Chapter 55 Drugs for Deficiency Anemias

. Chapter 55: Drugs for Deficiency Anemias Test Bank MULTIPLE CHOICE 1. 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. ANS: A 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. PTS: 1 DIF: Cognitive Level: Application REF: p. 645 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 2. 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. ANS: A Before therapy for iron deficiency anemia is started, the cause must be determined so that the appropriate treatment is given. Oral iron is safer and, most of the time, as effective as parenteral iron, so IV iron is not an initial choice. Oral iron will be given once the cause of the deficiency has been determined. Patients who are iron deficient should be taught about dietary iron, but this is not part of the initial treatment when a deficiency is detected. PTS: 1 DIF: Cognitive Level: Application REF: p. 646 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 3. 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 ANS: D 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. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 646 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 4. 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. ANS: B 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. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 642 TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 5. 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?” ANS: B 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. PTS: 1 DIF: Cognitive Level: Application REF: p. 642 TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential 6. A patient is receiving oral iron for iron deficiency anemia. Which antibiotic drug, taken concurrently with iron, would most concern the nurse? a. Tetracycline b. Cephalosporin c. Metronidazole [Flagyl] d. Penicillin ANS: A Coadministration of tetracycline and iron reduces absorption of both iron and tetracycline. Cephalosporin, metronidazole, and penicillin have no significant drug-to-drug interaction with iron. PTS: 1 DIF: Cognitive Level: Application REF: p. 643 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 7. 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. ANS: C Patients with vitamin B12 deficiency associated with B12 malabsorption need increased doses of oral cyanocobalamin of 1000 to 10,000 mcg/day. It is not necessary to give this drug intramuscularly. Folic acid is indicated when B12 deficiency is severe. Platelets are given when B12 deficiency is severe. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 648-649 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 8. 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 ANS: A 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. PTS: 1 DIF: Cognitive Level: Application REF: pp. 648-649 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 9. 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. ANS: B 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 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. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 647-648 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 10. 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 ANS: B The current recommendation is that all women of child-bearing age receive folic acid supplementation to prevent the development of neural tube defects that can occur early in pregnancy. Dietary folic acid is not sufficient to provide this amount. Iron supplements are given when pregnancy occurs and are not necessary before becoming pregnant. Vitamin B12 supplements are not recommended. PTS: 1 DIF: Cognitive Level: Application REF: pp. 647-648 TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 11. The patient with which of the following is most at risk for folic acid deficiency? a. Alcoholism b. Sprue c. Gastrectomy d. Peptic ulcer disease ANS: A 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. PTS: 1 DIF: Cognitive Level: Application REF: p. 650 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 12. 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 ANS: D 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. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 650 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 13. 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 B12 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. ANS: A 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. PTS: 1 DIF: Cognitive Level: Application REF: p. 651 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies 14. A patient who has been prescribed oral ferrous sulfate reports taking extra doses for the past few months. The patient’s serum iron level is 560 mcg/dL. What will the nurse expect the provider to order for this patient? a. Discontinuing the ferrous sulfate and rechecking the iron level in 1 month b. Gastric lavage and treatment for acidosis and shock c. Giving oral deferasirox [Exjade] d. Giving parenteral deferoxamine [Desferal] ANS: D If the plasma level of iron is high (above 500 mcg/dL), it should be lowered with parenteral deferoxamine. This level is toxic and must be treated. Gastric lavage is used if unabsorbed tablets are present. Oral deferasirox is used for chronic overload caused by blood transfusions. PTS: 1 DIF: Cognitive Level: Application REF: p. 643 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential MULTIPLE RESPONSE 1. What are the indications for administration of a parenteral iron preparation? (Select all that apply.) a. Blood loss of 750 mL/week b. Celiac disease with anemia c. History of alcoholism d. Intestinal disease impairing absorption e. Megaloblastic anemia ANS: A, B, D 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. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 644-645 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies .