Anemia Drugs
-- Pharmacology and the Nursing process
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.
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.
Answer: c. Take the iron tablets with meals if gastrointestinal distress occurs.
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.
The nurse is reviewing the medical record of a patient before giving a new order for iron sucrose (Venofer). 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.
The nurse is reviewing the medical record of a patient before giving a new order for iron sucrose (Venofer). 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.
Answer: d. The nurse will monitor the patient for hypotension during the infusion.
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. Low-weight elderly patients appear to be at greatest risk
for hypotension.
An oral iron supplement is prescribed for a patient. The nurse would question this order if the
patient's medical history includes which condition?
a. Decreased hemoglobin
b. Hemolytic anemia
c. Weakness
d. Concurrent therapy with erythropoietic
An oral iron supplement is prescribed for a patient. The nurse would question this order if the
patient's medical history includes which condition?
a. Decreased hemoglobin
b. Hemolytic anemia
c. Weakness
d. Concurrent therapy with erythropoietic
Answer: b. Hemolytic anemia
Rationale: Hemolytic anemia is a contraindication to the use of iron supplements. Decreased
hemoglobin and weakness are related to iron-deficiency anemia. Iron supplements are given with
erythropoietic drugs to aid in the production of red blood cells.
A patient has been taking iron supplements for anemia for 2 months. During a follow-up assessment, the nurse
will observe for which therapeutic response?
a. Decreased weight
b. Increased activity tolerance
c. Decreased palpitations
d. Increased appetite
A patient has been taking iron supplements for anemia for 2 months. During a follow-up assessment, the nurse
will observe for which therapeutic response?
a. Decreased weight
b. Increased activity tolerance
c. Decreased palpitations
d. Increased appetite
Answer: b. Increased activity tolerance
Rationale: Absence of fatigue, increased activity tolerance and well-being, and improved nutrition status are
therapeutic responses to iron supplementation. The other options are incorrect.
The nurse will teach a patient who is receiving oral iron supplements to watch for which expected
adverse effects?
a. Palpitations
b. Drowsiness and dizziness
c. Black, tarry stools
d. Orange-red discoloration of the urine
The nurse will teach a patient who is receiving oral iron supplements to watch for which expected
adverse effects?
a. Palpitations
b. Drowsiness and dizziness
c. Black, tarry stools
d. Orange-red discoloration of the urine
Answer: c. Black, tarry stools
Rationale: Black, tarry stools and other gastrointestinal disturbances may occur with the
administration of iron preparations. The other options are incorrect.
A patient has been receiving epoetin alfa (Epogen) for severe iron-deficiency anemia. Today, the
provider changed the order to darbepoetin (Aranesp). 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.“
A patient has been receiving epoetin alfa (Epogen) for severe iron-deficiency anemia. Today, the
provider changed the order to darbepoetin (Aranesp). 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.“
Answer: d. "Aranesp is a longer-acting form, so you will receive fewer injections.“
Rationale: Darbepoetin (Aranesp) is longer-acting than epoetin alfa (Epogen); therefore, fewer
injections are required. The other options are incorrect.
A cancer patient is receiving drug therapy with epoetin alfa (Epogen). The nurse knows that the
medication must be stopped if which laboratory result is noted?
a. White blood cell count of 550 cells/mm3
b. Hemoglobin level of 12 g/dL
c. Potassium level of 4.2 mEq/L
d. Glucose level of 78 mg/dL
A cancer patient is receiving drug therapy with epoetin alfa (Epogen). The nurse knows that the
medication must be stopped if which laboratory result is noted?
a. White blood cell count of 550 cells/mm3
b. Hemoglobin level of 12 g/dL
c. Potassium level of 4.2 mEq/L
d. Glucose level of 78 mg/dL
Answer: b. Hemoglobin level of 12 g/dL
Rationale: If epoetin is continued when hemoglobin levels are above 11 g/dL, patients may
experience serious adverse events, including heart attack, stroke, and death. Guidelines now
recommend that the drug be stopped when the hemoglobin level reaches 10 g/dL for cancer patients.
For renal patients, the target hemoglobin level is 11 g/dL for patients on dialysis and 10 g/dL for
chronic renal patients not on dialysis.
A patient with end-stage renal failure has been admitted to the hospital for severe anemia. She is
refusing blood transfusions. The nurse anticipates drug therapy with which drug to stimulate the
production of red blood cells?
a. Folic acid
b. Cyanocobalamin (vitamin B12)
c. Epoetin alfa (Epogen)
d. Filgrastim (Neupogen)
A patient with end-stage renal failure has been admitted to the hospital for severe anemia. She is
refusing blood transfusions. The nurse anticipates drug therapy with which drug to stimulate the
production of red blood cells?
a. Folic acid
b. Cyanocobalamin (vitamin B12)
c. Epoetin alfa (Epogen)
d. Filgrastim (Neupogen)
Answer: c. Epoetin alfa (Epogen)
Rationale: Epoetin alfa is a colony-stimulating factor that is responsible for erythropoiesis, or
formation of red blood cells. The other options are incorrect.
