Anemia - Iron Preparations
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Questions and Answers

What is the role of Vitamin B12 in the body?

  • Assisting with iron absorption in the small intestine
  • Aiding in the production of red blood cells in the bone marrow
  • Promoting the absorption of folic acid in the stomach
  • Protecting the myelin sheath of nerve fibers (correct)

    • A patient with a history of alcohol use disorder is diagnosed with megaloblastic anemia. Which vitamin is most likely prescribed?

  • Folic acid (correct)
  • Vitamin B12 (cyanocobalamin)
  • Vitamin C (ascorbic acid)
  • Iron (ferrous sulfate)

    • Which instruction should a nurse provide to a patient who is prescribed ferrous sulfate?

  • Discontinue the medication if nausea occurs.
  • Take the medication with orange juice. (correct)
  • Increase intake of dairy products to enhance absorption.
  • Expect stools to change to a dark green color.

    • A patient receiving Vitamin B12 reports muscle weakness and palpitations. Which potential adverse effect should the nurse suspect?

    <p>Hypokalemia (A)</p> Signup and view all the answers

    When administering iron dextran, what is the most critical action for the nurse to take related to potential drug reactions?

    <p>Monitor for anaphylactic reaction or seizures. (B)</p> Signup and view all the answers

    A patient is prescribed cyanocobalamin for treatment of intrinsic anemia. Which intervention is essential for the nurse to include in the plan of care?

    <p>Assessing the patient's stomach absorption for B12 with Schilling test. (D)</p> Signup and view all the answers

    Which food choice demonstrates a patient's understanding of dietary sources of folic acid?

    <p>Dark leafy greens (A)</p> Signup and view all the answers

    A elderly patient is newly diagnosed with iron-deficiency anemia. Besides medication, what dietary teaching is most appropriate?

    <p>Incorporating organ meats, whole grains, and eggs (C)</p> Signup and view all the answers

    A patient is prescribed heparin for a pulmonary embolism. Which of the following instructions should the nurse include in the patient's education?

    <p>Report any signs of bruising, black stools, shortness of breath, or calf pain. (C)</p> Signup and view all the answers

    A patient taking warfarin is scheduled for a dental procedure. Which laboratory value is most important for the nurse to review prior to the procedure?

    <p>International Normalized Ratio (INR)/Prothrombin Time (PT) (D)</p> Signup and view all the answers

    Which of the following is a key advantage of dabigatran (a non-vitamin K antagonist oral anticoagulant) compared to warfarin?

    <p>Has fewer drug interactions than warfarin. (C)</p> Signup and view all the answers

    A patient is prescribed clopidogrel after a coronary stent placement. What is a critical instruction the nurse should provide regarding potential adverse effects?

    <p>Monitor for signs of GI bleeding, like black or dark stools. (B)</p> Signup and view all the answers

    What is the primary reason that thrombolytics, such as alteplase, are considered 'ER medications'?

    <p>They are only effective if administered within a narrow time window after the onset of symptoms. (C)</p> Signup and view all the answers

    Which of the following is a contraindication for the administration of alteplase?

    <p>Confirmed brain bleed (B)</p> Signup and view all the answers

    A patient with a history of AFIB and liver failure is prescribed an anticoagulant. Which medication should the nurse question?

    <p>Warfarin (C)</p> Signup and view all the answers

    Which of the following nursing interventions is most important when caring for a patient receiving heparin therapy?

    <p>Monitoring aPTT levels (C)</p> Signup and view all the answers

    What is a key indication for administering thrombolytic agents?

    <p>Myocardial infarction within 2 hours (C)</p> Signup and view all the answers

    What condition should prevent the use of thrombolytic agents?

    <p>Peptic ulcer disease (B)</p> Signup and view all the answers

    What is a potential drug reaction associated with erythropoietic growth factor (epoetin alfa)?

    <p>Hypertension (D)</p> Signup and view all the answers

    For which patient condition is filgrastim primarily used?

    <p>Infection risk reduction (C)</p> Signup and view all the answers

    What monitoring is crucial for a patient receiving thrombopoietic growth factor (oprelvekin)?

