exam 4

Iron toxicity reversal

chelation therapy with Deferoxamine

what med is used for iron overload?

deferiprone

Which food will the nurse teach the patient to avoid when ingesting an iron supplement?

eggs

Some foods impair iron absorption

eggs, corn, beans, cereal products containing phytates

what type of iron is indicated for patients undergoing hemodialysis

ferric gluconate (ferrlecit)

food sources of folic acid

green leafy veggies, liver, meat, fish, legumes, whole grains, OJ, peanuts, avocado

Before administering epoetin alfa to a patient in renal failure, it is most important for the nurse to assess which laboratory result?

hemoglobin level

nurse intervention with deferiprone

monitor WBC because they are at increase risk of infection

what is the most frequently used form of iron

oral- ferrous sulfate

Some foods enhance iron absorption

orange juice, veal, fish, ascorbic acid

what type of anemia do you mostly see a beefy red tongue in?

pernicious anemia (b12)

what is the treatment for TTP

plasmapheresis

What is TTP (thrombotic thrombocytopenic purpura)?

small blood clots form throughout the body using up a large number of platelets

What is the term for low platelet count?

thrombocytopenia

what does VTE stand for?

venous thromboembolism

nursing intervention for iron dextran

you must do a test dose of 25 mg because it can cause fatal anaphylaxis

s/s of anemia

-Fatigue- first sign -weakness -Paleness -SOB -Chills -nail changes -pica -tongue changes

folic acid nursing implicationcs

-determine cause of anemia before administering (can mask symptoms of pernicious anemia) -give with food if taken orally

pt education for oral iron

-drink through straw to avoid staining -take between meals unless they can not tolerate -given with juice not milk or antacids -pt should remain upright for 15-30 min to avoid esophageal corrosion -encourage high iron/folic acid diet

therapeutic responses after giving meds for anemia

-improved nutritional status -increased weight, activity tolerance, well-being -absence of fatigue

A client with Parkinson's disease is showing passive movement of the limbs that elicits a start and stop movement. What common symptom of Parkinson's disease may this client be experiencing? 1. Pill rolling 2. Cogwheel rigidity 3. Shuffling gait 4. Disphagia

2. Cogwheel rigidity

When administering erythropoiesis-stimulating agents, it is important for the nurse to: A.not administer the erythropoiesis-stimulating agent with any other product. B.shake the vial prior to drawing up the medication. C.avoid use of vitamin B12 supplements when patients are taking erythropoiesis-stimulating agents. D.administer oral forms of iron with milk.

A.not administer the erythropoiesis-stimulating agent with any other product.

A nurse can teach a patient with megaloblastic anemia to incorporate the following into their diet to increase folic acid: (select all that apply) Kale Milk Liver Bananas Eggs

Answer: 1,2,3,5 Rationale: Patient's with megaloblastic anemia usually lack vitamin B12 or folic acid. Folic acid can be found in green leafy vegetables, milk, eggs, and liver.

You are caring for a patient with a diagnosis of iron-deficiency anemia. Which clinical manifestations are you most likely to observe when assessing this patient? A. Convex nails, bright red gums, and alopeciaB. Brittle nails; smooth, shiny tongue; and cheilosisC. Tenting of the skin, sunken eyes, and complaints of diarrheaD. Pale pink tongue; dull, brittle hair; and blue mucous membranes

Answer: B Rationale: Specific clinical manifestations may be related to iron-deficiency anemia. Pallor is the most common finding, and glossitis (inflammation of the tongue) is the second most common; another finding is cheilitis (inflammation of the lips). The patient may report headache, paresthesias, and a burning sensation of the tongue, all of which are caused by lack of iron in the tissues. A sore tongue is a sign of cobalamin deficiency. Tenting skin is a sign of dehydration that often accompanies diarrhea. Blue mucous membranes are associated with cyanosis.

A patient arrives at the emergency department complaining of extreme fatigue that has lasted about a month. After several tests, the patient's intrinsic antibody test indicates a positive result determining the patient has pernicious anemia secondary to vitamin B12 deficiency. What further signs and symptoms will the patient present with? SELECT ALL THAT APPLY A. beefy, sore, red tongue B. constipation C. diarrhea D. paresthesia E. confusion F. agitation

Answers: A, C, D, E Rationale: When a patient is lacking vitamin B12, the tongue becomes swollen, giving it a beefy appearance and making the tongue feel sore. The patient also experiences diarrhea due to the lack of absorption of B12; when there is not enough B12 there is a lack of RBCs, which means less oxygen that reaches the GI tract, causing diarrhea. Nerve cells require vitamin B12 to function properly, without sufficient absorption, the patient will display neurological symptoms (tingling and numbness in the lower extremities) and confusion.