The nurse is administering intravenous iron dextran for the first time to a patient with anemia. After
giving a test dose, how long will the nurse wait before administering the remaining portion of the dose?
a. 30 minutes
b. 1 hour
c. 6 hours
d. 24 hours
The nurse is administering intravenous iron dextran for the first time to a patient with anemia. After
giving a test dose, how long will the nurse wait before administering the remaining portion of the dose?
a. 30 minutes
b. 1 hour
c. 6 hours
d. 24 hours
Answer: b. 1 hour
Rationale: Although anaphylactic reactions usually occur within a few moments after the test dose, it is
recommended that a period of at least 1 hour elapse before the remaining portion of the initial dose is
given. The other options are incorrect.
The client diagnosed with sickle cell anemia is experiencing a vaso-occlusive sickle cell crisis
secondary to an infection. Which medical treatment should the nurse anticipate the HCP ordering for
the client?
1. Administer meperidine (Demerol) intravenously.
2. Admit the client to a private room and keep in reverse isolation.
3. Infuse D5W 0.33% NS at 150 mL/hr via pump.
4. Insert a 22-French Foley catheter with a urimeter.
The client diagnosed with sickle cell anemia is experiencing a vaso-occlusive sickle cell crisis
secondary to an infection. Which medical treatment should the nurse anticipate the HCP ordering for
the client?
1. Administer meperidine (Demerol) intravenously.
2. Admit the client to a private room and keep in reverse isolation.
3. Infuse D5W 0.33% NS at 150 mL/hr via pump.
4. Insert a 22-French Foley catheter with a urimeter.
Answer: 3. Infuse D5W 0.33% NS at 150 mL/hr via pump.
Rationale: Increased intravenous fluid reduces the viscosity of blood, thereby preventing further
sickling as a result of dehydration
The client diagnosed with sickle cell anemia comes to the emergency department complaining of
joint pain throughout the body. The oral temperature is 102.4˚F and the pulse oximeter reading is
91%. Which action should the emergency room nurse implement first?
1. Request arterial blood gases STAT.
2. Administer oxygen via nasal cannula.
3. Start an IV with an 18-gauge angiocath.
4. Prepare to administer analgesics as ordered.
The client diagnosed with sickle cell anemia comes to the emergency department complaining of
joint pain throughout the body. The oral temperature is 102.4˚F and the pulse oximeter reading is
91%. Which action should the emergency room nurse implement first?
1. Request arterial blood gases STAT.
2. Administer oxygen via nasal cannula.
3. Start an IV with an 18-gauge angiocath.
4. Prepare to administer analgesics as ordered.
Answer: 2. Administer oxygen via nasal cannula.
Rationale: A pulse oximeter reading of less than 93% indicates hypoxia, which warrants oxygen
administration.
The client's nephew has just been diagnosed with sickle cell anemia. The client asks the nurse, "How
did my nephew get this disease?" Which statement would be the best response by the nurse?
1. "Sickle cell anemia is an inherited autosomal recessive disease."
2. "He was born with it and both his parents were carriers of the disease."
3. "At this time, the cause of sickle cell anemia is unknown."
4. "Your sister was exposed to a virus while she was pregnant.“
The client's nephew has just been diagnosed with sickle cell anemia. The client asks the nurse, "How
did my nephew get this disease?" Which statement would be the best response by the nurse?
1. "Sickle cell anemia is an inherited autosomal recessive disease."
2. "He was born with it and both his parents were carriers of the disease."
3. "At this time, the cause of sickle cell anemia is unknown."
4. "Your sister was exposed to a virus while she was pregnant.“
Answer: 2. "He was born with it and both his parents were carriers of the disease."
Rationale: This explains the etiology in terms that a layperson could understand. When both parents
are carriers of the disease, each pregnancy has a 25% chance of producing a child who has sickle cell
anemia.
The client diagnosed with menorrhagia complains to the nurse of feeling listless and tired all the time.
Which scientific rationale would explain why these symptoms occur?
1. The pain associated with the menorrhagia does not allow the client to rest.
2. The client's symptoms are unrelated to the diagnosis of menorrhagia.
3. The client probably has been exposed to a virus that causes chronic fatigue.
4. Menorrhagia has caused the client to have decreased levels of hemoglobin
The client diagnosed with menorrhagia complains to the nurse of feeling listless and tired all the time.
Which scientific rationale would explain why these symptoms occur?
