Question 1

The patient with which of the following is most at risk for folic acid deficiency?&#10;A) Alcoholism&#10;B) Sprue&#10;C) Gastrectomy&#10;D) Peptic ulcer disease

Accepted Answer

The patient most at risk for folic acid deficiency secondary to a poor diet is a patient with a history of alcoholism. Malabsorption secondary to intestinal disease is another indication for folic acid therapy, but these patients are not most at risk.

Question 2

A patient who has recently immigrated to the United States from an impoverished country appears malnourished. The patient's folic acid levels are low, and the vitamin ₁₂ levels are normal. The nurse expects this patient's treatment to include:

A) a diet high in folic acid.
B) intramuscular folic acid.
C) oral folic acid and vitamin B₁₂.
D) oral folic acid supplements.

Accepted Answer

If a folic acid deficiency is caused by poor diet, it should be corrected with dietary measures, not supplements. IM or oral supplements of folic acid are not indicated. Vitamin B₁₂ is not recommended.

Question 3

A nurse is caring for a patient after hip replacement surgery. The patient has been receiving iron replacement therapy for 2 days. The nurse notes that the patient's stools appear black. The patient is pale and complains of feeling tired. The patient's heart rate is 98 beats per minute, respirations are 20 breaths per minute, and the blood pressure is 100/50 mm Hg. The nurse will contact the provider to:

A) report possible gastrointestinal hemorrhage.
B) request a hemoglobin and hematocrit (H&H).
C) request an order for a stool guaiac.
D) suggest giving a hypertonic fluid bolus.

Accepted Answer

This patient is showing signs of iron deficiency anemia, as manifested by tachycardia and pallor. Because this patient's blood pressure is low, the anemia probably has occurred secondary to blood loss, a common occurrence with hip replacement surgery. The first response should be to obtain an H&H to assess the anemia. GI hemorrhage is not a concern in this patient; black stools are an expected effect of oral iron administration. A stool guaiac is not indicated. If the patient has blood loss that is causing hypotension, an isotonic fluid bolus and packed red blood cells (PRBCs) are indicated to treat this.

Question 4

The nurse is taking a medication history on a newly admitted patient. The patient reports taking folic acid and vitamin B₁₂. The nurse notifies the provider because of the concern that folic acid can:

A) cause fetal malformation.
B) mask the signs of vitamin B₁₂ deficiency.
C) negatively affect potassium levels.
D) worsen megaloblastic anemia.

Accepted Answer

Folic acid can reverse the hematologic effects of vitamin B₁₂ deficiency, but it does not reverse the neurologic effects so it is important to determine the degree of B₁₂ deficiency in order to treat it. Folic acid does not cause fetal malformation; in fact, it can help prevent neural tube defects. Folic acid does not worsen megaloblastic anemia. Folic acid does not affect potassium levels.

Question 5

A patient is admitted to the hospital. The patient's initial laboratory results reveal megaloblastic anemia. The patient complains of tingling of the hands and appears confused. The nurse suspects what in this patient?

A) Celiac disease
B) Folic acid deficiency
C) Iron deficiency anemia
D) Vitamin B₁₂ deficiency

Accepted Answer

When patients present with megaloblastic anemia, it is essential to distinguish between folic acid deficiency and vitamin B₁₂ deficiency. If neurologic deficits are observed, vitamin B₁₂ deficiency is more likely to be the cause. This patient does not have signs of celiac disease. Iron deficiency anemia would be indicated by a low hemoglobin and hematocrit.

Question 6

A patient with renal failure is undergoing chronic hemodialysis. The patient's hemoglobin is 10.6 gm/dL. The provider orders sodium-ferric gluconate complex (SFGC [Ferrlecit]). What will the nurse expect to do?

A) Administer the drug intravenously with erythropoietin.
B) Give a test dose before each administration of the drug.
C) Have epinephrine on hand to treat anaphylaxis if needed.
D) Infuse the drug rapidly to achieve maximum effects quickly.

Accepted Answer

SFGC is given parenterally for iron deficiency anemia in patients undergoing chronic hemodialysis. It is always used in conjunction with erythropoietin to stimulate production of red blood cells (RBCs). A test dose is given only with the initial dose and is not necessary with subsequent doses. Anaphylaxis is not a common side effect. The drug should be infused slowly.

Question 7

A 12-year-old female patient is admitted to the hospital before sinus surgery. The nurse preparing to care for this patient notes that the admission hemoglobin is 10.2 gm/dL, and the hematocrit is 32%. The nurse will ask the child's parents which question about their daughter?

