Chapter 54: Anemia Drugs
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.
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.
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.