1. The pain associated with the menorrhagia does not allow the client to rest.
2. The client's symptoms are unrelated to the diagnosis of menorrhagia.
3. The client probably has been exposed to a virus that causes chronic fatigue.
4. Menorrhagia has caused the client to have decreased levels of hemoglobin
Answer: 4. Menorrhagia has caused the client to have decreased levels of hemoglobin
Rationale: Menorrhagia (excessive blood loss during menses) does not cause pain. Fibroids or other
factors that cause the menorrhagia may cause pain, but lack of rest or sleep is not responsible for the
listlessness or fatigue. The symptoms are the direct result of the excessive blood loss. Some viruses do
cause a chronic fatigue syndrome, but there is a direct cause and effect from the menorrhagia.
Menorrhagia is excessive blood loss during menses. If the blood loss is severe, then the client will not
have the blood's oxygen carrying capacity needed for daily activities. The most frequent symptom and
complication of anemia is fatigue. It frequently has the greatest impact on the client's ability to function
and quality of life.
The nurse is admitting a 24-year-old African American female client with a diagnosis of rule out anemia. The client
has a history of gastric bypass surgery for obesity four (4) years ago. Current assessment findings include height
5′5′′; weight 75 kg; P 110, R 27, and BP 104/66; pale mucous membranes and dyspnea on exertion. Which type of
anemia would the nurse suspect the client has developed?
1. Vitamin B12 deficiency.
2. Folic acid deficiency.
3. Iron deficiency.
4. Sickle cell anemia.
The nurse is admitting a 24-year-old African American female client with a diagnosis of rule out anemia. The client
has a history of gastric bypass surgery for obesity four (4) years ago. Current assessment findings include height
5′5′′; weight 75 kg; P 110, R 27, and BP 104/66; pale mucous membranes and dyspnea on exertion. Which type of
anemia would the nurse suspect the client has developed?
1. Vitamin B12 deficiency.
2. Folic acid deficiency.
3. Iron deficiency.
4. Sickle cell anemia.
Answer: 1. Vitamin B12 deficiency.
Rationale: The rugae in the stomach produce intrinsic factor, which allows the body to use vitamin B12 from the
foods eaten. Gastric bypass surgery reduces the amount of rugae drastically. Clients develop pernicious anemia
(vitamin B12 deficiency). Other symptoms of anemia include dizziness and the tachycardia and dyspnea listed in
the stem. Folic acid deficiency is usually associated with chronic alcohol intake. Iron deficiency is the result of
chronic blood loss or inadequate dietary intake of iron. Sickle cell anemia is associated with African Americans, but
the symptoms and history indicate a different anemia.
The male client with sickle cell anemia comes to the emergency room with a temperature of 101.4˚F
and tells the nurse that he is having a sickle cell crisis. Which diagnostic test should the nurse
anticipate the emergency room doctor ordering for the client?
1. Spinal tap.
2. Hemoglobin electrophoresis.
3. Sickle-turbidity test (Sickledex).
4. Blood cultures.
The male client with sickle cell anemia comes to the emergency room with a temperature of 101.4˚F
and tells the nurse that he is having a sickle cell crisis. Which diagnostic test should the nurse
anticipate the emergency room doctor ordering for the client?
1. Spinal tap.
2. Hemoglobin electrophoresis.
3. Sickle-turbidity test (Sickledex).
4. Blood cultures.
Answer: 4. Blood cultures.
Rationale: The elevated temperature is the first sign of bacteremia. Bacteremia leads to a sickle cell
crisis. Therefore, the bacteria must be identified so the appropriate antibiotics can be prescribed to
treat the infection. Blood cultures assist in determining the type and source of infection so that it can
be treated appropriately
Which sign/symptom will the nurse expect to assess in the client diagnosed with a vaso-occlusive
sickle cell crisis?
1. Lordosis
2. Epistaxis
3. Hematuria
4. Petechiae
Which sign/symptom will the nurse expect to assess in the client diagnosed with a vaso-occlusive
sickle cell crisis?
1. Lordosis
2. Epistaxis
3. Hematuria
4. Petechiae
Answer: 3. Hematuria
Rationale: Vaso-occlusive crisis, the most frequent crisis, is characterized by organ infarction, which
will result in bloody urine secondary to kidney infarction.
The nurse is completing discharge teaching for the client diagnosed with a sickle cell crisis. The nurse
recommends the client getting the flu and pneumonia vaccines. The client asks, "Why should I take
those shots? I hate shots." Which statement by the nurse is the best response?
1. "These vaccines promote health in clients with chronic illnesses."
2. "You are susceptible to infections. These shots may help prevent a crisis."
3. "The vaccines will help your blood from sickling secondary to viruses."
