in vitamin B12, folic acid, iron, and other micronutrients. Despite this, the patient is diagnosed with anemia. What is the most likely cause of anemia in this patient? 1 Fecal occult blood loss 2 Bone marrow depression 3 Poor absorption of vitamin B12 4 Deficiency of renal erythropoietin

3 Intrinsic factor is required for the absorption of vitamin B12. It is produced by the stomach lining. Patients who have undergone gastrectomy may have a deficiency of intrinsic factor, resulting in poor absorption of vitamin B12. It may lead to pernicious anemia, wherein the new red blood cells appear larger than normal. The anemia was probably not caused by fecal occult blood loss, bone marrow depression, or renal pathology, because the patient does not have a corresponding history for these conditions.

An elderly and malnourished patient is prescribed iron sucrose for anemia. What will the nurse monitor in the patient to ensure safe administration of the drug? 1 Fluid intake 2 Temperature 3 Blood pressure 4 Respiratory rate

3 Iron sucrose tends to cause hypotension in patients who are elderly and underweight. Therefore, the nurse should monitor the patient's blood pressure when administering the drug. Fluid intake does not have any effect on iron sucrose administration; therefore, it is not a primary intervention. Temperature and respiratory rate are unlikely to be affected by iron sucrose.

Which route of administration is associated with the Z-track method? 1 Oral 2 Intravenous 3 Intramuscular 4 Subcutaneous

3 The Z-track method is used for the administration of injectable drugs through the intramuscular route. Oral iron supplements can be ingested directly by the oral route. The Z-track method cannot be used for intravenous or subcutaneous administration.

A patient is prescribed oral iron supplements. What advice should the nurse give to the patient about taking iron supplements? 1 "Take the supplement with milk." 2 "Take the supplement at bed time." 3 "Take the supplement with orange juice." 4 "Take the supplement in the early morning."

3 The iron in oral iron supplements is absorbed better when taken along with foods rich in ascorbic acid. The absorption of iron is enhanced in the presence of the ascorbic acid in orange juice. The absorption of iron from iron supplements does not depend on the time of the day, but rather on the food items taken along with it. The calcium present in milk decreases the absorption of iron; therefore, milk should be avoided.

Which part of the body is associated with the formation of new blood cells? 1 Liver 2 Heart 3 Kidney 4 Bone marrow

4 Bone marrow is involved in the formation of new blood cells. The bone marrow produces erythrocytes, leukocytes, and thrombocytes. The liver is involved in the storage of iron and the destruction of red blood cells (RBCs) in the body. The heart is involved in the circulation of blood. Kidneys secrete the hormone erythropoietin, which is involved in the maturation of RBCs.

Which is a common expected adverse effect of iron supplementation? 1 Flatus 2 Fatigue 3 Heartburn 4 Constipation

4 Constipation and a change in the color of stool to darker or green are the most common complaints with iron supplementation and are expected. Flatus, fatigue, and heartburn are not common and expected adverse effects of iron supplementation.

Which route of administration results in a slow onset of action of epoetin alfa? 1 Oral 2 Intravenous 3 Intramuscular 4 Subcutaneous

4 Epoetin alfa has a slower onset of action when administered through the subcutaneous route compared with other routes. The drug requires more time to be absorbed in the bloodstream when given via the subcutaneous route. Epoetin alfa is not prescribed for the oral route. The intravenous route shows a quick onset of action, and the intramuscular route provides prolonged action.

An oral iron supplement (100 mg) is prescribed to a patient with iron-deficiency anemia. The nurse advises the patient to take six to eight tablets per day. Which iron supplement is most likely prescribed to the patient? 1 Ferumoxytol 2 Ferrous sulfate 3 Ferric gluconate 4 Ferrous fumarate

4 Ferrous fumarate is the oral iron supplement available in the form of 100 mg and 325 mg tablets. The 100 mg tablets should be administered as six to eight tablets per day. Patients can take two to three 325 mg tablets per day. Ferrous sulfate is also an oral iron supplement available in the form of tablets administered as two to three tablets per day. Ferumoxytol and ferric gluconate are available in the form of injections given via the intravenous or subcutaneous route.