A 29 year old woman in the ED previously diagnosed with MS with a current exacerbation of symptoms states she does not know why she is having flare up of symptoms because she is taking her medications like she is supposed to and has been active and taking hot baths to soothe her muscles every night. What should we educate this patient about her MS? A. Nothing, we should encourage exercise B. Avoid hot temperatures C. Decrease activity because it can cause further damage D. Medications could have caused a flare up in symptoms

B. Avoid hot temperatures Avoiding heat can be helpful in preventing MS exacerbations and we want to encourage exercise

Mr. Idontgtit has recently been diagnosed with Myasthenia gravis, an autoimmune disorder affecting the myoneural junction and is characterized by varying degrees of weakness. What is the initial manifestation 80% of these patients experience? A. Epistaxis B. Diplopia C. Micturition D. Bell's Palsy

B. Diplopia is the correct answer. Diplopia and ptosis (drooping of the eyelids) are the most common symptom a patient with Myasthenia gravis experiences. Many patients also experience weakness of the muscles of the face and throat (bulbar symptoms) and generalized weakness.

The nurse would instruct the patient with anemia to take iron supplements due to iron deficiency by a. taking it with milk and cookies b. drinking with orange juice c. having a glass of water in combination with iron supplement d. taking it after eating a large meal

B. Taking orange juice (vitamin C.) with iron supplement helps with better absorption. If it is taken with a large meal the absorption of iron will decrease. The water and milk/cookies can also slow absorption.

The use of folic acid to prevent fetal neural tube defects should be started: A.during a woman's adolescence. B.at least 1 month before pregnancy. C.when a pregnancy is first discovered. D.at the beginning of the last trimester of pregnancy.

B. at least 1 month before pregnancy.

The nurse has administered iron intravenously to a patient. To prevent orthostatic hypotension, it is recommended that the nurse have the patient remain in the recumbent position for how long? A.10 minutes B.30 minutes C.60 minutes D.90 minutes

B.30 minutes

The patient is diagnosed with iron-deficiency anemia and is prescribed ferrous sulfate orally. Which should the nurse teach the patient? A. Take an antidiarrheal OTC for diarrhea B. Limit exercise for several weeks until a tolerance is achieved C. The stools may be very dark colored D. Eat only red meats and organ meats for protein

C. An effect of ferrous sulfate is for the patient's stools to become a dark green-black colored.

Which action does the nurse perform when administering iron intravenously? A.Premedicate the patient with an antihistamine to prevent anaphylaxis. B.Administer the iron with a running dextrose solution. C.Flush the IV line with 10 mL of normal saline. D.Have available Regitine to reverse vasoconstriction at the site should infiltration occur.

C.Flush the IV line with 10 mL of normal saline.

The nurse sees an order for Epoetin alfa in the patient with end stage renal disease. What might make the nurse question this order? A. The patient has hypertension and is not taking medication for it yet. B. The patient is receiving an IV iron preparation. C. The patient has a hemoglobin level of 9 g/dL D. The patient had eggs and kale for breakfast.

Correct Answer: A Rationale: ➢Contraindications: drug allergy, uncontrolled hypertension, hemoglobin levels are above 10 g/dL for cancer patients and 11 g/dL for renal patients, head and neck cancers, risk of thrombosis

Your patient is admitted to the ICU for an acute exacerbation of hepatic cirrhosis. You note on your assessment that your patient has abdominal distention and discomfort as well as a dull percussive sound. You decide that they are having ascites secondary to their cirrhosis. You are educating your patient on all the treatment options that they can have to correct their ascites. Select all treatments that apply: A) Paracentesis B) Give Albumin C) Restrict fluid intake D) Give ordered Diuretics E) Restrict sodium intake

Correct Answer: A,B,C,D,E Rationale: All of the above answers are correct. A Paracentesis is a procedure in which a doctor will insert a needle and pull off fluid from the abdomen. Giving them albumin will increase oncotic pressure of the blood vessels and expand total blood volume for better cardiac and renal circulation. You want to reduce sodium and fluid intake because these patients are already retaining fluids and giving them more fluids or salts will counteract fluid reduction strategies. You also can give them diuretics in the hopes of voiding the excessive fluids.