    <p>Monitoring for edema and vital signs (A)</p> Signup and view all the answers

    What should be reported if hemoglobin levels exceed 12g during epoetin alfa treatment?

    <p>Chest pain (D)</p> Signup and view all the answers

    What is an important baseline lab test for a patient starting filgrastim therapy?

    <p>Baseline CBC with differential (B)</p> Signup and view all the answers

    Which of the following is NOT a use for epoetin alfa?

    <p>Increasing white blood cells (A)</p> Signup and view all the answers

    Flashcards

    Iron-Deficiency Anemia

    A condition caused by insufficient iron in the body leading to low hemoglobin levels.

    Ferrous Sulfate

    An iron supplement used to treat iron-deficiency anemia.

    Vitamin C and Iron

    Vitamin C enhances the absorption of iron from supplements and food.

    Folic Acid Deficiency

    Leads to megaloblastic anemia and is often linked to alcohol use.

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    Vitamin B12 (Cyanocobalamin)

    Essential for red blood cell formation and myelin sheath protection.

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    Schilling Test

    A test to assess vitamin B12 absorption in the body.

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    Food Sources of Iron

    Important dietary sources include muscle meats, whole grains, and fortified cereals.

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    B12 Deficiency Symptoms

    Symptoms include muscle weakness, nausea, and heart palpitations.

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    Heparin

    An anticoagulant used for strokes, DVT, and pulmonary embolism; prolongs clotting time.

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    Antidote for Heparin

    Protamine is the antidote used to reverse heparin's effects on clotting.

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    Warfarin (Coumadin)

    A vitamin K antagonist; used to prevent venous thrombosis and atrial fibrillation by slowing clotting time.

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    INR (International normalized ratio)

    A lab test to monitor the effectiveness of warfarin therapy.

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    Dabigatran

    An oral anticoagulant used for A-fib and DVT; no lab monitoring needed.

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    Clopidogrel (Plavix)

    An ADP receptor inhibitor used to prevent blood clots in heart attack and stroke patients.

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    Alteplase

    A thrombolytic medication used as a clot buster in acute heart attacks and strokes.

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    Safety precautions for anticoagulants

    Patients should report bruising, avoid NSAIDs, and consider using an electric razor.

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    Thrombolytic agents

    Medications administered to dissolve blood clots quickly in conditions like MI or CVA.

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    Indications for thrombolytics

    Administer within 2 hours for myocardial infarction (MI) and within 3-4.5 hours for cerebrovascular accident (CVA).

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    Contraindications for thrombolytics

    Should not be given to patients with peptic ulcers, bleeding disorders, thrombocytopenia, or intracranial bleeding.

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    Erythropoietic growth factor

    Epoetin alfa, a drug that stimulates red blood cell production, used in renal failure, anemia, and chemotherapy.

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    Erythropoietic reactions

    Can cause hypertension, seizures, and increased risk of cardio-cerebral events; monitor hemoglobin and blood pressure.

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    Leukopoietic growth factor

    Filgrastim, used to stimulate white blood cell production and reduce infection risk.

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    Thrombopoietic growth factor

    Oprelvekin, promotes platelet production in patients with thrombocytopenia due to chemotherapy.

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    Monitoring for thrombopoietic therapy

    Monitor vitals, weight, and CBC with platelet count; watch for edema and fluid retention.

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    Study Notes

    Anemia - Iron Preparations

    • Ferrous sulfate is used for iron-deficiency anemia. Symptoms include pain, shortness of breath, and dizziness. Causes can be nutritional deficiencies, menstruation, trauma, or bariatric surgery.
    • Iron dextran can cause anaphylactic reactions or seizures in some patients. It can also stain teeth. Care is needed to avoid overdosing, especially in children.
    • Complete blood count (CBC), hemoglobin (Hgb), hematocrit (HCT), and red cell distribution width (RDW) are checked to evaluate anemia. A low mean corpuscular volume (MCV) indicates iron deficiency.
    • Immature white blood cells (bands) and immature red blood cells (reticulocytes) are elevated in some cases of anemia.
    • Patients should be advised to take vitamin C with iron supplements for improved absorption. Iron supplements can cause stool to turn black.
    • Patients should be advised to eat foods rich in iron such as red meat, whole grains, liver, eggs, and fortified cereals.