What is the difference between ferumoxytol and other anemia drugs? 1 It can be diluted and infused over 2.5 to 3.5 hours. 2 It can be given to the patient only after a test dose. 3 It can be used only for nutrition-related iron-deficiency anemia. 4 It can be administered undiluted as an intravenous push over 1 minute

4 Ferumoxytol is an injectable iron product that can be injected directly through the intravenous route without dilution. It has the advantage of being given as an intravenous push over 1 minute. Unlike iron sucrose, ferumoxytol need not be diluted and infused over 2.5 to 3.5 hours to prevent adverse effects. Ferumoxytol does not need a test dose, because it does not trigger an anaphylactic reaction. Ferumoxytol can be used to treat anemia caused by renal failure.

The nurse would question the prescription for epoetin in a patient with which condition? 1 Anemia 2 HIV/AIDS 3 Chronic renal failure 4 Uncontrolled hypertension

4 Hypertension is a side effect of epoetin; hence, the drug should not be given to patients with uncontrolled hypertension. Anemia, antiretroviral treatment for HIV/AIDS, and chronic renal failure are indications for the therapeutic use of epoetin.

A patient with hyperacidity is diagnosed with iron-deficiency anemia. The prescription contains oral antacid preparations and oral iron supplements. What is the most important advice the nurse gives to the patient? 1 "Take the iron supplements with meals." 2 "Take the iron supplements along with antacids." 3 "Take the iron supplements with plenty of water." 4 "Take the iron supplements at least 2 hours after taking antacids."

4 Oral iron supplements should be taken at least 2 hours after taking antacids, because the presence of antacids decreases the absorption of iron. Iron supplements should not be administered along with meals, because the presence of food also decreases the absorption of iron from the gastrointestinal tract. The absorption of iron is inhibited if administered with antacids. Therefore iron should not be administered along with antacids. It is advisable to dilute the iron supplements with plenty of water to avoid discoloration of tooth enamel. However, this is not the nurse's most important advice.

The hemoglobin level in a patient undergoing chemotherapy is 8.5 g/dL. After intravenously administering epoetin alfa for a week, the nurse observes the patient's hemoglobin levels have increased to 11.7 g/dL. Which potential complication might result if the nurse continues with the drug administration? 1 The patient may experience hematemesis. 2 The patient may have difficulty defecating. 3 The patient may have increased sugar levels. 4 The patient may have increased blood pressure.

4 Overdose of epoetin alfa in patients undergoing chemotherapy causes hypertension, vomiting, and nausea. Administration of epoetin alfa in a patient who has a hemoglobin level of 12 g/dL or more can lead to serious adverse effects like stroke and myocardial infarction from high blood pressure. Hematemesis (vomiting blood) is a sign of toxicity caused by iron supplements. Excess iron supplementation can cause constipation. This difficulty in defecation can be minimized by increasing fluid and fiber intake in the diet. Hyperglycemia is an immediate effect of injecting iron preparations such as iron sucrose and iron dextran.

A child who accidently ingested an enteric-coated iron supplement develops seizures and is immediately hospitalized. The serum iron concentration is found to be 350 mcg/dL. What intervention should the nurse expect the provider to prescribe to reduce the serum iron levels? 1 Bowel irrigation 2 An electrolyte infusion 3 Abdominal radiographs 4 Administration of deferoxamine

4 Severe iron toxicity results in coma, shock, or seizures. The primary health care provider should initiate the chelation therapy with deferoxamine immediately to decrease the serum iron levels. The decontamination of the gastrointestinal (GI) tract will remove any traces of iron present in the GI tract but cannot reduce the serum concentration of iron. Electrolyte infusion will not reduce the serum levels of iron. It is used to maintain the electrolyte balance in the body. Abdominal radiographs are used to determine the presence of any traces of iron in the gastrointestinal tract.