4. "The doctor wanted to make sure that I discussed the vaccines with you.“
The nurse is completing discharge teaching for the client diagnosed with a sickle cell crisis. The nurse
recommends the client getting the flu and pneumonia vaccines. The client asks, "Why should I take
those shots? I hate shots." Which statement by the nurse is the best response?
1. "These vaccines promote health in clients with chronic illnesses."
2. "You are susceptible to infections. These shots may help prevent a crisis."
3. "The vaccines will help your blood from sickling secondary to viruses."
4. "The doctor wanted to make sure that I discussed the vaccines with you.“
Answer: 2. "You are susceptible to infections. These shots may help prevent a crisis."
Rationale: An individual with SCA has a reduction in splenic activity from infarcts occurring during
crises. This situation progresses to the spleen no longer being able to function, and this increases the
client’s susceptibility to infection.
Which is a potential complication that occurs specifically to a male client diagnosed with sickle cell
anemia during a sickle cell crisis?
1. Chest syndrome
2. Compartment syndrome
3. Priapism
4. Hypertensive crisis
Which is a potential complication that occurs specifically to a male client diagnosed with sickle cell
anemia during a sickle cell crisis?
1. Chest syndrome
2. Compartment syndrome
3. Priapism
4. Hypertensive crisis
Answer: 3. Priapism
Rationale: This is a term that means painful and constant penile erection that can occur in male clients
with SCA during a sickle cell crisis.
During therapy with the hematopoietic drug epoetin alfa (Epogen), the nurse instructs the patient
about adverse effects that may occur, such as:
a. anxiety
b. drowsiness
c. hypertension
d. Constipation
During therapy with the hematopoietic drug epoetin alfa (Epogen), the nurse instructs the patient
about adverse effects that may occur, such as:
a. anxiety
b. drowsiness
c. hypertension
d. Constipation
Answer: c. hypertension
Rationale: Hypertension is an adverse effect of hematopoietic drugs, along with headache, fever,
pruritus, rash, nausea, vomiting, arthralgia, cough, and injection site reaction. The other options are
incorrect.
The nurse is administering folic acid to a patient with a new diagnosis of anemia. Which statement
about treatment with folic acid is true?
a. Folic acid is used to treat any type of anemia.
b. Folic acid is used to treat iron-deficiency anemia.
c. Folic acid is used to treat pernicious anemia.
d. The specific cause of the anemia needs to be determined before treatment.
The nurse is administering folic acid to a patient with a new diagnosis of anemia. Which statement
about treatment with folic acid is true?
a. Folic acid is used to treat any type of anemia.
b. Folic acid is used to treat iron-deficiency anemia.
c. Folic acid is used to treat pernicious anemia.
d. The specific cause of the anemia needs to be determined before treatment.
Answer: d. The specific cause of the anemia needs to be determined before treatment.
Rationale: Folic acid should not be used to treat anemias until the underlying cause and type of anemia
have been identified. Administering folic acid to a patient with pernicious anemia may correct the
hematologic changes of anemia, but the symptoms of pernicious anemia (which is due to a vitamin B12
deficiency, not a folic acid deficiency) may be deceptively masked. The other options are incorrect.
A woman who is planning to become pregnant should ensure that she receives adequate levels of
which supplement to reduce the risk for fetal neural tube defects?
a. Vitamin B12
b. Vitamin D
c. Iron
d. Folic acid
A woman who is planning to become pregnant should ensure that she receives adequate levels of
which supplement to reduce the risk for fetal neural tube defects?
a. Vitamin B12
b. Vitamin D
c. Iron
d. Folic acid
Answer: d. Folic acid
Rationale: It is recommended that administration of folic acid be begun at least 1 month before
pregnancy and continue through early pregnancy to reduce the risk for fetal neural tube defects.
The nurse is caring for the female client recovering from a sickle cell crisis. The client tells the nurse her
family is planning a trip this summer to Yellowstone National Park. Which response would be best for
the nurse?
1. "That sounds like a wonderful trip to take this summer."
2. "Have you talked to your doctor about taking the trip?"
3. "You really should not take a trip to areas with high altitudes."
4. "Why do you want to go to Yellowstone National Park?“
The nurse is caring for the female client recovering from a sickle cell crisis. The client tells the nurse her
family is planning a trip this summer to Yellowstone National Park. Which response would be best for
the nurse?
1. "That sounds like a wonderful trip to take this summer."
2. "Have you talked to your doctor about taking the trip?"
3. "You really should not take a trip to areas with high altitudes."
4. "Why do you want to go to Yellowstone National Park?“
Answer: 3. "You really should not take a trip to areas with high altitudes."
Rationale: High altitudes have decreased oxygen, which could lead to a sickle cell crisis.
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.
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.
h. Tablets may be crushed to enhance iron absorption.
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.
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.
h. Tablets may be crushed to enhance iron absorption.
