Nokea
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
Correct Answer: C
Rationale: Intramuscular 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.
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The nurse is reviewing the medical record of a patient before giving a new order for iron sucrose. 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.
Correct Answer: D
Rationale: Iron 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.
A patient has been receiving epoetin alfa for severe iron-deficiency anemia. Today, the provider changed the order to darbepoetin. 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.
Correct Answer: D
Rationale: Darbepoetin (Aranesp) is longer-acting than epoetin alfa (Epogen); therefore, fewer injections are required.
During therapy with the hematopoietic drug epoetin alfa, the nurse instructs the patient about adverse effects that may occur, such as
- A. Anxiety
- B. Drowsiness
- C. Hypertension
- D. Constipation
Correct Answer: C
Rationale: Hypertension is an adverse effect of hematopoietic drugs, along with headache, fever, pruritus, rash, nausea, vomiting, arthralgia, cough, and injection site reaction.
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.
Correct Answer: C
Rationale: Although 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 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 to reduce GI upset.
- 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.
Correct Answer: A,E,G
Rationale: Iron 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.