A patient receives iron dextran (InFeD) 100 mg IM daily. After 7 days of medication, which patient assessments should the nurse use to evaluate the effectiveness of therapy? A. Hematocrit B. Hemoglobin C. Energy level D. Pink conjunctiva E. Functional status F. Decreased heart rate

A. Hematocrit B. Hemoglobin C. Energy level To determine whether supplemental iron therapy is effective, the nurse analyzes the patient's hemoglobin, hematocrit, and energy level. If therapy is effective, all of these parameters should increase. The hemoglobin and hematocrit increase because additional iron promotes the synthesis of heme for hemoglobin, and the patient's energy level increases as the blood regains oxygen-carrying capacity. Pink conjunctiva may indicate adequately oxygenated tissue, but this is a nonsensitive and nonspecific clinical indicator. A functional status assessment may include energy level, but it also involves skill at motor tasks and self-care activities. Decreased heart rate is a nonsensitive and nonspecific clinical indicator of adequate oxygenation.

Which deficiency can lead to anemia in malnourished patients? (Select all that apply.) A. Iron B. Zinc C. Calcium D. Folic acid E. Vitamin C F. Vitamin B12

A. Iron D. Folic acid F. Vitamin B12 Iron-deficiency anemia can develop in a malnourished patient as a result of a lack of iron in the diet; pernicious anemia can develop with deficiencies of folic acid and vitamin B12. Zinc, calcium, and vitamin C deficiencies do not cause anemia.

A male child has ingested tablets of ferrous sulfate, and his serum iron level is greater than 300 mcg/dL. What is the nurse's priority goal of therapy? A. Maintaining the blood pressure B. Evacuating the stomach contents C. Reversing the metabolic acidosis D. Balancing fluids and electrolytes

A. Maintaining the blood pressure The nurse's priority goal is maintaining the blood pressure because the patient is likely to have hypotension as a result of the toxic effects of an excessive serum iron level and because it is one of the three most important patient needs, along with airway and breathing. The nurse's next priority is to remove excess iron from the patient, which may require lavage of the entire gastrointestinal tract if an extended-release formulation of iron is used. Reversal of acidosis and balancing of fluids and electrolytes are interrelated and important for patient survival.

Which conditions are indications for the administration of medications that contain iron? (Select all that apply.) A. Pregnancy B. Thalessemia C. Gastric erosion D. Sickle cell anemia E. Hemochromatosis F. Surgical blood loss

A. Pregnancy C. Gastric erosion F. Surgical blood loss Pregnancy is a suitable indication for iron supplements, both because the patient is supporting two systems and because the fetus drains some maternal iron stores. Blood loss from GI bleeding or surgery is a suitable indication for iron supplements to replace lost iron stores and to provide iron for the production of new red blood cells. Thalessemia, sickle cell anemia, and hemochromatosis are not suitable indications for iron supplements.

A patient will be taking oral iron supplements at home. The nurse will include which statements in the teaching plan for this patient? (Select all that apply.) a. Take the iron tablets with meals. b. Take the iron tablets on an empty stomach 1 hour before meals. c. Take the iron tablets with an antacid to prevent heartburn. d. Drink 8 ounces of milk with each iron dose e.Taking iron supplements with orange juice enhances iron absorption. f.Stools may become loose and light in color. g.Stools may become black and tarry.h.Tablets may be crushed to enhance iron absorption

ANS: A, E, GIron tablets need to be taken with meals to reduce gastrointestinal distress, but antacids and milk interfere with absorption. Orange juice enhances the absorption of iron. Stools may become black and tarry in patients who are on iron supplements. Tablets need to be taken whole, not crushed, and the patient needs to be encouraged to eat foods high in iron.

A patient has been taking iron supplements for anemia for 2 months. During a follow-up assessment, the nurse will observe for which therapeutic response? a.Decreased weight b.Increased activity tolerance c.Decreased palpitations d.Increased appetite

ANS: BAbsence of fatigue, increased activity tolerance and well-being, and improved nutrition status are therapeutic responses to iron supplementation. The other options are incorrect

The nurse is administering intravenous iron dextran for the first time to a patient with anemia. After giving a test dose, how long will the nurse wait before administering the remaining portion of the dose? a.30 minutes b.1 hour c.6 hours d.24 hours

ANS: BAlthough anaphylactic reactions usually occur within a few moments after the test dose, it is recommended that a period of at least 1 hour elapse before the remaining portion of the initial dose is given. The other options are incorrect

