Chapter 55: Drugs for Deficiency Anemias

Chapter 55: Drugs for Deficiency Anemias

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

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