    Anemia - Folic Acid

    • Folic acid is used for megaloblastic (macrocytic) anemia, a condition where red blood cells are larger than normal.
    • Causes can include folate deficiency, often associated with alcohol use disorder.
    • Drug reactions to folic acid can include yellow urine.
    • Folic acid can mask B12 deficiencies. B12 is checked first to avoid incorrect treatment.
    • Patients should eat foods rich in folic acid.

    Vitamin B12 - Cyanocobalamin

    • Vitamin B12 is used for pernicious anemia (lack of intrinsic factor) and to protect the myelin sheath. B12 deficiency damages the myelin sheath.
    • Drug reactions can include erythema, hypertension, and hypokalemia.
    • Nurses should monitor patients for stomach absorption of B12 with a Schilling test.
    • Baseline values for B12, hemoglobin (Hgb), red blood cells (RBC), and reticulocytes are measured every 3-6 months.
    • Patients should consume foods high in B12, such as dairy products, eggs, and seafood.
    • Patients should be monitored for muscle weakness, nausea, palpitations, and paresthesia.

    Venous System - Heparin

    • Heparin (factor Xa/thrombin inhibitor) is used for stroke, pulmonary embolism, deep vein thrombosis (DVT).
    • Drug reactions may include bleeding and hemorrhage, and low platelet counts.
    • The nurse should stop heparin if other, non-heparin medications are needed.
    • Monitor activated partial thromboplastin time (aPTT), and watch for bleeding, bruising.
    • Protamine is used as an antidote for heparin in case of overdose.

    Vitamin K Antagonist - Warfarin

    • Warfarin (Coumadin) is used to prevent venous thrombosis, pulmonary embolism, and atrial fibrillation.
    • It slows blood clotting.
    • Nurses should monitor vital signs, and complete blood counts (INR/PT). This is a critical medication.
    • Patients should be advised to avoid dark leafy greens.

    Arterial System

    • Arterial system medications are used for heart attacks, ischemic strokes, transient ischemic attacks, coronary stents, and related issues.
    • Drug reactions can include bleeding (black/dark stool).
    • Nurses should monitor platelet counts.
    • Patients receiving surgery, should have their medication stopped, if possible.
    • Patients should avoid dark leafy greens.

    Thrombolytics - Alteplase

    • Thrombolytics (e.g., alteplase) are used for acute heart attacks, deep vein thrombosis (DVT), and massive pulmonary embolisms.
    • They are used in cases of ischemic cerebrovascular accident (stroke).
    • Medical professionals should never administer thrombolytics to a patient with an intracranial bleed.
    • Nurses need to ensure rapid initiation of thrombolytic therapy, and control bleeding appropriately.
    • These medications are given after patients have already had a stroke/heart attack within a specific timeframe.

    Erythropoietic Growth Factor - Epoetin Alfa

    • Erythropoietic growth factor (e.g., epoetin alfa) is used to stimulate red blood cell production.

    Leukopoietic Growth Factors - Filgrastim

    • Leukopoietic growth factors (e.g., filgrastim) stimulate white blood cell production.
    • Used for reducing infection risk, bone marrow transplants, chronic neutropenia, and myelosuppressive chemotherapy
    • Nurses monitor white blood cell counts (CBC).
    • Patients are monitored for leukocytosis (high white blood cell counts), potentially requiring medication adjustment (lowered dose, or stopped medication).

    Thrombopoietic Growth Factor - Oprelvekin

    • Thrombopoietic growth factors (e.g., oprelvekin) stimulate platelet production.
    • Used to treat thrombocytopenia (low platelet count) induced by chemotherapy.
    • Nurses should monitor vital signs and complete blood counts, including platelet counts.
    • Patients should report any concerning symptoms like bone pain, fever, or stomach pain.

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    Description

    This quiz covers key aspects of iron preparations used to treat iron-deficiency anemia. It discusses symptoms, causes, and recommended evaluations, as well as the importance of dietary supplements and iron-rich foods. Test your knowledge on safe practices and potential side effects associated with iron supplementation.

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