The nurse is administering liquid oral iron supplements. Which intervention is appropriate when administering this medication? a.Have the patient take the liquid iron with milk. b.Instruct the patient to take the medication through a plastic straw. c.Have the patient sip the medication slowly. d.Have the patient drink the medication, undiluted, from the unit-dose cup

ANS: BLiquid oral forms of iron need to be taken through a plastic straw to avoid discoloration of tooth enamel. Milk may decrease absorption

During drug therapy with epoetin alfa (Epogen), the nurse knows that therapy must be stoppedif which laboratory result is noted? a.White blood cell count of 550 cells/mm3 b.Hemoglobin level of 13 g/dL c.Potassium level of 4.2 mEq/L d.Glucose level of 78 mg/dL

ANS: BWhen hemoglobin levels are above 12 g/dL and the epoetin alfa is continued, patients may experience serious adverse events, including heart attack, stroke, and death. Epoetin must notbe given to patients with renal disorders unless their hemoglobin level is less than 12 g/dL. In cancer patients, the hemoglobin level needs to be less than 10 g/dL. The other options are incorrect

The nurse will teach a patient who is receiving oral iron supplements to watch for which expected adverse effects? a. Palpitations b. Drowsiness and dizziness c. Black, tarry stools d. Orange-red discoloration of the urine

ANS: C Black, tarry stools and other gastrointestinal disturbances may occur with the administration of iron preparations. The other options are incorrect

A nurse is giving instructions to a patient who will be receiving oral iron supplements. Which instructions will be included in the teaching plan? a.Take the iron tablets with milk or antacids .b.Crush the pills as needed to help with swallowing. c.Take the iron tablets with meals if gastrointestinal distress occurs. d.If black tarry stools occur, report it to the doctor immediately

ANS: CAlthough taking iron tablets with food may decrease absorption, doing so helps to reduce gastrointestinal distress. Antacids and milk may cause decreased iron absorption; iron tablets must be taken whole and not crushed. Black, tarry stools are expected adverse effects of oral iron supplements

A patient with end-stage renal failure has been admitted to the hospital for severe anemia. She is refusing blood transfusions. The nurse anticipates drug therapy with which drug to stimulate the production of red blood cells a.folic acid b.cyanocobalamin (vitamin B12) c.epoetin alfa (Epogen) d.filgrastim (Neupogen

ANS: CEpoetin alfa is a colony-stimulating factor that is responsible for erythropoiesis, or formation of red blood cells. The other options are incorrect

During therapy with the hematopoietic drug epoetin alfa (Epogen), the nurse instructs the patient about adverse effects that may occur, such as a.anxiety. b.drowsiness. c.hypertension. d.constipation.

ANS: CHypertension is an adverse effect of hematopoietic drugs, along with headache, fever, pruritus,rash, nausea, vomiting, arthralgia, cough, and injection site reaction. The other options are incorrect

A patient is to receive iron dextran injections. Which technique is appropriate when the nurse is administering this medication? a.Intravenous administration mixed with 5% dextrose b.Intramuscular injection in the upper arm c.Intramuscular injection using the Z-track method d.Subcutaneous injection into the abdomen

ANS: CIntramuscular iron is given using the Z-track method deep into a large muscle mass. If given intravenously, it is given with normal saline, not 5% dextrose

A patient has been receiving epoetin alfa (Epogen) for severe iron-deficiency anemia. Today, the provider changed the order to darbepoetin (Aranesp). The patient questions the nurse, "What is the difference in these drugs?" Which response by the nurse is correct? a."There is no difference in these two drugs." b."Aranesp works faster than Epogen to raise your red blood cell count." c."Aranesp is given by mouth, so you will not need to have injections." d."Aranesp is a longer-acting form, so you will receive fewer injections."

ANS: DDarbepoetin (Aranesp) is longer-acting than epoetin alfa (Epogen); therefore, fewer injections are required. The other options are incorrect.

The nurse is administering folic acid to a patient with a new diagnosis of anemia. Which statement about treatment with folic acid is true? a.Folic acid is used to treat any type of anemia. b.Folic acid is used to treat iron-deficiency anemia. c.Folic acid is used to treat pernicious anemia. d.The specific cause of the anemia needs to be determined before treatment.