What helps BEST enhance the absorption of iron? A : Antacids B: Dairy products C: Vitamin C D: Vitamin A

Correct Answer: C; Vitamin C Rational: Vitamin C ( citrus fruits and juices, strawberries, tomatoes, broccoli)) helps with the absorption of Iron in the GI tract. If iron is taken with antacids and dairy products the absorption of iron in the GI tract is reduced and if taken with food in general. Iron supplements work best if taken on an empty stomach.

The nurse is providing patient teaching to a patient who is going home with the medication Levodopa/Carbidopa. Based on the response from the patient what statement states that the teaching has been EFFECTIVE? A: The patient states this medication will decrease dopamine B: The patient states that these medications will have an increased risk for orthostatic hypotension and dyskinesia C: The patient states that this medication will cure their disease D: The patient states that they will stop taking this medication when they feel like their S/S have improved

Correct answer B Rational: The medication has an increased risk for orthostatic hypotension patient should sit for a couple minutes before standing to avoid falls related to the dizziness. Levodopa increases dopamine. Parkinson's disease has no cure. The patient should NOT stop taking this medication before contacting their HCP.

A nurse is caring for a patient with a neurological disorder. You notice the patient presents with dysphonia and ptosis. Upon placing a cold pack over the patient's eye for 2 minutes you notice improvement with the ptosis. You would conclude that the patient has a diagnosis of: A. Multiple Sclerosis B. Parkinson's C. Myasthenia Gravis D. ALS

Correct answer C. Rational: The ice pack test is a useful bedside test to help differentiate myasthenia gravis from other disorders. If the patient is positive for MG they will no longer have the characteristic ptosis.

When assessing a patient diagnosed with Iron Deficiency Anemia, the nurse should anticipate to find which sings on the assessment? Select all that apply A. Pallor B. microcytic red blood cells C. Bright red blood cells D. Big red blood cells E. Fatigue

Correct answer: A, B, E Rationale: in iron deficiency anemia, iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in red blood cells. this can lead to small, discolored, RBC which are not able to transport oxygen as effectively, resulting in pallor, weakness, and fatigue.

The nurse is admitting a 24-year-old African American female client with a diagnosis of rule-out anemia. The client has a history of gastric bypass surgery for obesity four(4) years ago. Current assessment findings include height 5′5′′; weight 75 kg; P 110, R 27, and BP 104/66; pale mucous membranes and dyspnea on exertion. Which type of anemia would the nurse suspect the client has developed? Vitamin B12 deficiency. Folic Acid deficiency Iron deficiency Sickle-Cell Anemia

Correct: Answer A Vitamin B12 deficiency. Rationale: The rugae in the stomach produce intrinsic factor, which allows the body to use vitamin B12 from the foods eaten. Gastric bypass surgery reduces the amount of rugae drastically. Clients develop pernicious anemia (vitamin B12 deficiency). Other symptoms of anemia include dizziness and the tachycardia and dyspnea listed in the stem. Why it's not the rest: Folic acid deficiency is usually associated with chronic alcohol intake. Iron deficiency is the result of chronic blood loss or inadequate dietary intake of iron. Sickle cell anemia is associated with African Americans, but the symptoms and history indicate a different anemia.

A RN goes to their primary care provider after complaining of a rash, arthralgia, jaundice, dyspepsia, and malaise. The patient most likely has what type of hepatitis? A. Hepatitis A B. Hepatitis B C. Hepatitis E D. Hepatits G

Correct: B Hepatitis B patient present with a loss of appetite, a rash, arthralgia, jaundice, dyspepsia, malaise and weakness. Hepatitis A & E present with flu like symptoms, jaundice, heartburn, headache, dark urine.

what is the treatment for ITP

IVIG

what are the clinical manifestations of ITP

Petechiae and purpura, progressing to major hemorrhage

Who is most at risk for folic acid deficiency anemia? Select that all apply. a) Individuals who follow diet that includes vegetables, fruit, yeast, fortified cereals and meats b) Older adults c) Individual with heavy alcohol use d) Individuals with liver disease e) pregnant women

The answer is c,d,e Alcohol reduces absorption of folic acid Liver disease caused reduced liver uptake and storage, and increased urinary folate excretion Pregnant women absorb folic acid much slower Older adults may develop folic acid deficiency anemia, but are not most at risk Diet rich in vegetables, fruit, yeast, fortified cereals and meats is also rich in folic acid