A) "Does she eat green, leafy vegetables?"
B) "Has she begun menstruating?"
C) "Is she a vegetarian?"
D) "Is there a chance she might be pregnant?"

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Accepted Answer

The most common cause of iron deficiency anemia in adolescent females is heavy periods, so asking about menses is an appropriate first question when evaluating the cause of low iron in young females. Iron deficiency only rarely occurs because of poor dietary intake. Although pregnancy is not unheard of in 12-year-old girls, a question about possible pregnancy should not be the first question asked.

Question 8

What are the indications for administration of a parenteral iron preparation? (Select all that apply.)&#10;A) Blood loss of 750 mL/week&#10;B) Celiac disease with anemia&#10;C) History of alcoholism&#10;D) Intestinal disease impairing absorption&#10;E) Megaloblastic anemia

Accepted Answer

Patients who have lost 750 mL/week of iron cannot absorb enough oral iron, so parenteral iron is indicated for these patients. Patients with celiac disease or other diseases that impair iron absorption must receive parenteral iron. Patients with a history of alcoholism are generally deficient in folic acid. Megaloblastic anemia is a symptom of vitamin B₁₂ and/or folic acid deficiency.

Question 9

A patient with vitamin B₁₂ deficiency is admitted with symptoms of hypoxia, anemia, numbness of hands and feet, and oral stomatitis. The nurse expects the prescriber to order which of the following therapies?

A) IM cyanocobalamin and folic acid
B) IM cyanocobalamin and antibiotics
C) PO cyanocobalamin and folic acid
D) PO cyanocobalamin and blood transfusions

Accepted Answer

This patient is showing signs of more severe vitamin B₁₂ deficiency with neurologic symptoms; therefore, cyanocobalamin should be given parenterally along with folic acid. Antibiotics are indicated only when signs of infection are present. Oral cyanocobalamin is not recommended.

Question 10

A patient was given a 30-day supply of Feosol and has been taking the drug for 4 weeks for iron deficiency anemia. The patient's initial hemoglobin was 8.9 gm/dL. The nurse notes that the hemoglobin has risen to 9.7 gm/dL. What will the nurse ask the patient about?

A) Dietary iron intake
B) Gastrointestinal (GI) upset
C) Whether stools have been tarry or black
D) Whether the prescription needs to be refilled

Accepted Answer

When therapy is successful, the hemoglobin level increases by 2 gm/dL within 1 month. If the hemoglobin does not increase as expected, patients should be asked about compliance. If a patient reports that the prescription does not need to be refilled, the medication probably has not been taken as prescribed. Dietary iron intake is not a part of iron replacement therapy but is an important part of the prevention of anemia. GI upset and tarry, black stools are expected side effects of iron products.

Question 11

A patient is receiving oral iron for iron deficiency anemia. Which antibiotic drug, taken concurrently with iron, would most concern the nurse?&#10;A) Tetracycline&#10;B) Cephalosporin&#10;C) Metronidazole (Flagyl)&#10;D) Penicillin

Accepted Answer

The answer of A patient is receiving oral iron for...

Question 12

A patient is diagnosed with moderate vitamin B₁₂ deficiency. The nurse reviews the laboratory work and notes that the plasma B₁₂ is low; also, a Schilling test reveals B₁₂ malabsorption. The provider orders oral cyanocobalamin 500 mcg per day. The nurse will contact the provider to:

A) discuss IM dosing.
B) request an order for folic acid.
C) suggest an increased dose.
D) suggest platelet transfusion therapy.

Accepted Answer

The answer of A patient is diagnosed with moderate vitamin...

Question 13

A patient tells a nurse that she is thinking about getting pregnant and asks about nutritional supplements. What will the nurse recommend? A) A balanced diet high in green vegetables and grains B) 400 to 800 mg of folic acid per day C) A multivitamin with iron D) Vitamin B₁₂ supplements

Accepted Answer

The answer of A patient tells a nurse that she...

Question 14

A nurse is reviewing a patient's most recent blood count and notes that the patient has a hemoglobin of 9.6 gm/dL and a hematocrit of 33%. The nurse will notify the provider and will expect initial treatment to include:

A) determining the cause of the anemia.
B) giving intravenous iron dextran.
C) giving oral carbonyl iron (Feosol).
D) teaching about dietary iron.

Accepted Answer

The answer of A nurse is reviewing a patient's most...

Deck 55: Drugs for Deficiency Anemias