ANS: DFolic acid should not be used to treat anemias until the underlying cause and type of anemia have been identified. Administering folic acid to a patient with pernicious anemia may correct the hematologic changes of anemia, but the symptoms of pernicious anemia (which is due to avitamin B12deficiency, not a folic acid deficiency) may be deceptively masked. The other options are incorrect.

The nurse is reviewing the medical record of a patient before giving a new order for iron sucrose (Venofer). Which statement regarding the administration of iron sucrose is correct? a.The medication is given with food to reduce gastric distress. b.Iron sucrose is contraindicated if the patient has renal disease. c.A test dose will be administered before the full dose is given. d.The nurse will monitor the patient for hypotension during the infusion

ANS: DIron sucrose (Venofer) is an injectable iron product indicated for the treatment of iron-deficiency anemia in patients with chronic renal disease. It is also used for patients without kidney disease. Its risk of precipitating anaphylaxis is much less than that of iron dextran, and a test dose is not required. Hypotension is the most common adverse effect and appears to be related to infusion rate. Low-weight elderly patients appear to be at greatest risk for hypotension.

A woman who is planning to become pregnant should ensure that she receives adequate levelsof which supplement to reduce the risk for fetal neural tube defects? a.vitamin B12 b.vitamin D c.iron d.folic acid

ANS: DIt is recommended that administration of folic acid be begun at least 1 month before pregnancy and continue through early pregnancy to reduce the risk for fetal neural tube defects

The nurse is teaching a patient with iron-deficiency anemia about foods to increase iron intake. Which food may enhance the absorption of oral iron forms? a.Milk b.Yogurt c.Antacids d.Orange juice

ANS: DOrange juice contains ascorbic acid, which enhances the absorption of oral iron forms; antacids, milk, and yogurt may interfere with absorption.

What intervention will the provider prescribe to increase the effectiveness of epoetin alfa?

Administer ferrous fumarate along with epoetin alfa. Epoetin alfa should always be administered along with oral supplements like ferrous fumarate to increase the effectiveness of the drug.

A child who accidently ingested an enteric-coated iron supplement develops seizures and is immediately hospitalized. The serum iron concentration is found to be 350 mcg/dL. What intervention should the nurse expect the provider to prescribe to reduce the serum iron levels?

Administration of deferoxamine Severe iron toxicity results in coma, shock, or seizures. The primary health care provider should initiate the chelation therapy with deferoxamine immediately to decrease the serum iron levels.

The nurse wants to administer iron preparations to patients with their meals to avoid gastric upset. Which foods should the nurse avoid when administering the iron medication? (Select all that apply.) A. Fish B. Corn C. Eggs D. Veal E. Beans F. Tomatoes

B. Corn C. Eggs E. Beans The nurse avoids administering iron supplements to patients with meals that contain beans, corn, or eggs because these foods contain substances called phytates that can impair iron absorption. Administering iron with fish, veal, or tomatoes may be suitable.

A patient has delivered her first baby. The patient is Rh negative, and the baby is Rh positive. The nurse administers RhoGAM to the patient to prevent which type of anemia in the fetus of a subsequent pregnancy? A. Intrinsic hemolytic B. Extrinsic hemolytic C. Nuclear maturation defect D. Cytoplasmic maturation defect

B. Extrinsic hemolytic The nurse administers RhoGAM to the patient to prevent the development of antibodies against Rh-positive blood in her system in a subsequent pregnancy involving an Rh-positive fetus. The patient may have been exposed to Rh-positive blood during the delivery of the first baby, and, because the patient is Rh negative, her immunologic system recognizes Rh-positive blood as foreign, attacks it, and produces antibodies against future attacks. If the patient carries another Rh-positive baby, her antibodies against Rh-positive blood will attack the fetal erythrocytes, causing hemolysis, or erythroblastosis fetalis. Therefore, the cause of the hemolysis is outside the baby, or extrinsic.

Where does the process of erythropoiesis take place in the human body?