Answer: a. Take the iron tablets with meals. e. Taking iron supplements with orange juice enhances iron absorption. g. Stools may become black and tarry.
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.
The nurse is administering liquid oral iron supplements. Which intervention is appropriate when
administering this medication?
a. Have the patient take the liquid iron with milk.
b. Instruct the patient to take the medication through a plastic straw.
c. Have the patient sip the medication slowly.
d. Have the patient drink the medication, undiluted, from the unit-dose cup.
The nurse is administering liquid oral iron supplements. Which intervention is appropriate when
administering this medication?
a. Have the patient take the liquid iron with milk.
b. Instruct the patient to take the medication through a plastic straw.
c. Have the patient sip the medication slowly.
d. Have the patient drink the medication, undiluted, from the unit-dose cup.
Answer: b. Instruct the patient to take the medication through a plastic straw.
Rationale: Liquid oral forms of iron need to be taken through a plastic straw to avoid discoloration of
tooth enamel. Milk may decrease absorption.
The nurse is teaching a patient with iron-deficiency anemia about foods to increase iron intake. Which
food may enhance the absorption of oral iron forms?
a. Milk
b. Yogurt
c. Antacids
d. Orange juice
The nurse is teaching a patient with iron-deficiency anemia about foods to increase iron intake. Which
food may enhance the absorption of oral iron forms?
a. Milk
b. Yogurt
c. Antacids
d. Orange juice
Answer: d. Orange juice
Rationale: Orange juice contains ascorbic acid, which enhances the absorption of oral iron forms;
antacids, milk, and yogurt may interfere with absorption.
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
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
Answer: c. Intramuscular injection using the Z-track method
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.
The nurse is administering an IV dose of iron dextran. For which potential adverse effect is it most
important for the nurse to monitor at this time?
A. anaphylaxis
B. Gi distress
C. black, tarry stools
D. Bradycardia
The nurse is administering an IV dose of iron dextran. For which potential adverse effect is it most
important for the nurse to monitor at this time?
A. anaphylaxis
B. Gi distress
C. black, tarry stools
D. Bradycardia
Answer: A. anaphylaxis
Rationale: The most important thing to be monitored during the intravenous iron dextran injection is the
anaphylactic shock. This is because the drug may cause allergic reactions when given through the vein.
Anaphylaxis is the condition of severe allergic reaction that occurs abruptly on administration of the
drug. The GIT (gastrointestinal tract) distress is impossible since the drug is directly injected into the vein
and bypasses the GIT. The color of the stools does not produce any harmful effect on the health. Thus,
there is no need to monitor it. The drug does not produce bradycardia. Thus, heartbeat needs not to be
monitored.
The nurse is teaching a patient about oral iron supplements. Which statement is correct?
A. "you need to take the medication on an empty stomach or it will not be absorbed"
B. "it is better absorbed on an empty stomach, but if this causes your stomach to be upset, you can take it with
food."
C. "take this medication with a sip of water, then lie down to avoid problems with low blood pressure."
D. "if you have trouble swallowing the tablet, you may crush it"
The nurse is teaching a patient about oral iron supplements. Which statement is correct?
A. "you need to take the medication on an empty stomach, or it will not be absorbed"
B. "it is better absorbed on an empty stomach, but if this causes your stomach to be upset, you can take it with
food."
C. "take this medication with a sip of water, then lie down to avoid problems with low blood pressure."
D. "if you have trouble swallowing the tablet, you may crush it"
Answer: B. "it is better absorbed on an empty stomach, but if this causes your stomach to be upset, you can take it with food."
Rationale: The iron supplement should be given on empty stomach or with food when stomach gets irritated on
empty stomach. It is not a compulsion to take the drug on empty stomach. It can be taken with food if it irritates
the stomach. There is no problem of low blood pressure with the iron supplements. The tablet should be engulfed
intact. Chewing it will render its effect half or null.
The nurse is assessing an African American client diagnosed with sickle cell crisis. Which assessment
data is most pertinent when assessing for cyanosis in clients with dark skin?
1. Assess the client's oral mucosa.
2. Assess the client's metatarsals.
3. Assess the client's capillary refill time.
4. Assess the sclera of the client's eyes.
The nurse is assessing an African American client diagnosed with sickle cell crisis. Which assessment
data is most pertinent when assessing for cyanosis in clients with dark skin?
1. Assess the client's oral mucosa.
2. Assess the client's metatarsals.
3. Assess the client's capillary refill time.
4. Assess the sclera of the client's eyes.
Answer: 1. Assess the client's oral mucosa.
Rationale: To assess for cyanosis (blueness) in individuals with dark skin, the oral mucosa and
conjunctiva should be assessed because cyanosis cannot be assessed in the lips or fingertips.