Blood Erythropoiesis involves the maturation of precursors of nucleated red blood cells (RBCs) into hemoglobin-filled, nucleus-free erythrocytes. It takes place in the circulation, where nucleated RBCs undergo a 24- to 36-hour maturation process to become mature, fully functional RBCs.

An elderly and malnourished patient is prescribed iron sucrose for anemia. What will the nurse monitor in the patient to ensure safe administration of the drug?

Blood pressure Iron sucrose tends to cause hypotension in patients who are elderly and underweight. Therefore, the nurse should monitor the patient's blood pressure when administering the drug.

A patient with chronic renal failure has uncontrolled hypertension and cannot take medication by mouth. What is the best iron preparation for the treatment of anemia for this patient? A. Iron dextran (InFeD) B. Ferrous sulfate C. Ferric gluconate (Ferrlecit) D. Ferrous fumarate (Feostat)

C. Ferric gluconate (Ferrlecit) Because it is an injectable medication, ferric gluconate is indicated in the treatment of iron-deficiency anemia in patients with chronic renal failure who cannot take medication by mouth. Iron dextran is also injectable, but it carries a risk of anaphylaxis. Ferrous sulfate and ferrous fumarate are not indicated because they are oral preparations.

Which groups of individuals are at highest risk for developing iron-deficiency anemia? Select all that apply.

Children, Pregnant women, Female patients age 12 to 40 years. Individuals who require the highest amount of iron are women (especially pregnant women) and children, and they are the groups most likely to develop iron-deficiency anemia. For women, this is partly because of ongoing menstrual blood losses.

Which is a common expected adverse effect of iron supplementation?

Constipation Constipation and a change in the color of stool to darker or green are the most common complaints with iron supplementation and are expected.

A patient informs the nurse she must take her iron with a meal to prevent stomach upset. To increase the uptake of oral iron, which food group will the nurse instruct the patient to avoid?

Dairy Many individuals find that they need to take oral iron products with meals or food because of the commonly encountered adverse effect of gastrointestinal upset, even though altered absorption occurs. However, the patient should avoid taking iron with dairy products; antacids or milk products should be consumed at least 1 to 2 hours before or after the oral dosage of iron.

A nurse is assessing an athlete who has been admitted for cardiac arrest. The investigation reports reveal increased blood viscosity. Which drug did the patient likely receive?

Epoetin alfa Athletes tend to abuse erythropoietin to increase oxygen-carrying capacity and thus improve their athletic performance. Epoetin alfa is administered to patients with iron-deficiency anemia. It increases the oxygen-carrying capacity of the blood and increases blood viscosity. This may lead to stroke and myocardial infarction.

The formation of erythrocytes and maturation of the red blood cell (RBC) is driven by what hormone?

Erythropoietin Erythropoiesis is the process of erythrocyte formation, and this involves the maturation of a nucleated RBC precursor into a hemoglobin-filled, nucleus-free erythrocyte. This process is driven by the hormone erythropoietin, which is produced by the kidneys. Erythropoietin is also produced commercially and is used to treat anemia in certain specific circumstances.

Which medication contains the largest amount of iron per gram of salt?

Ferrous fumarate Ferrous fumarate contains the largest amount of iron per gram of salt consumed. It contains 33% elemental iron.

What are the clinical complications associated with the continued use of epoetin alfa when the hemoglobin levels are above 12 g/dL?

Heart attack Epoetin alfa is an erythropoietic-stimulating agent that results in serious adverse effects such as heart attack, stroke, and death when used excessively.

A cardiac patient is transferred to the intensive care unit (ICU) because of decreased cardiac output. The cardiologist recommends an intraaortic balloon pump to increase the cardiac output. What is a complication associated with the use of intraaortic balloon pumps?

Hemolytic anemia Intraaortic balloon pumps are used to increase cardiac output through pumping action. The mechanical force of the intraaortic balloon pump may destroy excess red blood cells, causing hemolytic anemia.

What is the most common adverse effect of iron sucrose?

Hypotension

Which route of administration is associated with the Z-track method?

Intramuscular

The nurse should plan to inject iron dextran by which technique?

Intramuscular injection using the Z-track method Iron dextran should be administered deep in a large muscle mass using the Z-track method and a 23-gauge, 1½-inch needle to prevent skin irritation and potential necrosis.