The student nurse asks the nurse, "What is sickle cell anemia?" Which statement by
the nurse would be the best answer to the student's question?
1. "There is some written material at the desk that will explain the disease."
2. "It is a congenital disease of the blood in which the blood does not clot."
3. "The client has decreased synovial fluid that causes joint pain."
4. "The blood becomes thick when the client is deprived of oxygen.“
The student nurse asks the nurse, "What is sickle cell anemia?" Which statement by
the nurse would be the best answer to the student's question?
1. "There is some written material at the desk that will explain the disease."
2. "It is a congenital disease of the blood in which the blood does not clot."
3. "The client has decreased synovial fluid that causes joint pain."
4. "The blood becomes thick when the client is deprived of oxygen.“
Answer: 4. "The blood becomes thick when the client is deprived of oxygen.“
Rationale: Sickle cell anemia is a disorder of the red blood cells characterized by abnormally shaped
red cells that sickle or clump together, leading to oxygen deprivation and resulting in crisis and severe
pain.
A nurse is preparing to give iron sucrose to a 58-year-old patient and will monitor
for which common adverse effect?
A. hypotension
B. dyspnea
C. itching
D. cramps
A nurse is preparing to give iron sucrose to a 58-year-old patient and will monitor
for which common adverse effect?
Answer: A. hypotension
B. dyspnea
C. itching
D. cramps
The charge nurse is making assignments on a medical floor. Which client should be assigned to the most
experienced nurse?
1. The client diagnosed with iron-deficiency anemia who is prescribed iron supplements.
2. The client diagnosed with pernicious anemia who is receiving vitamin B12 intramuscularly.
3. The client diagnosed with aplastic anemia who has developed pancytopenia.
4. The client diagnosed with renal disease who has a deficiency of erythropoietin
The charge nurse is making assignments on a medical floor. Which client should be assigned to the most
experienced nurse?
1. The client diagnosed with iron-deficiency anemia who is prescribed iron supplements.
2. The client diagnosed with pernicious anemia who is receiving vitamin B12 intramuscularly.
3. The client diagnosed with aplastic anemia who has developed pancytopenia.
4. The client diagnosed with renal disease who has a deficiency of erythropoietin
Answer: 3. The client diagnosed with aplastic anemia who has developed pancytopenia.
Rationale: Pancytopenia is a situation that develops in clients diagnosed with aplastic anemia because the bone
marrow is not able to produce cells of any kind. The client has anemia, thrombocytopenia, and leukopenia. This
client could develop an infection or hemorrhage, go into congestive heart failure, or have a number of other
complications develop. This client needs the most experienced nurse. Any nurse should be able to administer
iron supplements, which are oral iron preparations. Any nurse should be able to give an intramuscular
medication. A deficiency of erythropoietin is common in clients diagnosed with renal disease. The current
treatment for this is to administer erythropoietin, a biologic response modifier, subcutaneously or, if the anemia
is severe enough, a blood transfusion.
The nurse is conducting an admission assessment of a client with vitamin B12 deficiency. Which of
the following would the nurse include in the physical assessment?
1. Palpate the spleen
2. Take the blood pressure
3. Examine the feet for petechiae
4. Examine the tongue
The nurse is conducting an admission assessment of a client with vitamin B12 deficiency. Which of
the following would the nurse include in the physical assessment?
1. Palpate the spleen
2. Take the blood pressure
3. Examine the feet for petechiae
4. Examine the tongue
Answer: 4. Examine the tongue
Rationale: The tongue is smooth and beefy red in the client with vitamin B12 deficiency, so
examining the tongue should be included in the physical assessment. Bleeding, splenomegaly, and
blood pressure changes do not occur, making answers.
The client is being admitted with folic acid deficiency anemia. Which would be the most appropriate
referral?
1. Alcoholics Anonymous
2. Leukemia Society of America
3. A hematologist
4. A social worker
The client is being admitted with folic acid deficiency anemia. Which would be the most appropriate
referral?
1. Alcoholics Anonymous
2. Leukemia Society of America
3. A hematologist
4. A social worker
Answer: 1. Alcoholics Anonymous
Rationale: Most clients diagnosed with folic acid deficiency anemia have developed the anemia from
chronic alcohol abuse. Alcohol consumption increases the use of folates, and the alcoholic diet is
usually deficient in folic acid. A referral to Alcoholics Anonymous would be appropriate. There is no
connection between folic acid deficiency and leukemia; therefore, this referral would not be
appropriate. A hematologist may see the client, but nurses usually don't make this kind of referral;
the HCP would make this referral if the HCP felt incapable of caring for the client. The social worker is
not the most appropriate referral.
The client diagnosed with iron-deficiency anemia is prescribed ferrous gluconate orally. Which should
the nurse teach the client?
1. Take Imodium, an antidiarrheal, over-the-counter (OTC) for diarrhea.
2. Limit exercise for several weeks until a tolerance is achieved.
3. The stools may be very dark, and this can mask blood.
4. Eat only red meats and organ meats for protein
The client diagnosed with iron-deficiency anemia is prescribed ferrous gluconate orally. Which should
the nurse teach the client?
1. Take Imodium, an antidiarrheal, over-the-counter (OTC) for diarrhea.
2. Limit exercise for several weeks until a tolerance is achieved.
3. The stools may be very dark, and this can mask blood.
4. Eat only red meats and organ meats for protein
Answer: 3. The stools may be very dark, and this can mask blood.
Rationales: The stool will be a dark green-black, which can mask the appearance of blood in the stool.
Iron is constipating; an antidiarrheal is contraindicated for this drug. Iron can cause gastrointestinal
distress and tolerance to it is built up gradually; exercise has nothing to do with tolerating iron. The
client should eat a well-balanced diet high in iron, vitamins, and protein. Fowl and fish are encouraged.
The nurse writes a diagnosis of altered tissue perfusion for a client diagnosed with anemia. Which
interventions should be included in the plan of care? Select all that apply.
1. Monitor the client's hemoglobin and hematocrit.
2. Move the client to a room near the nurse's desk.
3. Limit the client's dietary intake of green vegetables.
4. Assess the client for numbness and tingling.
5. Allow for rest periods during the day for the client.
The nurse writes a diagnosis of altered tissue perfusion for a client diagnosed with anemia. Which
interventions should be included in the plan of care? Select all that apply.
1. Monitor the client's hemoglobin and hematocrit.
2. Move the client to a room near the nurse's desk.
3. Limit the client's dietary intake of green vegetables.
4. Assess the client for numbness and tingling.
5. Allow for rest periods during the day for the client.
Answer: 1. Monitor the client's hemoglobin and hematocrit. 2. Move the client to a room near the nurse's desk. 4. Assess the client for numbness and tingling. 5. Allow for rest periods during the day for the client.
Rationale: The nurse should monitor the hemoglobin and hematocrit in all clients diagnosed with
anemia. Because decreased oxygenation levels to the brain can cause the client to become confused,
a room where the client can be observed frequently—near the nurse's desk—is a safety issue.
Numbness and tingling may occur in anemia as a result of neurological involvement. Fatigue is the
number-one presenting symptom of anemia. The client should include leafy, green vegetables in the
diet. These are high in iron.
Which lab findings would indicate to the nurse that the patient is responding favorably to
epoetin alfa?
A. an increase in reticulocytes
B. decrease in clotting time
C. an increase in platelets
D. a decrease in leukocytes
Which lab findings would indicate to the nurse that the patient is responding favorably to
epoetin alfa?
Answer: A. an increase in reticulocytes
B. decrease in clotting time
C. an increase in platelets
D. a decrease in leukocytes
A 30-year-old male from Haiti is brought to the emergency department in sickle cell crisis. What is
the best position for this client?
A. Side-lying with knees flexed
B. Knee-chest
C. High Fowler's with knees flexed
D. Semi-Fowler's with legs extended on the bed
A 30-year-old male from Haiti is brought to the emergency department in sickle cell crisis. What is
the best position for this client?
A. Side-lying with knees flexed
B. Knee-chest
C. High Fowler's with knees flexed
D. Semi-Fowler's with legs extended on the bed
Answer: D. Semi-Fowler's with legs extended on the bed
Rationale: Placing the client in semi-Fowler's position provides the best oxygenation for this client.
Flexion of the hips and knees, which includes the knee-chest position, impedes circulation and is
not correct positioning for this client.
A 25-year-old male is admitted in sickle cell crisis. Which of the following interventions would be of
highest priority for this client?
A. Taking hourly blood pressures with mechanical cuff
B. Encouraging fluid intake of at least 200mL per hour
C. Position in high Fowler's with knee gatch raised
D. Administering Tylenol as ordered
A 25-year-old male is admitted in sickle cell crisis. Which of the following interventions would be of
highest priority for this client?
A. Taking hourly blood pressures with mechanical cuff
B. Encouraging fluid intake of at least 200mL per hour
C. Position in high Fowler's with knee gatch raised
D. Administering Tylenol as ordered
Answer: B. Encouraging fluid intake of at least 200mL per hour
Rationale: It is important to keep the client in sickle cell crisis hydrated to prevent further sickling of
the blood. Answer A is incorrect because a mechanical cuff places too much pressure on the arm.
Answer C is incorrect because raising the knee gatch impedes circulation. Answer D is incorrect
because Tylenol is too mild an analgesic for the client in crisis.
The nurse admits a client who is in sickle cell crisis to the hospital. Which does the nurse prepare as
the priority in the management of the client?