Which drug requires a test dose to ensure safe medication administration?

Iron dextran Iron dextran is an injectable iron formulation that may cause an anaphylactic reaction in the patient. Therefore, a test dose of iron dextran is injected, and the patient is monitored for any adverse reactions.

A patient with end-stage renal failure is diagnosed with hypochromic and microcytic anemia. Which drug should the nurse expect in the patient's prescription?

Iron sucrose Iron sucrose is an injectable iron supplement prescribed for patients with iron-deficiency anemia and chronic renal failure. It can be easily eliminated from the body.

What is the difference between ferumoxytol and other anemia drugs?

It can be administered undiluted as an intravenous push over 1 minute. Ferumoxytol is an injectable iron product that can be injected directly through the intravenous route without dilution. It has the advantage of being given as an intravenous push over 1 minute.

Which type of anemia is associated with normochromic and macrocytic red blood cells (RBCs)?

Megaloblastic anemia Megaloblastic anemia or macrocytic anemia is caused by a deficiency of vitamin B12 and folic acid. It is associated with normochromic and macrocytic red blood cells (RBCs), in which case the RBCs have a normal color but are of larger-than-normal size.

When administering ferrous sulfate (iron) to a patient, the nurse should plan to give this medication with which fluid to increase absorption of the iron?

Orange juice The absorption of iron can be enhanced when it is given with ascorbic acid (vitamin C), which is present in orange juice.

What is the genetic disorder that is associated with excessive red blood cell (RBC) destruction?

Sickle cell anemia Sickle cell anemia is a genetic disorder associated with excessive RBC destruction. It results from defects in the intrinsic factors of RBCs that cause excessive RBC destruction.

Which route of administration results in a slow onset of action of epoetin alfa?

Subcutaneous Epoetin alfa has a slower onset of action when administered through the subcutaneous route compared with other routes. The drug requires more time to be absorbed in the bloodstream when given via the subcutaneous route.

A patient with a low hemoglobin count is prescribed an iron supplement along with erythropoiesis-stimulating agents. What strategy will the nurse adopt to increase the patient's energy levels? Select all that apply.

The nurse encourages the patient to build a physical activity plan. The nurse motivates the patient and increases the hope for better living. The nurse plans a proper diet chart for the patient to meet nutritional demands.

A patient with chronic renal failure who eats a well-balanced diet reports fatigue and lightheadedness. What is the most likely reason for fatigue in the patient?

The patient lacks erythropoietin. Erythropoiesis is the process of maturation of red blood cells. It is facilitated by erythropoietin, which is secreted by the kidneys. The secretion of erythropoietin decreases in chronic renal failure, leading to anemia, which manifests as fatigue.

A patient with chronic renal disease is prescribed an iron supplement along with erythropoiesis-stimulating agents. What is the reason for prescribing an iron supplement with erythropoiesis-stimulating agents?

To improve the efficacy of erythropoiesis-stimulating agents Iron supplements increase the efficacy of erythropoiesis-stimulating agents by promoting the maturation of erythrocytes.

The nurse would question the prescription for epoetin in a patient with which condition?

Uncontrolled hypertension Hypertension is a side effect of epoetin; hence, the drug should not be given to patients with uncontrolled hypertension.

The nurse is caring for a patient who is prescribed epoetin alfa. What should the nurse expect is the reason for the use of this medication in this patient?

Used for an anemic patient with renal failure Epoetin alfa is the synthetic form of erythropoietin and is a hormone produced by the kidneys. The patient in renal failure does not have typical kidney function and therefore may have this medication prescribed to treat anemia associated with the lack of natural production of the hormone. It is also indicated for chemotherapy-induced anemia.

An oral iron supplement is prescribed for a patient. The nurse would question this order if the patient's medical history includes which condition a.Decreased hemoglobin b.Hemolytic anemia c.Weakness d.Concurrent therapy with erythropoietics

erythropoieticsANS: BHemolytic anemia is a contraindication to the use of iron supplements. Decreased hemoglobinand weakness are related to iron-deficiency anemia. Iron supplements are given with erythropoietic drugs to aid in the production of red blood cells.