1 Pain management
2 Fluid administration
3 Oxygen administration
4 Red blood cell transfusion
The nurse admits a client who is in sickle cell crisis to the hospital. Which does the nurse prepare as
the priority in the management of the client?
1 Pain management
2 Fluid administration
3 Oxygen administration
4 Red blood cell transfusion
Answer: 3 Oxygen administration
Rationale: The priority nursing intervention for a client in sickle cell crisis is to administer supplemental
oxygen because the client is hypoxemic, and as a result, the red blood cells change to the sickle shape.
In addition, oxygen is the priority because airway and breathing are more important than circulatory
needs. The nurse also plans for fluid therapy to promote hydration and reverse the agglutination of
sickled cells, opioid analgesics for relief from severe pain, and blood transfusions to increase the
blood's oxygen-carrying capacity.
A pediatric nursing instructor asks a nursing student to describe the cause of the clinical manifestations
that occur in sickle cell disease. The student responds correctly by telling the instructor that
1. Sickled cells increase the blood flow through the body and cause a great deal of pain.
2. Sickled cells mix with the unsickled cells and cause the immune system to become depressed.
3. Bone marrow depression occurs because of the development of sickled cells.
4. Sickled cells are unable to flow easily through the microvasculature and their clumping obstructs
blood flow.
A pediatric nursing instructor asks a nursing student to describe the cause of the clinical manifestations
that occur in sickle cell disease. The student responds correctly by telling the instructor that
1. Sickled cells increase the blood flow through the body and cause a great deal of pain.
2. Sickled cells mix with the unsickled cells and cause the immune system to become depressed.
3. Bone marrow depression occurs because of the development of sickled cells.
4. Sickled cells are unable to flow easily through the microvasculature and their clumping obstructs
blood flow.
Answer: 4. Sickled cells are unable to flow easily through the microvasculature and their clumping obstructs blood flow.
Rationale: All of the clinical manifestations of sickle cell disease result from the sickled cells being
unable to flow easily through the microvasculature, and their clumping obstructs blood flow. With reoxygenation, most of the sickled red blood cells resume their normal shape
The nurse writes a client problem of "activity intolerance" for a client diagnosed with anemia. Which
intervention should the nurse implement?
1. Pace activities according to tolerance.
2. Provide supplements high in iron and vitamins.
3. Administer packed red blood cells.
4. Monitor vital signs every four (4) hours.
The nurse writes a client problem of "activity intolerance" for a client diagnosed with anemia. Which
intervention should the nurse implement?
1. Pace activities according to tolerance.
2. Provide supplements high in iron and vitamins.
3. Administer packed red blood cells.
4. Monitor vital signs every four (4) hours.
Answer: 1. Pace activities according to tolerance.
Rationale: The client's problem is activity intolerance and pacing of activities directly affects the
diagnosis. This is an appropriate intervention for iron or vitamin deficiency, but it is not for activity
intolerance. This may be done but not specifically for the diagnosis. This would not help activity
intolerance.
The nurse is discharging a client diagnosed with anemia. Which discharge instruction should the nurse
teach?
1. Take the prescribed iron until it is completely gone.
2. Monitor pulse and blood pressure at a local pharmacy weekly.
3. Have a complete blood count checked at the HCP's office.
4. Perform isometric exercise three (3) times a week
The nurse is discharging a client diagnosed with anemia. Which discharge instruction should the nurse
teach?
1. Take the prescribed iron until it is completely gone.
2. Monitor pulse and blood pressure at a local pharmacy weekly.
3. Have a complete blood count checked at the HCP's office.
4. Perform isometric exercise three (3) times a week
Answer: 3. Have a complete blood count checked at the HCP's office.
Rationale: The client should have a complete blood count regularly to determine the status of the
anemia. This is an instruction for antibiotics, not iron. The client will take iron for an indefinite period.
Pulse is indirectly affected by anemia when the body attempts to compensate for the lack of oxygen
supply, but this is an indirect measure, and blood pressure is not monitored for anemia. Isometric
exercises are bodybuilding exercises, and the client should not be exerting himself or herself in this
manner.
A patient will be receiving darbepoetin as part of treatment for postchemotherapy bone marrow
suppression. Which finding is a contraindication to darbepoetin therapy?
A. pulse rate of 100 beats per minute
B. blood pressure of 128/79 mm Hg
C. hemoglobin level of 11 g/dL
D. WBC count of 7000/mm
A patient will be receiving darbepoetin as part of treatment for postchemotherapy bone marrow
suppression. Which finding is a contraindication to darbepoetin therapy?
A. pulse rate of 100 beats per minute
B. blood pressure of 128/79 mm Hg
Answer: C. hemoglobin level of 11 g/dL
D. WBC count of 7000/mm